Journal of Pain Research (Jul 2018)
Personal experience and attitudes of pain medicine specialists in Israel regarding the medical use of cannabis for chronic pain
Abstract
Haggai Sharon,1–4 Noam Goldway,2 Itay Goor-Aryeh,5 Elon Eisenberg,6,7 Silviu Brill1,8 1Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2Center for Brain Functions, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 3Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 4Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ Hospital, London, UK; 5Pain Center, Sheba Medical Center, Tel Hashomer, Israel; 6Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; 7Rappaport Faculty of Medicine, Technion Institute for Technology, Haifa, Israel; 8Goldman School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel Introduction: The scientific study of the role of cannabis in pain medicine still lags far behind the growing use driven by public approval. Accumulated clinical experience is therefore an important source of knowledge. However, no study to date has targeted physicians who actually use cannabis in their daily practice. Methods: Registered, active, board-certified pain specialists in Israel (n=79) were asked to complete a Web-based survey. The survey was developed using the Qualtrics Online Survey Software. Questions were formulated as multiple-choice questions, and these addressed three areas of interest: 1) doctors’ personal experience; 2) the role of cannabis in pain medicine; and 3) cannabis medicalization and legalization. Results: Sixty-four percent of all practicing pain specialists in Israel responded. Almost all prescribe cannabis. Among them, 63% find cannabis moderately to highly effective, 56% have encountered mild or no side effects, and only 5% perceive it as significantly harmful. Common indications are neuropathic pain (65%), oncological pain (50%), arthralgias (25%), and any intractable pain (29%). Leading contraindications are schizophrenia (76%), pregnancy/breastfeeding (65%), and age <18 years (59%). Only 12% rated cannabis as more hazardous than opiates. On a personal note, 45% prefer cannabis for themselves or a family member. Lastly, 54% would like to see cannabis legalized in Israel. Conclusion: In this survey, pain clinicians experienced in prescribing cannabis over prolonged periods view it as an effective and relatively safe treatment for chronic pain, based on their own experience. Their responses suggest a possible change of paradigm from using cannabis as the last resort. Keywords: cannabis, pain, survey
