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People with lower back pain experienced significant pain relief and reduced their use of opioid painkillers, according to the results of recently published research.
The study, published this month by the European Spine Journal, was conducted by researchers with Tel Aviv University, Rabin Medical Center, and Clalit Health Services in Israel. The researchers recruited 1,000 patients with chronic lower back pain (CLBP), all of whom had never used cannabis. The researchers then monitored the participants annually over 10 years, recording their pain levels, use of medication, and disability status at an orthopedic pain clinic.
Study participants used medical cannabis products such as dried flower for vaporization or orally administered cannabis oils. Of the 1,000 participants enrolled in the study, 638 remained throughout the study period and completed the final evaluation.
After 10 years, participants’ opioid use, measured in morphine milligram equivalents, “decreased substantially” by 90%.
“Opioid reduction was rapid in the first year and remained stable through Year 10,” the researchers wrote, according to a report from Marijuana Moment.
Pain intensity decreased by 84%, while functional disability decreased by 30%.
Most Patients Met Goals For Reductions in Pain and Opioid Usage
The researchers also investigated how many study participants achieved significant pre-specified thresholds for the outcome metrics. Nine out of 10 patients (91%) met their target and reduced their use of opioids by at least 50%. More than half of the participants (62%) achieved a reduction in pain intensity scale values of at least 30%, meeting the goal for that metric. A similar percentage achieved the targeted decrease of 10 points or more in functional disability scores on a standardized scale.
“Medical cannabis therapy was associated with reductions in opioid use, pain intensity, and functional disability over 10 years, accompanied by polypharmacy reduction and acceptable tolerability,” the authors of the study wrote.
The researchers also observed a “substantial” reduction in the study participants’ use of non-opioid medications.
“Tramadol/tapentadol use decreased from 89.7% to 5.6% (−84.0% points), benzodiazepines from 78.8% to 5.3% (−73.5 pp), SSRIs from 77.7% to 5.8% (−71.9 pp), and gabapentinoids from 31.3% to 0.6% (−30.7 pp),” the study reads. “These reductions were clinically driven rather than protocol-mandated, reflecting individual physician-patient decisions based on symptom response. The pattern of polypharmacy reduction paralleled opioid reduction, occurring primarily in the first 2 years.”
The reduction in use of several different kinds of drugs suggests that “medical cannabis may address multiple symptom domains simultaneously,” the researchers wrote.
“Chronic pain patients frequently require polypharmacy to manage pain, sleep disturbance, anxiety, and depression, each of which carries risks of adverse effects and drug interactions,” they added.
The researchers warned that the nature of the study does not allow them to infer causality. They also noted that the magnitude of the reductions in the study’s outcome metrics “substantially exceeded” those observed in previously published randomized controlled trials, suggesting that “observational biases contribute to these findings.”
Even so, the researchers wrote that their study is the “longest follow-up of medical cannabis therapy specifically in CLBP patients and demonstrates sustained, clinically meaningful improvements exceeding pre-specified [minimal clinically important difference] thresholds for opioid reduction, pain relief, and functional disability.”
“In this 10-year single-arm observational study, medical cannabis therapy was associated with reductions in opioid use (−89.8%), pain intensity (−84.2%), and functional disability (−30.4%), with high proportions of patients achieving pre-specified MCID thresholds,” the study concluded. “Substantial polypharmacy reductions and acceptable tolerability were observed.”
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