Study register · detailMeta-Analyse · Fibromyalgia · 2018
Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies
Stockings et al.·PainImpact 4.2
No benefit demonstratedGRADEHigh466 citations
Samplek = 104 Studien n = 9.958 Pat.
Durationunclear
ControlPlacebo
EndpointVAS
Blindingn.a.
DesignMeta-Analyse
”Key finding
Cannabinoids show only minimal pain reduction (3 mm on a 100-mm scale) compared with placebo with a high rate of harm; benefit-harm ratio unfavourable (NNT 24 vs. NNH 6).
Summary
Comprehensive SR+MA on cannabinoids in chronic non-cancer pain; k=104 studies (47 RCTs, 57 observational studies), n=9.958 participants. Fibromyalgia subgroup: k=7 studies. Pooled RCT data: 30% pain reduction 29,0% (cannabinoids) vs. 25,9% (placebo), significant, NNTB=24 (95% CI 15-61); 50% pain reduction 18,2% vs. 14,4%, not significant. Pain intensity reduction SMD=-0,14 (95% CI -0,20 to -0,08), corresponds to 3 mm on 100-mm VAS. Adverse events 81,2% vs. 66,2%, NNTH=6 (95% CI 5-8). No significant effect on physical/emotional function; weak evidence for improvement in sleep. Authors' conclusion: limited efficacy, high NNTB, low NNTH.
P
PopulationAdults with chronic non-cancer pain (CNCP), pooled n=9.958
I
InterventionCannabinoids (various types and forms of application)
C
ControlPlacebo (in RCTs)
O
Outcome30% pain reduction: PER 29,0% vs. 25,9% (significant, NNT=24, 95%-CI 15–61); 50% pain reduction: no significant difference; pooled change in pain intensity SMD –0,14 (95%-CI –0,20 to –0,08), corresponds to ~3 mm on 100-mm VAS; adverse events: NNH=6 (95%-CI 5–8)
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
This review examines evidence for the effectiveness of cannabinoids in chronic noncancer pain (CNCP) and addresses gaps in the literature by: considering differences in outcomes based on cannabinoid type and specific CNCP condition; including all study designs; and following IMMPACT guidelines. MEDLINE, Embase, PsycINFO, CENTRAL, and clinicaltrials.gov were searched in July 2017. Analyses were conducted using Revman 5.3 and Stata 15.0. A total of 91 publications containing 104 studies were eligible (n = 9958 participants), including 47 randomised controlled trials (RCTs) and 57 observational studies. Forty-eight studies examined neuropathic pain, 7 studies examined fibromyalgia, 1 rheumatoid arthritis, and 48 other CNCP (13 multiple sclerosis-related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). Across RCTs, pooled event rates (PERs) for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo); significant effect for cannabinoids was found; number needed to treat to benefit was 24 (95% confidence interval [CI] 15-61); for 50% reduction in pain, PERs were 18.2% vs 14.4%; no significant difference was observed. Pooled change in pain intensity (standardised mean difference: -0.14, 95% CI -0.20 to -0.08) was equivalent to a 3 mm reduction on a 100 mm visual analogue scale greater than placebo groups. In RCTs, PERs for all-cause adverse events were 81.2% vs 66.2%; number needed to treat to harm: 6 (95% CI 5-8). There were no significant impacts on physical or emotional functioning, and low-quality evidence of improved sleep and patient global impression of change. Evidence for effectiveness of cannabinoids in CNCP is limited. Effects suggest that number needed to treat to benefit is high, and number needed to treat to harm is low, with limited impact on other domains. It seems unlikely that cannabinoids are highly effective medicines for CNCP.