University Emergency Department, University of Pecs, Clinical Centre, Hungary.
School of Medicine, Cardiff University, Cardiff, United Kingdom of Great Britain and Northern Ireland.
Expert Rev Clin Pharmacol. 2021 Jun;14(6):671-675. doi: 10.1080/17512433.2021.1917379. Epub 2021 Apr 28.
The pooled worldwide prevalence of low-back pain-related presentations in primary care varies between 6.8% and 28.4% in the high-income countries rendering it a major healthcare/economy problem. To best manage this complex bio-psycho-social condition a 360-degree approach is needed, as the psycho-social components are often more important than the scant pathophysiology. Pattern analysis of cannabis users suggested that attempts to alleviate musculo-skeletal pain is often seen as a major drive to use cannabinoids.
Unlike NSAIDs/opioids, cannabidiol might directly affect more than one modality of pain signaling/perception. The 2019 guideline of the National Institute for Clinical Excellence recommended further studies with cannabidiol in pain medicine because of its excellent safety profile and presumed therapeutic potential. Therefore, we have researched relevant databases for pharmaco-physiological papers published between 2000 and 2021 to collate evidence in a narrative fashion to determine the clinical rationale for this cannabinoid in low-back pain.
Observational research reported good results with CBD in pain and fear reduction, which are both key factors in low-back pain. Given the paucity of high-quality evidence, further research is needed to determine the efficacy/non-inferiority of CBD in primary/emergency care setting, using multimodal assessment of various patient-reported outcomes.
在高收入国家，初级保健中与下背痛相关的就诊率在 6.8%至 28.4%之间波动，这使其成为一个主要的医疗保健/经济问题。为了更好地管理这种复杂的生物-心理-社会状况，需要采用 360 度全方位方法，因为心理社会因素通常比微不足道的病理生理学更为重要。对大麻使用者的模式分析表明，缓解肌肉骨骼疼痛的尝试通常被视为使用大麻素的主要动力。
与非甾体抗炎药/阿片类药物不同，大麻二酚可能直接影响不止一种疼痛信号/感知模式。由于其出色的安全性和假定的治疗潜力，2019 年国家临床卓越研究所的指南建议在疼痛医学中进一步研究大麻二酚。
因此，我们研究了相关数据库中的药理学和生理学论文，这些论文发表于 2000 年至 2021 年之间，以叙述方式整理证据，以确定这种大麻素在治疗下背痛方面的临床原理。
观察性研究报告了 CBD 在减轻疼痛和恐惧方面的良好效果，这两者都是下背痛的关键因素。鉴于高质量证据的缺乏，需要进一步研究，以确定 CBD 在初级/急诊保健环境中的疗效/非劣效性，使用各种患者报告结局的多模式评估。
