Northwell Health Physician Partners, Institute for Neurology and Neurosurgery, 611 Northern Blvd, Great Neck, NY, 11021, USA.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 611 Northern Blvd, Suite 150, Great Neck, NY, 11021, USA.
Curr Pain Headache Rep. 2021 Oct 9;25(10):64. doi: 10.1007/s11916-021-00974-z.
Public acceptance of Cannabis sativa L. (cannabis) as a therapeutic option grows despite lags in both research and clinician familiarity. Cannabis-whether as a medical, recreational, or illicit substance-is and has been commonly used by patients. With ongoing decriminalization efforts, decreased perception of harms, and increased use of cannabis in the treatment of symptoms and disease, it is critical for clinicians to understand the rationale for specific therapies and their medical and practical implications for patients. In view of the opioid crisis, overall patient dissatisfaction, and lack of adherence to current chronic pain and headache therapies, this review provides up-to-date knowledge on cannabis as a potential treatment option for headache pain.
Research into the use of cannabinoids for disease treatment have led to FDA-approved drugs for seizures, nausea, and vomiting caused by cancer chemotherapy; and for decreased appetite and weight loss in people with HIV/AIDS. For a wide variety of conditions and symptoms (including chronic pain), cannabis has gained increasing acceptance in society. The effects of cannabidiol (CBD) and tetrahydrocannabinol (THC) in pain pathways have been significantly elucidated. An increasing number of retrospective studies have shown a decrease in pain scores after administration of cannabinoids, as well as long-term benefits such as reduced opiate use. Yet, there is no FDA-approved cannabis product for headache or other chronic pain disorders. More is being done to determine who is likely to benefit from cannabis as well as to understand the long-term effects and limitations of the treatment. Cannabis can refer to a number of products derived from the plant Cannabis sativa L. Relatively well-tolerated, these products come in different configurations, types, and delivery forms. Specific formulations of the plant have been shown to be an effective treatment modality for chronic pain, including headache. It is important for clinicians to know which product is being discussed as well as the harms, benefits, contraindications, interactions, and unknowns in order to provide the best counsel for patients.
尽管研究和临床医生的熟悉程度都存在滞后，但公众对大麻素治疗选择的接受度仍在提高。大麻无论是作为医疗、娱乐还是非法物质，都被患者广泛使用。随着不断的非刑事化努力、对危害的认知降低以及大麻在治疗症状和疾病方面的使用增加，临床医生了解特定疗法的基本原理及其对患者的医学和实际影响至关重要。鉴于阿片类药物危机、整体患者不满以及对当前慢性疼痛和头痛治疗的不依从性，本综述提供了大麻作为头痛潜在治疗选择的最新知识。
对大麻素用于疾病治疗的研究导致了 FDA 批准的用于治疗癫痫、癌症化疗引起的恶心和呕吐以及艾滋病患者的食欲下降和体重减轻的药物；对于各种疾病和症状（包括慢性疼痛），大麻在社会上的接受度越来越高。大麻素在疼痛通路中的作用已得到充分阐明。越来越多的回顾性研究表明，使用大麻素后疼痛评分降低，长期获益包括减少阿片类药物的使用。然而，目前还没有 FDA 批准的用于头痛或其他慢性疼痛疾病的大麻产品。人们正在做更多的工作来确定谁可能从大麻中受益，并了解治疗的长期效果和局限性。大麻可以指从大麻植物中提取的多种产品。这些产品相对耐受良好，有不同的配方、类型和给药形式。已证明植物的特定制剂是治疗慢性疼痛（包括头痛）的有效治疗方式。临床医生了解正在讨论的哪种产品以及其危害、益处、禁忌症、相互作用和未知因素，以便为患者提供最佳建议，这一点非常重要。
