Evidence map›Paper›PMID 34215346›Full record

ArticleJournal of cannabis research2021

Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process.

Arun Bhaskar, Alan Bell, Michael Boivin, Wellington Briques, Matthew Brown, Hance Clarke, Claude Cyr, Elon Eisenberg, Ricardo Ferreira de Oliveira Silva, Eva Frohlich and 13 more

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of cannabis research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07783295 (Evaluation of Bone Turnover Biomarkers, CB2 and TRPV1 Polymorphisms as Potential Preventive Data in Osteoporosis and Perception of Improvement in Quality of Life in Women With Chronic Pain Treated With Medicinal Cannabis), which is not on this map. Cited by 79 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
79citing papers in PubMed, 4 pooled it
17.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07783295 phase2not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Evaluation of Bone Turnover Biomarkers, CB2 and TRPV1 Polymorphisms as Potential Preventive Data in Osteoporosis and Perception of Improvement in Quality of Life in Women With Chronic Pain Treated With Medicinal Cannabis

TypeinterventionalSponsorAssociação Pan-Americana Multidisciplinar de EndocanabinologiaRan2026 to 2027Enrolled80ConditionsChronic Pain, Fibromyalgia, Osteoporosis, Orofacial PainArmsFull-Spectrum Cannabis Extract 5:1 (CBD:THC)
3 · Its place in the literature

Who cites it

79 citing papers in PubMed, 4 syntheses or guidelines pooled it, 155 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Trial
  6. Trial
  7. Trial
  8. Trial
  9. Ten-year outcomes of medical cannabis for chronic low back pain: opioid reduction, pain relief, and functional improvement in 1,000 patients.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
    Article
  10. Review
  11. Article
  12. Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article

19 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors at 16 institutions in 7 countries.

Arun BhaskarPain Management Centre, Imperial College Healthcare NHS Trust, London, UK.
Alan BellDepartment of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Michael BoivinCommPharm Consulting, Barrie, ON, Canada.
Wellington BriquesCanopy Growth Corporation, São Paulo, Brazil.
Matthew BrownDepartment of Pain Medicine, The Royal Marsden Hospital, London, UK.
Hance ClarkeDepartment of Anesthesia and Pain Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Claude CyrDepartment of Family Medicine, McGill University, Montreal, QC, Canada.
Elon EisenbergInstitute of Pain Medicine, Rambam Health Care Campus, The Technion, Israel Institute of Technology, Haifa, Israel.
Ricardo Ferreira de Oliveira SilvaVertebralis Spine Center, Rio de Janeiro, Brazil.
Eva FrohlichDepartment of Anaesthesiology and Pain Management, Helen Joseph Hospital, Johannesburg, South Africa.
Peter GeorgiusPain Rehab, Noosa Heads, Australia.
Malcolm HoggDepartment of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia.
Tina Ingrid HorstedClinic Horsted, Copenhagen, Denmark.
Caroline A MacCallumFaculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
Kirsten R Müller-VahlHannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany.
Colleen O'ConnellDepartment of Physical Medicine and Rehabilitation, Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada.
Robert SealeyCannabinoid Medicine Specialist, Victoria, BC, Canada.
Marc SeiboltAlgesiologikum- Centers for Pain Medicine, Day Clinic for Pain Medicine, Munich, Germany.
Aaron SihotaThe University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada.
Brennan K SmithCTC Communications, Medical Division, Mississauga, ON, Canada.
Dustin SulakIntegr8 Health, Falmouth, Maine, USA.
Antonio ViganoDepartment of Oncology, McGill University, Montreal, QC, Canada.
Dwight E MoulinDepartments of Clinical Neurological Sciences and Oncology, Earl Russell Chair of Pain Medicine, Western University, 800 Commissioners Road East, London, ON, N6A 5W9, Canada. Dwight.Moulin@lhsc.on.ca.
McGill University · CAUniversity of British Columbia · CABarrie Urology Group · CACommunications Research Centre Canada · CAFalmouth Hospital · USHelen Joseph Hospital · ZAImperial College Healthcare NHS Trust · GBInstitute of Cancer Research · GBMedizinische Hochschule Hannover · DENoosa Hospital · AUStan Cassidy Foundation · CATechnion – Israel Institute of Technology · ILThe University of Melbourne · AUUniversity Health Network · CAUniversity of Toronto · CAWestern University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGlobally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed.

methodsUsing a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain.

resultsThere was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day.

conclusionsIn summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.

Indexed as

CannabidiolCBDChronic painDelphi processMedical cannabisTetrahydrocannabinolTHC

Identifiers

PMID34215346
PMCPMC8252988
OpenAlexW3174330972

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.