Cannabis-based medicines for chronic pain: specialist assessment
Dr Arul James, Consultant in Pain Medicine (FFPMRCA) on the GMC Specialist Register, assesses adults with long-term pain face to face at The Vesey in Sutton Coldfield or by secure video. A cannabis-based medicine is one option he may discuss when other recognised treatments have not helped enough. It is never the only option, and many people will not be suitable. Initial consultation £260.
Since November 2018, specialist doctors in the UK have been able to prescribe cannabis-based products for medicinal use (CBMPs). At The Vesey, Dr Arul James, a consultant in pain medicine, reviews your diagnosis, the treatments you have already tried and your wider health, and agrees a plan with you. Because he also runs our interventional pain clinic, the options he discusses include guided injections, radiofrequency treatment, infusions, physiotherapy and a review of your current medicines. A cannabis-based medicine is considered only where other options have not helped enough and he judges it clinically appropriate.
At a glance
The Vesey offers a consultant-led assessment for adults with chronic pain who want to discuss every treatment option, including whether a cannabis-based medicine could be appropriate. You see Dr Arul James, Consultant in Pain Medicine, face to face in Sutton Coldfield or by secure video. The initial consultation costs £260 and lasts about 45 minutes.
- Who it is for: adults with long-term pain where recognised treatments have not helped enough.
- Who you see: Dr Arul James, MBBS, MD, FRCA, FFPMRCA, on the GMC Specialist Register (GMC 7462328).
- How: face to face at The Vesey, Sutton Coldfield, or by secure video from home.
- Cost: £260 for the initial consultation. No GP referral is needed for a self-pay appointment.
- What you leave with: a written plan, which may or may not include a prescription.
Your consultant: Dr Arul James
Dr James is a Consultant in Chronic Pain Medicine and Anaesthetics, and Clinical Lead for Chronic Pain Medicine at George Eliot Hospital NHS Trust. He holds MBBS and MD, is a Fellow of the Royal College of Anaesthetists (FRCA) and holds the Fellowship of the Faculty of Pain Medicine (FFPMRCA).
His practice covers persistent back and neck pain, joint pain, nerve pain, headache and fibromyalgia, alongside the image-guided procedures he carries out at The Vesey. That means one consultant can weigh every option with you, not just one. Read Dr James's full profile.
Every option for your pain, from one consultant
A cannabis-based medicine is rarely the first step, and for most people it is not the right one. These are the options Dr James can discuss and, where they suit you, arrange at The Vesey.
- Ultrasound-guided nerve blocks and joint injections
- X-ray-guided spinal injections
- Radiofrequency treatment for facet joint pain
- Lidocaine infusion for some types of nerve pain
- Procedures and prices
- LiveWell, our 8-week pain self-management programme, reviewed by our clinical team
- Physiotherapy and a graded return to activity
- Pacing, sleep and flare-up planning
- A review of the pain medicines you take now
- Planned, supported reduction of long-term opioids where appropriate
- A cannabis-based medicine, considered only when recognised treatments have not helped enough
Face-to-face or video consultation
You can choose to see Dr James in person at The Vesey or by secure video. Both appointments last about 45 minutes, cost £260 and follow the same specialist assessment, so pick whichever suits you when you book.
- At The Vesey, Unit 3, The Courtyard, Reddicap Trading Estate, Sutton Coldfield B75 7BU
- Free parking on site
- Dr James can examine you during the appointment
- Bring your GP records and specialist letters with you
- No travel, which helps if pain makes journeys hard
- You need a phone, tablet or computer with a camera, and a private space
- We tell you how to share your records before the appointment
- If Dr James needs to examine you, he may ask to see you in person before agreeing a plan
- About 45 minutes with Dr James
- £260 initial consultation fee
- A full review of your pain and the treatments you have tried
- A written plan, copied to your GP with your consent
Who the assessment is for
The assessment is for adults with long-term pain. Dr James considers cannabis-based medicines for chronic pain only, and they are not appropriate for most patients. For MS spasticity, epilepsy, sickness from chemotherapy or a mental health condition, your neurologist, oncologist or psychiatrist is the right specialist.
- Neuropathic pain — peripheral & central
- Fibromyalgia
- Complex regional pain syndrome (CRPS)
- Cancer-related chronic pain
- Musculoskeletal pain (refractory)
- Post-herpetic neuralgia
- Post-surgical and post-stroke pain
- Review of full treatment history
- Confirmation of diagnosis
- Review of treatments already tried
- Mental health & substance use screen
- Discussion of all options, risks and side effects
- A written plan, which may or may not include a prescription
- Prescribe without a full specialist assessment
- Prescribe for recreational use
- Sell or supply any medicine on site
- Prescribe for anyone under 18 or with active psychosis
Consultation fees
These are The Vesey's fees for the consultant's time. If a medicine is prescribed, the pharmacy that dispenses it charges for it separately.
| Stage | What's included | From |
|---|---|---|
| Initial consultation with Dr James | ≈ 45 mins, video or in person · history, review of treatments tried, discussion of options and a written plan | £260 |
| Follow-up review | Usually about 4 weeks after any new treatment starts | £180 |
| Repeat prescription | Administration fee where nothing has changed clinically | £80 |
| Any medicine prescribed | Dispensed by a specialist pharmacy, not The Vesey | Charged by pharmacy |
The same fees appear in our patient information. The Vesey does not sell or supply any medicine.
What to expect
How long your care takes depends on your condition and the options you and Dr James agree. Dr James usually holds his clinic on Tuesday mornings, in person or by video; live availability is shown when you book online.
Bring GP records, specialist letters and documentation of all treatments you have tried. Dr James needs to see what you have already tried.
About 45 minutes with Dr Arul James, video or in person. A full history, confirmation of your diagnosis, a mental health screen and an open discussion of every option, with its likely benefits, risks and side effects.
Dr James writes to you, and to your GP with your consent, with the plan you agreed. If it includes a prescription, it goes to a specialist pharmacy, which dispenses it.
Any new treatment is reviewed, usually after about four weeks, and stopped if it is not helping or causes side effects.
Cannabis-based medicines: the facts
Cannabis-based products for medicinal use (CBMPs) is the legal UK term for prescribed medicines made from cannabis. They vary in what they contain, how they are taken and their legal status.
THC (tetrahydrocannabinol) is the main psychoactive component of cannabis. CBD (cannabidiol) is not psychoactive. Medicines containing THC are Schedule 2 controlled drugs: they can be prescribed, but under strict rules.
Licensed and unlicensed. A small number of cannabis-based medicines hold a UK licence for specific conditions, such as MS spasticity and some rare forms of epilepsy. None is licensed for chronic pain. Most cannabis-based medicines prescribed privately are unlicensed 'specials', which a specialist may prescribe only when they judge a licensed option is not suitable. The evidence for using them in chronic pain is limited, and NICE does not recommend them for this purpose outside research.
CBD sold in shops as a food supplement is not a medicine and cannot be sold with health claims.
What the evidence and guidance say
You deserve a straight answer before you book, so here is what the national guidance says.
- NICE guideline NG144 (2019) recommends that cannabis-based medicines containing THC, and the synthetic cannabinoid medicines it names, are not offered to manage chronic pain in adults, and that CBD is used for chronic pain only within a clinical trial. NICE found the evidence of benefit limited.
- NICE guideline NG193 (2021) sets out the first steps for chronic primary pain, which include exercise programmes and psychological therapies, and asks clinicians to explore what matters to you.
- The law has allowed specialist doctors to prescribe cannabis-based products for medicinal use since 1 November 2018. Only a doctor on the GMC Specialist Register can make the decision to start one.
- Unlicensed medicines. Most cannabis-based medicines are unlicensed. GMC guidance allows a doctor to prescribe an unlicensed medicine only when they are satisfied it would better serve your needs than a licensed option, and they must explain what that means for you.
This is why Dr James treats a cannabis-based medicine as an individual specialist decision, considered only after other options, and why many people leave with a plan that does not include one.
Questions worth asking at your consultation
- Is my diagnosis confirmed, and what is most likely driving my pain?
- Which recognised treatments have I not yet tried, and why might they help?
- What are the realistic benefits, risks and side effects of each option for me?
- How will we know whether a treatment is working, and when would we stop it?
- What will each option cost, including any medicine, follow-up reviews and repeat prescriptions?
- Could a treatment affect my driving, my work or a workplace drug test?
Before your assessment: treatments already tried
Dr James will want to see that the recognised treatments for your type of pain have been tried, for example physiotherapy, a pain management programme and the medicines your GP or specialist would usually offer, and that they did not help enough or caused side effects.
Please bring your GP records and any specialist letters. Where there are gaps, he may recommend other treatments first, and he will explain why.
Frequently asked questions
Can I have a video consultation for chronic pain?
Yes. Dr Arul James offers the initial assessment by secure video as well as face to face in Sutton Coldfield. The fee (£260) and length (about 45 minutes) are the same. If he needs to examine you, he may ask to see you in person before agreeing a plan.
Where can I see Dr James face to face?
At The Vesey, Unit 3, The Courtyard, Reddicap Trading Estate, Sutton Coldfield B75 7BU, which has free parking. Live availability is shown when you book online.
Do I need a GP referral?
Not for a self-pay appointment. Please bring or share your GP records and any specialist letters, because Dr James needs to see the treatments you have already tried.
Is medical cannabis legal in the UK?
Yes, on prescription. Cannabis-based products for medicinal use (CBMPs) were rescheduled in November 2018 under the Misuse of Drugs Regulations 2001, so a specialist on the GMC Specialist Register may prescribe them where clinically appropriate. Cannabis remains a controlled drug, and possessing it without a valid prescription is illegal.
Who can prescribe cannabis-based medicines in the UK?
Only doctors on the GMC Specialist Register can start a prescription; GPs cannot. At The Vesey, Dr Arul James, Consultant in Pain Medicine on the GMC Specialist Register, assesses adults with chronic pain and decides with each patient whether any prescription is clinically appropriate.
Which conditions does Dr James consider?
Chronic pain only, and only after other recognised treatments have not helped enough. NICE does not recommend cannabis-based medicines for chronic pain outside research, so many patients will not be suitable. Other conditions are for the relevant specialist, such as a neurologist for MS spasticity or epilepsy.
Do I have to have tried other treatments first?
Yes. Dr James will review the treatments you have already tried in detail. If recognised treatments for your type of pain have not yet been tried, he is likely to recommend those first.
How much does an assessment cost?
The initial consultation is £260 (about 45 minutes). A follow-up review is £180, and a repeat prescription where nothing has changed clinically has an £80 administration fee. Any medicine is charged separately by the pharmacy that dispenses it.
Will my NHS GP continue a private prescription?
NHS GPs are generally not obliged to continue a private specialist prescription for a cannabis-based medicine, so ongoing prescriptions usually stay with the private specialist. Licensed cannabis-based medicines are available on the NHS only for a few specific conditions, through the relevant specialist.
Can I drive while taking a cannabis-based medicine?
It depends on the medicine and how it affects you. The drug driving law (Section 5A Road Traffic Act 1988) applies whether or not a medicine is prescribed, and you must not drive if you are impaired. Your prescriber will advise you, including whether you need to tell the DVLA.
What are the side effects?
Common side effects include drowsiness, dizziness, nausea, dry mouth and changes in appetite. Medicines containing THC can cause anxiety, paranoia or problems with thinking and memory, particularly at higher doses. A personal or family history of psychosis usually rules treatment out.
What is the difference between THC and CBD?
THC is the main psychoactive component of cannabis; CBD is not psychoactive. Cannabis-based medicines vary in how much of each they contain. Your specialist will explain the risks and side effects of any option you discuss.
Will a prescription show on a workplace drug test?
Workplace drug tests can detect THC whether or not it was prescribed. If you are tested at work, tell your employer's occupational health team about any prescription before you start treatment.
Sources
- National Institute for Health and Care Excellence. Cannabis-based medicinal products (NG144), 2019.
- National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s (NG193), 2021.
- The Misuse of Drugs (Amendments) (Cannabis and Licence Fees) (England, Wales and Scotland) Regulations 2018.
- General Medical Council. Good practice in proposing, prescribing, providing and managing medicines and devices (prescribing unlicensed medicines).
- Road Traffic Act 1988, section 5A (driving with a specified controlled drug in the body).
Specialist pain assessment in the West Midlands
Dr James's clinic usually runs on Tuesday mornings, in person or by video. Free parking. No GP referral needed.
Free reschedule with 48+ hours' notice · Pay per visit · CQC reg. 1-13508890408
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