Medical cannabis and its efficacy/effectiveness on the management of osteoarthritis pain and function

Abstract

Objective

Despite pharmacological treatments for osteoarthritis (OA), more individuals are choosing medical cannabis for OA symptom management and for mitigating opioid prescriptions for OA. This systematic review examines the global evidence of medical cannabis use on OA pain and function.

Methods

The search was completed in MEDLINE (PubMed), Embase, and CINAHL within the past 10 years (2012-2022). We limited the search to English language articles. We did not include grey literature or case studies. Participant demographics included all adult individuals with OA who were using medical cannabis for OA. Study quality and risk of bias were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations framework; and the Risk of Bias in Non-randomized Studies of Interventions tool. We used a narrative synthesis approach.

Results

Overall, 7 studies were included: 2 randomized controlled trials (RCT) and 5 observational studies. Only 1 of the 2 RCTs reported improvements in pain for cannabis users. All 5 observational studies reported an improvement in pain levels, reduction of opioid use, and/or improvement in overall OA function. Despite high risk of bias ratings and low study quality, the consensus across studies was that medical cannabis use was effective for a subgroup of individuals suffering from OA pain.

Conclusions

There is low quality evidence to support medical cannabis use as a substitute for primary pharmacological treatment of OA. However, this does not negate the observations that medical cannabis may provide therapeutic relief for a subset of patients.

Systematic Review PROPSERO registration

CRD42022354026

Keywords:

• Medical cannabis
• osteoarthritis
• pain
• systematic review
• epidemiology

Transparency

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

Data extraction supplementary tables can be accessed by request to corresponding author.

Acknowledgements

The corresponding author and guarantor accept full responsibility of the work and/or conduct of the study, had access to the data and controlled the decision to publish. CD attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Author contributions

CD designed the study and MB conducted the search. CD and ED were independent reviewers for the systematic review. DE revised it critically for important intellectual content and approved the final version to be published. All authors are accountable for the work and integrity of the work.

CD affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and if relevant) have been explained. All coauthors have provided permission to be acknowledged.

Additional information

Funding

This systematic review was funded by Northwestern University. ED was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant #90ARHF0003, PI: Allen Heinemann).