Meghani Salimah H, Quinn Ryan, Ashare Rebecca, Levoy Kristin, Worster Brooke, Naylor Mary, Chittams Jesse, Cheatle Martin
Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
J Pain Res. 2021 Nov 5;14:3493-3502. doi: 10.2147/JPR.S332447. eCollection 2021.
Based on many published reports, African American patients with cancer experience higher pain severity scores and lower pain relief than White patients. This disparity results from undertreatment of pain and is compounded by low adherence to prescribed non-opioid and opioid analgesics among African American patients with cancer. While nearly one in four patients use cannabis to manage cancer-related symptoms, less is known about how cannabis use influences pain relief in this patient population.
This study is based on preliminary data from an ongoing study of longitudinal outcomes of opioid therapy among African American and White patients with cancer. Linear mixed-effects models were utilized to assess the interaction of race and cannabis use on pain relief using "least pain" item scores from the Brief Pain Inventory (BPI) averaged across three time points. Models were adjusted for sociodemographic and clinical variables.
This analysis included 136 patients (49 African American, 87 White). Overall, 30.1% of the sample reported cannabis use for cancer pain. The mean "least pain" score on BPI was 3.3 (SD=2.42) on a scale of 0-10. African American patients had a mean "least pain" score 1.32±0.48 units higher (indicating lower pain relief) than White patients (=0.006). Cannabis use did not have a significant main effect (=0.28). However, cannabis use was a significant moderator of the relationship between race and "least pain" (=0.03). In the absence of cannabis use, African Americans reported higher "least pain" scores compared to Whites (mean difference=1.631±0.5, =0.001). However, this disparity was no longer observed in African American patients reporting cannabis use (mean "least pain" difference=0.587±0.59, =0.32).
These findings point to the possible role of cannabis in cancer pain management and its potential to reduce racial disparities. These findings are preliminary and further research into the role of cannabis in cancer pain outcomes is needed.
基于许多已发表的报告，患有癌症的非裔美国患者比白人患者经历更高的疼痛严重程度评分和更低的疼痛缓解程度。这种差异是由疼痛治疗不足导致的，并且因非裔美国癌症患者对处方非阿片类和阿片类镇痛药的低依从性而加剧。虽然近四分之一的患者使用大麻来管理与癌症相关的症状，但对于大麻使用如何影响该患者群体的疼痛缓解了解较少。
本研究基于一项正在进行的关于非裔美国和白人癌症患者阿片类药物治疗纵向结果的研究的初步数据。使用线性混合效应模型，利用简明疼痛量表（BPI）在三个时间点的平均“最轻微疼痛”项目评分来评估种族和大麻使用对疼痛缓解的相互作用。模型针对社会人口统计学和临床变量进行了调整。
该分析纳入了136名患者（49名非裔美国人，87名白人）。总体而言，30.1%的样本报告使用大麻来缓解癌症疼痛。BPI上的平均“最轻微疼痛”评分为3.3（标准差 = 2.42），范围为0至10。非裔美国患者的平均“最轻微疼痛”评分比白人患者高1.32±0.48个单位（表明疼痛缓解程度更低）（P = 0.006）。大麻使用没有显著的主效应（P = 0.28）。然而，大麻使用是种族与“最轻微疼痛”之间关系的显著调节因素（P = 0.03）。在不使用大麻的情况下，与白人相比，非裔美国人报告的“最轻微疼痛”评分更高（平均差异 = 1.631±0.5，P = 0.001）。然而，在报告使用大麻的非裔美国患者中不再观察到这种差异（平均“最轻微疼痛”差异 = 0.587±0.59，P = 0.32）。
这些发现表明大麻在癌症疼痛管理中可能发挥的作用及其减少种族差异的潜力。这些发现是初步的，需要对大麻在癌症疼痛结果中的作用进行进一步研究。
