School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Pain Pract. 2022 Nov;22(8):718-732. doi: 10.1111/papr.13161. Epub 2022 Sep 10.
RATIONALE, AIMS, AND OBJECTIVES: Chronic pain is a global public health problem that negatively impacts individuals' quality of life and imposes a substantial economic burden on societies. The use of medicinal cannabis (MC) is often considered by patients to help manage chronic pain as an alternative or supplement to more conventional treatments, given enabling legalization in a number of countries. However, healthcare professionals involved in providing guidance for patients related to MC are often doing so in the absence of strong evidence and clinical guidelines. Therefore, it is crucial to understand their perspectives regarding the clinical use and relevance of MC for chronic pain. As little is known about attitudes of HCPs with regard to MC use for chronic pain specifically, the aim of this review was to identify and synthesize the published evidence on this topic.
A systematic search was conducted across six databases: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and PubMed from 2001 to March 26, 2021. Three authors independently performed the study selection and data extraction. Thematic analysis was undertaken to identify key themes.
A total of 26 studies were included, involving the United States, Israel, Canada, Australia, Ireland, and Norway, and the perspectives of physicians, nurses, and pharmacists. Seven key themes were identified: MC as a treatment option for chronic pain, and perceived indicated uses; willingness to prescribe MC; legal issues; low perceived knowledge and the need for education; comparative safety of MC versus opioids; addiction and abuse; and perceived adverse effects; CONCLUSION: To support best practice in the use of MC for chronic pain, healthcare professionals require education and training, as well as clinical guidelines that provide evidence-based information about efficacy, safety, and appropriate dosage of products for this indication. Until these gaps are addressed, healthcare professionals will be limited in their capacity to make treatment recommendations about MC for people/patients with chronic pain.
背景、目的和目标：慢性疼痛是一个全球性的公共卫生问题，它对个人的生活质量产生负面影响，并给社会带来巨大的经济负担。鉴于一些国家使医用大麻合法化，患者经常将其用作替代或补充传统治疗方法来帮助管理慢性疼痛。然而，参与为患者提供医用大麻相关指导的医疗保健专业人员通常在缺乏有力证据和临床指南的情况下这样做。因此，了解他们对医用大麻治疗慢性疼痛的临床应用和相关性的看法至关重要。由于人们对医疗保健专业人员在慢性疼痛方面使用医用大麻的态度知之甚少，因此本综述的目的是确定和综合这一主题的已发表证据。
对六个数据库（MEDLINE、EMBASE、CINAHL、Scopus、Web of Science 和 PubMed）进行了系统检索，检索时间为 2001 年至 2021 年 3 月 26 日。三名作者独立进行了研究选择和数据提取。采用主题分析来确定关键主题。
共纳入 26 项研究，涉及美国、以色列、加拿大、澳大利亚、爱尔兰和挪威的医生、护士和药剂师的观点。确定了七个关键主题：医用大麻是治疗慢性疼痛的一种选择，以及被认为的适应症；愿意开医用大麻处方；法律问题；知识水平低，需要教育；医用大麻与阿片类药物相比的相对安全性；成瘾和滥用；以及被认为的不良反应。
为了支持慢性疼痛医用大麻使用的最佳实践，医疗保健专业人员需要教育和培训，以及提供有关疗效、安全性和该适应症产品适当剂量的循证信息的临床指南。在这些差距得到解决之前，医疗保健专业人员在为慢性疼痛患者提供医用大麻治疗建议方面的能力将受到限制。
