Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, HKSAR, People's Republic of China.
Department of Anaesthesiology, The University of Hong Kong, Room 424, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, People's Republic of China.
J Neuroimmune Pharmacol. 2020 Dec;15(4):801-829. doi: 10.1007/s11481-020-09905-y. Epub 2020 Mar 14.
There is growing interest in using cannabinoids for chronic pain. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the analgesic efficacy and adverse effects of cannabinoids for chronic non-cancer pain. PubMed, EMBASE, Web of Science, Cochrane CENTRAL and clinicaltrials.gov were searched up to December 2018. Information on the type, dosage, route of administration, pain conditions, pain scores, and adverse events were extracted for qualitative analysis. Meta-analysis of analgesic efficacy was performed. Meta-regression was performed to compare the analgesic efficacy for different pain conditions (neuropathic versus non-neuropathic pain). Risk of bias was assessed by The Cochrane Risk of Bias tool, and the strength of the evidence was assessed using the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Forty-three randomized controlled trials were included. Meta-analysis was performed for 33 studies that compared cannabinoids to placebo, and showed a mean pain score (scale 0-10) reduction of -0.70 (p < 0.001, random effect). Meta-regression showed that analgesic efficacy was similar for neuropathic and non-neuropathic pain (Difference = -0.14, p = 0.262). Inhaled, oral, and oromucosal administration all provided statistically significant, but small reduction in mean pain score (-0.97, -0.85, -0.45, all p < 0.001). Incidence of serious adverse events was rare, and non-serious adverse events were usually mild to moderate. Heterogeneity was moderate. The GRADE level of evidence was low to moderate. Pain intensity of chronic non-cancer patients was reduced by cannabinoids consumption, but effect sizes were small. Efficacy for neuropathic and non-neuropathic pain was similar.
人们对使用大麻素治疗慢性疼痛越来越感兴趣。我们进行了系统评价和荟萃分析，以评估大麻素治疗慢性非癌性疼痛的镇痛疗效和不良反应。检索了 PubMed、EMBASE、Web of Science、Cochrane CENTRAL 和 clinicaltrials.gov，检索截至 2018 年 12 月。对定性分析提取了类型、剂量、给药途径、疼痛状况、疼痛评分和不良反应的信息。对镇痛疗效进行荟萃分析。进行荟萃回归分析以比较不同疼痛状况（神经病理性与非神经病理性疼痛）的镇痛疗效。采用 The Cochrane 风险偏倚工具评估偏倚风险，并采用推荐评估、制定与评价（GRADE）方法评估证据强度。纳入了 43 项随机对照试验。对 33 项比较大麻素与安慰剂的研究进行了荟萃分析，结果显示平均疼痛评分（0-10 分）降低了-0.70（p<0.001，随机效应）。荟萃回归显示，神经病理性和非神经病理性疼痛的镇痛疗效相似（差异=-0.14，p=0.262）。吸入、口服和口腔黏膜给药均使平均疼痛评分有统计学意义但较小的降低（-0.97、-0.85、-0.45，均 p<0.001）。严重不良事件的发生率罕见，非严重不良事件通常为轻度至中度。异质性为中度。GRADE 证据水平为低到中度。慢性非癌性疼痛患者的疼痛强度因大麻素的使用而降低，但效应大小较小。神经病理性和非神经病理性疼痛的疗效相似。
