Expertenkonsens empfiehlt drei strukturierte Titrationsprotokolle für medizinisches Cannabis bei chronischen Schmerzen, ohne direkte Wirksamkeitsmessung.
Zusammenfassung
20 internationale Experten aus 9 Ländern; Konsens: medizinisches Cannabis geeignet für neuropathische, inflammatorische, nociplastische und gemischte Schmerzen; 3 Dosierungsprotokolle entwickelt (Routine: Start 5 mg CBD 2×/Tag, Titration bis 40 mg/Tag; konservativ: 5 mg 1×/Tag; rapid: balanciert THC:CBD 2,5–5 mg 1–2×/Tag).
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PopulationErwachsene mit chronischen Schmerzen (neuropathisch, entzündlich, noziplastisch, gemischt); 20 globale Experten aus 9 Ländern
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InterventionMedizinisches Cannabis (CBD-dominant, THC:CBD balanciert) – drei Dosierungsprotokolle (Routine, Konservativ, Rapid) mit strukturierter Titration bis max. 40 mg/Tag THC und/oder CBD
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OutcomeKonsens erzielt für drei Behandlungsprotokolle zur Dosierung und Verabreichung von medizinischem Cannabis bei chronischen Schmerzen
<h4>Background</h4>Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed.<h4>Methods</h4>Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain.<h4>Results</h4>There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day.<h4>Conclusions</h4>In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.