Title	Cannabinoids Ease Chronic Nonmalignant Neuropathic Pain
Clinical Question	Are cannabinoids beneficial for neuropathic pain in conditions that are refractory to other treatments?
Clinical Bottom Line	Cannabinoids ease chronic nonmalignant neuropathic pain conditions that are refractory to other treatments. This is supported by a systematic review of 13 randomized placebo-controlled trials in which reductions in pain and adverse events were noted. Further studies are necessary to understand the time length of its effects and to establish the best delivery method.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 25635955 Boychuk/2015 771 Subjects in 13 included systematic studies Systematic review of randomized trials Key results The review looked at 3 different cannabinoids types and methods of delivery. A systemic review of these studies suggests that cannabinoids are indeed helpful in treating neuropathic pain among those with conditions refractory to other analgesia treatments. Abrams et al. reported that in those taking the active drug (synthetic cannabinoid CT-3) the daily pain decreased by 34% over the placebo and a greater than 30% reduction was reported in 54% of patients taking the active drug as opposed to only a 24% reduction in those taking the placebo. Furthermore, Ware et al. reported that a single inhalation of 25mg of 9.4% tetrahydrocannabinol herbal cannabis three times daily for five days reduced the pain threshold. Nurmikko et al. used a specific extract of Cannabis (Sativex) and reported a greater reduction in pain compared to the provided placebo by 30%.
Evidence Search	(("cannabis"[MeSH Terms] OR "cannabis"[All Fields] OR "marijuana"[All Fields]) AND ("pain management"[MeSH Terms] OR ("pain"[All Fields] AND "management"[All Fields]) OR "pain management"[All Fields])) AND (Review[ptyp] AND "humans"[MeSH Terms])
Comments on The Evidence	Validity: This is a systematic review of randomized controlled trials. A comprehensive and detailed search history is included and the method used to assess their validity is also described. 771 patients within 13 randomized trials were ultimately used after narrowing them down from the initial 24 studies. A Meta-analysis was not performed. The studies included in this systematic review were not restricted to testing patients with pain refractory to other treatments.
Applicability	It is unknown if the subjects are representative of any particular population, other than having chronic neuropathic pain. The treatments may not be feasible in all dental settings as medicinal marijuana is highly controlled and legally prohibited in most states. This literature suggests marijuana would be beneficial for someone with chronic nonmalignant neuropathic pain.
Specialty	(Oral Medicine/Pathology/Radiology) (General Dentistry)
Keywords	Marijuana, Pain Management, Neuropathic Pain, Cannabinoids
ID#	3037
Date of submission	03/20/2016
E-mail	patelnc@livemail.uthscsa.edu
Author	Nikita Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Edward F. Wright, DDS, MS
Faculty mentor e-mail	WrightE2@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available