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Patient Evidence Summary
Doctor, I have chronic neuropathic pain and can't sleep. Would taking cannabinoids help me to sleep and reduce my pain?
There is some evidence that cannabinoids improve sleep and reduce neuropathic pain. However, these benefits come with increased adverse effects such as daytime sleepiness, dizziness, and nausea.
What is the evidence?
SUMMARY OF FINDINGS
Different forms of cannabinoids vs placebo
| Outcome | Effect | Quality of Evidence |
|---|---|---|
| Sleep quality | Improved sleep by a small amount | Moderate |
| Somnolence (drowsiness or feeling sleepy during the day) | Increased somnolence by a large amount | High |
| Pain | Reduced pain by a moderate amount | Moderate |
| Dizziness | Increased dizziness by a large amount | High |
| Nausea | Increased nausea by a large amount | High |
What kind of study was this?
This was a systematic review of eight randomized controlled trials published up to March 2021.
Who? This review included 1,051 adults (average age 51 years) who had central or peripheral neuropathic pain for at least 3 months. People with schizophrenia, other psychotic illnesses, depression, serious heart, kidney or liver disease, epilepsy or history of seizures or a history of substance abuse were excluded.
What? The reviewers included studies that compared cannabinoids with placebo.
Natural or Synthetic Cannabinoids | vs | Placebo |
|---|---|---|
Natural or Synthetic Cannabinoids: THC (tetrahydrocannabinol) :CBD (cannabidiol) intraoral spray, nabilone, and medical cannabis combinations (THC dose ranging from 1 to 130 mg per day and CBD dose ranging from 2.5 to 120 mg per day) . Duration of treatment: 2 to 15 weeks. Participants were allowed to continue other pain control medications including opioids | Placebo: A pill/spray containing an inactive substance that has no effect on the outcome. Sometimes, it is referred to as a "sugar pill." Participants were allowed to continue other pain control medications including opioids |
Why was this research done?
Neuropathic pain is sometimes described as shooting pain or burning pain or a sensation of electrical shock. It is caused by injury or dysfunction of nerves within the central nervous system (brain or spinal cord) or peripheral nervous system (nerves outside of the brain or spinal cord). Cannabinoids refer to a group of chemicals that are related to the cannabis (marijuana) plant. Different cannabinoid products contain different chemicals (for example, THC, CBD) that act on the nervous system. It is thought that CBD might improve sleep while THC improves pain.
Reviewers wanted to know if cannabinoids improve sleep and reduce pain in people with chronic neuropathic pain. They found moderate quality evidence that cannabinoids do improve sleep and pain, but there is also high quality evidence that they increase daytime sleepiness, dizziness, and nausea. Concerns about this study include combining participants with central and peripheral neuropathic pain together (they are not the same), inability to come to a conclusion on the best dose of THC:CBD, and the fact that the studies allowed participants to continue on other medications for pain at the same time as study drugs (so we don't know for certain that all of the benefits or all of the adverse effects were due to the cannabinoids).
This Evidence Summary is based on the following article:
McParland AL, Bhatia A, Matelski J, et al. 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. Reg Anesth Pain Med. 2023 Apr;48(4):180-190. doi: 10.1136/rapm-2021-103431. Epub 2022 Dec 5. PubMed
Published: Thursday, March 9, 2023
Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.
, McMaster University