A new case study highlights the effects of medicinal cannabis in a chronic pain patient who feels she has been ‘given a second chance at life’ since starting the treatment.
A paper, published this month by researchers at Drug Science, documents the improvements in quality of life a chronic pain patient enrolled on the patient registry, T21 has experienced thanks to cannabis-based medicine.
The patient is a 61-year-old woman living with chronic neuropathic pain due to a diagnosis of idiopathic small fibre neuropathy, which among other symptoms, causes a persistent burning pain.
For almost two decades she had been prescribed the gabapentinoid pregabalin, along with numerous other pharmaceuticals to manage her symptoms. But while her pain was controlled she experienced side effects such as ‘hearing loss, sleepiness, tinnitus, confusion and worsening anxiety’.
After enrolling in the UK’s first cannabis patient registry in August 2021, the patient was prescribed full-plant extract THC 10 mg: CBD 15 mg/mL oil, increasing the dose slowly under the guidance of her clinician.
By the end of August the patient had been able to reduce her dose of pregabalin, which she then continued to decrease until January 2022, alongside a 0.3ml dose of cannabis oil twice daily.
According to the paper, after four months of treatment the patient said she felt she had been ‘given a second chance at life’, with her husband describing her as a ‘new woman’.
“I have had peripheral neuropathy for over 17 years and I have tried all sorts of medications and treatments, (traditional and alternative), too many to mention but include ketamine infusions and I even twice trialled a spinal cord stimulator. Nothing has come anywhere close to the pain relief I gain from the prescription cannabis that I have been taking whilst on the Twenty21 study,” the patient shares.
“I have struggled with side effects from medication and also bouts of depression in the early days of my diagnosis. My mood has always, understandably, been affected due to the constant pain but now I get very little break-through pain. I am able to do twice as much as was able to do – I am now much more active!”
A case for medicinal cannabis in chronic pain
While this is just one patient’s story, the authors argue that it makes a compelling case for the benefits of cannabis-based medicinal products to treat chronic pain, potentially as an alternative to conventional medicines including gabapentinoids and opioids.
Research shows around half of patients with neuropathic pain ‘only partially relieve their pain on recommended regimens’. Small fibre neuropathy is ‘particularly difficult to manage’ with the most effective drugs only reducing ‘magnitude of pain by 20% to 40%’.
“The prescription of CBMPs [cannabis-based medicinal products] provided a better solution for this patient than previously prescribed medications, relieving her pain symptoms, and contributing to other medication sparing, hence reducing the associated intolerable side effects,” the authors say.
“In turn, the patient could be afforded a better quality of life.”
Lead author of the paper, Professor Peter Sunderland, lecturer in pharmacy practice at the University of Bath, told Cannabis Health that he believes the patient may have had a ‘better outcome’ had cannabis been prescribed earlier.
“This case is clear cut in that all the evidence-based medicines had been tried, so there wasn’t really anywhere else to go,” he said.
“My gut feeling as a clinician is that if cannabis was prescribed at an early stage for this patient, she would have had a much better outcome earlier on, and not 17 plus years of suffering.
“As this is just one case it’s difficult to say too much about [the potential of CBMPs] other patients, but I wouldn’t hesitate in recommending that CBMPs were at least considered in chronic neuropathic pain patients, especially when conventional treatments have failed or caused unacceptable side effects.”
He added: “I think clinicians need to bear in mind that the evidence is on the way for cannabis, and in many cases the evidence-based options on offer for pain come with lots of problems – side effects, tolerance and addiction with opioids especially.”
Easing the burden on the NHS
The NHS currently spends billions on the treatment of chronic pain conditions. With the potential to reduce the number of medicines being prescribed, more widespread adoption of cannabis medicines could ease the financial burden on the healthcare system and cut down the time and resources spent on patients.
With the University of York, Drug Science is currently conducting a health economics analysis on the cost-effectiveness of prescribing cannabis medicines to treat chronic pain on the NHS. Professor Mike Barnes, chair of the Cannabis Industry Council, which is supporting the project, believes this could be done at a ‘net-zero’ cost.
“CBMPs are quite expensive compared to many generic drugs. I would expect this to change over time though,” Professor Sunderland said.
“I think the health benefits are greatest now and cost benefits may come in future if CBMPs are more widely adopted. Saying that, a lot of NHS time might have been saved if this patient was prescribed cannabis much earlier on.”
The value of real world evidence
While regulators continue to call for randomised control trials (RCTs) to evaluate the safety and efficacy of medicinal cannabis, this paper indicates the ‘value of real world evidence’ in assessing this too.
Head of research at Drug Science and co-author, Dr Anne Katrin Schlag, has previously called for the government and policymakers to consider real world data when establishing guidelines.
“Including the patient narrative, in addition to other scientific data, is always valuable,” she said.
“It matters what the treatment means for the patient and this can not always be adequately captured by quantitative data alone. For example, in our case, including the patient perspective helps us understand the improvement in quality of life she experienced.”
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