Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions


Alan D. Bell, Caroline MacCallum, Shari Margolese, Zach Walsh, Patrick Wright, Paul J. Daeninck, Enrico Mandarino, Gary Lacasse, Jagpaul Kaur Deol, Lauren de Freitas, Michelle St. Pierre, Lynne Belle-Isle, Marilou Gagnon, Sian Bevan, Tatiana Sanchez, Stephanie Arlt, Max Monahan-Ellison, James O’Hara, Michael Boivin and Cecilia Costiniuk


March 27, 2023


Background: One in five individuals live with chronic pain globally, which often co-occurs with sleep problems, anxiety, depression, and substance use disorders. Although these conditions are commonly managed with cannabinoid-based medicines (CBM), health care providers report lack of information on the risks, benefits, and appropriate use of CBM for therapeutic purposes.

Aims: We present these clinical practice guidelines to help clinicians and patients navigate appropriate CBM use in the management of chronic pain and co-occurring conditions.
Materials and Methods: We conducted a systematic review of studies investigating the use of CBM for the treatment of chronic pain. Articles were dually reviewed in accordance with Preferred Reporting Items for Sys- tematic Reviews and Meta-Analyses guidelines. Clinical recommendations were developed based on available evidence from the review. Values and preferences and practical tips have also been provided to support clinical application. The GRADE system was used to rate the strength of recommendations and quality of evidence.

Results: From our literature search, 70 articles met inclusion criteria and were utilized in guideline development, including 19 systematic reviews and 51 original research studies. Research typically demonstrates moderate ben- efit of CBM in chronic pain management. There is also evidence for efficacy of CBM in the management of comorbidities, including sleep problems, anxiety, appetite suppression, and for managing symptoms in some chronic conditions associated with pain including HIV, multiple sclerosis, fibromyalgia, and arthritis.

Conclusions: All patients considering CBM should be educated on risks and adverse events. Patients and clini- cians should work collaboratively to identify appropriate dosing, titration, and administration routes for each in- dividual.


DOI: 10.1089/can.2021.0156


Bell, A. D., MacCallum, C., Margolese, S., Walsh, Z., Wright, P., Daeninck, P. J., … & External Review Panel. (2023). Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions. Cannabis and Cannabinoid Research.