Pain prevalence among adults in the United States has increased 25% over the past two decades, resulting in high health-care costs and impacts to patient quality of life. In the last 30 years, our understanding of pain circuits and (intra)cellular mechanisms has grown exponentially, but this understanding has not yet resulted in improved therapies. Options for pain management are limited. Many analgesics have poor efficacy and are accompanied by severe side effects such as addiction, resulting in a devastating opioid abuse and overdose epidemic. These problems have encouraged scientists to identify novel molecular targets and develop alternative pain therapeutics. Increasing preclinical and clinical evidence suggests that cannabis has several beneficial pharmacological activities, including pain relief. Cannabis sativa contains more than 500 chemical compounds, with two principle phytocannabinoids, Δ⁹-tetrahydrocannabinol (Δ⁹-THC) and cannabidiol (CBD). Beyond phytocannabinoids, more than 150 terpenes have been identified in different cannabis chemovars. Although the predominant cannabinoids, Δ⁹-THC and CBD, are thought to be the primary medicinal compounds, terpenes including the monoterpenes β-myrcene, α-pinene, limonene, and linalool, as well as the sesquiterpenes β-caryophyllene and α-humulene may contribute to many pharmacological properties of cannabis, including anti-inflammatory and antinociceptive effects. The aim of this review is to summarize our current knowledge about terpene compounds in cannabis and to analyze the available scientific evidence for a role of cannabis-derived terpenes in modern pain management.

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大麻萜烯的镇痛潜力

过去 20 年来，美国成年人的疼痛患病率增加了 25%，导致医疗费用高昂并影响患者的生活质量。在过去 30 年中，我们对疼痛回路和（内）细胞机制的理解呈指数级增长，但这种理解尚未带来治疗方法的改进。疼痛管理的选择是有限的。许多镇痛药疗效不佳，并伴有严重的副作用，如成瘾，导致毁灭性的阿片类药物滥用和过量流行。这些问题鼓励科学家们寻找新的分子靶点并开发替代性疼痛疗法。越来越多的临床前和临床证据表明大麻具有多种有益的药理活性，包括缓解疼痛。大麻含有 500 多种化合物，其中有两种主要植物大麻素：Δ ⁹ -四氢大麻酚 (Δ ⁹ -THC) 和大麻二酚 (CBD)。除了植物大麻素之外，在不同的大麻化学变体中还发现了 150 多种萜烯。尽管主要的大麻素 Δ ⁹ -THC 和 CBD 被认为是主要的药用化合物，但萜烯包括单萜β-月桂烯、α-蒎烯、柠檬烯和芳樟醇，以及倍半萜烯β-石竹烯和α-葎草烯可能有助于大麻的许多药理学特性，包括抗炎和抗伤害作用。本综述的目的是总结我们目前对大麻中萜烯化合物的了解，并分析大麻衍生萜烯在现代疼痛管理中作用的现有科学证据。