Ashton John C, Milligan Erin D
University of Otago, Otago School of Medical Sciences, Department of Pharmacology and Toxicology, Dunedin, New Zealand.
Curr Opin Investig Drugs. 2008 Jan;9(1):65-75.
Neuropathic pain is a worldwide epidemic that occurs in 3 to 8% of individuals in industrialized countries and is often refractory to existing treatments. Drugs currently available to target neuropathic pain are, at best, moderately effective and include antidepressants, gabapentin, NMDA receptor antagonists, as well as other anticonvulsants, all of which are limited by their adverse-effect profiles. Cannabinoid drugs are emerging as a promising class of drugs to treat neuropathic pain and have been tested for analgesic effects in a range of chronic pain conditions. Data show that cannabinoids are often effective in individuals with refractory pain receiving concomitant analgesic drugs. Clinical studies on cannabinoids for the treatment of neuropathic pain are reviewed, focusing on clinical trials published within the last five years. Data from large, well-controlled studies show that cannabinoids are moderately effective in reducing chronic pain and that side effects are comparable to existing treatments, suggesting that cannabinoids can play a useful role in the management of chronic pain. Like other drugs for neuropathic pain, cannabinoids have a dose titration that is limited by psychoactive side effects. The development of cannabinoid drugs to target neuropathic pain with improved therapeutic ratios will depend upon the development of cannabinoid treatments with reduced psychoactivity.
神经性疼痛是一种全球性的流行病，在工业化国家3%至8%的人群中出现，并且常常对现有治疗方法具有耐药性。目前用于治疗神经性疼痛的药物，充其量只是中度有效，包括抗抑郁药、加巴喷丁、NMDA受体拮抗剂以及其他抗惊厥药，所有这些药物都受到其副作用的限制。大麻素类药物正在成为一类有前景的治疗神经性疼痛的药物，并已在一系列慢性疼痛病症中测试其镇痛效果。数据表明，大麻素类药物对于同时服用镇痛药物的耐药性疼痛患者往往有效。本文综述了关于大麻素类药物治疗神经性疼痛的临床研究，重点关注过去五年内发表的临床试验。来自大型、严格对照研究的数据表明，大麻素类药物在减轻慢性疼痛方面有一定效果，且副作用与现有治疗方法相当，这表明大麻素类药物在慢性疼痛管理中可发挥有益作用。与其他治疗神经性疼痛的药物一样，大麻素类药物的剂量滴定受到精神活性副作用的限制。开发具有更好治疗比率的用于治疗神经性疼痛的大麻素类药物将取决于开发精神活性降低的大麻素类疗法。
