Medical Cannabis and MS: A Neurologist’s Perspective In this video, I share my years of experience as an MS Neurologist and Medical Cannabis Recommender, treating patients with Multiple Sclerosis (MS). I discuss the potential benefits of medical cannabis for MS patients, such as reducing spasticity, relieving pain, and improving sleep. I also address common concerns and misconceptions about medical cannabis, including its safety and potential side effects. As a medical professional, I emphasize the importance of discussing medical cannabis use with a qualified healthcare provider and obtaining a medical cannabis recommendation from a licensed physician. Whether you are a patient with MS considering medical cannabis as a treatment option or a healthcare provider seeking to learn more about this emerging therapy, this video provides valuable insights and perspectives from a seasoned neurologist.
Cannabis prescribed for chronic pain is associated with an elevated risk of heart rhythm disorders,according to research presented at ESC Congress 2022.1 Cannabis prescribed for chronic pain is associated with an elevated risk of heart rhythm disorders,according to research presented at ESC Congress 2022.1
Study author Dr. Nina Nouhravesh of Gentofte University Hospital, Denmark said: “Chronic pain is a rising problem. According to Danish health authorities, 29% of Danish adults over 16 years of age reported chronic pain in 2017, up from 19% in 2000. Medical cannabis was approved in January 2018 on a trial basis in Denmark, meaning that physicians can prescribe it for chronic pain if all other measures, including opioids, have proven insufficient. Safety data are sparse, hence this study investigated the
cardiovascular side effects of medical cannabis, and arrhythmias in particular, since heart rhythm disorders have previously been found in users of recreational cannabis.”2
Medical cannabis comes in various formulations depending on tetrahydrocannabinol (THC) and cannabidiol (CBD) levels. Dronabinol (high THC), cannabinoid (more THC than CBD), and cannabidiol (high CBD) can be prescribed in Denmark. The drug can be inhaled, eaten, or sprayed in the mouth.
The researchers identified a total of 1.6 million patients diagnosed with chronic pain in Denmark between 2018 and 2021. Of those, 4,931 patients (0.31%) claimed at least one prescription of cannabis (dronabinol 29%, cannabinoids 46%, cannabidiol 25%). Each user was matched by age, sex and pain diagnosis to five non-users with chronic pain who acted as controls. Users and controls were followed for 180 days and their risks of new cardiovascular conditions were compared.
The median age of participants was 60 years and 63% were women. The study reports, for the first time, the chronic pain conditions of medical cannabis users in Denmark. Some 17.8% had cancer, 17.1% arthritis, 14.9% back pain, 9.8% neurological diseases, 4.4% headaches, 3.0% complicated fractures, and 33.1% other diagnoses (mostly unspecified chronic pain).
The absolute risk of new-onset arrhythmia was 0.86% in medical cannabis users compared with 0.49% in non-users, for a relative risk of 1.74. The risks of new-onset acute coronary syndrome and heart failure did not differ between the two groups. The results were similar for each chronic pain condition and each type of medical cannabis.
Dr. Nouhravesh said: “Our study found that medical cannabis users had a 74% higher risk of heart rhythm disorders compared with non-users; however, the absolute risk difference was modest. It should be noted that a higher proportion of those in the cannabis group were taking other pain medications, namely non-steroidal anti-inflammatory drugs (NSAIDs), opioids and anti-epileptics, and we cannot rule out that this might explain the greater likelihood of arrhythmias.”
She concluded: “Since medical cannabis is a relatively new drug for a large market of patients with chronic pain, it is important to investigate and report serious side effects. This study indicates that there may be a previously unreported risk of arrhythmias following medical cannabis use. Even though the absolute risk difference is small, both patients and physicians should have as much information as possible when weighing up the pros and cons of any treatment.”
The evidence behind the effectiveness of cannabis-related products to treat chronic pain is surprisingly thin, according to a new systematic evidence review by researchers at Oregon Health & Science University.
Researchers did find evidence to support a short-term benefit in treating neuropathic pain – caused by damage to peripheral nerves, such as diabetic neuropathy resulting in pain described as burning and tingling, involving two FDA-approved synthetic products with 100% tetrahydrocannabinol, or THC: dronabinol (under the trade name Marinol) and nabilone (Cesamet). Both products also lead to notable side effects including sedation and dizziness, according to the review.
Another product, a sublingual spray of equal parts THC and cannabidiol, or CBD, extracted from the cannabis plant, known as nabiximols, also showed evidence of some clinical benefit for neuropathic pain, although that product is not available in the U.S. This product also led to side effects, such as nausea, sedation and dizziness.
“In general, the limited amount of evidence surprised all of us,” said lead author Marian S. McDonagh, Pharm.D., emeritus professor of medical informatics and clinical epidemiology in the OHSU School of Medicine. “With so much buzz around cannabis-related products, and the easy availability of recreational and medical marijuana in many states, consumers and patients might assume there would be more evidence about the benefits and side effects.
“Unfortunately, there is very little scientifically valid research into most of these products,” she said. “We saw only a small group of observational cohort studies on cannabis products that would be easily available in states that allow it, and these were not designed to answer the important questions on treating chronic pain.”
Voters in Oregon, Washington and 20 other states have legalized medical and recreational marijuana, however, the researchers found many of the products now available at U.S. dispensaries have not been well studied.
“For some cannabis products, such as whole-plant products, the data are sparse with imprecise estimates of effect and studies had methodological limitations,” the authors write.
This situation makes it difficult to guide patients.
“Cannabis products vary quite a bit in terms of their chemical composition, and this could have important effects in terms of benefits and harm to patients,” said co-author Roger Chou, M.D., director of OHSU’s Pacific Northwest Evidence-based Practice Center. “That makes it tough for patients and clinicians since the evidence for one cannabis-based product may not be the same for another.”
The living review, including a visual abstract summary of the findings, will also be shared on a new web-based tool launched by OHSU and VA Portland Health Care System early this year to help clinicians and researchers evaluate the latest evidence around the health effects of cannabis. Known as Systematically Testing the Evidence on Marijuana, or STEM, the project includes “clinician briefs” to help health care workers translate the clinical implications.
“This new living evidence review is exactly the type of resource clinicians need to clarify for patients the areas of potential promise, the cannabis formulations that have been studied and, importantly, the major gaps in knowledge,” said co-author Devan Kansagara, M.D., M.C.R., professor of medicine in the OHSU School of Medicine and a staff physician at the VA Portland.
Reviewers searched more than 3,000 studies in the scientific literature as of January of this year and landed on a total of 25 with scientifically valid evidence – 18 randomized controlled studies and seven observational studies of at least four weeks.
The effects of cannabis and related products are based on their ability to mimic the body’s own endocannabinoid system. The system is comprised of receptors and enzymes in the nervous system that regulate bodily functions and can affect the sensation of pain. In the evidence review, researchers sorted the types of product into high, comparable and low ratios of THC to CBD and compared their reported benefits and side effects.
Dronabinol and nabilone fit into the high THC to CBD ratio category, with 100% THC (no CBD), showing the most benefit among the products studied, with meta-analysis of the six randomized controlled studies demonstrating statistically valid benefits for easing neuropathic pain compared to a placebo.
“Honestly, the best advice is to talk to your primary care physician about possible treatments for chronic pain,” McDonagh said. “If you want to consider cannabis, you need to talk to your doctor.”
As more states across the country legalize marijuana in a variety of forms the usefulness of cannabinoids as a treatment method for people with neuropathic pain remains a question that many studies have explored.
Medical marijuana users who say they have high levels of pain are more likely than those with low pain to say they use cannabis three or more times a day, a new study finds.
However, daily marijuana users with severe pain also reported their health had become worse in the past year.
The results don’t necessarily mean that marijuana is not effective in treating at least some kinds of pain, according to the researchers. But it suggests more research is needed before marijuana is accepted as an effective treatment for severe pain.
“It’s not clear if marijuana is helping or not,” said Bridget Freisthler, co-author of the study and professor of social work at The Ohio State University.
“The benefits aren’t as clear-cut as some people assume.”
The study was published recently in the International Journal of Drug Policy.
One issue is the complex relationship between pain, marijuana use and self-reported health, said Alexis Cooke, lead author of the study and postdoctoral scholar in psychiatry at the University of California, San Francisco.
“Having high chronic pain is related to poorer health, so it may be that people who are using marijuana more often already had worse health to begin with,” Cooke said.
“There are still a lot of questions to answer.”
The study involved a survey of 295 medical marijuana dispensary patients in Los Angeles. The surveys were conducted in 2013, when California allowed marijuana use only for medical purposes.
All participants were asked how often they used marijuana; rated how their current health compared to one year ago (on a five-point scale from “much better” to “much worse”); and were asked two questions about their pain levels. Based on their answers, the researchers rated participants’ pain as low, moderate or high.
Among those surveyed, 31 percent reported high pain, 24 percent moderate pain, and 44 percent were in the low-pain category.
Daily marijuana use was reported by 45 percent of the sample, and 48 percent said they used three or more times per day.
The percentage of participants who used marijuana every day did not differ by pain categories. But about 60 percent of those who reported high pain used the drug three or more times a day, compared to 51 percent of those with moderate pain and 39 percent of those in the low-pain group.
Findings showed no association between daily marijuana use and change in health status among those with low levels of pain. But daily marijuana use was linked to worsening health status among those reporting high levels of pain.
However, strangely, there was no association between how often participants used marijuana per day and changes in health status. There’s no easy explanation for this, Freisthler said.
“It shows how little we know about marijuana as medicine, how people are using it, the dosages they are receiving and its long-term effects,” she said.
People use marijuana for a variety of different types of pain, including cancer, joint pain, HIV and nerve pain. Researchers don’t know if marijuana has different effects on different causes of pain, Cooke said.
“Chronic pain is also associated with depression and anxiety. Marijuana may help with these problems for some people, even if it doesn’t help with the pain,” she said.
In addition, marijuana use seems to help people who have lost their appetite due to pain or nausea caused by cancer drugs.
“It may not be the pain that patients are trying to address,” Cooke said.
The results do suggest we need to know more about the link between marijuana and pain relief, Freisthler said.
“Particularly since the opioid crisis, some people have been touting marijuana as a good substitute for opioids for people in pain,” she said.
“But our study suggests we don’t know that marijuana is helping to address pain needs.”
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