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Pain is an unpleasant experience that is subjective in nature; it differs in duration and etiology. Chronic pain, often described as pain that persists for a minimum of 3 months, may stem from an initial injury (e.g., back sprain), illness, or an unexplained cause [1]. Non-cancer chronic pain differs from cancer pain because cancer pain arises from the invasion of a tumor and the interaction among tumor cells, the nervous system, and an individual’s immune system [2, 3]. Cancer pain often advances as the disease progresses [2]. Because of differences in etiology and management of these forms of pain, this review focused on non-cancer chronic pain.

The search yielded 4316 articles and 24 reports from the databases and grey literature, respectively. One thousand and nine hundred duplicates were eliminated, leaving 2440 unique studies. Two authors screened the 2440 studies and selected full texts of nine studies that qualified for inclusion (Fig. 1).

Systematic review registration

One cohort study [18] had a serious risk of confounding and did not provide enough information to make an overall risk of bias assessment. The other cohort study [19] had a serious risk of bias related to missing data and inadequate measurement of outcomes The third cohort study [20] had a serious risk of bias for confounding and measurement of outcomes, and critical risk of bias related to missing data, with an overall critical risk of bias assessment. See Additional file 1 for the risk of bias assessment of included cohort studies.

Among a cohort of 35 MC users in the cannabis program of New Hampshire or Vermont, USA, there was a reduction in mean daily opioid usage of 126.6 mg, compared to 138.5 mg in those not on the program [18]. In the same population, there was also reduction in mean emergency department visits and hospital admissions from chronic pain in the preceding calendar year [18]. Furthermore, in 37 habitual opioid users for chronic pain enrolled in the medical cannabis program, patients on MC were more likely to reduce daily opioid dosage than those not using MC (83.8% vs. 44.8%) over a 21-month period [19]. A cohort study, with a 4-year follow-up period, reported an occasional or regular reduction of opioid use with MC in 22% and 30% of participants on the 3rd and 4th year follow-up waves, respectively [20]. In a cross-sectional online survey of 1513 members of dispensaries in New England, USA, 76.7% of patients with non-cancer chronic pain using opioids reduced opioid use after starting MC [25]. Similarly, a sample of 244 MC patients with non-cancer chronic pain attending a Michigan MC dispensary reported a 64% reduction in opioid use after starting MC [21], and 18.4% of 2032 Canadian MC patients reported up to a 75% reduction in opioid dosage [23]. In a case series of three patients with non-cancer chronic pain of 6–10 years duration, the use of MC led to 60–100% reduction in the opioid dosage compared to when MC was not used [26]. Among 1514 respondents who used MC for non-cancer chronic pain in Australia, there was an average of 70% pain relief, where 100% meant complete pain relief [22].

The goal of this review was to assess the use of MC as an adjunct to opioids to reduce opioid dosage in the treatment of non-cancer chronic pain. After screening eligible studies, we found nine studies that reported using MC to reduce opioid dosage for the treatment of non-cancer chronic pain. This review found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by MC users, compared to people with no additional use of MC. There was 64–75% reduction in opioid dosage for MC users and complete stoppage of opioid use for chronic non-cancer pain by 32–59.3% of MC users, when compared to patients without additional use of MC.

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As the ravages of the opioid epidemic lead many to avoid these powerful painkillers, a significant number of people with fibromyalgia are finding an effective replacement in CBD-containing products, finds a new Michigan Medicine study.

For this study, the team focused on 878 people with fibromyalgia who said they used CBD to get more insight into how they used CBD products.

“I was not expecting that level of substitution,” said Boehnke, noting that the rate is quite similar to the substitution rate reported in the medical cannabis literature. People who said they used CBD products that also contained THC had higher odds of substitution and reported greater symptom relief.

Yet the finding that products containing only CBD also provided pain relief and were substituted for pain medications is promising and merits future study, noted Boehnke.

The team noted that much of the widespread use of CBD is occurring without physician guidance and in the absence of relevant clinical trials. “Even with that lack of evidence, people are using CBD, substituting it for medication and doing so saying it’s less harmful and more effective,” he said.