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Medical cannabis in chronic pain An option for some types of pain, while awaiting further evaluation

机译：医疗大麻在慢性疼痛中为某些类型的疼痛提供一种选择，同时等待进一步评估

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France has announced the start of an experimental programme in 2021 involving the use of medical cannabis for certain painful conditions. How effective are cannabis and its derivatives in these situations? And what are their adverse effects?To answer these questions, we reviewed the available evidence using the standard Prescrire methodology. The main cannabis-derived substances that have been evaluated in these situations are: a mixture of standardised Cannabis sativa extracts, containing delta-9-tetrahydrocannabinol (THC) and cannabidiol; THC or preparations containing THC; and the synthetic THC analogue nabilone. In an analysis of 16 double-blind randomised trials, including a total of 1750 adults with neuropathic pain, the analgesic effect of the cannabis derivatives evaluated appeared to be tangibly superior to placebo in only about 5% of treated patients. Possible publication bias reduces the strength of this evidence. The mixture of standardised Cannabis sativa extracts in oromucosal spray form has been evaluated in five double-blind randomised trials in a total of 1539 patients with cancer-related pain. No analgesic effect beyond that of a placebo was found. In three randomised trials in a total of 686 patients with multiple sclerosis, the oromucosal spray containing a mixture of standardised Cannabis sativa extracts was more effective than placebo in relieving painful muscle spasms for about 10% of patients. Adverse effects were common in the clinical trials, and were consistent with those known to occur with recreational cannabis use, primarily dizziness and psychiatric disorders. Many drug interactions are foreseeable with cannabinoids. Withdrawal symptoms have been observed in newborns exposed to cannabis in utero. A potential long-term effect on neuropsychological development after in utero exposure has not been ruled out. Cannabinoids pass into breast milk in considerable quantities. In practice, the adverse effects of cannabis are quite well known, except in pregnancy. They are frequent and sometimes severe, but reversible. Despite little evidence of their efficacy, cannabis-derived drugs sometimes appear to be an option to consider to produce a feeling of wellbeing in patients with neuropathic pain, cancer pain or spasticity-related pain.
机译：法国宣布在2021开始一个实验方案，包括使用医用大麻治疗某些痛苦的疾病。大麻及其衍生物在这些情况下的效果如何？它们的副作用是什么？为了回答这些问题，我们使用标准的Prescrire方法回顾了现有的证据。在这些情况下评估的主要大麻衍生物质是：标准化大麻提取物的混合物，含有δ-9-四氢大麻酚（THC）和大麻二酚；THC或含有THC的制剂；以及合成的THC类似物纳比隆。在对16项双盲随机试验（包括总共1750名患有神经病理性疼痛的成年人）的分析中，仅在约5%的接受治疗的患者中，大麻衍生物的镇痛效果明显优于安慰剂。可能的发表偏倚降低了这一证据的强度。在总共1539名癌症相关疼痛患者的五项双盲随机试验中，对口腔粘膜喷雾剂形式的标准化大麻提取物混合物进行了评估。除安慰剂外，未发现其他镇痛作用。在总共686名多发性硬化症患者的三项随机试验中，含有标准化大麻提取物混合物的口腔粘膜喷雾剂在缓解约10%患者的疼痛性肌肉痉挛方面比安慰剂更有效。不良反应在临床试验中很常见，与已知的娱乐性大麻使用（主要是头晕和精神障碍）的不良反应一致。大麻素与许多药物的相互作用是可以预见的。在子宫内接触大麻的新生儿中观察到了戒断症状。子宫内暴露对神经心理发育的潜在长期影响尚未排除。大麻素大量进入母乳。实际上，大麻的副作用是众所周知的，怀孕期间除外。它们是经常发生的，有时很严重，但是可逆的。尽管很少有证据表明他们的疗效，大麻衍生药物有时似乎是一种选择，以产生一种幸福感在神经病理性疼痛，癌症疼痛或痉挛相关的疼痛患者。

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    《Prescrire international》 |2021年第226期|共5页
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  • 中图分类 药学;
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