Stevens A J, Higgins M D
St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia.
Flinders Medical Centre, Bedford Park, SA, Australia.
Acta Anaesthesiol Scand. 2017 Mar;61(3):268-280. doi: 10.1111/aas.12851. Epub 2017 Jan 16.
Cannabinergic medications have been postulated to demonstrate efficacy in the management of pain. The aim of this systematic review was to assess the analgesic efficacy and adverse effects of cannabinoids when used for the management of acute pain.
A systematic review was performed by searching the MEDLINE, EMBASE and CENTRAL databases, and the World Health Organization International Clinical Trials Registry Platform for human randomized controlled trials that assessed the analgesic efficacy of cannabinoids compared to placebo or active comparators. The reported outcomes for analgesic efficacy and adverse effects in included studies were qualitatively analysed.
Seven studies, including 611 patients were included in the systematic review. In five studies, cannabinoids were found to provide equivalent analgesia to placebo, in one study the analgesia provided by cannabinoids was superior to placebo, and in one study cannabinoids provided analgesia that was inferior to that provided by placebo. No synergistic or additive analgesic effect was observed when cannabinoids were used in combination with opioids. In five of the seven studies, certain adverse effects were more frequent with cannabinoid treatment than with placebo or active comparator.
On the basis of the available randomized controlled trial evidence, cannabinoids have no role in the management of acute pain.
大麻素类药物被认为在疼痛管理中具有疗效。本系统评价的目的是评估大麻素类药物用于急性疼痛管理时的镇痛效果及不良反应。
通过检索MEDLINE、EMBASE和CENTRAL数据库以及世界卫生组织国际临床试验注册平台，纳入评估大麻素类药物与安慰剂或活性对照药相比镇痛效果的人体随机对照试验，进行系统评价。对纳入研究中报道的镇痛效果和不良反应结果进行定性分析。
该系统评价纳入了7项研究，共611例患者。5项研究发现大麻素类药物与安慰剂的镇痛效果相当，1项研究中大麻素类药物的镇痛效果优于安慰剂，1项研究中大麻素类药物的镇痛效果劣于安慰剂。大麻素类药物与阿片类药物联合使用时未观察到协同或相加镇痛作用。7项研究中的5项显示，与安慰剂或活性对照药相比，大麻素类药物治疗的某些不良反应更常见。
基于现有随机对照试验证据，大麻素类药物在急性疼痛管理中无作用。
