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Analgesic Effects of Cannabinoids for Chronic Non-cancer Pain: a Systematic Review and Meta-Analysis with Meta-Regression
Journal of Neuroimmune Pharmacology ( IF 6.2 ) Pub Date : 2020-03-14 , DOI: 10.1007/s11481-020-09905-y
Stanley Sau Ching Wong 1, 2 , Wing Shing Chan 2 , Chi Wai Cheung 1, 2
Affiliation  

There is growing interest in using cannabinoids for chronic pain. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the analgesic efficacy and adverse effects of cannabinoids for chronic non-cancer pain. PubMed, EMBASE, Web of Science, Cochrane CENTRAL and clinicaltrials.gov were searched up to December 2018. Information on the type, dosage, route of administration, pain conditions, pain scores, and adverse events were extracted for qualitative analysis. Meta-analysis of analgesic efficacy was performed. Meta-regression was performed to compare the analgesic efficacy for different pain conditions (neuropathic versus non-neuropathic pain). Risk of bias was assessed by The Cochrane Risk of Bias tool, and the strength of the evidence was assessed using the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Forty-three randomized controlled trials were included. Meta-analysis was performed for 33 studies that compared cannabinoids to placebo, and showed a mean pain score (scale 0–10) reduction of −0.70 (p < 0.001, random effect). Meta-regression showed that analgesic efficacy was similar for neuropathic and non-neuropathic pain (Difference = −0.14, p = 0.262). Inhaled, oral, and oromucosal administration all provided statistically significant, but small reduction in mean pain score (−0.97, −0.85, −0.45, all p < 0.001). Incidence of serious adverse events was rare, and non-serious adverse events were usually mild to moderate. Heterogeneity was moderate. The GRADE level of evidence was low to moderate. Pain intensity of chronic non-cancer patients was reduced by cannabinoids consumption, but effect sizes were small. Efficacy for neuropathic and non-neuropathic pain was similar.



中文翻译:

大麻素对慢性非癌症疼痛的镇痛作用:系统评价和 Meta 回归分析

人们对使用大麻素治疗慢性疼痛越来越感兴趣。我们对随机对照试验进行了系统回顾和荟萃分析,以评估大麻素对慢性非癌性疼痛的镇痛效果和不良反应。PubMed、EMBASE、Web of Science、Cochrane CENTRAL 和clinicaltrials.gov 的检索截至2018 年12 月。提取有关类型、剂量、给药途径、疼痛状况、疼痛评分和不良事件的信息进行定性分析。进行了镇痛效果的荟萃分析。进行元回归以比较不同疼痛状况(神经性与非神经性疼痛)的镇痛效果。偏倚风险由 Cochrane 偏倚风险工具评估,证据强度使用推荐等级评估、发展、和评估 (GRADE) 方法。纳入了 43 项随机对照试验。对 33 项比较大麻素与安慰剂的研究进行了荟萃分析,结果显示平均疼痛评分(0-10 级)降低了 -0.70(p  < 0.001,随机效应)。Meta 回归表明,神经性和非神经性疼痛的镇痛效果相似(差异 = -0.14,p  = 0.262)。吸入、口服和口腔粘膜给药均具有统计学意义,但平均疼痛评分略有降低(-0.97、-0.85、-0.45,所有p  < 0.001)。严重不良事件的发生率很少,非严重不良事件通常为轻度至中度。异质性中等。GRADE 证据级别为低至中等。慢性非癌症患者的疼痛强度因食用大麻素而降低,但效果很小。对神经性和非神经性疼痛的疗效相似。

更新日期:2020-04-21
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