基于大麻的产品治疗慢性疼痛：系统评价。

Cannabis-Based Products for Chronic Pain : A Systematic Review.

机构信息

Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (M.S.M., J.W., A.Y.A., R.C.).

Center to Improve Veteran Involvement in Care, VA Portland Health Care System, and Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, Oregon (B.J.M.).

出版信息

Ann Intern Med. 2022 Aug;175(8):1143-1153. doi: 10.7326/M21-4520. Epub 2022 Jun 7.

DOI:10.7326/M21-4520

PMID:35667066

Abstract

BACKGROUND

Contemporary data are needed about the utility of cannabinoids in chronic pain.

PURPOSE

To evaluate the benefits and harms of cannabinoids for chronic pain.

DATA SOURCES

Ovid MEDLINE, PsycINFO, EMBASE, the Cochrane Library, and Scopus to January 2022.

STUDY SELECTION

English-language, randomized, placebo-controlled trials and cohort studies (≥1 month duration) of cannabinoids for chronic pain.

DATA EXTRACTION

Data abstraction, risk of bias, and strength of evidence assessments were dually reviewed. Cannabinoids were categorized by THC-to-CBD ratio (high, comparable, or low) and source (synthetic, extract or purified, or whole plant).

DATA SYNTHESIS

Eighteen randomized, placebo-controlled trials ( = 1740) and 7 cohort studies ( = 13 095) assessed cannabinoids. Studies were primarily short term (1 to 6 months); 56% enrolled patients with neuropathic pain, with 3% to 89% female patients. Synthetic products with high THC-to-CBD ratios (>98% THC) may be associated with moderate improvement in pain severity and response (≥30% improvement) and an increased risk for sedation and are probably associated with a large increased risk for dizziness. Extracted products with high THC-to-CBD ratios (range, 3:1 to 47:1) may be associated with large increased risk for study withdrawal due to adverse events and dizziness. Sublingual spray with comparable THC-to-CBD ratio (1.1:1) probably is associated with small improvement in pain severity and overall function and may be associated with large increased risk for dizziness and sedation and moderate increased risk for nausea. Evidence for other products and outcomes, including longer-term harms, were not reported or were insufficient.

LIMITATION

Variation in interventions; lack of study details, including unclear availability in the United States; and inadequate evidence for some products.

CONCLUSION

Oral, synthetic cannabis products with high THC-to-CBD ratios and sublingual, extracted cannabis products with comparable THC-to-CBD ratios may be associated with short-term improvements in chronic pain and increased risk for dizziness and sedation. Studies are needed on long-term outcomes and further evaluation of product formulation effects.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. (PROSPERO: CRD42021229579).

摘要

背景

需要了解有关大麻素在慢性疼痛中的应用的最新数据。

目的

评估大麻素治疗慢性疼痛的疗效和安全性。

数据来源

2022 年 1 月前 Ovid MEDLINE、PsycINFO、EMBASE、Cochrane 图书馆和 Scopus 中的英文随机对照试验、安慰剂对照试验和队列研究。

研究选择

评估大麻素治疗慢性疼痛的随机、安慰剂对照试验和队列研究（持续时间≥1 个月）。

数据提取

对数据提取、偏倚风险和证据强度评估进行了双重审查。根据 THC 与 CBD 比值（高、相当或低）和来源（合成、提取或纯化或全植物）对大麻素进行分类。

数据综合

18 项随机、安慰剂对照试验（=1740）和 7 项队列研究（=13095）评估了大麻素。研究主要为短期（1-6 个月）；56%的患者患有神经性疼痛，女性患者占 3%-89%。高 THC 与 CBD 比值（>98%THC）的合成产品可能与疼痛严重程度和反应（≥30%改善）的适度改善以及镇静的风险增加相关，并且可能与头晕的风险显著增加相关。高 THC 与 CBD 比值（范围为 3:1 至 47:1）的提取产品可能与因不良反应和头晕导致的研究退出的风险显著增加相关。具有相当 THC 与 CBD 比值（1.1:1）的舌下喷雾可能与疼痛严重程度和整体功能的适度改善相关，并且可能与头晕和镇静的风险增加以及恶心的风险中度增加相关。其他产品和结局（包括长期危害）的证据没有报道或不足。