• Winfried Häuser, Mary-Ann Fitzcharles, Lukas Radbruch, and Frank Petzke.
• Department of Internal Medicine I, Klinikum Saarbrücken, Germany; McGill University Health Centre, Division of Rheumatology and Alan Edwards Pain Management Unit, Montreal, Quebec, Canada; Palliative Care Center, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany.
• Dtsch Arztebl Int. 2017 Sep 22; 114 (38): 627634627-634.

BackgroundThere are conflicting interpretations of the evidence regarding the efficacy, tolerability, and safety of cannabinoids in pain management and palliative medicine.MethodsWe conducted a systematic review (SR) of systematic reviews of randomized controlled trials (RCT) and prospective long-term observational studies of the use of cannabinoids in pain management and palliative medicine. Pertinent publications from January 2009 to January 2017 were retrieved by a selective search in the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and Medline. The methodological quality of the SRs was assessed with the AMSTAR instrument, and the clinical relevance of quantitative data syntheses was assessed according to the standards of the Cochrane Collaboration.ResultsOf the 750 publications identified, 11 SRs met the inclusion criteria; 3 of them were of high and 8 of moderate methodological quality. 2 prospective long-term observational studies with medical cannabis and 1 with tetrahydrocannabinol/cannabidiol spray (THC/CBD spray) were also analyzed. There is limited evidence for a benefit of THC/CBD spray in the treatment of neuropathic pain. There is inadequate evidence for any benefit of cannabinoids (dronabinol, nabilone, medical cannabis, or THC/CBD spray) to treat cancer pain, pain of rheumatic or gastrointestinal origin, or anorexia in cancer or AIDS. Treatment with cannabis-based medicines is associated with central nervous and psychiatric side effects.ConclusionThe public perception of the efficacy, tolerability, and safety of cannabis-based medicines in pain management and palliative medicine conflicts with the findings of systematic reviews and prospective observational studies conducted according to the standards of evidence-based medicine.

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