Veterans, compared with the general population, display a higher incidence of chronic pain and the suicide risk that comes with it, and finding safe and effective treatments for chronic pain remains an important concern for researchers, particularly in light of the opioid epidemic and the increasing need for alternatives to opioids for long-term pain care. A new State of Michigan grant will allow U-M pain researchers to test whether cannabidiol (CBD) and medical cannabis products—therapies with few existing treatment guidelines—are effective for managing chronic pain among US Veterans.

The five-year, $7.4 million grant from the Veteran Marijuana Research (VMR) grant program will fund the study “Pragmatic Trial of Cannabidiol and Tailored Cannabis Coaching to Improve Chronic Pain Symptoms among Veterans.” It is led by co-Principal Investigators Kevin Boehnke, PhD, a research investigator in the Department of Anesthesiology and the Chronic Pain and Fatigue Research Center; Rachel Bergmans, PhD, a research investigator in the department of anesthesiology and the Chronic Pain and Fatigue Research Center; and Amy Bohnert, PhD, MHS, professor of anesthesiology, psychiatry, and epidemiology, and co-investigator of Precision Health’s PROMPT study and Precision Opioid Prescribing use case.

Bohnert acknowledged how useful her work with Precision Health has been in developing this study, and how the study will enrich her Precision Health work. “This project benefits from the years of experience, developed across several Precision Health projects, with collecting health data remotely and securely. It will also further the goals of Precision Health by studying which people benefit from which treatments to manage pain and mental health problems,” she said.

The clinical trial includes two consecutive interventions. In the first, the study team will assess the effectiveness of commercially available CBD products on chronic pain symptoms, and in the second, participants will receive tailored guidance on how to appropriately use products from licensed dispensaries.

Bergmans and Boehnke explained the significance of the two study interventions.

“In the first part of our study, we will get a better understanding of what kinds of chronic pain might best respond to cannabidiol (CBD) products,” said Boehnke. “CBD is very low risk and remarkably safe, with potential as a first-line cannabis-based pain reliever, so conducting this large, pragmatic trial will help inform whether and when it might be useful.” Bergmans added that they will investigate the effects of CBD “among veterans with varying types of pain.”

“Many people report that cannabis and/or CBD are helpful, both in reducing pain and associated symptoms, as well as being used as a substitute for other pain medications, including opioids,” said Boehnke. But established treatment guidelines have not been developed, so “unfortunately, many people typically use medical cannabis without much guidance or support,” said Boehnke, due to a combination of health care providers’ lack of relevant training, and their reluctance to provide guidance on products that “remain federally illegal.”

“Our educational clinical trial will be the first to empirically test guidance proposed by experts on appropriate use of cannabis products for chronic pain,” said Bergmans. A goal of the study is “to develop practical advice based on the scientific literature that could help people with chronic pain thoughtfully approach cannabis products for pain management,” said Boehnke.

“We are developing an intervention to help empower veterans with chronic pain to maximize benefit and minimize harm from products available in legal dispensaries,” Boehnke explained.

Recruiting a veteran population to participate in such a study is itself significant for breaking down research barriers. Bergmans stated that, “to expand upon existing literature, one of the aims of our study is to report on barriers and facilitators to participation.”

Bergmans, who will lead community and participant engagement efforts for the study, explained that “the veteran community is underrepresented in research on health interventions. A recently published study [Miller et al 2022] reports in a racially and ethnically diverse sample, the most common barrier was not knowing about research opportunities.” In addition, “Black and Asian Veterans were more likely than white Veterans to report that distrust of researchers, and being assigned to an experimental treatment, were barriers to research participation. Black veterans who experienced higher levels of discrimination due to race/ethnicity also reported greater barriers to research,” she said.

“Our overall study design is unique, in that we will use a community-engaged approach,” said Bergmans.

“We will establish a community advisory board so that we can partner with Veteran groups in Michigan to tailor our recruitment approach, identify barriers to participation and help overcome them, interpret study findings, and disseminate our results.” She added, “Community-engaged approaches and authentic academic-community partnerships can help overcome barriers to research participation and ensure equitable access to research opportunities like this study.”

“We have and will continue to prioritize Veteran voices throughout the process of the study,” said Boehnke. “In so doing, we will be responsive to Veteran needs, which is incredibly important to our team given [Veterans’] extraordinary commitment and advocacy, which has helped make this research possible in the first place. I feel excited and privileged that this project focuses on working with Veterans to improve their pain management outcomes,” he said.

“Veterans with chronic pain want their voices to be heard, and many have been tirelessly advocating for more research on whether medical cannabis can be helpful for pain management,” said Boehnke. This study “addresses critical knowledge gaps in the cannabinoid and chronic pain literature,” said Bergmans. Through it, Veterans and others with chronic pain could receive the guidance they need on a promising pain management therapy.