Background & Aims

As of 2020, the most common reason for medical cannabis licensure in the US was chronic pain.1 Chronic pain is especially common among Veterans and significantly affects quality of life.2 Due to limited efficacy and aversive side effects of many pain medications, such as opioids, some Veterans use medical cannabis—often without physician oversight or guidance. Indeed, many healthcare providers do not support use of cannabinoid therapies for pain, and among those who do, few have sufficient knowledge of medical cannabis to adequately counsel patients how to do so safely and effectively.3 Further, there are no approved cannabinoid medications for pain but a plethora of cannabis products available in state-licensed dispensaries.4 As such, we developed a protocol and conducted a feasibility study to test the efficacy of a coaching intervention to help Veterans optimize their use of medical cannabis products that they selected and purchased from state-licensed dispensaries.

Methods

The intervention drew from multiple sources, including relevant scientific literature, consultation from experts with substantial clinical experience working with cannabis, input from Veterans via a Community Advisory Board, and tenets of motivational interviewing. Interventions were delivered remotely by trained behavioral health consultants. Participants were Veterans with chronic pain who endorsed either current use or interest in using cannabis for pain symptoms. Participants received up to 4 live video coaching sessions, spaced 2 weeks apart to allow participants to adjust use patterns. We assessed feasibility (adherence, satisfaction, and acceptability) and preliminary efficacy on pain symptoms 12 weeks after baseline. The primary efficacy outcome was the Patient Global Impression of Change (PGIC), and other outcomes included Patient Reported Outcome Measurement Information System (PROMIS) measures of pain severity, pain interference, anxiety, and sleep disturbance.

Results

We enrolled 21 participants, of whom 17 attended all 4 educational sessions, 2 attended 3 educational sessions, and 2 attended 2 educational sessions. 16/21 (76.2%) completed surveys at the end of the intervention. 87.5% were very or completely satisfied with the intervention and 81.3% rated coaching as very or extremely helpful. 63% of participants reported clinically significant improvement on the PGIC, and relative to baseline, participants reported decreased pain (7.1/10 vs. 5.7/10), pain interference (PROMIS T-score 66.3 vs. 61.8), and anxiety (T-score 59.3 vs. 58.5), but increased sleep disturbance (T-score 55.8 vs. 57.1) at the end of treatment. Participants reported that many aspects of the intervention were helpful, including developing a personalized plan, connectivity with the coach, ability to address questions/concerns, and trying different strategies. Some participants reported wanting more coaching sessions, especially if they were inexperienced with cannabis.

Conclusions

Participants were satisfied with the intervention and reported improvements in pain symptoms, demonstrating a positive signal that we will test in a larger upcoming clinical trial of N=468 Veterans with chronic pain. We anticipate recruitment in the full trial will be ongoing by spring 2024.

References

1.Boehnke KF, Dean O, Haffajee RL, Hosanagar A. U.S. Trends in Registration for Medical Cannabis and Reasons for Use From 2016 to 2020 : An Observational Study. Ann Intern Med. 2022;175(7):945-51. Epub 2022/06/14. doi: 10.7326/M22-0217. PubMed PMID: 35696691.
2.Qureshi AR, Patel M, Neumark S, Wang L, Couban R, Sadeghirad B, Bengizi A, Busse J. Prevalence of chronic non-cancer pain among military veterans: a systematic review and meta-analysis of observational studies. BMJ Mil Health. 2023.
3.Ronne ST, Rosenbaek F, Pedersen LB, Waldorff FB, Nielsen JB, Riisgaard H, Sondergaard J. Physicians’ experiences, attitudes, and beliefs towards medical cannabis: a systematic literature review. BMC Fam Pract. 2021;22(1):212. Epub 2021/10/23. doi: 10.1186/s12875-021-01559-w. PubMed PMID: 34674661; PMCID: PMC8532330.
4.Boehnke KF, Wu CL, Clauw DJ. Thoughtfully integrating cannabis products into chronic pain treatment. Anesthesia & Analgesia. 2024;138(1):5-15.

Presenting Author

Kevin F. Boehnke

Poster Authors

Kevin Boehnke, PhD

PhD

University of Michigan

Lead Author

Gabrielle Bowyer

MSW

Lead Author

Jenna McAfee

PhD

Lead Author

Laura Thomas

MSW

Lead Author

Evangelos Litinas

MD

Lead Author

Daniel Clauw

University of Michigan Chronic Pain and Fatigue Research Center

Lead Author

David Williams

University of Michigan

Lead Author

Mia Railing

BS

Lead Author

Poonam Purohit

BDS

Lead Author

Anne Arewasikporn

University of Michigan

Lead Author

Jennifer Eckersley

MPH

Lead Author

Dana Horowitz

MSW

Lead Author

Tristin Smith

MPH

Lead Author

Catherine Klida

Lead Author

Vivian Kurtz

MPH

Lead Author

Rachel Bergmans

MPH

Lead Author

Amy Bohnert

MHS

Lead Author

Topics

  • Treatment/Management: Cannabinoids and Cannabis
  • Trial Design