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Cannabis for Chronic Pain: Challenges and Considerations.

Authors
  • Romero-Sandoval, E Alfonso1
  • Fincham, Jack E2
  • Kolano, Ashley L2
  • Sharpe, Brandi N2
  • Alvarado-Vázquez, P Abigail1
  • 1 Department of Anesthesiology, Pain Mechanisms Laboratory, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
  • 2 Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, South Carolina.
Type
Published Article
Journal
Pharmacotherapy
Publication Date
Jun 01, 2018
Volume
38
Issue
6
Pages
651–662
Identifiers
DOI: 10.1002/phar.2115
PMID: 29637590
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The paradoxical superiority of the cannabis plant over cannabinoid molecules represents a challenge for the medical community and the established processes that define modern pharmacy. The expanding and variable legalization of cannabis in multiple states nationwide represents an additional challenge for patients and the medical community because recreational and medicinal cannabis are irresponsibly overlapped. Cannabis designed for recreational use (containing high levels of active ingredients) is increasingly available to patients with chronic pain who do not find relief with current pharmacologic entities, which exposes patients to potential harm. This article analyzes the available scientific evidence to address controversial questions that the current state of cannabis poses for health care professionals and chronic pain patients and sets the basis for a more open discussion about the role of cannabis in modern medicine for pain management. A critical discussion on these points, the legal status of cannabis, and considerations for health care providers is presented. © 2018 Pharmacotherapy Publications, Inc.

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