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Cannabis-Based Medicines and Medical Cannabis in the Treatment of Nociplastic Pain

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Abstract

Nociplastic pain is defined as pain due to sensitization of the nervous system, without a sufficient underlying anatomical abnormality to explain the severity of pain. Nociplastic pain may be manifest in various organ systems, is often perceived as being more widespread rather than localized and is commonly associated with central nervous system symptoms of fatigue, difficulties with cognition and sleep, and other somatic symptoms; all features that contribute to considerable suffering. Exemplified by fibromyalgia, nociplastic conditions also include chronic visceral pain, chronic headaches and facial pain, and chronic musculoskeletal pain. It has been theorized that dysfunction of the endocannabinoid system may contribute to persistent pain in these conditions. As traditional treatments for chronic pain in general and nociplastic pain in particular are imperfect, there is a need to identify other treatment options. Cannabis-based medicines and medical cannabis (MC) may hold promise and have been actively promoted by the media and advocacy. The medical community must be knowledgeable of the current evidence in this regard to be able to competently advise patients. This review will briefly explain the understanding of nociplastic pain, examine the evidence for the effect of cannabinoids in these conditions, and provide simplified guidance for healthcare providers who may consider prescribing cannabinoids for these conditions.

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Authors and Affiliations

  1. Alan Edwards Pain Management Unit, Division of Rheumatology, Health Centre Montreal, McGill University, Montreal, QC, Canada

    Mary-Ann Fitzcharles

  2. Division of Rheumatology, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada

    Mary-Ann Fitzcharles

  3. Pain Medicine, Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany

    Frank Petzke

  4. Department of Neurology, Technische Universität München, Munich, Germany

    Thomas R. Tölle

  5. Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany

    Winfried Häuser

  6. Health Care Center for Pain Medicine, and Mental Health Saarbrücken, Saarbrücken, Germany

    Winfried Häuser

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  1. Mary-Ann Fitzcharles
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  2. Frank Petzke
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  4. Winfried Häuser
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Correspondence to Mary-Ann Fitzcharles.

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Conflicts of interest/Competing interests:

MAF, FP and WH have no financial conflicts of interest to declare. MAF is the head of a task force of the Canadian Association of Rheumatology of a position paper on medical cannabis for rheumatic diseases; core member of Health Canada Science Advisory Committee on Health Products Containing Cannabis WH is the head of EFIC’s task force of a position paper on cannabis-based medicines and medical cannabis for chronic pain and member of the task force of the German Pain Society on the same topic. FP is the head of the task force of the German Pain Society of a position paper on cannabis-based medicines and medical cannabis for chronic pain. TT has received honoraria for consultancies, travel grants and speaking fees for AOP Orphan, Almiral Hermal, Bionest Partners, Benkitt Renkiser, Grünenthal, Hexal, Indivior, Kaia Health, Lilly, Medscape, Mundipharma, MSD, Novartis, Pfizer, Recordati Pharma, Sanofi-Aventis, and TAD Pharma.

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Fitzcharles, MA., Petzke, F., Tölle, T.R. et al. Cannabis-Based Medicines and Medical Cannabis in the Treatment of Nociplastic Pain. Drugs 81, 2103–2116 (2021). https://doi.org/10.1007/s40265-021-01602-1

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