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Cancer pain

Studies generally suggested improvements in chronic pain measures associated with taking cannabis in cancer patients.1, 2 Most studies have been performed with a commercial oral-mucosal spray [nabiximols (Sativex)] containing THC+CBD in a 1:1 ratio and generally show positive results. 1, 3 One study in cancer patients had mixed results, but was overall favorable: a total dose of 10.8mg THC + 10mg CBD per day achieved a 26% improvement in pain compared with baseline.3 Recently, a couple studies were published that looked at the quality of life (QoL) in cancer patients.4, 5 Pain is one of the important measures of QoL. While overall quality of life was improved, the improvement in pain was an important contributor to the total. Zhang and colleagues performed a study in which cannabis users showed statistically significant improvement on two separate quality of life surveys, the EuroQOL-5D (EQ5D) and the Edmonton Symptom Assessment System (ESAS), as compared to matching non-users. On the EQ5D, which has 5 categories, using a 3-point scale, cannabis users had lower anxiety/depression (difference=0.74) and lower pain/discomfort (difference=0.29), so an improvement in 2 out of 5 categories.5  While on the ESAS (10-point scale), all of the categories (9 in total) showed significant improvement in cannabis user, including pain (difference = 0.87), anxiety (difference = 4.53), depression (difference = 2.47) and general well-being (difference = 1.93).5 Also, a study by Turcott administered a QoL survey, and on the dimension of pain there was a significant improvement over time compared to the control group. The cannabis group’s score improved from a 50/100 at baseline to 37/100 after 8 weeks, where a lower score represents lesser symptoms.4 References:
  1. Johnson, Jeremy R.; Burnell-Nugent, Mary; Lossignol, Dominique; Ganae-Motan, Elena Doina; Potts, Richard; Fallon, Marie T. (2010). Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. Journal of Pain and Symptom Management, 39(2), 167--79.
  2. Whiting, Penny F.; Wolff, Robert F.; Deshpande, Sohan; Di Nisio, Marcello; Duffy, Steven; Hernandez, Adrian V.; Keurentjes, J. Christiaan; Lang, Shona; Misso, Kate; Ryder, Steve; Schmidlkofer, Simone; Westwood, Marie; Kleijnen, Jos (2015). Cannabinoids for Medical Use. Jama, 313(24), 2456.
  3. Portenoy, Russell K.; Ganae-Motan, Elena Doina; Allende, Silvia; Yanagihara, Ronald; Shaiova, Lauren; Weinstein, Sharon; McQuade, Robert; Wright, Stephen; Fallon, Marie T. (2012). Nabiximols for Opioid-Treated Cancer Patients With Poorly-Controlled Chronic Pain: A Randomized, Placebo-Controlled, Graded-Dose Trial. The Journal of Pain, 13(5), 438--449.
  4. Turcott, Jenny G.; Del Rocio Guillen Nunez, Maria; Flores-Estrada, Diana; Onate-Ocana, Luis F.; Zatarain-Barron, Zyanya Lucia; Barron, Feliciano; Arrieta, Oscar (2018). The effect of nabilone on appetite, nutritional status, and quality of life in lung cancer patients: a randomized, double-blind clinical trial. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 26(9), 3029--3038.
  5. Zhang, Han; Xie, Michael; Archibald, Stuart D.; Jackson, B. Stanley; Gupta, Michael K. (2018). Association of Marijuana Use With Psychosocial and Quality of Life Outcomes Among Patients With Head and Neck Cancer. JAMA Otolaryngology–Head & Neck Surgery, 144(11), 1017.