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Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis

BACKGROUND: For patients with chronic, non-cancer pain, traditional pain-relieving medications include opioids, which have shown benefits but are associated with increased risks of addiction and adverse effects. Medical cannabis has emerged as a treatment alternative for managing these patients and...

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Autores principales: Johal, Herman, Devji, Tahira, Chang, Yaping, Simone, Jonathan, Vannabouathong, Christopher, Bhandari, Mohit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031792/
https://www.ncbi.nlm.nih.gov/pubmed/32127750
http://dx.doi.org/10.1177/1179544120906461
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author Johal, Herman
Devji, Tahira
Chang, Yaping
Simone, Jonathan
Vannabouathong, Christopher
Bhandari, Mohit
author_facet Johal, Herman
Devji, Tahira
Chang, Yaping
Simone, Jonathan
Vannabouathong, Christopher
Bhandari, Mohit
author_sort Johal, Herman
collection PubMed
description BACKGROUND: For patients with chronic, non-cancer pain, traditional pain-relieving medications include opioids, which have shown benefits but are associated with increased risks of addiction and adverse effects. Medical cannabis has emerged as a treatment alternative for managing these patients and there has been a rise in the number of randomized clinical trials in recent years; therefore, a systematic review of the evidence was warranted. OBJECTIVE: To analyze the evidence surrounding the benefits and harms of medical cannabinoids in the treatment of chronic, non-cancer-related pain. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Medline, Embase, CINAHL, SCOPUS, Google Scholar, and Cochrane Databases. ELIGIBILITY CRITERIA: English language randomized clinical trials of cannabinoids for the treatment of chronic, non-cancer-related pain. DATA EXTRACTION AND SYNTHESIS: Study quality was assessed using the Cochrane risk of bias tool. All stages were conducted independently by a team of 6 reviewers. Data were pooled through meta-analysis with different durations of treatment (2 weeks, 2 months, 6 months) and stratified by route of administration (smoked, oromucosal, oral), conditions, and type of cannabinoids. MAIN OUTCOMES AND MEASURES: Patient-reported pain and adverse events (AEs). RESULTS: Thirty-six trials (4006 participants) were included, examining smoked cannabis (4 trials), oromucosal cannabis sprays (14 trials), and oral cannabinoids (18 trials). Compared with placebo, cannabinoids showed a significant reduction in pain which was greatest with treatment duration of 2 to 8 weeks (weighted mean difference on a 0-10 pain visual analogue scale −0.68, 95% confidence interval [CI], −0.96 to −0.40, I(2) = 8%, P < .00001; n = 16 trials). When stratified by route of administration, pain condition, and type of cannabinoids, oral cannabinoids had a larger reduction in pain compared with placebo relative to oromucosal and smoked formulations but the difference was not significant (P[interaction] > .05 in all the 3 durations of treatment); cannabinoids had a smaller reduction in pain due to multiple sclerosis compared with placebo relative to other neuropathic pain (P[interaction] = .05) within 2 weeks and the difference was not significant relative to pain due to rheumatic arthritis; nabilone had a greater reduction in pain compared with placebo relative to other types of cannabinoids longer than 2 weeks of treatment but the difference was not significant (P[interaction] > .05). Serious AEs were rare, and similar across the cannabinoid (74 out of 2176, 3.4%) and placebo groups (53 out of 1640, 3.2%). There was an increased risk of non-serious AEs with cannabinoids compared with placebo. CONCLUSIONS: There was moderate evidence to support cannabinoids in treating chronic, non-cancer pain at 2 weeks. Similar results were observed at later time points, but the confidence in effect is low. There is little evidence that cannabinoids increase the risk of experiencing serious AEs, although non-serious AEs may be common in the short-term period following use.
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spelling pubmed-70317922020-03-03 Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis Johal, Herman Devji, Tahira Chang, Yaping Simone, Jonathan Vannabouathong, Christopher Bhandari, Mohit Clin Med Insights Arthritis Musculoskelet Disord Review BACKGROUND: For patients with chronic, non-cancer pain, traditional pain-relieving medications include opioids, which have shown benefits but are associated with increased risks of addiction and adverse effects. Medical cannabis has emerged as a treatment alternative for managing these patients and there has been a rise in the number of randomized clinical trials in recent years; therefore, a systematic review of the evidence was warranted. OBJECTIVE: To analyze the evidence surrounding the benefits and harms of medical cannabinoids in the treatment of chronic, non-cancer-related pain. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Medline, Embase, CINAHL, SCOPUS, Google Scholar, and Cochrane Databases. ELIGIBILITY CRITERIA: English language randomized clinical trials of cannabinoids for the treatment of chronic, non-cancer-related pain. DATA EXTRACTION AND SYNTHESIS: Study quality was assessed using the Cochrane risk of bias tool. All stages were conducted independently by a team of 6 reviewers. Data were pooled through meta-analysis with different durations of treatment (2 weeks, 2 months, 6 months) and stratified by route of administration (smoked, oromucosal, oral), conditions, and type of cannabinoids. MAIN OUTCOMES AND MEASURES: Patient-reported pain and adverse events (AEs). RESULTS: Thirty-six trials (4006 participants) were included, examining smoked cannabis (4 trials), oromucosal cannabis sprays (14 trials), and oral cannabinoids (18 trials). Compared with placebo, cannabinoids showed a significant reduction in pain which was greatest with treatment duration of 2 to 8 weeks (weighted mean difference on a 0-10 pain visual analogue scale −0.68, 95% confidence interval [CI], −0.96 to −0.40, I(2) = 8%, P < .00001; n = 16 trials). When stratified by route of administration, pain condition, and type of cannabinoids, oral cannabinoids had a larger reduction in pain compared with placebo relative to oromucosal and smoked formulations but the difference was not significant (P[interaction] > .05 in all the 3 durations of treatment); cannabinoids had a smaller reduction in pain due to multiple sclerosis compared with placebo relative to other neuropathic pain (P[interaction] = .05) within 2 weeks and the difference was not significant relative to pain due to rheumatic arthritis; nabilone had a greater reduction in pain compared with placebo relative to other types of cannabinoids longer than 2 weeks of treatment but the difference was not significant (P[interaction] > .05). Serious AEs were rare, and similar across the cannabinoid (74 out of 2176, 3.4%) and placebo groups (53 out of 1640, 3.2%). There was an increased risk of non-serious AEs with cannabinoids compared with placebo. CONCLUSIONS: There was moderate evidence to support cannabinoids in treating chronic, non-cancer pain at 2 weeks. Similar results were observed at later time points, but the confidence in effect is low. There is little evidence that cannabinoids increase the risk of experiencing serious AEs, although non-serious AEs may be common in the short-term period following use. SAGE Publications 2020-02-19 /pmc/articles/PMC7031792/ /pubmed/32127750 http://dx.doi.org/10.1177/1179544120906461 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Johal, Herman
Devji, Tahira
Chang, Yaping
Simone, Jonathan
Vannabouathong, Christopher
Bhandari, Mohit
Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis
title Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis
title_full Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis
title_fullStr Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis
title_full_unstemmed Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis
title_short Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis
title_sort cannabinoids in chronic non-cancer pain: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031792/
https://www.ncbi.nlm.nih.gov/pubmed/32127750
http://dx.doi.org/10.1177/1179544120906461
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