Inhaled Cannabis for Chronic Neuropathic Pain

A Meta-analysis of Individual Patient Data

Michael H. Andreae, George M. Carter, Naum Shaparin, Kathryn Suslov, Ronald J. Ellis, Mark A. Ware, Donald I. Abrams, Hannah Prasad, Barth Wilsey, Debbie Indyk, Matthew Johnson, Henry S. Sacks

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Chronic neuropathic pain, the most frequent condition affecting the peripheral nervous system, remains underdiagnosed and difficult to treat. Inhaled cannabis may alleviate chronic neuropathic pain. Our objective was to synthesize the evidence on the use of inhaled cannabis for chronic neuropathic pain. We performed a systematic review and a meta-analysis of individual patient data. We registered our protocol with PROSPERO CRD42011001182. We searched in Cochrane Central, PubMed, EMBASE, and AMED. We considered all randomized controlled trials investigating chronic painful neuropathy and comparing inhaled cannabis with placebo. We pooled treatment effects following a hierarchical random-effects Bayesian responder model for the population-averaged subject-specific effect. Our evidence synthesis of individual patient data from 178 participants with 405 observed responses in 5 randomized controlled trials following patients for days to weeks provides evidence that inhaled cannabis results in short-term reductions in chronic neuropathic pain for 1 in every 5 to 6 patients treated (number needed to treat = 5.6 with a Bayesian 95% credible interval ranging between 3.4 and 14). Our inferences were insensitive to model assumptions, priors, and parameter choices. We caution that the small number of studies and participants, the short follow-up, shortcomings in allocation concealment, and considerable attrition limit the conclusions that can be drawn from the review. The Bayes factor is 332, corresponding to a posterior probability of effect of 99.7%. Perspective: This novel Bayesian meta-analysis of individual patient data from 5 randomized trials suggests that inhaled cannabis may provide short-term relief for 1 in 5 to 6 patients with neuropathic pain. Pragmatic trials are need to evaluate the long-term benefits and risks of this treatment.

Original languageEnglish (US)
JournalJournal of Pain
DOIs
StateAccepted/In press - Feb 24 2015

Fingerprint

Neuralgia
Cannabis
Chronic Pain
Meta-Analysis
Randomized Controlled Trials
Pragmatic Clinical Trials
Numbers Needed To Treat
Bayes Theorem
Peripheral Nervous System
PubMed
Placebos
Therapeutics
Population

Keywords

  • Bayesian analysis
  • Cannabis
  • Chronic pain
  • Human immunodeficiency virus
  • Meta-analysis
  • Meta-analysis of individual patient data
  • Neuropathy
  • Painful
  • Polyneuropathy

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology

Cite this

Andreae, M. H., Carter, G. M., Shaparin, N., Suslov, K., Ellis, R. J., Ware, M. A., ... Sacks, H. S. (Accepted/In press). Inhaled Cannabis for Chronic Neuropathic Pain: A Meta-analysis of Individual Patient Data. Journal of Pain. https://doi.org/10.1016/j.jpain.2015.07.009

Inhaled Cannabis for Chronic Neuropathic Pain : A Meta-analysis of Individual Patient Data. / Andreae, Michael H.; Carter, George M.; Shaparin, Naum; Suslov, Kathryn; Ellis, Ronald J.; Ware, Mark A.; Abrams, Donald I.; Prasad, Hannah; Wilsey, Barth; Indyk, Debbie; Johnson, Matthew; Sacks, Henry S.

In: Journal of Pain, 24.02.2015.

Research output: Contribution to journalArticle

Andreae, MH, Carter, GM, Shaparin, N, Suslov, K, Ellis, RJ, Ware, MA, Abrams, DI, Prasad, H, Wilsey, B, Indyk, D, Johnson, M & Sacks, HS 2015, 'Inhaled Cannabis for Chronic Neuropathic Pain: A Meta-analysis of Individual Patient Data', Journal of Pain. https://doi.org/10.1016/j.jpain.2015.07.009
Andreae, Michael H. ; Carter, George M. ; Shaparin, Naum ; Suslov, Kathryn ; Ellis, Ronald J. ; Ware, Mark A. ; Abrams, Donald I. ; Prasad, Hannah ; Wilsey, Barth ; Indyk, Debbie ; Johnson, Matthew ; Sacks, Henry S. / Inhaled Cannabis for Chronic Neuropathic Pain : A Meta-analysis of Individual Patient Data. In: Journal of Pain. 2015.
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