Study register · detailSystematische Review · Chronic Pain · 2001
Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review
Campbell et al.·BMJ
No benefit demonstratedGRADEHigh424 citations
Samplek = 9 Studien n = 222 Pat.
ControlCodeine 50–120 mg or placebo
EndpointPain intensity / pain…
Blindingunklar
DesignSystematische Review
Cannabinoidthc
Max. dose20.0 mg
”Key finding
Cannabinoids are not superior to codeine and cause frequent psychotropic side effects, so that broad clinical use for pain therapy is considered not advisable.
Summary
Systematic review of k=9 RCTs (n=222) on cannabinoids in acute, chronic non-malignant and cancer pain; oral THC 5-20 mg, synthetic THC analogue and i.m. levonantradol comparably effective to codeine 50-120 mg; oral benzopyranoperidine worse than codeine 60-120 mg and not better than placebo. Cannabinoids NOT superior to codeine; frequent CNS side effects.
P
PopulationPatients with acute, chronic non-malignant or tumour pain; pooled participant number n=222 from 9 RCTs
OutcomeCannabinoids approximately as effective as codeine 50–120 mg (THC, levonantradol); benzopyranopiperine worse than codeine and not better than placebo; frequent psychotropic side effects
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
<h4>Objective</h4>To establish whether cannabis is an effective and safe treatment option in the management of pain.<h4>Design</h4>Systematic review of randomised controlled trials.<h4>Data sources</h4>Electronic databases Medline, Embase, Oxford Pain Database, and Cochrane Library; references from identified papers; hand searches.<h4>Study selection</h4>Trials of cannabis given by any route of administration (experimental intervention) with any analgesic or placebo (control intervention) in patients with acute, chronic non-malignant, or cancer pain. Outcomes examined were pain intensity scores, pain relief scores, and adverse effects. Validity of trials was assessed independently with the Oxford score.<h4>Data extraction</h4>Independent data extraction; discrepancies resolved by consensus.<h4>Data synthesis</h4>20 randomised controlled trials were identified, 11 of which were excluded. Of the 9 included trials (222 patients), 5 trials related to cancer pain, 2 to chronic non-malignant pain, and 2 to acute postoperative pain. No randomised controlled trials evaluated cannabis; all tested active substances were cannabinoids. Oral delta-9-tetrahydrocannabinol (THC) 5-20 mg, an oral synthetic nitrogen analogue of THC 1 mg, and intramuscular levonantradol 1.5-3 mg were about as effective as codeine 50-120 mg, and oral benzopyranoperidine 2-4 mg was less effective than codeine 60-120 mg and no better than placebo. Adverse effects, most often psychotropic, were common.<h4>Conclusion</h4>Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use. Their widespread introduction into clinical practice for pain management is therefore undesirable. In acute postoperative pain they should not be used. Before cannabinoids can be considered for treating spasticity and neuropathic pain, further valid randomised controlled studies are needed.