Cannabinoids have a role in treating chronic neuropathic pain as evidenced by significant improvements in sleep quality, pain intensity and patients’ global impression of change (PGIC), according to a new study led by UBC Department of Emergency Medicine (DEM) RCPSC-EM resident Dr. Aidan McParland. However, more research is needed to comprehensively evaluate the impact of cannabinoids on sleep health and analgesic efficacy.
The study, “Evaluating the impact of cannabinoids on sleep health and pain in patients with chronic neuropathic pain: a systematic review and meta-analysis of randomized controlled trials”, was published in the BMJ’s Regional Anesthesia & Pain Medicine. The systematic review and meta-analysis found a gradual improvement in both neuropathic pain and sleep in patients who have neuropathic pain when using varying combinations of THC and CBD, as well as improvements in overall functional capacity and quality of life.
“It is estimated that as many as 40 per cent of all patients seen in the Emergency Department (ED) have some form of chronic pain, and 70 per cent of ED visits are a result of some sort of pain, whether acute or chronic. Neuropathic pain specifically is thought to affect more than 10 per cent of the global population,” said Dr. McParland. “It is something that we see quite commonly in the ED, inpatient, and outpatient settings, and there is an ongoing need to develop further understanding of non-opioid analgesic options in the management of neuropathic pain states.”
In over 10 years of studying neuropathic pain, Dr. McParland recognized that there is little understanding of the interplay between sleep and neuropathic pain. Further to this, there is a paucity of literature that looks at this relationship as well as the benefits of using cannabinoids to treat neuropathic pain and its symptoms.
“Cannabinoids are potentially a much safer alternative to opioids or even other medications that we’re currently using for neuropathic pain, but we are still learning about their utility as a treatment for various chronic pain states.” added Dr. McParland.
This project was conducted during Dr. McParland’s time as a participant in the DEM’s Novel Education in Research and Design (NERD) block, a month-long research skills and critical appraisal education course. The course provides participants the opportunity to develop and advance their own research project with the support of academic faculty members.
Dr. McParland first developed an interest in chronic pain management as a first-year undergraduate student while studying in the U.S., where he played NCAA soccer and recognized how often opioids were prescribed to treat sporting injuries. Since then, he has devoted his career to combining his passion for emergency medicine and further investigating chronic pain, including the role of the ED in chronic pain management.
Dr. McParland hopes this work will lend some support for the use case of cannabinoids as one of several possible treatment modalities for neuropathic pain, as well as to promote more robust studies that look at the impact of sleep on neuropathic pain, and alternative chronic pain states, by developing research that monitors and measures sleep more objectively. Additionally, more research is needed to understand what specific dose combinations of CBD and THC can help optimize pain and sleep outcomes, while reducing side effects, such as fatigue and nausea.
This study was a partnership between researchers at the University of British Columbia, the University Health Network, University of Toronto Department of Anesthesia and Pain Medicine, and McMaster University. Co-authors include Anuj Bhatia, John Matelski, Chenchen Tian, Calvin Diep, Hance Clarke, Daniel Kapustin, Aditya Triveda, Richard Brull, and Mandeep Singh.
