Cannabinoids in Chronic Pain: Clinical Outcomes, Adverse Effects and Legal Challenges.

IF 3 Q2 CLINICAL NEUROLOGY
Aleksandar Sic, Conor George, Daniela Ferrer Gonzalez, Vasilis-Spyridon Tseriotis, Nebojsa Nick Knezevic
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引用次数: 0

Abstract

Cannabinoids have gained increasing attention as potential therapeutic agents in chronic pain management. Their mechanisms of action, mediated through CB1 and CB2 receptors, provide a pharmacological alternative to conventional analgesics. The evidence is strongest for neuropathic pain and multiple sclerosis-related spasticity, while the results for fibromyalgia, osteoarthritis, and musculoskeletal pain remain inconsistent. The average pain reduction is modest, often not exceeding 0.5-1.0 points on a 10-point scale, and therapeutic gains are offset by safety concerns. Quantitative data show that discontinuation rates range from 4.3% at low-dose CBD to 12.9% at high-dose CBD, compared with 3.5% on placebo, while nabiximols (THC + CBD spray) are associated with dizziness in 25% of patients, somnolence in 8%, and treatment discontinuation in 12%. High-dose CBD also carries a measurable risk of hepatotoxicity. Regulatory heterogeneity further constrains trial feasibility, scalability, and patient access, with disparities evident across the United States, Europe, Canada, and Australia. Overall, cannabinoids provide modest, condition-specific analgesia and should be considered adjunctive rather than first-line options, reserved for patients unresponsive to conventional therapy. Future progress requires standardized formulations, harmonized international regulations, long-term safety data, and large-scale randomized controlled trials to clarify their role in evidence-based pain management.

大麻素治疗慢性疼痛:临床结果、不良反应和法律挑战。
大麻素作为潜在的治疗药物在慢性疼痛管理中得到了越来越多的关注。它们的作用机制,通过CB1和CB2受体介导,提供了一种替代传统镇痛药的药理作用。对神经性疼痛和多发性硬化症相关痉挛的证据最强,而对纤维肌痛、骨关节炎和肌肉骨骼疼痛的结果仍不一致。平均疼痛减轻是适度的,在10分制中通常不超过0.5-1.0分,治疗收益被安全问题所抵消。定量数据显示,低剂量CBD的停药率为4.3%,高剂量CBD的停药率为12.9%,而安慰剂的停药率为3.5%,而nabiximols (THC + CBD喷雾)导致25%的患者头晕,8%的患者嗜睡,12%的患者停药。大剂量的CBD也具有可测量的肝毒性风险。监管异质性进一步限制了试验的可行性、可扩展性和患者可及性,在美国、欧洲、加拿大和澳大利亚存在明显的差异。总的来说,大麻素提供适度的,条件特异性镇痛,应考虑辅助而不是一线选择,保留给对常规治疗无反应的患者。未来的进展需要标准化的配方、协调的国际法规、长期的安全性数据和大规模的随机对照试验来阐明它们在循证疼痛管理中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurology International
Neurology International CLINICAL NEUROLOGY-
CiteScore
3.70
自引率
3.30%
发文量
69
审稿时长
11 weeks
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