The Cancer Pain Conundrum | CRx Podcast

Opioids play a critical role in managing cancer-associated pain, but they’re highly addictive, and they don’t always provide sufficient pain relief for cancer patients. Many patients therefore turn to cannabis or cannabis-derived products to help manage their pain, using them either as standalone treatments or as an adjuvant therapy to opioids. But does research support cannabis use for this purpose? The evidence is mixed, and some studies suggest there may indeed be benefits for cancer pain—but there’s also reason for caution. How Much Research Is There? There’s a relatively strong body of research on cannabis for the treatment of chronic pain generally, according to Eloise Theisen, RN, MSN, president of the American Cannabis Nurses Association and co-founder of Radicle Health, a cannabis education and advocacy organization. However, much of this research has focused on neuropathic pain in multiple sclerosis and spinal cord injuries, and comparatively few studies have examined pain in the cancer context. Among the studies that exist for cancer, many have small sample sizes, and study design is also an issue. “We have animal studies and some clinical human studies,” says Theisen, but there’s “a lack of randomized controlled trials, which are considered to be the gold standard.” A further complicating factor in the research on cannabis and cancer pain is that most of the existing studies on this topic have relied on products that do not match those cancer patients actually use in practice. According to Hance Clarke, MD, PhD, associate professor of anesthesia at the University of Toronto and author of a recent review article on cannabis and pain,1 the products that have been studied most extensively are pharmaceutical-grade cannabis isolates, such as nabiximols (an extract containing THC and CBD in a precise one-to-one ratio), nabilone (synthetic THC), and dronabinol (also synthetic THC). However, cancer patients outside of the research context are much more likely to use dispensary cannabis and non-pharmaceutical-grade plant-based extracts. “We’re kind of stuck without enough evidence on the products that people are currently using,” says Clarke. This is important, because patients may react quite differently to a dispensary product than to a pharmaceutical product, according to Clarke. Guests:  Eloise Theisen, MSN, RN, is a board certified Adult Geriatric Nurse Practitioner who specializes in cannabis therapy. For over 20 years, Eloise has worked primarily with cancer, dementia and chronic pain patients. In the last several years, Eloise has focused her efforts on cannabinoid therapies. Eloise was one of the first healthcare professionals to bring a clinical dosing regimen to the cannabis space. In 2019, Eloise was elected President of the American Cannabis Nurses Association and will serve through 2022. In 2019, Eloise co-authored Pain Free with CBD: Everything You Need to Know and Effectively Use Cannabidiol with Alice O’Leary Randall.    Joe Jeffries, Pharm D is currently Director of Pharmacy at FarmaceuticalRx, a medical cannabis dispensary in East Liverpool Ohio. Joe is the former Director of Pharmacy at Barnesville Hospital and was named the Healthcare Worker of the Year, largely for his creation of a program to help those struggling with drug addiction. Joe was also President of the Ohio Pharmacists Association from 2000-2001.  Host:  Joseph Friedman  CannaRPh Consultants CRx Magazine Advisory Board, CRx Podcast  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices