Perceptions and Preoccupations of Patients and Physicians Regarding Use of Medical Cannabis as an Intervention Against Chronic Musculoskeletal Pain: Results from a Qualitative Study

Abstract

Lise Poisblaud,1,2 Edeltraut Kröger,1– 3 Nathalie Jauvin,4 Julie Pelletier-Jacob,1 Richard E Bélanger,2,5 Guillaume Foldes-Busque,5,6 Michèle Aubin,1,2,5 Pierre Pluye7 ,† Laurence Guillaumie,8 Malek Amiri,8 Pierre Dagenais,9 Clermont E Dionne1,2,5 1Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada; 2Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada; 3Faculty of Pharmacy, Université Laval, Québec, Quebec, Canada; 4Institut national de santé publique du Québec, Québec, Quebec, Canada; 5School of Psychology, Université Laval, Québec, Quebec, Canada; 6Research Centre, Centre Intégré de Santé et de Services Sociaux (CISSS) de Chaudière-Appalaches, Lévis, Quebec, Canada; 7Faculty of Medicine, McGill University, Montréal, Quebec, Canada; 8Faculty of Nursing, Université Laval, Québec, Quebec, Canada; 9Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada†Dr. Pierre Pluye passed away on August 1st 2023Correspondence: Edeltraut Kröger, BPharm, Hôpital du Saint-Sacrement, 1050 Chemin Ste-Foy, Room L2-30, Québec, Quebec, Canada, G1S 4L8, Tel [phone] extension 84834, Fax [phone], Email [email protected]: Explore perceptions and preoccupations regarding use of medical cannabis against chronic musculoskeletal pain, among patients and physicians.Design: Qualitative study using interviews with patients and physicians, based on the Theory of Planned Behavior (TPB).Setting: The study was conducted in Quebec, Canada, in spring 2020.Subjects: We included 27 adult patients and 11 physicians (GPs, anesthesiologists, psychiatrists, and a rheumatologist); the mean age of patients was 48.2 years; 59.3% of patients and 36.4% of physicians were women; 59.3% of patients used no medical cannabis at the time of study; 45.5% of physicians had never authorized it.Methods: Semi-structured interviews were conducted, transcribed and for the qualitative analysis codes were developed in a hybrid, inductive and deductive approach. Guided by the TPB, facilitators and barriers, perceived benefits and harms, and perceived norms that may influence cannabis use or authorization were documented.Results: Although medical cannabis is an interesting avenue for the relief of chronic musculoskeletal pain, doctors and patients agreed that it remained a last line option, due to the lack of scientific evidence regarding its safety and efficacy. The norms surrounding medical cannabis also play an important role in the social and professional acceptance of this therapeutic option.Conclusion: Medical cannabis is seen as a last line option among interventions in the management of chronic pain, and attitudes and prior experiences play a role in the decision to use it. Study results may contribute to improved shared decision making between patients and physicians regarding this option.Plain Language Summary: Little is known about the motivations, perceptions, and preoccupations of patients with chronic pain and their physicians regarding the use of medical cannabis against chronic pain. A qualitative study was done on the attitudes and perceptions of these patients and their physicians. We performed semi-structured interviews, guided by the Theory of Planned Behavior, with chronic pain patients and with physicians treating such patients. Results indicate that both patients and physicians consider medical cannabis as a last line therapeutic option against chronic pain. Also, both groups expressed a need for stronger evidence on the effectiveness and safety of medical cannabis, as well as for more and clearer guidance on when and how to use this additional option in the treatment of chronic pain.Keywords: medical cannabis, theory of planned behavior, chronic musculoskeletal pain, qualitative study, lack of knowledge, stigma

Keywords

• medical cannabis
• theory of planned behavior
• chronic musculoskeletal pain
• qualitative study
• lack of knowledge
• stigma