Vaporisiertes Cannabis in niedriger Dosis führte zu signifikanter Schmerzreduktion bei neuropathischen Schmerzen mit NNT von 3,2 und minimalem psychoaktivem Effekt.
Zusammenfassung
n=39 zentrale und periphere neuropathische Schmerzen, vaporisiertes Cannabis 1,29%/3,53% THC vs. Placebo; NNT=3,2 (Placebo vs. low-dose) und NNT=2,9 (Placebo vs. medium-dose) für 30% Schmerzreduktion, kein signifikanter Unterschied zwischen aktiven Dosen (p>0,7). Psychoaktive Effekte minimal und gut toleriert, neuropsychologische Effekte reversibel innerhalb 1-2 Stunden.
P
PopulationErwachsene mit zentralem und peripherem neuropathischem Schmerz unter laufender konventioneller Behandlung, n=39
OutcomeSignifikante Schmerzreduktion unter beiden Aktivdosen vs. Placebo; NNT für 30%-Reduktion: 3,2 (Placebo vs. niedrig), 2,9 (Placebo vs. mittel); kein signifikanter Unterschied zwischen den Aktivdosen (p>0,7)
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Moderat
Dritte von vier GRADE-Stufen, die Effektschätzung ist wahrscheinlich verlässlich.
We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling medium-dose (3.53%), low-dose (1.29%), or placebo cannabis with the primary outcome being visual analog scale pain intensity. Psychoactive side effects and neuropsychological performance were also evaluated. Mixed-effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the 2 active dose groups' results (P > .7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo versus low-dose, 2.9 for placebo versus medium-dose, and 25 for medium- versus low-dose. As these NNTs are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well tolerated, and neuropsychological effects were of limited duration and readily reversible within 1 to 2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. PERSPECTIVE: The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (1.29%) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome. In general, the effect sizes on cognitive testing were consistent with this minimal dose. As a result, one might not anticipate a significant impact on daily functioning.