Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, New York, USA.
State University of New York Upstate Medical University, Norton School of Medicine, Syracuse, New York, USA.
Am J Addict. 2023 Nov;32(6):532-538. doi: 10.1111/ajad.13456. Epub 2023 Aug 7.
Public opinion about cannabis as a medical treatment is generally favorable. As many as 35% of primary care patients report medical use of cannabis, most commonly for pain treatment. We designed a way to test whether cannabis helps chronic pain.
A retrospective cohort study was conducted to explore whether daily long-term cannabis use was associated with increased pain sensitivity using the cold pressor test (CPT) to measure pain tolerance. Patients who used cannabis every day were compared to patients who inhaled tobacco and control patients who never used tobacco or cannabis. The effect of cannabis use on CPT was assessed using a generalized linear model.
Patients using cannabis daily had a median CPT of 46 s, similar to those who did not use cannabis but who inhaled tobacco (median CPT 45 s). Patients who used both cannabis and tobacco had the lowest CPT (median 26 s). The control group had a median CPT of 105 s. Cannabis use was associated with a significantly decreased pain tolerance (χ² = 8.0, p = .004). The effect of tobacco on CPT was only marginally significant (χ² = 3.8, p = .052).
This suggests a phenomenon similar to opioid-induced hyperalgesia; a drug that reduces pain short term, induces pain long term-opponent process. Daily cannabis use may make chronic pain worse over time by reducing pain tolerance. In terms of risk/benefit, daily cannabis users risk addiction without any long-term benefit for chronic pain.
公众对大麻作为一种治疗方法的看法普遍较为积极。多达 35%的初级保健患者报告说使用大麻进行医疗治疗，最常见的是用于治疗疼痛。我们设计了一种方法来测试大麻是否有助于治疗慢性疼痛。
进行了一项回顾性队列研究，以探索使用冷加压测试（CPT）测量疼痛耐受力来衡量，长期每日使用大麻是否与疼痛敏感性增加有关。将每天使用大麻的患者与吸入烟草的患者和从未使用过烟草或大麻的对照组患者进行比较。使用广义线性模型评估大麻使用对 CPT 的影响。
每天使用大麻的患者的 CPT 中位数为 46 秒，与未使用大麻但吸入烟草的患者相似（CPT 中位数为 45 秒）。同时使用大麻和烟草的患者 CPT 最低（中位数 26 秒）。对照组的 CPT 中位数为 105 秒。大麻使用与疼痛耐受力显著降低相关（χ²=8.0，p=0.004）。烟草对 CPT 的影响仅具有边缘统计学意义（χ²=3.8，p=0.052）。
这表明存在一种类似于阿片类药物引起的痛觉过敏的现象；一种短期减轻疼痛的药物，长期会导致疼痛-对立过程。随着时间的推移，每日使用大麻可能会通过降低疼痛耐受力而使慢性疼痛恶化。就风险/获益而言，每日使用大麻的患者有上瘾的风险，而对慢性疼痛没有任何长期益处。
