Salottolo Kristin, Peck Laura, Tanner Ii Allen, Carrick Matthew M, Madayag Robert, McGuire Emmett, Bar-Or David
1Trauma Research Department, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113 USA.
2Trauma Research Department, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228 USA.
Patient Saf Surg. 2018 Jun 19;12:16. doi: 10.1186/s13037-018-0163-3. eCollection 2018.
Widespread legislative efforts to legalize marijuana have increased the prevalence of marijuana use and abuse. The effects of marijuana on pain tolerance and analgesic pain management in the acute pain setting have not been reported. Although marijuana has been shown to have antinociceptive effects and is approved for medical use to treat chronic pain, anecdotal evidence suggests marijuana users admitted with traumatic injuries experience poorer pain control than patients who do not use marijuana. We hypothesized that marijuana users would report higher pain scores and require more opioid analgesia following traumatic injury.
This retrospective pilot study included all patients involved in motor vehicle crashes, consecutively admitted to four trauma centers from 1/1/2016-4/30/2016. Marijuana status was examined as non-use and use, and was further categorized as chronic and episodic use. We performed a repeated measures mixed model to examine the association between marijuana use and a) average daily opioid consumption and b) average daily pain scores (scale 0-10). Opioid analgesics were converted to be equianalgesic to 1 mg IV hydromorphone.
Marijuana use was reported in 21% (54/261), of which 30% reported chronic use (16/54). Marijuana use was reported more frequently in Colorado hospitals (23-29%) compared to the hospital in Texas (6%). Drug use with other prescription/street drugs was reported in 9% of patients. Other drug use was a significant effect modifier and results were presented after stratification by drug use. After adjustment, marijuana users who did not use other drugs consumed significantly more opioids (7.6 mg vs. 5.6 mg, < 0.001) and reported higher pain scores (4.9 vs. 4.2, < 0.001) than non-marijuana users. Conversely, in patients who used other drugs, there were no differences in opioid consumption (5.6 mg vs. 6.1 mg, = 0.70) or pain scores (5.3 vs. 6.0, = 0.07) with marijuana use compared to non-use, after adjustment. Chronic marijuana use was associated with significantly higher opioid consumption compared to episodic marijuana use in concomitant drug users (11.3 mg vs. 4.4 mg, = 0.008) but was similar in non-drug users ( = 0.41).
These preliminary data suggest that marijuana use, especially chronic use, may affect pain response to injury by requiring greater use of opioid analgesia. These results were less pronounced in patients who used other drugs.
广泛的将大麻合法化的立法努力增加了大麻使用和滥用的流行率。大麻对急性疼痛环境下疼痛耐受性和镇痛性疼痛管理的影响尚未见报道。尽管大麻已被证明具有抗伤害感受作用，并被批准用于治疗慢性疼痛的医学用途，但轶事证据表明，因创伤性损伤入院的大麻使用者比不使用大麻的患者疼痛控制更差。我们假设大麻使用者在创伤性损伤后会报告更高的疼痛评分，并需要更多的阿片类镇痛药。
这项回顾性试点研究纳入了2016年1月1日至2016年4月30日连续入住四个创伤中心的所有机动车碰撞事故患者。大麻使用状况分为不使用和使用，并进一步分为长期使用和偶尔使用。我们进行了重复测量混合模型，以检验大麻使用与以下两者之间的关联：a）每日平均阿片类药物消耗量；b）每日平均疼痛评分（0 - 10分制）。阿片类镇痛药被换算为等效于1毫克静脉注射氢吗啡酮。
21%（54/261）的患者报告使用过大麻，其中30%（16/54）报告长期使用。与德克萨斯州的医院（6%）相比，科罗拉多州的医院报告大麻使用情况更频繁（23% - 29%）。9%的患者报告同时使用其他处方/街头药物。其他药物使用是一个显著的效应修饰因素，在按药物使用情况分层后呈现结果。调整后，未使用其他药物的大麻使用者比不使用大麻的使用者消耗更多的阿片类药物（7.6毫克对5.6毫克，<0.001），且报告的疼痛评分更高（4.9对4.2，<0.001）。相反，在使用其他药物的患者中，调整后，与不使用大麻相比，使用大麻的患者在阿片类药物消耗量（5.6毫克对6.1毫克，=0.70）或疼痛评分（5.3对6.0，=0.07）方面没有差异。在同时使用药物的患者中，长期使用大麻与偶尔使用大麻相比，阿片类药物消耗量显著更高（11.3毫克对4.4毫克，=0.008），但在不使用其他药物的患者中情况相似（=0.41）。
这些初步数据表明，大麻使用，尤其是长期使用，可能通过需要更多地使用阿片类镇痛药来影响对损伤的疼痛反应。在使用其他药物的患者中，这些结果不太明显。
