Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies
Stockings et al.·PainImpact 4.2
Kein Nutzen nachgewiesenGRADEHoch466 Zitate
Stichprobek = 104 Studien n = 9.958 Pat.
Dauerunklar
KontrollePlacebo
EndpunktVAS
Verblindungn.a.
DesignMeta-Analyse
”Kernaussage
Cannabinoide zeigen nur minimale Schmerzreduktion (3 mm auf 100-mm-Skala) gegenüber Placebo mit hoher Schadensrate; Nutzen-Schaden-Verhältnis ungünstig (NNT 24 vs. NNH 6).
Zusammenfassung
Umfassende SR+MA zu Cannabinoiden bei chronischem Nicht-Tumor-Schmerz; k=104 Studien (47 RCTs, 57 Beobachtungsstudien), n=9.958 Teilnehmende. Fibromyalgie-Subgruppe: k=7 Studien. Gepoolte RCT-Daten: 30%-Schmerzreduktion 29,0% (Cannabinoide) vs. 25,9% (Placebo), signifikant, NNTB=24 (95% CI 15-61); 50%-Schmerzreduktion 18,2% vs. 14,4%, nicht signifikant. Schmerzintensitäts-Reduktion SMD=-0,14 (95% CI -0,20 bis -0,08), entspricht 3 mm auf 100-mm-VAS. Unerwünschte Ereignisse 81,2% vs. 66,2%, NNTH=6 (95% CI 5-8). Kein signifikanter Effekt auf körperliche/emotionale Funktion; schwache Evidenz für Schlaf-Verbesserung. Autoren-Schlussfolgerung: begrenzte Wirksamkeit, hohes NNTB, niedriges NNTH.
P
PopulationErwachsene mit chronischem nicht-tumorbedingtem Schmerz (CNCP), gepoolt n=9.958
I
InterventionCannabinoide (verschiedene Typen und Applikationsformen)
C
KontrollePlacebo (in RCTs)
O
Outcome30%-Schmerzreduktion: PER 29,0% vs. 25,9% (signifikant, NNT=24, 95%-CI 15–61); 50%-Schmerzreduktion: kein signifikanter Unterschied; gepoolte Schmerzintensitätsänderung SMD –0,14 (95%-CI –0,20 bis –0,08), entspricht ~3 mm auf 100-mm-VAS; unerwünschte Ereignisse: NNH=6 (95%-CI 5–8)
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Hoch
Höchste von vier GRADE-Stufen, die Effektschätzung ist sehr verlässlich.
This review examines evidence for the effectiveness of cannabinoids in chronic noncancer pain (CNCP) and addresses gaps in the literature by: considering differences in outcomes based on cannabinoid type and specific CNCP condition; including all study designs; and following IMMPACT guidelines. MEDLINE, Embase, PsycINFO, CENTRAL, and clinicaltrials.gov were searched in July 2017. Analyses were conducted using Revman 5.3 and Stata 15.0. A total of 91 publications containing 104 studies were eligible (n = 9958 participants), including 47 randomised controlled trials (RCTs) and 57 observational studies. Forty-eight studies examined neuropathic pain, 7 studies examined fibromyalgia, 1 rheumatoid arthritis, and 48 other CNCP (13 multiple sclerosis-related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). Across RCTs, pooled event rates (PERs) for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo); significant effect for cannabinoids was found; number needed to treat to benefit was 24 (95% confidence interval [CI] 15-61); for 50% reduction in pain, PERs were 18.2% vs 14.4%; no significant difference was observed. Pooled change in pain intensity (standardised mean difference: -0.14, 95% CI -0.20 to -0.08) was equivalent to a 3 mm reduction on a 100 mm visual analogue scale greater than placebo groups. In RCTs, PERs for all-cause adverse events were 81.2% vs 66.2%; number needed to treat to harm: 6 (95% CI 5-8). There were no significant impacts on physical or emotional functioning, and low-quality evidence of improved sleep and patient global impression of change. Evidence for effectiveness of cannabinoids in CNCP is limited. Effects suggest that number needed to treat to benefit is high, and number needed to treat to harm is low, with limited impact on other domains. It seems unlikely that cannabinoids are highly effective medicines for CNCP.