Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. L226, Portland, OR, 97239, USA.
Curr Neurol Neurosci Rep. 2018 Jun 19;18(8):50. doi: 10.1007/s11910-018-0859-x.
Cannabis and cannabinoids have been used medically and recreationally for thousands of years and recently there has been a growing body of research in this area. With increased access now that medical marijuana is available in many jurisdictions, patients and providers want to know more about the evidence for benefits and risks of cannabinoid use. This paper provides an overview of the available cannabinoid-based formulations, a summary of the highest quality evidence for the use of cannabinoids for treating spasticity and pain associated with multiple sclerosis (MS), and a discussion of possible dosing regimens based on information from these studies.
Two recent high-quality systematic reviews concluded that the only strong evidence for medical marijuana in neurological disorders was for reducing the symptoms of patient-reported spasticity and central pain in MS and that the only complementary and alternative medicine (CAM) intervention in MS with strong supportive evidence was cannabinoids. Based on this review, they concluded that nabiximols (Sativex oral spray), oral cannabis extract (OCE), and synthetic tetrahydrocannabinol (THC) are probably effective at reducing patient-reported symptoms of spasticity in people with MS, but OCE and synthetic THC were not found to be effective for reducing physician-administered measures of spasticity. In addition, nabiximols, OCE, and synthetic THC are probably effective at reducing MS-related pain. Cannabinoids were generally well-tolerated. However, cannabis use has been associated with an increased risk of psychosis and schizophrenia in at-risk individuals, there is growing evidence that cannabis can increase the risk for cardiovascular diseases, including myocardial infarction (MI), hypertension, heart failure, and stroke, and a recently recognized adverse effect of cannabis is cannabinoid hyperemesis syndrome. The medical use of cannabinoids remains controversial. While cannabinoids have been studied for a variety of neurologic disorders, there is strongest evidence to indicate benefits in treatment of spasticity and neuropathic pain in multiple sclerosis. Although the best dose for an individual remains uncertain, most participants in the studies discussed in this paper used between 20 and 40 mg of THC a day in divided doses. Adverse events in studies were generally more common in the groups using cannabinoid products but serious adverse events were rare and cannabis products were generally well-tolerated. Cannabis use does appear to be associated with increased risk of certain adverse events, including psychosis, cardiovascular diseases, and cannabinoid hyperemesis syndrome.
目的综述：大麻素及其制品在医学和娱乐领域的应用已有数千年的历史，最近这方面的研究也越来越多。随着大麻合法化的地区增多，患者和医生都想更多地了解使用大麻素治疗多发性硬化症（MS）相关痉挛和疼痛的益处和风险的证据。本文概述了现有的大麻素制剂，总结了高质量证据支持大麻素治疗多发性硬化症痉挛和疼痛的证据，并根据这些研究的信息讨论了可能的剂量方案。
最新发现：最近的两项高质量系统评价得出结论，在神经系统疾病中，医用大麻唯一的强证据是缓解患者报告的多发性硬化症痉挛和中枢性疼痛的症状，而在多发性硬化症中唯一具有强烈支持证据的补充和替代医学（CAM）干预是大麻素。基于这项综述，他们得出结论，纳比西酮（Sativex 口腔喷雾）、大麻口服提取物（OCE）和合成四氢大麻酚（THC）可能对减轻多发性硬化症患者报告的痉挛症状有效，但 OCE 和合成 THC 并未发现对减轻医生评估的痉挛症状有效。此外，纳比西酮、OCE 和合成 THC 可能对减轻多发性硬化症相关疼痛有效。大麻素通常耐受性良好。然而，大麻的使用与高危人群中精神分裂症和精神分裂症的风险增加有关，越来越多的证据表明大麻会增加心血管疾病的风险，包括心肌梗死（MI）、高血压、心力衰竭和中风，最近还发现大麻的一种不良作用是大麻素呕吐综合征。医用大麻的使用仍然存在争议。虽然大麻素已经被研究用于多种神经系统疾病，但在治疗多发性硬化症痉挛和神经病理性疼痛方面有最强的证据支持。虽然个体的最佳剂量仍不确定，但本文讨论的研究中的大多数参与者每天分剂量使用 20 到 40 毫克的 THC。研究中的不良事件一般在使用大麻素产品的组中更常见，但严重不良事件很少见，且大麻素产品通常耐受性良好。大麻的使用似乎与某些不良事件的风险增加有关，包括精神分裂症、心血管疾病和大麻素呕吐综合征。
