Pain intensity of chronic non-cancer patients was reduced by cannabinoids consumption , but effect sizes were small .
Efficacy for neuropathic and non-neuropathic pain was similar
There is growing interest in using cannabinoids for chronic pain .
We performed a systematic review and meta- analysis of r and omized controlled trials to evaluate the analgesic efficacy and adverse effects of cannabinoids for chronic non-cancer pain .
Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial
Importance Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain . Objective To compare opioid vs nonopioid medications over 12 months on pain-related function , pain intensity , and adverse effects . Design , Setting , and Participants Pragmatic , 12-month , r and omized trial with masked outcome assessment . Patients were recruited from Veterans Affairs primary care clinics from June 2013 through December 2015 ; follow-up was completed December 2016 . Eligible patients had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use . Of 265 patients enrolled , 25 withdrew prior to r and omization and 240 were r and omized . Interventions Both interventions ( opioid and nonopioid medication therapy ) followed a treat-to-target strategy aim ing for improved pain and function . Each intervention had its own prescribing strategy that included multiple medication options in 3 steps . In the opioid group , the first step was immediate-release morphine , oxycodone , or hydrocodone/acetaminophen . For the nonopioid group , the first step was acetaminophen ( paracetamol ) or a nonsteroidal anti-inflammatory drug . Medications were changed , added , or adjusted within the assigned treatment group according to individual patient response . Main Outcomes and Measures The primary outcome was pain-related function ( Brief Pain Inventory [ BPI ] interference scale ) over 12 months and the main secondary outcome was pain intensity ( BPI severity scale ) . For both BPI scales ( range , 0 - 10 ; higher scores = worse function or pain intensity ) , a 1-point improvement was clinical ly important . The primary adverse outcome was medication-related symptoms ( patient-reported checklist ; range , 0 - 19 ) . Results Among 240 r and omized patients ( mean age , 58.3 years ; women , 32 [ 13.0 % ] ) , 234 ( 97.5 % ) completed the trial . Groups did not significantly differ on pain-related function over 12 months ( overall P = .58 ) ; mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group ( difference , 0.1 [ 95 % CI , −0.5 to 0.7 ] ) . Pain intensity was significantly better in the nonopioid group over 12 months ( overall P = .03 ) ; mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group ( difference , 0.5 [ 95 % CI , 0.0 to 1.0 ] ) . Adverse medication-related symptoms were significantly more common in the opioid group over 12 months ( overall P = .03 ) ; mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group ( difference , 0.9 [ 95 % CI , 0.3 to 1.5 ] ) . Conclusions and Relevance Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months . Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain . Trial Registration clinical trials.gov Identifier :
Pain intensity of chronic non-cancer patients was reduced by cannabinoids consumption , but effect sizes were small .
Efficacy for neuropathic and non-neuropathic pain was similar
There is growing interest in using cannabinoids for chronic pain .
We performed a systematic review and meta- analysis of r and omized controlled trials to evaluate the analgesic efficacy and adverse effects of cannabinoids for chronic non-cancer pain .