Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review
Campbell et al.·BMJ
Kein Nutzen nachgewiesenGRADEHoch424 Zitate
Stichprobek = 9 Studien n = 222 Pat.
KontrolleCodein 50–120 mg oder Placebo
EndpunktSchmerzintensität /…
Verblindungunklar
DesignSystematische Review
Cannabinoidthc
Max. Dosis20.0 mg
”Kernaussage
Cannabinoide sind Codein nicht überlegen und verursachen häufige psychotrope Nebenwirkungen, sodass ein breiter klinischer Einsatz zur Schmerztherapie als nicht empfehlenswert gilt.
Zusammenfassung
Systematische Review über k=9 RCTs (n=222) zu Cannabinoiden bei akutem, chronisch-nicht-malignem und Krebsschmerz; orales THC 5-20 mg, synthetisches THC-Analogon und i.m. Levonantradol vergleichbar wirksam wie Codein 50-120 mg; orales Benzopyranoperidol schlechter als Codein 60-120 mg und nicht besser als Placebo. Cannabinoide NICHT überlegen gegenüber Codein; häufige ZNS-Nebenwirkungen.
P
PopulationPatienten mit akutem, chronisch nicht-malignem oder Tumorschmerz; gepoolte Teilnehmerzahl n=222 aus 9 RCTs
OutcomeCannabinoide etwa so wirksam wie Codein 50–120 mg (THC, Levonantradol); Benzopyranopiperin schlechter als Codein und nicht besser als Placebo; häufige psychotrope Nebenwirkungen
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Hoch
Höchste von vier GRADE-Stufen, die Effektschätzung ist sehr verlässlich.
<h4>Objective</h4>To establish whether cannabis is an effective and safe treatment option in the management of pain.<h4>Design</h4>Systematic review of randomised controlled trials.<h4>Data sources</h4>Electronic databases Medline, Embase, Oxford Pain Database, and Cochrane Library; references from identified papers; hand searches.<h4>Study selection</h4>Trials of cannabis given by any route of administration (experimental intervention) with any analgesic or placebo (control intervention) in patients with acute, chronic non-malignant, or cancer pain. Outcomes examined were pain intensity scores, pain relief scores, and adverse effects. Validity of trials was assessed independently with the Oxford score.<h4>Data extraction</h4>Independent data extraction; discrepancies resolved by consensus.<h4>Data synthesis</h4>20 randomised controlled trials were identified, 11 of which were excluded. Of the 9 included trials (222 patients), 5 trials related to cancer pain, 2 to chronic non-malignant pain, and 2 to acute postoperative pain. No randomised controlled trials evaluated cannabis; all tested active substances were cannabinoids. Oral delta-9-tetrahydrocannabinol (THC) 5-20 mg, an oral synthetic nitrogen analogue of THC 1 mg, and intramuscular levonantradol 1.5-3 mg were about as effective as codeine 50-120 mg, and oral benzopyranoperidine 2-4 mg was less effective than codeine 60-120 mg and no better than placebo. Adverse effects, most often psychotropic, were common.<h4>Conclusion</h4>Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use. Their widespread introduction into clinical practice for pain management is therefore undesirable. In acute postoperative pain they should not be used. Before cannabinoids can be considered for treating spasticity and neuropathic pain, further valid randomised controlled studies are needed.