University of Michigan Medical School, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan.
J Pain. 2021 Nov;22(11):1418-1428. doi: 10.1016/j.jpain.2021.04.011. Epub 2021 May 13.
People report substituting cannabis for pain medications, but whether cannabidiol (CBD) is used similarly remains unknown. CBD products can be CBD alone (isolate), hemp extract (containing <0.3% Δ-9-tetrahydrocannabinol [THC], other cannabinoids, and terpenes), or CBD-cannabis (containing >0.3% THC). In a secondary analysis from a cross-sectional survey, we examined substitution patterns among n = 878 individuals with fibromyalgia who currently used CBD. We sub-grouped participants by most commonly used CBD product (CBD isolate, hemp, CBD-cannabis, no preference) and whether they substituted CBD for medications. We investigated rationale for substituting, substitution-driven medication changes, CBD use patterns, and changes in pain-related symptoms (eg, sleep, anxiety). The study population was 93.6% female and 91.5% Caucasian, with an average age of 55.5 years. The majority (n = 632, 72.0%) reported substituting CBD products for medications, most commonly NSAIDs (59.0%), opioids (53.3%), gabapentanoids (35.0%), and benzodiazepines (23.1%). Most substituting participants reported decreasing or stopping use of these pain medications. The most common reasons for substitution were fewer side effects and better symptom management. Age, hemp products, past-year use of marijuana, and higher somatic burden were all associated with substituting (P's ≤ .05). Those who substituted reported larger improvements in health and pain than those who did not. Participants using CBD-cannabis reported significantly more substitutions than any other group (P's ≤ .001) and larger improvements in health, pain, memory, and sleep than other subgroups. This widespread naturalistic substitution for pain medications suggests the need for more rigorous study designs to examine this effect. PERSPECTIVE: This article shows that people with fibromyalgia are deliberately substituting CBD products for conventional pain medications despite the dearth of evidence suggesting CBD products may be helpful for fibromyalgia. CBD's medication-sparing and therapeutic potential should be examined in more rigorous study designs.
人们报告说用大麻素替代止痛药，但 CBD 是否以类似方式使用仍不清楚。CBD 产品可以是 CBD 纯品（分离物）、大麻提取物（含<0.3% Δ-9-四氢大麻酚 [THC]、其他大麻素和萜烯）或 CBD-大麻素（含>0.3% THC）。在一项横断面调查的二次分析中，我们检查了 878 名患有纤维肌痛症且目前使用 CBD 的个体的替代模式。我们根据最常使用的 CBD 产品（CBD 分离物、大麻、CBD-大麻素、无偏好）和他们是否用 CBD 替代药物将参与者分组。我们调查了替代的理由、替代驱动的药物变化、CBD 使用模式以及与疼痛相关症状（如睡眠、焦虑）的变化。研究人群中 93.6%为女性，91.5%为白种人，平均年龄为 55.5 岁。大多数（n=632，72.0%）报告说用 CBD 产品替代药物，最常见的是 NSAIDs（59.0%）、阿片类药物（53.3%）、加巴喷丁类药物（35.0%）和苯二氮䓬类药物（23.1%）。大多数替代药物的参与者报告说减少或停止使用这些止痛药。替代的最常见原因是副作用更少和更好的症状管理。年龄、大麻素产品、过去一年使用大麻和更高的躯体负担均与替代相关（P 值均≤.05）。那些替代的人报告说在健康和疼痛方面的改善明显大于那些没有替代的人。使用 CBD-大麻素的人报告的替代药物数量明显多于任何其他组（P 值均≤.001），并且在健康、疼痛、记忆和睡眠方面的改善也明显大于其他亚组。这种广泛的自然替代常规止痛药的做法表明需要更严格的研究设计来检验这种效果。观点：本文表明，尽管缺乏 CBD 产品可能对纤维肌痛症有帮助的证据，但患有纤维肌痛症的人故意用 CBD 产品替代常规止痛药。应在更严格的研究设计中检查 CBD 的节省药物和治疗潜力。
