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| First author/organization (year) | Quoted recommendations from publications |
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| Acevedo (2009) | “Cannabinoids can be used for NP (neuropathic pain) associated with multiple sclerosis, but the long-term effects remain unclear” |
| Allan (2018) | “Neuropathic pain: We recommend against medical cannabinoids as first- or second-line therapy in neuropathic pain owing to limited benefits and high risk of harms (strong recommendation)
Clinicians could consider medical cannabinoids for refractory neuropathic pain, with the following considerations (weak recommendation)
A discussion has taken place with patients regarding the benefits and risks of medical cannabinoids for pain
Patients have had a reasonable therapeutic trial of ≥3 prescribed analgesics and have persistent problematic pain despite optimized analgesic therapy
Medical cannabinoids are adjuncts to other prescribed analgesics” |
| Australian DoH (2017) | “The use of medications, including medicinal cannabis, is not the core component of therapy for CNCP. Cannabinoids should not replace current approved first-line treatments for pain and there is significant potential for drug interactions which needs further study” |
| Bruce (2017) | “Medical cannabis may be an effective treatment in appropriate patients living with human immunodeficiency virus and chronic pain” |
| CAG (2018) | “Cannabis and cannabinoids may be helpful for GI symptom control, such as abdominal pain where conventional therapies have failed. […] moderate-quality evidence supported the use of cannabinoids for the treatment of chronic pain […]
Medical cannabis use should not replace health Canada approved medical therapy for treatment of any gastroenterologic or hepatologic disease if the approved therapy is available and has not been used” |
| CRA (2019) | “Medical cannabis is not an alternative to standard care for any rheumatic disease, and rheumatologists should adhere to current treatment standards and guidelines for rheumatic disease management. Common reasons that patients may consider use of medical cannabis are for pain relief, improvement in mood and/or sleep promotion. Current treatment strategies for pain relief and sleep promotion, including non-pharmacologic treatments must be tried before consideration of trial of medical cannabis” |
| Dworkin (2007) | “Based on the results of a small number of RCTs, the following specific medications should be considered for patients with central NP: […] cannabinoids for NP associated with multiple (was “ple” cut off in the quote?) sclerosis. […] Lack of long-term follow-up data, limited availability, and concerns over precipitating psychosis or schizophrenia, especially in individuals with environmental or genetic risk factors, restrict the use of cannabinoids to second-line therapy for patients with multiple sclerosis NP at present, and additional trials are needed to further establish their efficacy and safety” |
| Hauser (2018) | “Chronic neuropathic pain: Cannabis‐based medicines can be considered as third‐line therapy. Chronic non-neuropathic non-cancer pain: In exceptional cases, cannabis‐based medicines can be considered as an individual therapeutic trial, if all established treatments have failed and after careful analyses and multidisciplinary assessment” |
| Moulin (2014) | “One class of medication is recommended for third-line treatment in the management of NeP (neuropathic pain)–cannabinoids” |
| NICE (2013) | “Do not start the following (including Cannabis sativa extract) to treat neuropathic pain in non-specialist settings, unless advised by a specialist to do so” |
| Sahraian (2018) | “Oral cannabis could be effective for central dysaesthetic pain” |
| Yadav (2014) | “Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain)
Clinicians might offer tetrahydro-cannabinol (THC) for spasticity symptoms and pain (excluding central neuropathic pain)
Clinicians might offer sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency
Data are inadequate to support or refute use of the following in MS: […] smoked cannabis for spasticity, pain, […]” |
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