By Paul Kleutghen | Posted - Jan 30th, 2020





Don't Shoot the Messenger: Pain and Cannabis in Multiple Myeloma

Cannabis. That’s the topic for today. There are plenty of posts on a variety of cancer blogs, not just multiple myeloma, touting cannabis for this or that solution to a problem or side effect from cancer and/or cancer treatment. It seems that most of those deal with cancer pain, though nausea is also high on the list. Medicinal use of cannabis is currently legal in 29 states in the US and more are expected to follow suit in the future.

The most recent issue of the British Medical Journal – Supportive & Palliative Care presents an extensive study of the efficacy of the use of cannabis to treat cancer related pain in adults.

“The systemic review included six randomized controlled trials that involved 1,460 adults and the meta-analysis included five studies of 1,442 adults that assessed use of cannabinoids compared with placebo and other active agents for the treatment of cancer-associated pain. The studies all had a low risk for bias.”

“Pain” was measured on a numerical scale. I am quite certain that most of us are familiar with such scales from our periodic visits with our medical teams, where we routinely circle numbers of our pain scores, or color in ‘thermometers’ with our pain score or circle emoji’s going from smiley faces to total distress. Marking down our ‘pain score’ is technically subjective, in the sense that it reflects our personal sentiment at that moment. Aggregating those scores over nearly 1,500 patients, however, gives us a good measure of comparison of the pain management efficacy between two different regimens (one based on cannabis and the other non-cannabis).

The conclusions of this encompassing review of these half dozen well-controlled studies is this :

  • “There was no difference between cannabinoids and placebo for the difference in the change in average Numeric Rating Scale pain scores; this remained when only phase III studies were meta-analysed.
  • Cannabinoids had a higher risk of adverse events when compared with placebo, especially somnolence [trouble falling asleep] and dizziness.
  • No treatment-related deaths were reported.”


The authors indicate, however, that, “The analysis may not have included all relevant studies, and inconsistencies existed among the studies in terms of the patients included, interventions, comparators and outcomes.” That having been said, the lead author was also quoted:

‘Our systematic review brought together randomized studies assessing the effects of cannabinoids vs. placebo [and other active agents] on pain in patients with cancer. Based on the pooled findings from these high-quality studies, cannabinoids do not have a role in cancer-associated pain.’ [emphasis added]

So, this is some scientific level of guidance with respect to cancer associated pain. I cannot comment on the use of cannabinoids in potentially providing relief with other issues (e.g., nausea). I do wish to add that, for those of us who are preparing for stem cell transplant, smoking and the use of “recreational drugs”, will most likely cause a delay in your life-lengthening treatment. Ergo, you may wish to think twice before continuing either or both.

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Paul Kleutghen
About the Author

Paul Kleutghen - I am a patient diagnosed in 2014 with primary plasma cell leukemia (pPCL), a rare and aggressive variant of multiple myeloma and have been very fortunate to find treatment at the division of Cellular Therapy at the Duke University Cancer Institute. My wife, Vicki, and I have two adult children and a grandson who is the ‘light of my life’. Successful treatment has allowed Vicki and I to do what we love best : traveling the world, albeit it with some extra precautions to keep infections away. My career in the pharmaceutical industry has given me insights that I am currently putting to use as an advocate to lower drug pricing, especially prices for anti-cancer drugs and, very specifically, CAR-T therapies, with recent contributions posted by Health affairs, the Institute for Clinical and Economic Review and the Centers for Medicare and Medicaid Services.


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