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. 2017 Sep 22;114(38):627-634.
doi: 10.3238/arztebl.2017.0627.

Cannabinoids in Pain Management and Palliative Medicine

Winfried Häuser  1 , Mary-Ann Fitzcharles, Lukas Radbruch, Frank Petzke
Affiliations

Cannabinoids in Pain Management and Palliative Medicine

Winfried Häuser et al. Dtsch Arztebl Int. .

Abstract

Background: There are conflicting interpretations of the evidence regarding the efficacy, tolerability, and safety of cannabinoids in pain management and palliative medicine.

Methods: We conducted a systematic review (SR) of systematic reviews of randomized controlled trials (RCT) and prospective long-term observational studies of the use of cannabinoids in pain management and palliative medicine. Pertinent publications from January 2009 to January 2017 were retrieved by a selective search in the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and Medline. The methodological quality of the SRs was assessed with the AMSTAR instrument, and the clinical relevance of quantitative data syntheses was assessed according to the standards of the Cochrane Collaboration.

Results: Of the 750 publications identified, 11 SRs met the inclusion criteria; 3 of them were of high and 8 of moderate methodological quality. 2 prospective long-term observational studies with medical cannabis and 1 with tetrahydrocannabinol/cannabidiol spray (THC/CBD spray) were also analyzed. There is limited evidence for a benefit of THC/CBD spray in the treatment of neuropathic pain. There is inadequate evidence for any benefit of cannabinoids (dronabinol, nabilone, medical cannabis, or THC/CBD spray) to treat cancer pain, pain of rheumatic or gastrointestinal origin, or anorexia in cancer or AIDS. Treatment with cannabis-based medicines is associated with central nervous and psychiatric side effects.

Conclusion: The public perception of the efficacy, tolerability, and safety of cannabis-based medicines in pain management and palliative medicine conflicts with the findings of systematic reviews and prospective observational studies conducted according to the standards of evidence-based medicine.

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Figures

Figure
Figure
Results of literature search CDSR, Cochrane Database of Systematic Reviews; DARE, Database of Abstracts of Reviews of Effects
See this image and copyright information in PMC

Comment in

  • Considerable Heterogeneity.
    Karst M, Passie T. Karst M, et al. Dtsch Arztebl Int. 2018 Mar 2;115(9):143. doi: 10.3238/arztebl.2018.0143a. Dtsch Arztebl Int. 2018. PMID: 29563008 Free PMC article. No abstract available.

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