New Guidelines Issued on Medical Cannabis for Chronic Pain

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International task force shares recommendations for dosing, administering.

Chronic pain patients can be treated with medical cannabis following one of three protocols based on patient characteristics, according to an international task force at the virtual PAINWeek meeting.

Citing limited clinician knowledge about medical cannabis treatment and the opioid crisis, one task force member said the recommendations are timely.

“We as a task force believe it’s extremely important to bring [medical cannabis] to patients,” Alan Bell, MD, of the University of Toronto, told MedPage Today. “Our main focus was to provide directions to clinicians.”

Among their recommendations:

  • Treat the majority of patients along the “routine” scale. This means starting patients with 5 mg of cannabidiol (CBD) twice daily. Tetrahydrocannabinol (THC) should only be introduced if patients do not respond to at least 40 mg of CBD daily, starting with 2.5-mg daily THC doses. THC doses should be capped at 40 mg daily.
  • Frail and elderly patients, and those with severe co-morbidity or polypharmacy should be treated via a conservative route. This means starting the THC dosses at 1 mg daily and titrating up the THC more slowly.
  • Patients suffering from severe pain and those who have significant prior cannabis consumption can follow the rapid protocol. This mean starting with a CBD-THC balanced dose of between 2.5-5 mg per each compound once or twice daily.

The task force recommends starting with CBD in most cases because they have seen many patients benefit solely from CBD. Unlike THC, CBD does not have psychoactive properties.

The task force encourages providers to consider medical cannabis for patients dealing with neuropathic, inflammatory, nociplastic, and mixed pain.

The task force did not set a maximum treatment age; many of its clinicians reported seeing best results among geriatric patients, Bell said. They did not set a minimum CBD treatment age, with many treating pediatric patients with high doses of CBD for epilepsy.

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