Determining the place and role of cannabinoids in the standardsof chronic pain management in Poland – position statementof the Polish Association for the Study of Pain, the Polish Societyof Palliative Medicine, the Polish Association for Palliative Care,the Polish Society of Anaesthesiology and Intensive Therapy, thePolish Society of Regional Anaesthesia and Pain Therapy, the PolishPsychiatric Association, and the Polish Society of Phytotherapy

A group of 14 experts representing the Polish Association for the Study of Pain, the Polish Society of Palliative Medicine, the Polish Association for Palliative Care, the Polish Society of Anaesthesiology and Intensive Therapy, the Polish Society of Regional Anaesthesia and Pain Therapy, the Polish Psychiatric Association, and the Polish Society of Phytotherapy developed a position statement on the place and role of cannabinoids in the standards of chronic pain management in Poland, based on a comprehensive and up-to-date review of the literature. During a series of meetings, the experts critically appraised the available evidence on the use of medical cannabis in patients with chronic pain, with particular emphasis on systematic reviews and more recent randomized controlled trials that had not been included in earlier reviews. Major medical databases, including PubMed, MEDLINE, and Cochrane, were searched using the following keywords: “cannabinoids”, “tetrahydrocannabinol (THC)”, “cannabidiol (CBD)”, “endocannabinoid system (ECS)”, “chronic pain”, “cancer-related pain”, “neuropathic pain”, “multiple sclerosis (MS)”, “fibromyalgia”, “pain pharmacotherapy”, and “perioperative management”. The analysis included publications describing the mechanisms of action of the endocannabinoid system and the effects of cannabinoids on CB1 and CB2 receptors, as well as other receptors functionally associated with this system and clinically relevant. The concept of the endocannabinoidome (eCBome) was introduced, encompassing not only endocannabinoids but also related proteins, enzymes, and lipids that interact with the cannabinoid system. These components are relevant to health and well-being beyond the classical CB receptor-mediated effects. The experts’ work focused on evaluating the efficacy of cannabinoids, particularly CBD and THC, their therapeutic potential depending on chemotype (i.e., concentration, composition, and ratio – THC-dominant, balanced THC/CBD, or CBD-dominant), as well as possible routes of administration of cannabis-based medicinal products (CBMPs). Proposed principles for the use of cannabinoids in the management of various types of chronic pain were also developed, including cancer pain, neuropathic pain, pain associated with multiple sclerosis, fibromyalgia, and perioperative management in patients receiving CBM/CBMPs. The most common adverse effects of cannabinoids and the risk factors for their occurrence were discussed. Attention was also given to potential drug–drug interactions resulting from the influence of individual cannabinoids on enzymatic systems, and specific medications requiring careful clinical monitoring when co-administered with cannabinoids were identified. Relevant practical and legal considerations were also presented. This position statement is intended for practicing physicians of various specialties involved in the diagnosis and management of patients with difficult-to-control chronic pain. The experts hope that these recommendations will support everyday clinical practice and improve the quality of care and the effectiveness of pain management. At the same time, the need for further research was emphasized, as current scientific evidence does not keep pace with political changes, public opinion, and the growing commercial and professional interest in the use of medical cannabis as an adjunctive therapy, including its potential opioid-sparing effect. The current state of knowledge does not support the efficacy of medical cannabis as a standalone analgesic. However, it may represent a component of an individually tailored, multimodal approach to chronic pain management, particularly in patients receiving palliative care, with the potential to improve quality of life. Future research should focus on standardizing dosing regimens, comparing different routes of administration, and evaluating the effectiveness of medical cannabis when used in combination with established pharmacological and non-pharmacological therapies.