Specialist chronic pain solicitor, Andrew Atkinson, examines a recent study which concludes that cannabis and CBD are no more effective at treating pain than a placebo.
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In recent years, the push to legalise cannabis for medicinal purposes has seen prescribing guidelines issued by the National Institute for Health and Care Excellence (NICE). In addition, a bewildering range of CBD products are now available on the high street.
Cannabis vs placebo
But now, a study published recently in the Journal of the American Medical Association has concluded that cannabis and CBD are no more effective at treating pain than a placebo.
The study is a ‘meta-analysis’, which means that it’s not a primary study on patients. Rather, researchers analyse the data from a range of different studies on the same subject. In this case, researchers at the Karolinska Institute in Sweden analysed 20 studies featuring a total of 1,459 people. They represented a wide range of persistent pain conditions, including neuropathic pain and multiple sclerosis.
Products used included CBD, THC, and synthetic cannabis, taken in a variety of ways, including oils, pills, sprays, and smoking.
The study concluded that pain intensity reduced significantly in response to both a placebo and cannabis. The authors said, “Our meta-analysis showed that pain was rated as being significantly less intense after treatment with a placebo, with a moderate to large effect depending on each person.” Clarifying the action of a placebo, they added, “In line with general principles of human perception, expectations of (possible) pain relief can modulate sensory processing and thereby reduce the perception of incoming nociceptive signals.”
This study follows a similar one published in 2018 which focused on cannabis products as a treatment for chronic neuropathic pain. In that earlier study, the authors concluded that the effectiveness of cannabis-based products for treating pain was unsupported by the available evidence. Further, the potential for psychiatric and neurological side effects outweighed the benefits seen.
It will be interesting to monitor the response generated by this latest study, particularly in the US, where 37 states have now legalised cannabis for the treatment of pain. Medicinal cannabis is now seen in the US as an important weapon in the fight against opioid addiction.
Whilst real-world evidence suggests that cannabis is effective in managing pain, there are innumerable variables and competing harms to health (eg the effects of smoking cannabis, differing strengths of cannabis and variations in levels of CBD and THC) which makes it very difficult for medical practitioners to recommend cannabis. Developing a licenced cannabis drug has so far proved very difficult for pharmaceutical companies, who are yet to develop a product with the “magic” combination of CBD and THC.
In the meantime, perhaps we should bear in mind that the results of this latest study may well reflect the well-documented (and genuine) power of the placebo effect as much as the analgesic effects of cannabis.