大麻素类药物在术后疼痛管理中的应用:从分子机制到临床现实。

Cannabinoid Analgesia in Postoperative Pain Management: From Molecular Mechanisms to Clinical Reality.

机构信息

Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain.

Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain.

出版信息

Int J Mol Sci. 2024 Jun 6;25(11):6268. doi: 10.3390/ijms25116268.

Abstract

Postoperative pain (POP) is a challenging clinical phenomenon that affects the majority of surgical patients and demands effective management to mitigate adverse outcomes such as persistent pain. The primary goal of POP management is to alleviate suffering and facilitate a seamless return to normal function for the patient. Despite compelling evidence of its drawbacks, opioid analgesia remains the basis of POP treatment. Novel therapeutic approaches rely on multimodal analgesia, integrating different pharmacological strategies to optimize efficacy while minimizing adverse effects. The recognition of the imperative role of the endocannabinoid system in pain regulation has prompted the investigation of cannabinoid compounds as a new therapeutic avenue. Cannabinoids may serve as adjuvants, enhancing the analgesic effects of other drugs and potentially replacing or at least reducing the dependence on other long-term analgesics in pain management. This narrative review succinctly summarizes pertinent information on the molecular mechanisms, clinical therapeutic benefits, and considerations associated with the plausible use of various cannabinoid compounds in treating POP. According to the available evidence, cannabinoid compounds modulate specific molecular mechanisms intimately involved in POP. However, only two of the eleven clinical trials that evaluated the efficacy of different cannabinoid interventions showed positive results.

摘要

术后疼痛(POP)是一种具有挑战性的临床现象,影响着大多数手术患者,需要有效的管理来减轻不良后果,如持续性疼痛。POP 管理的主要目标是减轻痛苦,促进患者恢复正常功能。尽管阿片类镇痛药存在明显的弊端,但仍是 POP 治疗的基础。新的治疗方法依赖于多模式镇痛,整合不同的药理策略以优化疗效,同时最小化不良反应。内源性大麻素系统在疼痛调节中的重要作用得到了认识,这促使人们研究大麻素化合物作为一种新的治疗途径。大麻素类药物可用作佐剂,增强其他药物的镇痛效果,并有可能替代或至少减少疼痛管理中长期使用的其他药物的依赖。本综述简要总结了各种大麻素化合物治疗 POP 的分子机制、临床治疗益处以及潜在应用相关的信息。根据现有证据,大麻素类化合物调节与 POP 密切相关的特定分子机制。然而,在评估不同大麻素干预措施疗效的 11 项临床试验中,只有两项显示出积极的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c325/11172912/2ac10e43d450/ijms-25-06268-g001.jpg

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