Medicinal cannabis for chronic pain- The Bermuda triangle of low-quality studies, countless meta-analyses and conflicting recommendations

Abstract

The combination of the ongoing opioid crisis, inappropriateness of long-term use of NSAIDs, limited efficacy and tolerability of existing analgesics and the fact that no new analgesics (except for anti-migraine medications) were launched during the past two decades, has considerably depleted the arsenal of chronic pain pharmacotherapy. No wonder therefore, that the old-new player, medicinal cannabis (MC), has erupted onto the pain field. Indeed, MC, which consists of herbal cannabis (HC), in either inflorescence or oil extract forms, and cannabis-based medicinal products (CBMP), is being increasingly used in chronic pain management. As a result of public pressure by media, patient advocacies and political lobbyists, MC has bypassed established routes of regulatory approval in many countries. In addition, many unregulated cannabis-based products lacking robust efficacy and safety data, especially cannabidiol (CBD) containing preparations, are readily available in some countries.