Cannabis and intractable chronic pain: an explorative retrospective analysis of Italian cohort of 614 patients

Guido Fanelli; Giuliano De Carolis; Claudio Leonardi; Adele Longobardi; Ennio Sarli; Massimo Allegri; Michael E Schatman

doi:10.2147/JPR.S132814

Cannabis and intractable chronic pain: an explorative retrospective analysis of Italian cohort of 614 patients

J Pain Res. 2017 May 22:10:1217-1224. doi: 10.2147/JPR.S132814. eCollection 2017.

Authors

Guido Fanelli^{1

2}, Giuliano De Carolis³, Claudio Leonardi⁴, Adele Longobardi^{5

6}, Ennio Sarli^{7

8}, Massimo Allegri^{1

2}, Michael E Schatman⁹

Affiliations

¹ Anesthesia, Critical Care and Pain Medicine Unit, Division of Surgical Sciences, Department of Medicine and Surgery, University of Parma.
² Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliero Universitaria Parma, Parma.
³ Pain Therapy Service, Azienda Ospedaliero Universitaria Pisana, Pisa.
⁴ Department of Drug Addiction Diseases, Local Public Health of Rome, Rome.
⁵ Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples.
⁶ Young Against the Pain (YAP) Group, Parma.
⁷ Progetti Live Surgery.
⁸ PinHub Group, Florence, Italy.
⁹ Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.

Abstract

Background: Despite growing interest in the therapeutic use of cannabis to manage chronic pain, only limited data that address these issues are available. In recent years, a number of nations have introduced specific laws to allow patients to use cannabis preparations to treat a variety of medical conditions. In 2015, the Italian government authorized the use of cannabis to treat several diseases, including chronic pain generally, spasticity in multiple sclerosis, cachexia and anorexia among AIDS and cancer patients, glaucoma, Tourette syndrome, and certain types of epilepsy. We present the first snapshot of the Italian experience with cannabis use for chronic pain over the initial year of its use.

Methods: This is a retrospective case series analysis of all chronic pain patients treated with oral or vaporized cannabis in six hubs during the initial year following the approval of the new Italian law (December 2015 to November 2016). We evaluated routes of administration, types of cannabis products utilized, dosing, and effectiveness and safety of the treatment.

Results: As only one of the six centers has extensively used cannabinoids for intractable chronic pain (614 patients of 659), only the population from Azienda Ospedaliero Universitaria Pisana (Pisa) was considered. Cannabis tea was the primary mode of delivery, and in almost all cases, it was used in association with all the other pain treatments. Initial and follow-up cannabinoid concentrations were found to vary considerably. At initial follow-up, 76.2% of patients continued the treatment, and <15% stopped the treatment due to side effects (none of which were severe).

Conclusion: We present the first analysis of Italian clinical practice of the use of cannabinoids for a large variety of chronic pain syndromes. From this initial snapshot, we determined that the treatment seems to be effective and safe, although more data and subsequent trials are needed to better investigate its ideal clinical indication.

Keywords: cannabidiol; cannabinoids; cannabis; chronic pain; safety.