Utilization of medicinal cannabis for pain by individuals with spinal cord injury

Abstract

Study design

A cross-sectional multi-center study using an on-line survey addressing utilization, knowledge, and perceptions of medicinal cannabis (MC) by people with spinal cord injury (SCI).

Objective

To characterize differences between current (CU), past (PU), and never users (NU) of MC with SCI; to determine why people with SCI use MC; to examine reports of MCs’ efficacy and tolerability by individuals with SCI.

Setting

Three academic medical centers in the United States.

Methods

Comparison of demographic and attitudinal differences between CU, PU, and NU and differences in the groups’ reports of pain, health, and quality of life (QOL). Evaluation of utilization patterns and perceived efficacy of MC among CU and PU and reports of side effects of MC versus prescription medications. Data were analyzed using either Chi Square, distribution-free exact statistics, or t-tests for continuous data.

Results

Among a nationwide sample (n = 353) of individuals with SCI, NU were less likely than CU and PU to believe that cannabis ought to be legalized and more likely to endorse risks of use. Current users and PU reported greater pain interference in daily life than did NU, but there were no between group differences in QOL or physical or emotional health. Current users and PU took MC to address pain (65.30%), spasms (63.30%), sleeplessness (32.70%), and anxiety (24.00%), and 63.30% reported it offered “great relief” from symptoms. Participants reported that MC is more effective and carries fewer side effects than prescription medications.

Conclusions

Medicinal cannabis is an effective and well-tolerated treatment for a number of SCI-related symptoms.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Choi NG, DiNitto DM, Marti CN. Nonmedical versus medical marijuana use among three age groups of adults: Associations with mental and physical health status. Am J Addict 2017;26:697–706.

  2. 2.

    National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: an Evidence Review and Research Agenda. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington, DC: The National Academies Press; 2017.

  3. 3.

    Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA. Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abus 2014;40:23–30.

  4. 4.

    Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. J Am Med Assoc. 2015;313:2456–73.

  5. 5.

    Andreae MH, Carter GM, Shaparin N, et al. Inhaled cannabis for chronic neuropathic pain: a meta-analysis of individual patient data. J Pain 2015;16:1221–32.

  6. 6.

    Smith LA, Azariah F, Lavender VT, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.CD009464.pub2.

  7. 7.

    Badowski ME. A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy-induced nausea and vomiting: A focus on pharmacokinetic variability and pharmacodynamics. Cancer Chemother Pharm. 2017;80:441–9.

  8. 8.

    Leocani L, Nuara A, Houdayer E, et al. Sativex((R)) and clinical-neurophysiological measures of spasticity in progressive multiple sclerosis. J Neurol 2015;262:2520–7.

  9. 9.

    Koppel BS, Brust JC, Fife T, et al. Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the guideline development subcommittee of the american academy of neurology. Neurology 2014;82:1556–63.

  10. 10.

    Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain 2016;17:739–44.

  11. 11.

    Bradford AC, Bradford WD. Medical marijuana laws reduce prescription medication use in medicare part D. Health Aff (Millwood) 2016;35:1230–6.

  12. 12.

    Wen H, Hockenberry JM. Association of medical and adult-use marijuana laws with opioid prescribing for medicaid enrollees. JAMA Intern Med 2018;178:673–9.

  13. 13.

    Charlifue SW, Weitzenkamp DA, Whiteneck GG. Longitudinal outcomes in spinal cord injury: Aging, secondary conditions, and well-being. Arch Phys Med Rehabil 1999;80:1429–34.

  14. 14.

    New PW. Secondary conditions in a community sample of people with spinal cord damage. J Spinal Cord Med 2016;39:665–70.

  15. 15.

    Anson CA, Shepherd C. Incidence of secondary complications in spinal cord injury. Int J Rehabil Res. 1996;19:55–66.

  16. 16.

    Adriaansen JJ, Ruijs LE, van Koppenhagen CF, et al. Secondary health conditions and quality of life in persons living with spinal cord injury for at least 10 years. J Rehabil Med 2016;48:853–60.

  17. 17.

    Wollaars MM, Post MW, van Asbeck FW, Brand N. Spinal cord injury pain: the influence of psychologic factors and impact on quality of life. Clin J Pain. 2007;23:383–91.

  18. 18.

    Ataoglu E, Tiftik T, Kara M, Tunc H, Ersoz M, Akkus S. Effects of chronic pain on quality of life and depression in patients with spinal cord injury. Spinal Cord 2013;51:23–26.

  19. 19.

    Nagoshi N, Kaneko S, Fujiyoshi K, et al. Characteristics of neuropathic pain and its relationship with quality of life in 72 patients with spinal cord injury. Spinal Cord 2016;54:656–61.

  20. 20.

    Kennedy P, Lude P, Taylor N. Quality of life, social participation, appraisals and coping post spinal cord injury: a review of four community samples. Spinal Cord 2006;44:95–105.

  21. 21.

    Lo C, Tran Y, Anderson K, Craig A, Middleton J. Functional priorities in persons with spinal cord injury: using discrete choice experiments to determine preferences. J Neurotrauma 2016;33:1958–68.

  22. 22.

    Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004;21:1371–83.

  23. 23.

    Rintala DH, Fiess RN, Tan G, Holmes SA, Bruel BM. Effect of dronabinol on central neuropathic pain after spinal cord injury: A pilot study. Am J Phys Med Rehabil. 2010;89:840–8.

  24. 24.

    Wilsey BL, Deutsch R, Samara E, et al. A preliminary evaluation of the relationship of cannabinoid blood concentrations with the analgesic response to vaporized cannabis. J Pain Res 2016;9:587–98.

  25. 25.

    Wade DT, Robson P, House H, Makela P, Aram J. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil 2003;17:21–29.

  26. 26.

    Drossel C, Forchheimer M, Meade MA. Characteristics of individuals with spinal cord injury who use cannabis for therapeutic purposes. Top Spinal Cord Inj Rehabil 2016;22:3–12.

  27. 27.

    Andresen SR, Biering-Sorensen F, Hagen EM, Nielsen JF, Bach FW, Finnerup NB. Cannabis use in persons with traumatic spinal cord injury in denmark. J Rehabil Med 2017;49:152–60.

  28. 28.

    Cardenas DD, Jensen MP. Treatments for chronic pain in persons with spinal cord injury: a survey study. J Spinal Cord Med 2006;29:109–17.

  29. 29.

    Hawley LA, Ketchum JM, Morey C, Collins K, Charlifue S. Cannabis use in individuals with spinal cord injury or moderate to severe traumatic brain injury in colorado. Arch Phys Med Rehabil 2018;99:1584–90.

  30. 30.

    Stillman M, Mallow M, Ransom T, Gustafson K, Bell A, Graves D. Attitudes toward and knowledge of medical cannabis among individuals with spinal cord injury. Spinal Cord Ser Cases. 2019;5:6–019-0151-6.

  31. 31.

    Cuttler C, Spradlin A. Measuring cannabis consumption: Psychometric properties of the daily sessions, frequency, age of onset, and quantity of cannabis use inventory (DFAQ-CU). PLoS One. 2017;12:e0178194.

  32. 32.

    Widerstrom-Noga E, Biering-Sorensen F, Bryce TN, et al. The international spinal cord injury pain basic data set (version 2.0). Spinal Cord 2014;52:282–6.

  33. 33.

    Charlifue S, Post MW, Biering-Sorensen F, et al. International spinal cord injury quality of life basic data set. Spinal Cord 2012;50:672–5.

  34. 34.

    Schug SA, Parsons B, Almas M, Whalen E. Effect of concomitant pain medications on response to pregabalin in patients with postherpetic neuralgia or spinal cord injury-related neuropathic pain. Pain Physician 2017;20:E53–E63.

  35. 35.

    Cardenas DD, Nieshoff EC, Suda K, et al. A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury. Neurology 2013;80:533–9.

  36. 36.

    Mehta S, McIntyre A, Dijkers M, Loh E, Teasell RW. Gabapentinoids are effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: A meta-analysis. Arch Phys Med Rehabil 2014;95:2180–6.

  37. 37.

    Han ZA, Song DH, Oh HM, Chung ME. Botulinum toxin type A for neuropathic pain in patients with spinal cord injury. Ann Neurol. 2016;79:569–78.

  38. 38.

    Mehta S, Guy S, Lam T, Teasell R, Loh E. Antidepressants are effective in decreasing neuropathic pain after SCI: a meta-analysis. Top Spinal Cord Inj Rehabil 2015;21:166–73.

  39. 39.

    Vranken JH, Hollmann MW, van der Vegt MH, et al. Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: A randomized, double-blind, placebo-controlled trial. Pain 2011;152:267–73.

  40. 40.

    National spinal cord injury statistical center. Spinal cord injury facts and figures at a glance. 2016. www.nscisc.uab.edu. Accessed 16 Dec 2017.

  41. 41.

    Prevalence of marijuana use among U.S. adults doubles over the past decade. 2015. http://www.niaaa.nih.gove/news-events/news-releases/prevalence-marijuana-use-among-us-adults-doubles-over-past-decade. Accessed 15 Feb 2019.

Download references

Author contributions

MS was responsible for researching and developing the survey, submitting the project to the IRB, coordinating survey distribution, and drafting the manuscript. MC assisted with survey development, was primarily responsible for data analysis, and helped draft the manuscript. MM was responsible for researching and developing the survey, building the on-line survey, and drafting the manuscript. TR was responsible for researching and developing the survey, helping analyze the data, and drafting the manuscript. KG was responsible for researching and developing the survey, helping analyze the data, and drafting the manuscript. AB was responsible for researching and developing the survey, helping analyze the data, and drafting the manuscript. DG was responsible for researching and developing the survey, helping analyze the data, and drafting the manuscript.

Author information

Correspondence to Michael Stillman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of ethics

This study was reviewed by the Thomas Jefferson University Institutional Review Board and deemed exempt. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were following during the course of this research.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

supplement

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark