FIGURE 1.

Consultation steps and oral cannabinoid therapy algorithm

1. Pain intensity, quality of sleep, and quality of life measured by use of the numeric rating scale (NRS) ranging from 0 to 10.

2. Different pain characteristics and related symptoms are included when selecting a CBM regimen: THC‐dominant (neuropathic pain, nausea/vomiting, and insomnia), CBD‐dominant (inflammatory pain, anxiety, and muscle spasms), and THC+CBD balanced (neuropathic pain‐related, centralized pain, and insomnia)

3. THC (tetrahydrocannabinol); CBD (cannabidiol).

4. CBM therapy has a wide therapeutic range of dosing and is highly individual from patient to patient. Dosing follows the principles of “start low‐go slow” and patients‐determined self‐titrating. The following dosing criteria are applied in administration of cannabis‐based medicine as oil or capsule: THC‐dominant (1‐2.5 mg once a day and increase every third day with 1‐2.5 mg until effect, and up till 25 mg/day in 3 doses), CBDdominant (10 mg once a day and increase every third day with 10 mg up to 50 mg/day in 3 doses. For anti‐inflammatory effect up to 5 mg/kg/day), and THC+CBD balanced (same criteria as for THC‐dominant regimen).

5. Therapy evaluation and decision is based upon patient‐reported effect and adverse events, e.g. discontinuation, switch, or increasing dosing of current CBM regimen in case of inadequate pain‐relieving effect OR discontinuation, switch, pausing, or decreasing dosing of current CBM regimen in case of intolerable adverse effects.