Cannabinoid Use for Pain Reduction in Spinal Cord

     Sung Huang Laurent Tsai, Chun-Ru Lin, Shih-Chieh Shao, Chao-Hua Fang, Tsai-Sheng Fu, Tung-Yi Lin, Yu-Chiang Hung(2022). Cannabinoid Use for Pain Reduction in Spinal Cord Injuries: A Meta-Analysis of Randomized Controlled Trials. Frontiers in Pharmacology. 2022:13.  

Background: Spinal cord injury (SCI) often involves multimodal pain control. This study

aims to evaluate the efficacy and safety of cannabinoid use for the reduction of pain in SCI

patients.

Methods and Findings: This study followed the Preferred Reporting Items for Systematic

reviews and Meta-Analyses (PRISMA) statement. We searched PubMed, EMBASE,

Scopus, Cochrane, Web of Science, and ClinicalTrials.gov for relevant randomized

controlled trials (RCTs) reporting the efficacy (e.g., pain relief) or safety (e.g., adverse

events) of cannabinoids in patients with SCI, from inception to 25 December 2021. The

study quality and the quality of evidence were evaluated by Cochrane ROB 2.0 and the

Grading of Recommendations, Assessment, Development, and Evaluations system

(GRADE), respectively. We used the random-effects model to perform the metaanalysis.

From a total of 9,500 records, we included five RCTs with 417 SCI patients

in the systematic review and meta-analysis. We judged all five of the included RCTs as

being at high risk of bias. This meta-analysis indicated no significant difference in pain relief

between the cannabinoids and placebo in SCI patients (mean difference of mean

differences of pain scores: −5.68; 95% CI: −13.09, 1.73; p = 0.13; quality of evidence:

very low), but higher odds of adverse events were found in SCI patients receiving

cannabinoids (odds ratio: 3.76; 95% CI: 1.98, 7.13; p < 0.0001; quality of evidence:

moderate).

Conclusion: The current best evidence suggests that cannabinoids may not be beneficial

for pain relief in SCI patients, but they do increase the risks of adverse events, including

dizziness, somnolence, and dysgeusia, compared to the placebo. Cannabinoids should

not be regularly suggested for pain reduction in SCI patients. Updating the systematic

reviews and meta-analyses by integrating future RCTs is necessary to confirm these

findings.

Keywords: cannabinoids, spinal cord injury, trauma, spine, pain, adverse events