Table 4.
Reported benefits of cannabinoid use from observational studies.
| Author, Year | Study Type | Legalization (Location) | Number of Participants (SCI/Total) | Inclusion Criteria | Exclusion Criteria | Male/Female/ Transgender | Mean Age | Reported Pain Relief | Reported Spasticity Relief | Other Benefits | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dunn & Davis, 1974 [63] | Cross-sectional | Illegal (Florida, USA) |
10/10 | SCI patients using cannabis | - | 10/0/0 | NR | Relief: 50% (headache), 40% (phantom); Pain distraction (phantom): 20% |
Relief: 50% | Pleasant sensations: 50% | ||||||||
| Malec et al., 1982 [64] | Cross-sectional | Illegal (Wisconsin, USA) |
43/43 | SCI patients | - | 38/5/0 | NR | NR | Relief: 88% (Complete relief 38%, reduction to mild 46%, severe to moderate 4%) | NR | ||||||||
| Warms et al., 2002 [68] | Cross-sectional | MC legal starting Nov 1998, study V1 Feb 1997 – Jul 1998, V2 Aug 1998 – June 2000 (Washington, USA) | 471/471 | 18+ age, 6+ mo since SCI | - | 334/137/0 | 42.5 ± 13.2 (18-84) |
Pain helpfulness: 4.25 ± 0.76 (max 5); Most effective pain treatment |
NR | Pain relief greater than opioids, mexiletine, baclofen, acetaminophen, TCAs, NSAIDs, gabapentin, carbamazepine, etc | ||||||||
| Grotenhermen & Schnellea, 2003 [51] | Cross-sectional | Dronabinol prescription and ∆9-THC special permit (Germany) and permit (Switzerland) | 4/165 | Members of Association for Cannabis as Medicine | No severe disease | 101/64/0 | Median age: 40.3 ± 12.4 (16-87) | NR | NR | Large disease improvement: 75%, small improvement: 13%, no improvement: 2%, unknown: 7%, no answer: 3%; Large improvement over other drugs: 69%, small improvement: 7%, no improvement: 3%, unknown: 18%, no answer: 4% |
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| Gortera, 2005 [52] | Cross-sectional | MC legal (Netherlands) | ?/107 | Members of Multiple Sclerosis society | - | 48/59/0 | Median age: 58.0 | NR | NR | Efficacy: excellent 18%, good 47%, somewhat 18%, none 18%; Statistical significance in greater efficacy with inhalation vs. oral |
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| Cardenas & Jensen, 2006 [53] | Cross-sectional | MC legal (Washington, USA) | 117/117 | 18+ age, tSCI, chronic pain | Incomplete questionnaires | 85/32/0 | 48.8 ± 11.7 (21-79) | Relief: 6.62 ± 2.54 (max 10) Benefit duration: 9%: min, 80%: hr, 3%: days, 3%: mo, 6%: y. Most effective pain treatment |
NR | Pain relief greater than opioids, mexiletine, baclofen, acetaminophen, TCAs, NSAIDs, gabapentin, carbamazepine, etc | ||||||||
| Mahoney et al., 2007 [69] | Interview | Illegal (Texas, USA) |
24/24 | 1+ y since SCI, spasticity, English language | - | 17/7/0 | 45.1 (21-68) | NR | Prevents, modulates and stops spasms | NR | ||||||||
| Author, Year | Study Type | Legalization (Location) | Number of Participants (SCI/Total) | Inclusion Criteria | Exclusion Criteria |
Male/ Female/ Transgender |
Mean Age | Reported Pain Relief | Reported Spasticity Relief | Other Benefits | ||||||||
| Aggarwal et al.a, 2009 [46] | Retrospective chart review | MC legal (Washington, USA) | 5/139 | 18+ age, pain clinic patients, access to MC with valid doctor documentation | Cannabinoid receptor 1 blocker drug rimonabant | 88/51/0 | Median age: 48 (18-84) | Chronic pain relief; often described as the most effective pain treatment |
NR | Preferred for less side effects; adjunctive use with opioids reduced opioid dosages and 6% used to reduce opioid dependence | ||||||||
| Heutink et al., 2011 [70] |
Cross-sectional | MC legal starting 2003, study 1990-2005 (the Netherlands) | 279/279 | 18+ age, SCI rehab patients, living in community | - | 173/106/0 | 51.3 ± 14.0 (25-81) | (Alcohol and cannabis pooled) Largely effective 83%, somewhat effective 17%, not effective 0% |
NR | NR | ||||||||
| Shroff, 2015 [54] | Interview | MC legal (Canada) | 53/53 | 19-65 age, 1+ years since SCI, BC resident, member of paraplegic association | - | 42/11/0 | NR | NR | NR | Preferred for less side effects | ||||||||
| Andresen et al., 2017 [44] | Cross-sectional | MC legal starting 2011, study 1990-2012 (Denmark) | 537/537 | Inclusion: 18+ age, acquired tSCI, rehab clinic patients | Incomplete questionnaires | 413/124/0 | 54.6 ± 14.6 (18-88) | Relief: good 35%, very good 24% | Relief: good 32%, very good 27% | NR | ||||||||
| Bruce et ala., 2018 [50] |
Interview | MC legal (Illinois, USA) | 6/30 | 18+ age, smoked MC in past 3 mo, qualifying health condition for MC | - | 19/11/0 | 44.6 ± 15.9 | NR | NR | Preferred over other pain treatments for quick action, long effects, symptom relief, less side effects; adjunctive use with opioids reduced opioid dose and dependence | ||||||||
| Bourke et al., 2019 [72] |
Interview | Illegal (New Zealand) | 8/8 | 18+ age, SCI patients using cannabis for pain, residing in New Zealand, English speaking, |
Comorbid conditions inhibiting communication and participation in the interview | 6/2/0 | Age 20-39: n = 1, 40-59: n= 5, 60+: n=2 | Pain relief improving function, community participation and decreased disability | NR | Preferred for relatively lower fatigue and drowsiness as of prescribed medications Sleep improvement Quality of life improvement |
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| Stillman et al., 2019 [75] |
Cross-sectional | 39 states in USA, not disclosed; mixed legality | 353/353 | SCI patients included in mailing lists maintained by Thomas Jefferson University, University of Washington at Seattle, and University of Alabama at Birmingham | - | 183/107/3 | 52.74 (19-82) | NR | NR | Muscle relaxation: 90% Sleep promotion: 84% Well-being: 75% Anxiety relief: 70% Appetite promotion: 53% All prevalence of positive effects from cannabis were rated higher than prescription medications Cannabis use: lower prevalence of dehydration, memory loss, lethargy, drowsiness, constipation |
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Abbreviations: BC: British Columbia; d: days; hr: hours; MC: medical cannabis; min: minutes; mo: months; NR: not reported; NSAIDs: nonsteroidal anti-inflammatory drugs; SCI: spinal cord injury; TCAs: tricyclic antidepressants; ∆9-THC: delta-9-tetracannabidiol; tSCI: traumatic spinal cord injury; y: years. adata listed not limited to people with SCI.