Internal Medicine 1, Klinikum Saarbrücken gGmbH, Germany.
Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Germany.
Eur J Pain. 2018 Mar;22(3):455-470. doi: 10.1002/ejp.1118. Epub 2017 Oct 15.
Medicinal cannabis has already entered mainstream medicine in some countries. This systematic review (SR) aimed at evaluating the efficacy, acceptability and safety of cannabis-based medicines for chronic pain management. Qualitative systematic review of SRs of randomized controlled trials with cannabis-based medicines for chronic pain management. The Cochrane databases of SRs, Database of Abstracts of Reviews of Effects and PubMed were searched for SR published in the period January 2009 to January 2017. Assessment of the methodological quality of SR was performed by the AMSTAR checklist. Out of 748 papers identified, 10 SRs met the inclusion criteria. The methodological quality was high in four and moderate in six SRs. There were inconsistent findings of four SRs on the efficacy of cannabis-based medicines in neuropathic pain and of one SR for painful spasms in multiple sclerosis. There were consistent results that there was insufficient evidence of any cannabis-based medicine for pain management in patients with rheumatic diseases (three SRs) and in cancer pain (two SRs). Cannabis-based medicines undoubtedly enrich the possibilities of drug treatment of chronic pain conditions. It remains the responsibility of the health care community to continue to pursue rigorous study of cannabis-based medicines to provide evidence that meets the standard of 21st century clinical care.
We provide an overview of systematic reviews on the efficacy, tolerability and safety of cannabis-based medicines for chronic pain management. There are inconsistent findings of the efficacy of cannabinoids in neuropathic pain and painful spasms in multiple sclerosis. There are inconsistent results on tolerability and safety of cannabis-based medicines for any chronic pain.
药用大麻已在一些国家进入主流医学。本系统评价 (SR) 旨在评估基于大麻的药物治疗慢性疼痛管理的疗效、可接受性和安全性。对基于大麻的药物治疗慢性疼痛管理的随机对照试验的 SR 的定性系统评价。对 Cochrane 数据库的 SR、效果摘要数据库和 PubMed 进行了检索，以获取 2009 年 1 月至 2017 年 1 月期间发表的基于大麻的药物治疗慢性疼痛管理的 SR。采用 AMSTAR 清单评估 SR 的方法学质量。在确定的 748 篇论文中，有 10 篇 SR 符合纳入标准。4 篇 SR 的方法学质量较高，6 篇 SR 的方法学质量中等。有 4 篇 SR 关于基于大麻的药物治疗神经病理性疼痛的疗效存在不一致的发现，有 1 篇 SR 关于多发性硬化症的疼痛性痉挛的疗效也存在不一致的发现。有 3 篇 SR 关于风湿性疾病患者的疼痛管理，2 篇 SR 关于癌症疼痛的管理，都一致表明没有任何基于大麻的药物治疗有充分的证据。基于大麻的药物无疑丰富了慢性疼痛状况药物治疗的可能性。医疗保健界有责任继续对基于大麻的药物进行严格研究，提供符合 21 世纪临床护理标准的证据。
我们对基于大麻的药物治疗慢性疼痛管理的疗效、耐受性和安全性的系统评价进行了综述。大麻素在神经病理性疼痛和多发性硬化症的疼痛性痉挛中的疗效存在不一致的发现。对于任何慢性疼痛，基于大麻的药物的耐受性和安全性的结果不一致。
