Department of Clinical Research, Castile-La Mancha Health Research Foundation (FISCAM), Toledo, Spain.
Pain Med. 2009 Nov;10(8):1353-68. doi: 10.1111/j.1526-4637.2009.00703.x. Epub 2009 Sep 1.
Cannabis preparations have been used as a remedy for thousands of years in traditional medicine. Clinical use of cannabinoid substances is restricted, due to legal and ethical reasons, as well as limited evidence showing benefits.
To assess the efficacy and harms of cannabis preparations in the treatment of chronic pain.
Systematic review and meta-analysis of double-blind randomized controlled trials that compared any cannabis preparation to placebo among subjects with chronic pain. An electronic search was made in Medline/Pubmed, Embase, and The Cochrane Controlled Trials Register (TRIALS CENTRAL) of all literature published until February 2008, as well as specific web pages devoted to cannabis. Studies were cross-checked, selected, and assessed.
Eighteen trials were included. The efficacy analysis (visual analog scales) displayed a difference in standardized means in favor of the cannabis arm of -0.61 (-0.84 to -0.37), with statistical homogeneity (I(2) = 0.0%; P = 0.50). For the analysis of harms, the following Odds Ratios (OR) and number needed to harm (NNH) were obtained: for events linked to alterations to perception, OR: 4.51 (3.05-6.66), NNH: 7 (6-9); for events affecting motor function, 3.93 (2.83-5.47), NNH: 5 (4-6); for events that altered cognitive function, 4.46 (2.37-8.37), NNH: 8 (6-12).
Currently available evidence suggests that cannabis treatment is moderately efficacious for treatment of chronic pain, but beneficial effects may be partially (or completely) offset by potentially serious harms. More evidence from larger, well-designed trials is needed to clarify the true balance of benefits to harms.
大麻制剂在传统医学中已被用作治疗数千种疾病的药物。由于法律和伦理原因以及有限的证据表明其益处，大麻素物质的临床应用受到限制。
评估大麻制剂治疗慢性疼痛的疗效和危害。
对比较任何大麻制剂与安慰剂治疗慢性疼痛患者的双盲随机对照试验进行系统评价和荟萃分析。在 2008 年 2 月之前，在 Medline/Pubmed、Embase 和 The Cochrane Controlled Trials Register（TRIALS CENTRAL）中对所有已发表的文献进行电子搜索，并专门搜索了有关大麻的网页。对研究进行了交叉核对、选择和评估。
纳入了 18 项试验。疗效分析（视觉模拟量表）显示大麻组的标准化均值差异有利于大麻组，差值为 -0.61（-0.84 至 -0.37），具有统计学同质性（I(2) = 0.0%；P = 0.50）。对于危害分析，得到了以下比值比（OR）和需要治疗的人数（NNH）：与感知改变相关的事件，OR：4.51（3.05-6.66），NNH：7（6-9）；影响运动功能的事件，OR：3.93（2.83-5.47），NNH：5（4-6）；影响认知功能的事件，OR：4.46（2.37-8.37），NNH：8（6-12）。
目前的证据表明，大麻治疗对慢性疼痛的治疗有一定的疗效，但有益的效果可能会被潜在的严重危害部分（或完全）抵消。需要更多来自更大、设计良好的试验的证据来阐明受益与危害的真实平衡。
