A 52-year-old man with chronic low back pain and hypertension (controlled) comes to see you for his annual physical. Approximately 15 years ago he underwent spinal fusion after a bulging disc at L4-L5 was found on an MRI. The surgery provided him a bit of relief for a few months but his back pain soon returned to the presurgery level. He has used various analgesic medications including acetaminophen and NSAIDs over the years and at best these have offered him some mild relief. Several years ago another physician prescribed hydrocodone/acetaminophen (Vicodin) and then oxycodone/acetaminophen (Percocet) but the patient reports that while they each offered him a bit more relief than the other medications, he found these too sedating.
He has heard about medical marijuana and lives in a state where it has been approved for the management of chronic pain. His only experience with marijuana was smoking it while in college more than 30 years ago. He is willing to try it if it would help his pain but he’d like to know whether you think there is a likelihood that it would be beneficial for his low back pain.
1. You tell him that, based on currently available medical evidence:
A. There is a very good chance that marijuana would be beneficial for his pain.
B. There is limited evidence that marijuana would be beneficial for his pain.
C. You refuse to discuss the use of marijuana as it is still against Federal law.
D. Although marijuana may be beneficial for chronic pain, the evidence is far stronger supporting its use for other medical conditions.
Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313:2456-2473.
Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA. 2015;313:2474-2483.