大麻和大麻素治疗慢性非癌症疼痛患者：对照和观察性研究的系统评价和荟萃分析。

Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies.

机构信息

National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia.

Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia.

出版信息

Pain. 2018 Oct;159(10):1932-1954. doi: 10.1097/j.pain.0000000000001293.

DOI:10.1097/j.pain.0000000000001293

PMID:29847469

Abstract

This review examines evidence for the effectiveness of cannabinoids in chronic noncancer pain (CNCP) and addresses gaps in the literature by: considering differences in outcomes based on cannabinoid type and specific CNCP condition; including all study designs; and following IMMPACT guidelines. MEDLINE, Embase, PsycINFO, CENTRAL, and clinicaltrials.gov were searched in July 2017. Analyses were conducted using Revman 5.3 and Stata 15.0. A total of 91 publications containing 104 studies were eligible (n = 9958 participants), including 47 randomised controlled trials (RCTs) and 57 observational studies. Forty-eight studies examined neuropathic pain, 7 studies examined fibromyalgia, 1 rheumatoid arthritis, and 48 other CNCP (13 multiple sclerosis-related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). Across RCTs, pooled event rates (PERs) for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo); significant effect for cannabinoids was found; number needed to treat to benefit was 24 (95% confidence interval [CI] 15-61); for 50% reduction in pain, PERs were 18.2% vs 14.4%; no significant difference was observed. Pooled change in pain intensity (standardised mean difference: -0.14, 95% CI -0.20 to -0.08) was equivalent to a 3 mm reduction on a 100 mm visual analogue scale greater than placebo groups. In RCTs, PERs for all-cause adverse events were 81.2% vs 66.2%; number needed to treat to harm: 6 (95% CI 5-8). There were no significant impacts on physical or emotional functioning, and low-quality evidence of improved sleep and patient global impression of change. Evidence for effectiveness of cannabinoids in CNCP is limited. Effects suggest that number needed to treat to benefit is high, and number needed to treat to harm is low, with limited impact on other domains. It seems unlikely that cannabinoids are highly effective medicines for CNCP.

摘要

这篇综述考察了大麻素在慢性非癌性疼痛（CNCP）中的有效性证据，并通过以下方式解决了文献中的空白：根据大麻素类型和特定的 CNCP 状况考虑结果差异；包括所有研究设计；并遵循 IMMPACT 指南。2017 年 7 月，对 MEDLINE、Embase、PsycINFO、CENTRAL 和 clinicaltrials.gov 进行了搜索。使用 Revman 5.3 和 Stata 15.0 进行分析。共有 91 篇包含 104 项研究的出版物符合条件（n = 9958 名参与者），包括 47 项随机对照试验（RCT）和 57 项观察性研究。48 项研究检查了神经性疼痛，7 项研究检查了纤维肌痛，1 项研究检查了类风湿关节炎，48 项其他 CNCP（13 项多发性硬化症相关疼痛，6 项内脏疼痛，29 项混合或未定义的 CNCP 样本）。在 RCT 中，疼痛减轻 30%的总发生率（PER）为 29.0%（大麻素）与 25.9%（安慰剂）；大麻素的效果显著；需要治疗的人数为 24（95%置信区间 [CI] 15-61）；疼痛减轻 50%时，PER 为 18.2%比 14.4%；无显著差异。疼痛强度的平均变化（标准化均数差：-0.14，95%CI-0.20 至-0.08）相当于 100mm 视觉模拟量表上的 3mm 疼痛缓解，大于安慰剂组。在 RCT 中，所有原因不良事件的 PER 为 81.2%比 66.2%；需要治疗的人数为 6（95%CI 5-8）。对身体或情绪功能没有显著影响，睡眠质量和患者对变化的总体印象有低质量证据改善。大麻素治疗 CNCP 的有效性证据有限。结果表明，需要治疗的人数很高，需要治疗的人数很少，对其他领域的影响有限。大麻素似乎不太可能是治疗 CNCP 的高效药物。