The European Pain Federation EFIC produces its own position papers on the topics of relevance to our work, our community and the education and managment of pain. For futher information.
Cannabis‐based medicines and medical cannabis for chronic pain management
European Pain Federation (EFIC) position paper on appropriate use of cannabis‐based medicines and medical cannabis for chronic pain management
Cannabis‐based medicines are being approved for pain management in an increasing number of European countries. There are uncertainties and controversies on the role and appropriate use of cannabis‐based medicines for the management of chronic pain. EFIC convened a European group of experts, drawn from a diverse range of basic science and relevant clinical disciplines, to prepare a position paper to empower and inform specialist and nonspecialist prescribers on appropriate use of cannabis‐based medicines for chronic pain. The expert panel reviewed the available literature and harnessed the clinical experience to produce these series of recommendations. Therapy with cannabis‐based medicines should only be considered by experienced clinicians as part of a multidisciplinary treatment and preferably as adjunctive medication if guideline‐recommended first‐ and second‐line therapies have not provided sufficient efficacy or tolerability. The quantity and quality of evidence are such that cannabis‐based medicines may be reasonably considered for chronic neuropathic pain. For all other chronic pain conditions (cancer, non‐neuropathic noncancer pain), the use of cannabis‐based medicines should be regarded as an individual therapeutic trial. Realistic goals of therapy have to be defined. All patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to reach the predefined goals and/or the patient is additionally burdened by an unacceptable level of adverse effects and/or there are signs of abuse and misuse of the drug by the patient, therapy with cannabis‐based medicines should be terminated.
Use of opioids for pain management
While opioid prescription and use for pain management is a major concern in some parts of the world, the context of opioid use clearly differs between countries. Many countries in Europe have in place significant barriers to optimal pain management due to inappropriate restrictions on supply and use. Opioids are an important part of a modern approach to pain management and palliative care, and misplaced barriers to access can lead to unnecessary suffering.
Opioids are not a panacea for all types of pain, and must only be used in selected and supervised pain patients as part of a comprehensive, multi-modal, multi-disciplinary approach to treatment. In this context alone, opioid therapy is an essential and indispensable tool in achieving and maintaining an optimal level of pain control in selected patients.
The European Pain Federation calls for continuous medical education on the correct use of opioids in multi-professional and multi-modal therapeutic approaches. We also call for enhancing access to comprehensive pain assessment clinics and therapies and increasing funds for robust research on pain management.
Please find the full European Pain Federation position paper on appropriate opioid use in chronic pain management here.