Survey on current treatments for pain after spinal cord damage

Analyzing the Impact of Cannabinoids on the Treatment of Spinal Disorders

PURPOSE OF REVIEW

Cannabis is among the most used illicit substances globally, with medical applications, increased legalization, and shifting social attitudes leading to increased use in recent years. Cannabinoids are a group of psychoactive substances found within the cannabis plant, with the most common being Δ9-tetrahydrocannabinol and cannabidiol. Due to the high prevalence of use, it is increasingly important to evaluate the effects of cannabis and cannabinoids on spine patients, in both operative and nonoperative settings.

RECENT FINDINGS

Cannabis and cannabinoids may be effective in treating patients with chronic conditions such as back pain and spinal cord injuries. Longitudinal effects and implications on surgical outcomes and complications are poorly understood. High-quality, outcomes-focused research can inform approaches for clinicians to approach cannabis and cannabinoid use. Studies to elucidate the standardization of cannabis regimens can help develop guidelines for potential therapeutic applications. Cannabis and cannabinoids may be useful alternatives or additions for many spine patients, but future research is needed for recommendations to be determined. Our manuscript reviews the available literature regarding cannabis use and various spinal conditions, organizing our findings into the following narrative themes: (1) the management of chronic lower back pain, (2) perioperative outcomes, (3) cannabis use in general orthopaedic procedures, and (4) spinal cord injuries.

Opioid Use Among Individuals With Spinal Cord Injury: Prevalence Estimates Based on State Prescription Drug Monitoring Program Data

OBJECTIVE

To identify the prevalence of opioid use in individuals with chronic spinal cord injury (SCI) living in South Carolina.

DESIGN

Cohort study.

SETTING

Data from 2 statewide population-based databases, an SCI Registry and the state prescription drug monitoring program, were linked and analyzed.

PARTICIPANTS

The study included individuals (N=503) with chronic (>1y) SCI who were injured between 2013 and 2014 in South Carolina and who survived at least 3 years postinjury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Filled opioid prescriptions over a 2-year period (months 13-36 after injury). The main outcomes were total number of days with an opioid prescription over the 2-year period, length of coverage period [(final day of prescription coverage+the days supplied)-first day of prescription coverage], average daily morphine milligram equivalents (MME) over the coverage period, and concurrent days covered by an opioid and a prescription for benzodiazepines, sedatives, or hypnotics.

RESULTS

A total of 53.5% of the cohort (269 individuals) filled at least 1 opioid prescription during their second or third year after SCI. In total, there were 3386 opioid fills during the 2-year study. On average, the total number of opioid prescription days was 293±367. The average coverage period was 389±290 days, and the average daily MME during the coverage period was 41±70 MME. Of those who filled an opioid prescription, 23% had high-risk fills (>50 MME), and 38% had concurrent prescriptions for benzodiazepines, sedatives, or hypnotics.

CONCLUSIONS

The prevalence of opioid use was high among individuals with chronic SCI, exceeding rates observed in the general population. Also concerning were the rates of high-risk fills, based on average daily MME and concurrent benzodiazepine, sedative, or hypnotic prescriptions. These findings, taken together with those of earlier studies, should be used by providers to assess and monitor opioid use, decrease concurrent high-risk medication use, and attenuate the risk of adverse outcomes.

Using cannabis for pain management after spinal cord injury: a qualitative study

Study design

A descriptive qualitative study.

Objectives

To explore why individuals with spinal cord injury (SCI) choose to use cannabis to manage their pain and their experiences in doing so.

Setting

Community-dwelling adults with SCI in New Zealand.

Methods

Semi-structured interviews were conducted with individuals who had a SCI, experienced pain, and self-reported use of cannabis to manage their pain. Interviews were recorded, transcribed, and subject to thematic analysis.

Results

Eight individuals participated in this study. We interpreted six themes that captured the participants' perspectives regarding their choice to, and perceptions of, using cannabis to manage SCI pain. Participants were motivated to use cannabis when other pain management strategies had been ineffective and were well-informed, knowledgeable cannabis consumers. Participants reported cannabis reduced their pain quickly and enabled them to engage in activities of daily living and participate in life roles without the drowsiness of traditional prescribed pain medication. Despite the positive aspects, participants were concerned about the irregularity of supply and inconsistent dosage.

Conclusions

Findings show that cannabis is used to reduce pain after SCI and enable increased community participation. Findings suggest that future studies examining the efficacy of cannabinoids in managing pain include function and participation outcome measures rather than solely focusing on measuring pain intensity. Focusing on meaningful outcomes may contribute to a greater understanding of the experiences of people with SCI.