Study register · detailSystematic Review · Neuropathic Pain · 2017
The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms
Nugent et al.·Annals of Internal MedicineImpact 4.3
MixedGRADEHigh300 citations
Samplek = 27 Studien
DurationDatabase inception to March 2017
ControlPlacebo or control groups
EndpointPain intensity
Blindingunklar
DesignSystematic Review
Cannabinoidvollspektrum
”Key finding
Weak evidence of benefit for neuropathic pain, insufficient evidence for other pain types; limited evidence for increased risk of mental health consequences in the general population.
Summary
Comprehensive SR of k=27 chronic pain trials plus 11 SRs and 32 primary studies on harms. Low-strength evidence that cannabis relieves neuropathic pain; insufficient evidence for other pain populations. Harms in the general population: increased risk of motor vehicle accidents, psychotic symptoms, short-term cognitive impairment.
P
PopulationAdults with chronic pain (intervention studies) as well as general adult population (observational studies)
ControlPlacebo or control groups (depending on individual study)
O
OutcomeLow strength of evidence for relief of neuropathic pain; insufficient evidence for other pain types; increased risk of motor vehicle accidents, psychotic symptoms, and short-term cognitive impairment in the general population
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
Background: Cannabis is increasingly available for the treatment of chronic pain, yet its efficacy remains uncertain.
Purpose: To review the benefits of plant-based cannabis preparations for treating chronic pain in adults and the harms of cannabis use in chronic pain and general adult populations.
Data Sources: MEDLINE, Cochrane Database of Systematic Reviews, and several other sources from database inception to March 2017.
Study Selection: Intervention trials and observational studies, published in English, involving adults using plant-based cannabis preparations that reported pain, quality of life, or adverse effect outcomes.
Data Extraction: Two investigators independently abstracted study characteristics and assessed study quality, and the investigator group graded the overall strength of evidence using standard criteria.
Data Synthesis: From 27 chronic pain trials, there is low-strength evidence that cannabis alleviates neuropathic pain but insufficient evidence in other pain populations. According to 11 systematic reviews and 32 primary studies, harms in general population studies include increased risk for motor vehicle accidents, psychotic symptoms, and short-term cognitive impairment. Although adverse pulmonary effects were not seen in younger populations, evidence on most other long-term physical harms, in heavy or long-term cannabis users, or in older populations is insufficient.
Limitation: Few methodologically rigorous trials; the cannabis formulations studied may not reflect commercially available products; and limited applicability to older, chronically ill populations and patients who use cannabis heavily.
Conclusion: Limited evidence suggests that cannabis may alleviate neuropathic pain in some patients, but insufficient evidence exists for other types of chronic pain. Among general populations, limited evidence suggests that cannabis is associated with an increased risk for adverse mental health effects.
Primary Funding Source: U.S. Department of Veterans Affairs. (PROSPERO: CRD42016033623).