Abrams D I, Jay C A, Shade S B, Vizoso H, Reda H, Press S, Kelly M E, Rowbotham M C, Petersen K L
Community Consortium, Positive Health Program, San Francisco General Hospital, San Francisco, CA 94110, USA.
Neurology. 2007 Feb 13;68(7):515-21. doi: 10.1212/01.wnl.0000253187.66183.9c.
To determine the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an experimental pain model.
Prospective randomized placebo-controlled trial conducted in the inpatient General Clinical Research Center between May 2003 and May 2005 involving adults with painful HIV-associated sensory neuropathy. Patients were randomly assigned to smoke either cannabis (3.56% tetrahydrocannabinol) or identical placebo cigarettes with the cannabinoids extracted three times daily for 5 days. Primary outcome measures included ratings of chronic pain and the percentage achieving >30% reduction in pain intensity. Acute analgesic and anti-hyperalgesic effects of smoked cannabis were assessed using a cutaneous heat stimulation procedure and the heat/capsaicin sensitization model.
Fifty patients completed the entire trial. Smoked cannabis reduced daily pain by 34% (median reduction; IQR = -71, -16) vs 17% (IQR = -29, 8) with placebo (p = 0.03). Greater than 30% reduction in pain was reported by 52% in the cannabis group and by 24% in the placebo group (p = 0.04). The first cannabis cigarette reduced chronic pain by a median of 72% vs 15% with placebo (p < 0.001). Cannabis reduced experimentally induced hyperalgesia to both brush and von Frey hair stimuli (p < or = 0.05) but appeared to have little effect on the painfulness of noxious heat stimulation. No serious adverse events were reported.
Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain.
确定吸食大麻对HIV相关感觉神经病变所致神经性疼痛以及一种实验性疼痛模型的影响。
2003年5月至2005年5月在住院综合临床研究中心进行的前瞻性随机安慰剂对照试验,纳入患有疼痛性HIV相关感觉神经病变的成年人。患者被随机分配吸食大麻(四氢大麻酚含量为3.56%)或相同的安慰剂香烟,每天吸食3次,共5天。主要结局指标包括慢性疼痛评分以及疼痛强度降低>30%的患者百分比。使用皮肤热刺激程序和热/辣椒素致敏模型评估吸食大麻的急性镇痛和抗痛觉过敏作用。
50名患者完成了整个试验。吸食大麻使每日疼痛减轻34%(中位数减轻;四分位数间距=-71,-16),而安慰剂组为17%(四分位数间距=-29,8)(p=0.03)。大麻组52%的患者报告疼痛减轻超过30%,安慰剂组为24%(p=0.04)。第一支大麻香烟使慢性疼痛中位数减轻72%,而安慰剂组为15%(p<0.001)。大麻减轻了实验诱导的对刷擦和von Frey毛发刺激的痛觉过敏(p≤0.05),但对有害热刺激的疼痛似乎影响不大。未报告严重不良事件。
吸食大麻耐受性良好,可有效缓解HIV相关感觉神经病变所致的慢性神经性疼痛。这些发现与用于慢性神经性疼痛的口服药物相当。