Department of Experimental Dentistry, Wroclaw Medical University, Poland.
Collegium Medicum, Jan Dlugosz University in Czestochowa, Poland.
Dent Med Probl. 2024 Sep-Oct;61(5):765-782. doi: 10.17219/dmp/193020.
Chronic pain affects up to 40% of adults, contributing to high medical expenses, the loss of productivity, reduced quality of life (QoL), and disability. Chronic pain requires detailed diagnostic assessment, treatment and rehabilitation, yet approx. 80% of patients report inadequate pain management. As new treatment options are needed, we aimed to explore the effectiveness of medical cannabis-based products in managing chronic pain, with a particular focus on treatment patterns.We searched the PubMed, Scopus and Web of Science databases using keywords related to cannabinoids and chronic pain syndromes. In total, 3,954 articles were identified, and 74 studies involving 12,562 patients were included. The effectiveness of cannabis-based products varied across studies. Cannabinoids were most effective in treating chronic secondary headache and orofacial pain, chronic secondary musculoskeletal pain, chronic secondary visceral pain, and chronic neuropathic pain. Properly qualifying patients is the first crucial step in managing chronic pain, considering pain characteristics, comorbidities and other treatment options. Treatment should start with low doses of cannabinoids, which are then increased to achieve the desired therapeutic effect while minimizing adverse effects.This narrative review revealed significant gaps in the evidence regarding precise treatment patterns, particularly for the long-term maintenance treatment needed by patients with chronic pain. Medical cannabis can be considered an option for carefully selected patients with chronic pain syndromes when other treatment options fail to achieve an adequate response, and when the potential benefits outweigh the risks. However, there is still a need for well-designed clinical research to establish the long-term efficacy and safety of cannabinoids.
慢性疼痛影响高达 40%的成年人，导致高额医疗费用、生产力下降、生活质量降低和残疾。慢性疼痛需要详细的诊断评估、治疗和康复，但约 80%的患者报告疼痛管理不足。由于需要新的治疗选择，我们旨在探索基于医用大麻的产品在管理慢性疼痛方面的有效性，特别关注治疗模式。我们使用与大麻素和慢性疼痛综合征相关的关键词，在 PubMed、Scopus 和 Web of Science 数据库中进行了搜索。总共确定了 3954 篇文章，并纳入了 74 项涉及 12562 名患者的研究。大麻素产品的有效性因研究而异。大麻素在治疗慢性继发性头痛和口腔面部疼痛、慢性继发性肌肉骨骼疼痛、慢性继发性内脏疼痛和慢性神经性疼痛方面最为有效。正确甄别患者是管理慢性疼痛的第一步，要考虑疼痛特征、合并症和其他治疗选择。治疗应从低剂量的大麻素开始，然后逐渐增加剂量，以达到理想的治疗效果，同时最小化不良反应。这项叙述性综述揭示了关于精确治疗模式的证据存在显著差距，特别是对于慢性疼痛患者需要的长期维持治疗。当其他治疗选择无法达到足够的反应，并且潜在益处大于风险时，可以考虑将医用大麻作为慢性疼痛综合征的精选患者的一种选择。然而，仍需要进行精心设计的临床研究，以确定大麻素的长期疗效和安全性。
