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Conducted by the Gentofte University Hospital in Denmark, the new analysis suggests that cannabis prescribed for pain relief could be linked with an increased risk of heart disease.

Published in the European Society of Cardiology journal, the study analysed data from 1.6 million chronic pain patients in Denmark. They discovered those who had been prescribed medicinal cannabis to deal with the pain faced a 0.86 percent risk of new-onset arrhythmia.

New-onset arrhythmia, also known as new-onset atrial fibrillation, occurs when a patient has an irregular heartbeat. Symptoms of the condition include:
• Heart palpitations
• Dyspnoea
• Chest pain
• Fatigue
• Dizziness
• Polyuria – passage of large volumes of urine alongside increased need to pee
• Syncope – temporary loss of consciousness.

Does this mean cannabis causes the condition?

No, a 0.86 percent increase in risk in heart disease risk is a miniscule amount of increase. Nevertheless, it could lead to some practitioners questioning the efficacy of the medication.

Meanwhile, the main symptoms of the most common form of heart disease, coronary heart disease (CHD) include:

  • Chest pain
  • Shortness of breath
  • Pain throughout the body
  • Feeling faint
  • Nausea.

What do the researchers say?

Speaking about the research, study author Dr Nina Nouhravesh said: “Chronic pain is a rising problem. According to Danish health authorities, 29 percent of Danish adults over 16 years of age reported chronic pain in 2017, up from 19 percent in 2000.

“Medical cannabis was approved in January 2018 on a trial basis in Denmark, meaning that physicians can prescribe it for chronic pain if all other measures, including opioids, have proven insufficient.”

Dr Nouhravesh added: “Safety data are sparse, hence this study investigated the cardiovascular side effects of medical cannabis, and arrhythmias in particular, since heart rhythm disorders have previously been found in users of recreational cannabis.”

How common is chronic pain in the UK?

Chronic pain isn’t just a problem for Denmark, it’s an issue affecting more and more people in the UK as well. According to charity Versus Arthritis, around a third (34 percent) of the population live with a form of chronic pain.

What are the main treatments for chronic pain?

Treatments vary between those centred around lifestyle and those with a focus on medication. Often, the two will be mixed in combination.

With regard to lifestyle, the NHS recommends low-strain exercises such as walking, swimming, cycling, dancing, yoga, or pilates. It adds that these “may reduce the number of bad days you have and help you feel more in control”.

Other options for treatment include physical therapy which, say the NHS, “helps you to move better, relieves your pain, and makes daily tasks and activities easier”. The therapy in question involves the manipulation of muscles and pain-relieving exercises.

While these therapies and lifestyle changes may help alleviate the pain, often those living with the condition take painkillers to manage the condition, such as paracetamol and anti-inflammatory medication, such as ibuprofen.

How can medicinal cannabis help?

Since medicinal cannabis was legalised in part of the UK in 2018, more and more studies have been conducted on the potential health benefits of the plant most associated with recreational use.

However, there is more to cannabis than just the recreational. The plant in question is made up of hundreds of cannabinoids and terpenes, which in certain combinations can be used for a range of conditions; chronic pain is one of them.

Studies conducted in recent years have found medicinal cannabis can be used to help relieve chronic pain in patients and enable them to live a normal life without the need for painkillers.

However, as with studies and medications, there is are several caveats to medicinal cannabis, particularly in the UK. Chief among this is the argument over the type of evidence used to assess its efficacy.

What is the evidence barrier?

Before a medication is approved by the NHS, MHRA (Medicines and Healthcare products Regulatory Agency), or NICE (National Institute for Health and Care Excellence), it has to pass an RCT (randomised control trial) involving a comparison with a medicine and a placebo. However, many medicinal cannabis medications have been studied using RWEs (real world evidence studies) which the NHS, MHRA, and NICE don’t accept.

This has meant there’s a clash between the huge body of evidence presented by various studies and health bodies which stipulate which type of evidence they will accept, holding up the expansion of medicinal cannabis medication in the UK.

Furthermore, there is also a lack of education among GPs and health professionals who, owing to their duty of care, don’t want to prescribe a medication they don’t fully understand.

All of this makes the medicinal cannabis debate a highly fraught one with campaigners calling for these patients to be helped and the authorities wanting to provide medication which is safe for the patients in question.

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