Division of Clinical and Translational Research and Washington University Pain Center, Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States.
Center for Neuroplasticity and Pain (CNAP) and Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.
Pain. 2021 Jul 1;162(Suppl 1):S117-S124. doi: 10.1097/j.pain.0000000000002266.
The President of the International Association for the Study of Pain established a task force on cannabis and cannabinoid analgesia to systematically examine the evidence on (1) analgesic pharmacology of cannabinoids and preclinical evidence on their efficacy in animal models of injury-related or pathological persistent pain; (2) the clinical efficacy of cannabis, cannabinoids, and cannabis-based medicines for pain; (3) harms related to long-term use of cannabinoids; as well as (4) societal issues and policy implications related to the use of these compounds for pain management. Here, we summarize key knowledge gaps identified in the task force outputs and propose a research agenda for generating high-quality evidence on the topic. The systematic assessment of preclinical and clinical literature identified gaps in rigor of study design and reporting across the translational spectrum. We provide recommendations to improve the quality, rigor, transparency, and reproducibility of preclinical and clinical research on cannabis and cannabinoids for pain, as well as for the conduct of systematic reviews on the topic. Gaps related to comprehensive understanding of the endocannabinoid system and cannabinoid pharmacology, including pharmacokinetics and drug formulation aspects, are discussed. We outline key areas where high-quality clinical trials with cannabinoids are needed. Remaining important questions about long-term and short-term safety of cannabis and cannabinoids are emphasized. Finally, regulatory, societal, and policy challenges associated with medicinal and nonmedicinal use of cannabis are highlighted, with recommendations for improving patient safety and reducing societal harms in the context of pain management.
国际疼痛研究协会主席成立了一个关于大麻和大麻素镇痛的特别工作组,以系统地检查以下方面的证据:(1)大麻素的镇痛药理学和它们在与损伤相关或病理性持续性疼痛的动物模型中的疗效的临床前证据;(2)大麻、大麻素和基于大麻的药物治疗疼痛的临床疗效;(3)长期使用大麻素相关的危害;以及(4)与使用这些化合物治疗疼痛相关的社会问题和政策影响。在这里,我们总结了特别工作组报告中确定的主要知识空白,并提出了一个研究议程,以生成有关该主题的高质量证据。对临床前和临床文献的系统评估确定了在整个转化谱中研究设计和报告的严谨性方面存在差距。我们提出了建议,以提高大麻和大麻素治疗疼痛的临床前和临床研究的质量、严谨性、透明度和可重复性,以及对该主题的系统评价的进行。讨论了与全面了解内源性大麻素系统和大麻素药理学(包括药代动力学和药物配方方面)相关的差距。我们概述了需要进行高质量大麻素临床试验的关键领域。强调了关于大麻和大麻素长期和短期安全性的重要问题。最后,突出了与药用和非药用大麻使用相关的监管、社会和政策挑战,并提出了在疼痛管理背景下提高患者安全性和减少社会危害的建议。
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