Überall Michael A
Institute of Neurological Sciences, Nürnberg, Germany.
J Pain Res. 2020 Feb 14;13:399-410. doi: 10.2147/JPR.S240011. eCollection 2020.
The 20% prevalence of chronic pain in the general population is a major health concern given the often profound associated impairment of daily activities, employment status, and health-related quality of life in sufferers. Resource utilization associated with chronic pain represents an enormous burden for healthcare systems. Although analgesia based on the World Health Organization's pain ladder continues to be the mainstay of chronic pain management, aside from chronic cancer pain or end-of-life care, prolonged use of non-steroidal anti-inflammatory drugs or opioids to manage chronic pain is rarely sustainable. As the endocannabinoid system is known to control pain at peripheral, spinal, and supraspinal levels, interest in medical use of cannabis is growing. A proprietary blend of cannabis plant extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) as the principal cannabinoids is formulated as an oromucosal spray (USAN name: nabiximols) and standardized to ensure quality, consistency and stability. This review examines evidence for THC:CBD oromucosal spray (nabiximols) in the management of chronic pain conditions. Cumulative evidence from clinical trials and an exploratory analysis of the German Pain e-Registry suggests that add-on THC:CBD oromucosal spray (nabiximols) may have a role in managing chronic neuropathic pain, although further precise clinical trials are required to draw definitive conclusions.
考虑到慢性疼痛患者日常活动、就业状况以及与健康相关的生活质量常常受到严重损害，普通人群中20%的慢性疼痛患病率成为一个主要的健康问题。与慢性疼痛相关的资源利用给医疗系统带来了巨大负担。尽管基于世界卫生组织疼痛阶梯的镇痛方法仍然是慢性疼痛管理的主要手段，但除了慢性癌痛或临终关怀外，长期使用非甾体抗炎药或阿片类药物来管理慢性疼痛很少能持续下去。由于已知内源性大麻素系统在周围、脊髓和脊髓上水平控制疼痛，对大麻药用的兴趣正在增加。一种含有δ-9-四氢大麻酚（THC）和大麻二酚（CBD）作为主要大麻素的大麻植物提取物专有混合物被制成口腔黏膜喷雾（通用名：纳布西莫尔），并进行了标准化以确保质量、一致性和稳定性。本综述研究了THC:CBD口腔黏膜喷雾（纳布西莫尔）在慢性疼痛病症管理中的证据。来自临床试验的累积证据以及对德国疼痛电子登记处的探索性分析表明，添加THC:CBD口腔黏膜喷雾（纳布西莫尔）可能在管理慢性神经性疼痛中发挥作用，尽管需要进一步精确的临床试验才能得出明确结论。
