Cannabis, concussion, and chronic pain: An ongoing retrospective analysis at Dent Neurologic Institute in Buffalo, NY

Objective To examine medical cannabis (MC) as treatment for concussion-related chronic pain.

Design/methods Individuals with concussion often experience chronic discomfort from headaches. MC treatment was approved for use in chronic pain by New York State in March 2017. DENT has treated 4,123 patients with MC, including 2,792 for chronic pain and 142 with concussion symptoms. Sixty-six charts were reviewed, with a total of 100 expected by presentation.

Preliminary results (1) The Patient Global Impression of Improvement (PGI-I) scale revealed 80% of patients experienced significant improvement in activity level and symptoms. (2) Five common concussion symptoms (headache, mood, sleep, attention, and dizziness) were evaluated via modified-Likert scale (0 rated as “Much Worse” and 10 as “Much Better”). Moderate improvement (MI) was defined as 7–8 and significant improvement (SI) 9–10. Improvement was greatest in mood (63% MI, 20% SI), sleep (53% MI, 23% SI), and headache (60% MI, 14% SI). (3) Quality of Life after Brain Injury Score (QOLIBRI) scores were obtained on patients who had started MC (46) and those who had not yet (19). Comparison of the groups showed a significant improvement (p = 0.0035) in quality of life in individuals on MC. (4) The routes of administration that produced optimal benefit were 1:1 (THC:CBD) oral tincture at an average dose of 1.5 mL TID for prophylaxis and 20:1 vapor pen for acute pain. Together these products cost an average of $242 per month. (5) 15% of patients reported side effects, all minimal, with 63% related to administration route (poor taste, cough). No patients discontinued MC due to side effects.

Conclusions These results support MC as an option for treatment of concussion-related chronic pain. While prospective studies are required, these preliminary results lay the foundation for investigating MC as a valid treatment for concussion and chronic pain.