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Review: cannabinoids and codeine have similar effects on pain relief, but cannabinoids commonly cause psychotropic adverse effects

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 QUESTION: What are the effectiveness and safety of cannabinoids for pain management?

Data sources

Full publications of studies were identified by searching Medline (1966 to 1999), EMBASE/Excerpta Medica (1974 to 1999), the Oxford Pain Database (1950 to 1994), and the Cochrane Library (1999, Issue 3) with the terms marijuana, marihuana, mariuana, cannabis, cannabinoids, tetrahydrocannabinol (THC), delta-9-THC, nabilone, pain, analgesia, and random. Bibliographies of relevant studies were scanned.

Study selection

Studies were selected if they were randomised controlled trials (RCTs) that compared cannabis or cannabinoids with an analgesic agent or placebo for pain management. Studies of experimental pain were excluded.

Data extraction

Data were extracted on study quality, interventions, and outcomes.

Main results

20 RCTs were identified, 9 of which met the selection criteria (222 patients). The types of cannabinoids used were oral delta-9-THC 5 to 10 mg; an oral synthetic nitrogen analogue of THC 4 mg; oral benzopyranoperidine 2 to 4 mg; and intramuscular levonantradol 1.5 to 3 mg. No study assessed cannabis or other inhaled or smoked cannabinoids. The other active treatment drugs were oral codeine 50 to 120 …

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  • Sources of funding: Swiss National Research Foundation and Royal College of Nursing Institute.

  • For correspondence: Ms F A Campbell, Pain Management Centre, Undercroft, South Block, Queen's Medical Centre, Nottingham NG7 2UH, UK. Fax +44 115 970 9196.