Short-Term Cannabis Use May Help Patients With Chronic Pain Maintain Sleep

Medical cannabis use may help patients with chronic pain maintain sleep throughout the night, according to a new study. However, the findings, which were published in BMJ Supportive & Palliative Care, also indicated that tolerance toward these sleep-inducing properties may build over time.

Patients are increasingly using medical cannabis to relieve chronic pain symptoms. Individuals with chronic pain can also often experience comorbid insomnia, which can have a detrimental effect on their wellbeing. Recently, more patients are turning to cannabis to help manage their comorbid insomnia, despite lack of quality evidence supporting its positive effect.

The study, which is among the first to test the link between whole-plant medical cannabis and sleep quality, suggests that older patients with chronic pain may experience an initial benefit from medical cannabis in terms of sleep maintenance.

For the study, a total of 128 individuals with chronic pain over the age of 50 years old were recruited. Of these individuals, 66 were medical cannabis users and 62 were non-users. Medical cannabis use measures (dose, length and frequency of use, number of strains used, tetrahydrocannabinol/cannabidiol levels) and sleep problems were assessed.

Of the total sample of 129 participants, 24.1% reported always waking up early and not falling back asleep, 20.2% reported always having difficulties falling asleep, and 27.2% reported always waking up during the night. According to the findings, patients who used medical cannabis were less likely to wake up at night, whereas there were no differences between the 2 other groups in the other sleep measures.

“This suggests that [medical cannabis] may have a sleep-promoting characteristic in terms of minimizing awakenings during the night, but not in terms of other types of sleep problems,” the authors wrote.

Nighttime awakenings are the most commonly reported sleep problem in this patient population. Medications such as benzodiazepines, barbiturates, and non-benzodiazepine hypnotic drugs are often prescribed for sleep disorder, but all of these carry the risk of serious adverse effects. Medical cannabis may serve as a potential sleep aid with less adverse effects for these patients.

However, in terms of use patterns, more frequent use of medical cannabis was associated with problems staying asleep during the night and more problems falling asleep, according to the study. The authors noted that this may point to the development of tolerance in frequent users. Additionally, patients who use medical cannabis more frequently may also suffer from more pain and comorbidities, which in turn may disrupt sleep.

According to the authors, more research is needed in order to better understand the potential acute and long-term effects of different strains/doses and modes of administration on different sleep parameters. 

References:

• Sznitman SR, Vulfsons S, Meiri D, et al. Medical cannabis and insomnia in older adults with chronic pain: a cross-sectional study. BMJ Supportive & Palliative Care. 2020. doi: 10.1136/bmjspcare-2019-001938