UK medical cannabis registry: A clinical outcome analysis of medical cannabis therapy in chronic pain patients with and without co-morbid sleep impairment

Ishita Datta; Simon Erridge; Carl Holvey; Ross Coomber; Rahul Guru; Wendy Holden; Alia Darweish Medniuk; Mohammed Sajad; Robert Searle; Azfer Usmani; Sanjay Varma; James J Rucker; Michael Platt; Mikael H Sodergren

doi:10.1111/papr.13438

UK medical cannabis registry: A clinical outcome analysis of medical cannabis therapy in chronic pain patients with and without co-morbid sleep impairment

Pain Pract. 2024 Nov 15. doi: 10.1111/papr.13438. Online ahead of print.

Authors

Ishita Datta¹, Simon Erridge^{1

2}, Carl Holvey², Ross Coomber^{2

3}, Rahul Guru^{2

4}, Wendy Holden², Alia Darweish Medniuk^{2

5}, Mohammed Sajad², Robert Searle², Azfer Usmani², Sanjay Varma², James J Rucker^{2

6

7}, Michael Platt², Mikael H Sodergren^{1

2}

Affiliations

¹ Department of Surgery and Cancer, Medical Cannabis Research Group, Imperial College London, London, UK.
² Curaleaf Clinic, London, UK.
³ St. George's Hospital NHS Trust, London, UK.
⁴ Cardiff and Vale University Health Board, Cardiff, UK.
⁵ Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
⁶ Department of Psychological Medicine, Kings College London, London, UK.
⁷ South London and Maudsley NHS Foundation Trust, London, UK.

PMID: 39545361
DOI: 10.1111/papr.13438

Abstract

Introduction: Chronic pain (CP) affects 35.0%-51.3% of the UK population, with 67%-88% reporting sleep disturbances. Cannabis-based medicinal products (CBMPs) have shown therapeutic potential in managing CP. Evidence suggests poor sleep worsens pain perception; therefore, this study aimed to assess patient-reported outcome measures (PROMs) following CBMP treatment in CP patients with and without co-morbid sleep impairment.

Methods: A prospective cohort study of CP patients from the UK Medical Cannabis Registry was conducted. Participants were separated by baseline single-item sleep quality scale (SQS) score into sleep impaired (SQS ≤3) and unimpaired (SQS ≥4) cohorts. The primary outcome assessed changes in PROMs from baseline to 1-, 3-, 6-, and 12-months. Participants completed the following: SQS, General Anxiety Disorder-7, EQ-5D-5L, Brief Pain Inventory (BPI), and Short-Form McGill Pain Questionnaire-2. Significance was defined as p < 0.050.

Results: 1139 participants met the inclusion criteria (sleep impaired: n = 517, 45.4%; sleep unimpaired: n = 622, 54.61%). The sleep impaired cohort showed improvements in all PROMs at each follow-up (p < 0.010). The sleep unimpaired cohort showed similar results (p < 0.050), except in SQS and ED-5Q-5L: self-care and anxiety/depression scores (p > 0.050). However, the sleep impaired cohort observed greater improvements in BPI pain severity (p < 0.050) and SQS (p < 0.001) than the sleep unimpaired cohort at all follow-ups. 2817 adverse events were self-reported between both cohorts (p = 0.197).

Discussion: These findings align with literature that shows associated improvements in pain outcomes following CBMP administration. Sleep impaired individuals were more likely to experience greater pain severity improvements. However, this was not confirmed on multivariate logistic regression analysis and instead may be confounded by baseline pain severity.

Conclusion: Whilst these results show promise for the effects of CBMPs on CP, they must be examined within the limitations of the study design. These findings provide further evidence to support the design of subsequent randomized controlled trials to verify causality between CBMPs and pain outcomes.

Keywords: CBD; THC; cannabinoids; chronic pain; medical cannabis; sleep impairment.