From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Madden, Bhandari); the Department of Surgery, McMaster University, Hamilton, Ont. (George, Bhandari); the Department of Medicine, University of Groningen, Groningen, the Netherlands (van der Hoek); the Department of Orthopaedic Surgery, Vall d’Hebron University Hospital, Barcelona, Spain (Borim); and Beleave Inc., Dundas, Ont. (Mammen).
Can J Surg. 2019 Dec 1;62(6):369-380. doi: 10.1503/cjs.001018.
Medical cannabis use is an emerging topic of interest in orthopedics. Although there is a large amount of literature on medical cannabis use for managing various types of pain, few studies have focused on orthopedic conditions. There is little high-quality evidence in core orthopedic areas. The objective of this study was to summarize the literature on the efficacy of cannabis use for pain related to orthopedic conditions.
We conducted a systematic review of the literature on the use of cannabinoids for pain management in core orthopedic conditions. Two independent reviewers extracted information on reporting quality, risk of bias, drugs, population, control, duration of study, pain outcomes and the authors’ conclusions regarding efficacy for pain outcomes.
We identified 33 orthopedic studies, including 21 primary studies and 12 reviews. Study quality was generally low to moderate. Six of the included studies had a control group and 15 were noncontrolled studies. Methodologies, drugs and protocols of administration varied greatly across studies. Study conclusions were generally positive in noncontrolled studies and mixed in controlled studies. Studies using higher doses tended to conclude that cannabis use was effective, but the potential for harmful effects may also be increased with higher doses.
Variability in the methodologies used in cannabis research makes it challenging to draw conclusions about dosing, routes and frequency of administration. Most of the existing evidence suggests that medical cannabis use is effective, but this efficacy has been demonstrated only when either there is no comparator or cannabis is compared with placebo. Studies using an active comparator have not demonstrated efficacy. Future research should focus on improving study reporting and methodologic quality so that protocols that optimize pain control while minimizing harmful effects can be determined.
医用大麻的使用是骨科领域一个新兴的研究课题。虽然有大量关于医用大麻治疗各种类型疼痛的文献，但很少有研究关注骨科疾病。在核心骨科领域，高质量证据较少。本研究的目的是总结关于大麻治疗骨科疾病相关疼痛的疗效的文献。
我们对有关大麻素用于治疗核心骨科疾病疼痛的文献进行了系统回顾。两名独立的审查员提取了关于报告质量、偏倚风险、药物、人群、对照、研究持续时间、疼痛结局以及作者对疼痛结局疗效的结论的信息。
我们确定了 33 项骨科研究，包括 21 项原始研究和 12 项综述。研究质量普遍较低到中等。纳入的研究中有 6 项有对照组，15 项为非对照研究。研究方法、药物和给药方案在不同研究中差异很大。非对照研究的结论通常是积极的，而对照研究的结论则较为混杂。使用较高剂量的研究往往得出大麻使用有效的结论，但随着剂量的增加，潜在的有害影响也可能增加。
大麻研究中使用的方法学的可变性使得很难就剂量、途径和给药频率得出结论。大多数现有证据表明医用大麻的使用是有效的，但这种疗效仅在没有对照或大麻与安慰剂比较时才得到证实。使用活性对照的研究并未显示出疗效。未来的研究应侧重于提高研究报告和方法学质量，以便确定既能优化疼痛控制又能最小化有害影响的方案。
