Lehigh Valley Health Network, Allentown, Pennsylvania.
Carver College of Medicine, University of Iowa, Iowa City, Iowa.
Sports Health. 2020 Nov/Dec;12(6):540-546. doi: 10.1177/1941738120956604. Epub 2020 Sep 16.
With increased use of cannabis-based products by the public for both recreational and medical use, sports medicine clinicians should be informed of historical context, current legal considerations, and existing evidence with regard to efficacy, safety, and risks in the athletic community.
A review of ClinicalTrials.gov, MEDLINE, and CINAHL from 2015 to present was conducted with emphasis on the most recent literature using search terms, . Bibliographies based on original search were utilized to pursue further literature search.
Clinical review.
Level 3.
At present, limited high-quality studies exist for use of cannabinoids for acute pain, chronic pain, or concussion. None of the trials involving cannabinoids included the athletic population. Thus, results from this clinical review are extrapolated to conditions of the sports medicine population. For acute pain, 2 small-randomized double-blinded crossover trials concluded no immediate effect of cannabinoid therapy. More robust evidence exists for treatment of chronic pain conditions through meta-analysis and systemic reviews. Cannabinoid therapy exhibits moderate efficacy as a treatment for some chronic pain conditions. Investigations included a broad spectrum of chronic pain conditions, including neuropathic, musculoskeletal, inflammatory, and central pain conditions, and reveal reduction in pain and improvement of quality of life with limited adverse effects. For concussion, evidence is based on preclinical in vitro and animal models revealing possible neuroprotective effects as well as 2 clinical studies involving the presence of cannabinoids for concussion (some sports-related), but there are no high-quality trials evaluating efficacy for treatment with cannabinoids at this time.
Although various biochemical explanations exist on the use of cannabinoid therapy through modulation of the endocannabinoid system for several medical issues affecting athletes, recommendations from clinicians must be extrapolated from a majority of research done in the nonathletic population. Lack of strong-quality clinical evidence, coupled with inconsistent federal and state law as well as purity issues with cannabis-based products, make it difficult for the sports medicine clinician to widely recommend cannabinoid therapeutics at present. Future larger, higher quality clinical research studies with standardized pure extracts will better guide appropriate medical use going forward. At present, evidence for a multitude of therapeutic applications is emerging for cannabinoid treatment approaches. With emphasis placed on patient-centered clinical decisions, cannabinoids hold promise of treatment for athletes with chronic pain conditions. Clinicians who treat the athletic community must consider legal and ethical issues when discussing and recommending the use of cannabinoids, with acknowledgment of inconsistencies in purity of various formulations and concerns of drug testing.
随着公众对大麻类产品在娱乐和医疗方面的使用增加，运动医学临床医生应该了解其历史背景、当前的法律考虑因素以及在运动员群体中关于疗效、安全性和风险的现有证据。
对 2015 年至今的 ClinicalTrials.gov、MEDLINE 和 CINAHL 进行了综述，重点是使用搜索词的最新文献。根据原始搜索的参考文献，利用这些文献进行了进一步的文献搜索。
临床综述。
3 级。
目前，对于大麻素治疗急性疼痛、慢性疼痛或脑震荡的高质量研究有限。没有一项涉及大麻素的试验包括运动员群体。因此，本临床综述的结果被推断为运动医学人群的情况。对于急性疼痛，2 项小型随机双盲交叉试验的结论是大麻素治疗没有立即效果。通过荟萃分析和系统评价有更有力的证据表明慢性疼痛状况的治疗。大麻素治疗作为某些慢性疼痛疾病的治疗方法具有中等疗效。研究包括广泛的慢性疼痛疾病，包括神经病理性、肌肉骨骼性、炎症性和中枢性疼痛疾病，并显示出疼痛减轻和生活质量改善，同时不良反应有限。对于脑震荡，证据基于临床前体外和动物模型，显示出可能的神经保护作用，以及 2 项涉及大麻素存在的临床研究（包括一些与运动相关的），但目前尚无评估大麻素治疗效果的高质量试验。
尽管存在各种生化解释，即通过调节内源性大麻素系统治疗影响运动员的几种医学问题，但临床医生的建议必须从大多数在非运动员人群中进行的研究中推断出来。由于缺乏强有力的高质量临床证据，以及联邦和州法律的不一致以及大麻类产品的纯度问题，运动医学临床医生目前很难广泛推荐大麻素治疗。未来更大、更高质量的临床研究，使用标准化的纯提取物，将更好地指导未来的适当医疗应用。目前，大麻素治疗方法的多种治疗应用的证据正在出现。强调以患者为中心的临床决策，大麻素为慢性疼痛疾病的运动员提供了治疗的希望。治疗运动员群体的临床医生在讨论和推荐大麻素的使用时，必须考虑法律和道德问题，同时承认各种配方的纯度不一致以及药物检测的担忧。
