Cannabinoids added to opioids yields no effect for cancer pain: meta-analysis

  • Boland EG & al.
  • BMJ Support Palliat Care
  • 20/01/2020

  • Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Adding cannabinoids, including cannabis, to opioids does not significantly reduce cancer pain, conclude the authors of this meta-analysis of 5 randomized controlled trials (RCTs) with more than 1400 patients.
  • The addition of cannabinoids was tied to more adverse events (AEs).

Why this matters

  • Although studies suggest that many patients with cancer use cannabinoids for pain relief, WHO guidelines note that evidence is lacking for their effectiveness in cancer pain management.

Study design

  • Systematic review and meta-analysis (narrative analysis: 6 RCTs, n=1460; meta-analysis, 5 RCTs, n=1442).
  • Primary outcome: absolute change in mean pain intensity in patients with advanced cancer.
  • Funding: None disclosed.

Key results

  • Cannabinoids vs placebo group showed no difference in the change in average Numeric Rating Scale pain scores:
    • Mean difference (MD), −0.21 (P=.14).
  • Including only phase 3 studies showed no benefit from cannabinoid use vs placebo:
    • MD, −0.02 (P=.80).
  • Cannabinoid group had higher odds (ORs) for:
    • Dizziness: 1.58 (P=.05).
    • Somnolence: 2.69 (P<.001>
  • Cannabinoid group showed higher odds (ORs; not significant) for nausea (1.41; P=.08) and vomiting (1.34; P=.21).
  • No treatment-related deaths were reported in any study.

Limitations

  • Inconsistencies among studies.
  • Self-reported pain scores.

Coauthored with Chitra Ravi, MPharm