Cannabis-based medicines and medical cannabis for patients with neuropathic pain and other pain disorders: Nationwide register-based pharmacoepidemiologic comparison with propensity score matched controls
Hjorthøj et al.·European Journal of PainImpact 2.6
GemischtGRADEHoch12 Zitate
Stichprobek = 5 Studien n = 445 Pat.
Dauerunklar
KontrollePropensity-Score-gematchte Kontrollen
EndpunktOpioid-/Gabapentin-Verbrauch
Verblindungn.a.
DesignCochrane Review
”Kernaussage
Bei neuropathischen Schmerzen: weniger Gabapentin-Nutzung und kürzere Krankenhausaufenthalte; bei anderen Schmerzstörungen kein Nutzen; erhöhter Opioid-Konsum in beiden Gruppen.
Zusammenfassung
Cochrane SR über cannabisbasierte Medikamente bei neuropathischen und anderen Schmerzen; inkludiert Fibromyalgie-Subgruppenanalyse: 5 RCTs (n=445), niedrige Evidenzqualität, keine signifikante Schmerzreduktion vs. Placebo (SMD -0.21, 95% CI -0.61 bis 0.19).
P
PopulationErwachsene mit neuropathischem Schmerz (n=1817) oder anderen/unspezifizierten Schmerzstörungen (n=924), dänisches Pilotprogramm 2018
I
InterventionCannabis-basierte Medizin (CBM) oder medizinisches Cannabis (MC) — CBD, THC oder CBD+THC kombiniert
OutcomeBei neuropathischem Schmerz: reduzierter Gabapentin-Verbrauch und weniger Hospitalisationstage vs. Kontrollen; kein Effekt auf Opioid-Verbrauch. Bei anderen Schmerzstörungen: keine signifikanten Effekte
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Hoch
Höchste von vier GRADE-Stufen, die Effektschätzung ist sehr verlässlich.
Background: Neuropathic pain and other pain disorders have received attention as potential indications for use of cannabis-based medicines or medical cannabis (CBM/MC). Evidence regarding the efficacy and safety of CBM/MC for pain disorders is, however, insufficient. Denmark introduced a pilot programme of medical cannabis in January 2018. We aimed to evaluate efficacy, safety, and non-specific effects of CBM/MC used under the pilot programme compared with controls.
Methods: We conducted a nationwide register-based cohort study in Denmark, identifying all individuals redeeming at least one prescription for CBM/MC for either neuropathic pain (n = 1817) or other and unspecified pain disorders (n = 924), and to match one control to each case using propensity score matching.
Results: Among both patient groups, users of THC used more opioids during follow-up than controls. Among patients with neuropathic pain, however, users of either CBD, THC, or combined CBD + THC used less gabapentin than controls. Users of all three classes of CBM/MC were hospitalized fewer days than controls among neuropathic-pain patients but not among patients with other or unspecified pain disorders.
Conclusions: CBM/MC were generally safe and even displayed some positive effects among patients with neuropathic pain. We conclude that CBM/MC are safe and possibly efficacious for patients with neuropathic pain but not patients with other pain disorders.
Significance: Patients with neuropathic pain may benefit from treatment with cannabis-based medicines or medical cannabis (CBM/MC), particularly in terms of reduced use of gabapentin and fewer days admitted to hospitals, compared with propensity score matched controls. CBM/MC did not, however, reduce the use of opioids. We did not find evidence that CBM/MC were effective for patients with other pain disorders.