Psychology Department, Ariel University, Ariel, Israel.
Pain Center, Sourasky Medical Center, Tel Aviv, Israel.
J Psychosom Res. 2020 Aug;135:110130. doi: 10.1016/j.jpsychores.2020.110130. Epub 2020 May 12.
The use of medical marijuana (MM) for the treatment of chronic pain is rapidly growing in the United States and Europe; however there is concern regarding the specificity of its therapeutic effects and the motivation underlying its use. While research indicates that among chronic pain prescribed opioids, depression has been associated with increased opioid dosage (regardless of pain levels), the extent to which depression and pain each contribute to MM dose among chronic pain patients is yet unknown.
This cross-sectional study included 209 chronic pain patients prescribed smoked MM, in flower or other plant form, with no concurrent opioid treatment. Ordinal regression analyses were performed in order to explore the unique contribution of mean pain level (1-10 scale), depression severity (measured by the Patient Health Questionnaire (PHQ-9)) and anxiety severity (measured by the Generalized Anxiety Disorder scale (GAD-7)) to doses of MM, while taking into account additional sociodemographic and clinical factors.
Individuals with mild depression and those with moderate to severe depression were at significantly increased odds for using higher doses of MM in grams per month(Adjusted Odds Ratio(AOR) = 2.06,95% Confidence Interval(CI) = 1.05-4.01, and AOR = 5.95,95% CI = 1.97-17.98, respectively) compared to those without depression. In addition, individuals with mild depression were at significantly increased odds for smoking more MM joints daily(AOR = 2.07, 95% CI = 1.01-4.23) compared to individuals without depression. Mean levels of pain or anxiety severity were not significantly associated with either dose measures.
Depression and MM dose are highly correlated and should be concurrently addressed during chronic pain treatment.
医用大麻（MM）治疗慢性疼痛在美国和欧洲的应用迅速增长；然而，人们对其治疗效果的特异性以及使用背后的动机表示担忧。虽然研究表明，在慢性疼痛患者开具的阿片类药物中，抑郁与阿片类药物剂量的增加有关（无论疼痛程度如何），但抑郁和疼痛在多大程度上共同导致慢性疼痛患者 MM 剂量尚不清楚。
这项横断面研究纳入了 209 名接受吸食 MM（花或其他植物形式）治疗的慢性疼痛患者，这些患者没有同时接受阿片类药物治疗。为了探索平均疼痛水平（1-10 分）、抑郁严重程度（用患者健康问卷（PHQ-9）测量）和焦虑严重程度（用广泛性焦虑障碍量表（GAD-7）测量）对 MM 剂量的独特贡献，同时考虑到其他社会人口统计学和临床因素，进行了有序回归分析。
轻度抑郁和中重度抑郁患者使用 MM 的剂量（以克/月计）显著增加（调整后的优势比（AOR）分别为 2.06，95%置信区间（CI）为 1.05-4.01 和 5.95，95%CI 为 1.97-17.98），与无抑郁者相比。此外，与无抑郁者相比，轻度抑郁者每天吸食更多 MM 烟卷的可能性显著增加（AOR 为 2.07，95%CI 为 1.01-4.23）。疼痛或焦虑严重程度的平均水平与剂量测量均无显著相关性。
抑郁和 MM 剂量高度相关，在慢性疼痛治疗中应同时处理。
