CLINICAL USE OF MEDICAL CANNABIS IN A COHORT OF PATIENTS WITH CHRONIC PAIN AND COGNITIVE DECLINE: FOCUS ON NEUROPSYCHIATRIC SYMPTOM RELIEF

P. Krasniqi¹, G. Guerrieri² | ¹Emergency Department - Usl Umbria2, Anaesthesia, Resuscitation and Pain Therapy Department of Narni and Amelia, Narni (Terni); ²Anaesthesia, Resuscitation Department, Narni

INTRODUCTION
The medical use of cannabis is increasingly adopted in patients with neurodegenerative diseases, particularly for the management of behavioral symptoms in dementia. This study aims to describe the clinical characteristics and treatment response to medical cannabis in a cohort of patients treated for chronic pain, with a specific focus on subgroups affected by neurodegenerative conditions.
METHODS
We conducted a retrospective analysis of a monocentric cohort of 200 patients treated with medical cannabis between 2016 and 2025. Patients were stratified into subgroups based on their predominant diagnosis:
- Oncological pain: 9,5%
- Chronic non-oncological pain
° Fibromyalgia, psychological: 29%
° Chronic inflammatory diseases, Glaucoma 26,5%
° Neurodegenerative disorders (e.g., multiple sclerosis, Parkinson’s disease, ALS, dementia): 12,5%
° Neuropathic pain: 22,5%.
RESULTS
Among these, a notable subgroup of six patients with cognitive decline experienced clinical benefits from cannabis treatment, particularly in terms of neuropsychiatric symptom relief rather than cognitive improvement. These symptoms—such as anxiety, agitation, aggression, and hallucinations—are recognized features of dementia's clinical trajectory and significantly contribute to patient morbidity and caregiver burden. All six patients reported improved perceived quality of life, in line with emerging evidence in the current literature. The treatment was well tolerated, with only mild and transient adverse effects. Dosages ranged from 3.25 mg to 41.28 mg of THC, and from 1 mg to 18 mg of CBD daily.
CONCLUSIONS
This clinical experience suggests that therapeutic cannabis may represent an effective treatment option for chronic pain, even in vulnerable populations such as patients with dementia. The observed improvements in behavioral and affective symptoms further support its potential role. However, further multicenter, randomized controlled trials are necessary to investigate the neuroprotective potential of cannabinoids, to prevent neurodegenerative diseases, given their involvement in key pathological mechanisms including oxidative stress, neuroinflammation, mitochondrial dysfunction, neurotoxicity, and protein misfolding.