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Systematic review

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A systematic review of the analgesic efficacy of cannabinoid medications in the management of acute pain.

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Authors Stevens AJ , Higgins MD
Journal Acta anaesthesiologica Scandinavica
Year 2017
Links Pubmed DOI

This article is included in 2 Broad syntheses 7 Broad syntheses (2 references)

This article includes 7 Primary studies 7 Primary studies (7 references)

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BACKGROUND: Cannabinergic medications have been postulated to demonstrate efficacy in the management of pain. The aim of this systematic review was to assess the analgesic efficacy and adverse effects of cannabinoids when used for the management of acute pain. METHODS: A systematic review was performed by searching the MEDLINE, EMBASE and CENTRAL databases, and the World Health Organization International Clinical Trials Registry Platform for human randomized controlled trials that assessed the analgesic efficacy of cannabinoids compared to placebo or active comparators. The reported outcomes for analgesic efficacy and adverse effects in included studies were qualitatively analysed. RESULTS: Seven studies, including 611 patients were included in the systematic review. In five studies, cannabinoids were found to provide equivalent analgesia to placebo, in one study the analgesia provided by cannabinoids was superior to placebo, and in one study cannabinoids provided analgesia that was inferior to that provided by placebo. No synergistic or additive analgesic effect was observed when cannabinoids were used in combination with opioids. In five of the seven studies, certain adverse effects were more frequent with cannabinoid treatment than with placebo or active comparator. CONCLUSION: On the basis of the available randomized controlled trial evidence, cannabinoids have no role in the management of acute pain.

Systematic review

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Cannabis and pain: A review.

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Journal Journal of Pain Management
Year 2016

This article is included in 1 Broad synthesis 27 Broad syntheses (1 reference)

This article includes 27 Primary studies 27 Primary studies (27 references)

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Cannabis and cannabis derivatives are sometimes used to relieve pain. OBJECTIVE: To conduct a scoping review to explore the extent of the literature on the efficacy, safety, and side effects of cannabis and cannabis derivatives as a treatment for pain. METHODS: The English-language literature was searched using electronic databases for studies published from 1960 to August 15, 2016. All randomized controlled trials that compared cannabis to a control and that examined pain as an outcome were included. Data on demographic and clinical characteristics, study duration, intervention duration, and outcomes were abstracted. RESULTS: Of 4,472 articles identified through the literature search, only 28 studies satisfied eligibility criteria. An additional 5 were identified through hand search Most studies had very small sample sizes. The primary methods of administration were oromucosal spray of nabiximol, oral ingestion of cannabis extract capsules, and inhalation of smoked cannabis. Overall, nabiximol oromucosal sprays resulted in reductions in pain that were statistically significant but of variable clinical relevance. Studies of oral cannabis extracts nabilone and dronabinol yielded mixed results, with some studies demonstrating effectiveness and others being negative. Studies of smoked cannabis consistently demonstrated statistically significant and clinically relevant reductions in neuropathic pain. CONCLUSIONS: Published research on the efficacy of cannabis as a treatment for pain is extremely limited. Evidence of effectiveness was strongest for smoked cannabis for neuropathic pain.

Systematic review

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Efficacy, Tolerability, and Safety of Cannabinoid Treatments in the Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials.

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Journal Arthritis care & research
Year 2016
Links Pubmed DOI

This article is included in 9 Broad syntheses 4 Broad syntheses (9 references)

This article includes 4 Primary studies 4 Primary studies (4 references)

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OBJECTIVE: To assess the efficacy, tolerability, and safety of cannabinoids (phyto- and syntheto-) in the management of rheumatic diseases. METHODS: Multiple databases, including Medline, Embase, and CENTRAL, were searched. Randomized controlled trials with outcomes of pain, sleep, quality of life, tolerability (dropouts due to adverse events), and safety (serious adverse events), with comparison of cannabinoids with any type of control, were included. Study methodology quality was evaluated with the Cochrane risk of bias tool. RESULTS: In 4 short-term studies comprising 203 patients (58 with rheumatoid arthritis, 71 with fibromyalgia, and 74 with osteoarthritis [OA]), cannabinoids had a statistically significant effect on pain in 2, sleep in 2, and improved quality of life in 1, with the OA study prematurely terminated due to futility. The risk of bias was high for all 3 completed studies. Dizziness, cognitive problems, and drowsiness, as well as nausea, were reported for almost half of the patients. No serious adverse events were reported for cannabinoids during the study duration. No studies of herbal cannabis were identified. CONCLUSION: Extremely small sample sizes, short study duration, heterogeneity of rheumatic conditions and products, and absence of studies of herbal cannabis allow for only limited conclusions for the effects of cannabinoids in rheumatic conditions. Pain relief and effect on sleep may have some potential therapeutic benefit, but with considerable mild to moderate adverse events. There is currently insufficient evidence to recommend cannabinoid treatments for management of rheumatic diseases pending further study.

Systematic review

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Medical cannabis dosing strategies in pain-related conditions: a scoping review of current literature

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Journal J Pain Manag
Year 2016

Without references

This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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Systematic review

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Cannabinoids for the Treatment of Chronic Non-Cancer Pain: An Updated Systematic Review of Randomized Controlled Trials

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Authors Lynch ME , Ware MA
Journal Journal of Neuroimmune Pharmacology
Year 2015
Links Pubmed DOI

This article is included in 5 Broad syntheses 11 Broad syntheses (5 references)

This article includes 11 Primary studies 11 Primary studies (11 references)

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An updated systematic review of randomized controlled trials examining cannabinoids in the treatment of chronic non-cancer pain was conducted according to PRISMA guidelines for systematic reviews reporting on health care outcomes. Eleven trials published since our last review met inclusion criteria. The quality of the trials was excellent. Seven of the trials demonstrated a significant analgesic effect. Several trials also demonstrated improvement in secondary outcomes (e.g., sleep, muscle stiffness and spasticity). Adverse effects most frequently reported such as fatigue and dizziness were mild to moderate in severity and generally well tolerated. This review adds further support that currently available cannabinoids are safe, modestly effective analgesics that provide a reasonable therapeutic option in the management of chronic non-cancer pain.

Systematic review

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Efficacy and adverse effects of medical marijuana for chronic noncancer pain: Systematic review of randomized controlled trials.

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Journal Canadian family physician Médecin de famille canadien
Year 2015
Links Pubmed PubMed Central

This article is included in 4 Broad syntheses 6 Broad syntheses (4 references)

This article includes 6 Primary studies 6 Primary studies (6 references)

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OBJECTIVE: To determine if medical marijuana provides pain relief for patients with chronic noncancer pain (CNCP) and to determine the therapeutic dose, adverse effects, and specific indications. DATA SOURCES: In April 2014, MEDLINE and EMBASE searches were conducted using the terms chronic noncancer pain, smoked marijuana or cannabinoids, placebo and pain relief, or side effects or adverse events. STUDY SELECTION: An article was selected for inclusion if it evaluated the effect of smoked or vaporized cannabinoids (nonsynthetic) for CNCP; it was designed as a controlled study involving a comparison group, either concurrently or historically; and it was published in English in a peer-review journal. Outcome data on pain, function, dose, and adverse effects were collected, if available. All articles that were only available in abstract form were excluded. Synthesis A total of 6 randomized controlled trials (N = 226 patients) were included in this review; 5 of them assessed the use of medical marijuana in neuropathic pain as an adjunct to other concomitant analgesics including opioids and anticonvulsants. The 5 trials were considered to be of high quality; however, all of them had challenges with masking. Data could not be pooled owing to heterogeneity in delta-9-tetrahydrocannabinol potency by dried weight, differing frequency and duration of treatment, and variability in assessing outcomes. All experimental sessions in the studies were of short duration (maximum of 5 days) and reported statistically significant pain relief with nonserious side effects. CONCLUSION: There is evidence for the use of low-dose medical marijuana in refractory neuropathic pain in conjunction with traditional analgesics. However, trials were limited by short duration, variability in dosing and strength of delta-9-tetrahydrocannabinol, and lack of functional outcomes. Although well tolerated in the short term, the long-term effects of psychoactive and neurocognitive effects of medical marijuana remain unknown. Generalizing the use of medical marijuana to all CNCP conditions does not appear to be supported by existing evidence. Clinicians should exercise caution when prescribing medical marijuana for patients, especially in those with nonneuropathic CNCP.

Systematic review

Unclassified

Efficacy and safety of cannabinoids for pain in musculoskeletal diseases: a systematic review and meta-analysis

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Journal J Rheumatol
Year 2011

Without references

This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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Systematic review

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Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review.

Journal Rheumatology (Oxford, England)
Year 2011
Links Pubmed DOI www.epistemonikos.org

This article is included in 1 Broad synthesis 33 Broad syntheses (1 reference)

This article includes 33 Primary studies 33 Primary studies (33 references)

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OBJECTIVE: To critically evaluate the evidence regarding complementary and alternative medicine (CAM) taken orally or applied topically (excluding fish oil) in the treatment of RA. METHODS: Randomized controlled trials (RCTs) of RA using CAMs, in comparison with other treatments or placebo, published in English up to August 2010, were eligible for inclusion. They were identified using systematic searches of bibliographic databases and manual searching of reference lists. Information was extracted on outcomes and statistical significance, in comparison with alternative treatments, and reported side effects. The methodological quality of the primary studies was determined using the Jadad scoring system. RESULTS: Reported RCTs were available for 18 CAMs in the management of RA. There was no consistent evidence available for any of the reviewed substances to suggest that they were efficacious as complementary medicines to standard treatment. Nevertheless, the studies conducted on borage seed oil (n = 2) and thunder god vine (n = 3) have been positive and may warrant further investigation. Not all CAM compounds studied were free of major adverse effects. CONCLUSION: The major limitation in reviewing the evidence for CAMs is the paucity of RCTs in the area. The available evidence does not support their current use in the management of RA.

Systematic review

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Systematic review and meta-analysis of cannabis treatment for chronic pain

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Journal Pain medicine (Malden, Mass.)
Year 2009
Links Pubmed DOI

This article is included in 1 Structured summary of systematic reviews 17 Structured summaries of systematic reviews (1 reference) 9 Broad syntheses 17 Broad syntheses (9 references)

This article includes 17 Primary studies 17 Primary studies (17 references)

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Setting. Cannabis preparations have been used as a remedy for thousands of years in traditional medicine. Clinical use of cannabinoid substances is restricted, due to legal and ethical reasons, as well as limited evidence showing benefits. Objective. To assess the efficacy and harms of cannabis preparations in the treatment of chronic pain. Design. Systematic review and meta-analysis of double-blind randomized controlled trials that compared any cannabis preparation to placebo among subjects with chronic pain. An electronic search was made in Medline/Pubmed, Embase, and The Cochrane Controlled Trials Register (TRIALS CENTRAL) of all literature published until February 2008, as well as specific web pages devoted to cannabis. Studies were cross-checked, selected, and assessed. Results. Eighteen trials were included. The efficacy analysis (visual analog scales) displayed a difference in standardized means in favor of the cannabis arm of -0.61 (-0.84 to -0.37), with statistical homogeneity (I. 2 = 0.0%; P = 0.50). For the analysis of harms, the following Odds Ratios (OR) and number needed to harm (NNH) were obtained: for events linked to alterations to perception, OR: 4.51 (3.05-6.66), NNH: 7 (6-9); for events affecting motor function, 3.93 (2.83-5.47), NNH: 5 (4-6); for events that altered cognitive function, 4.46 (2.37-8.37), NNH: 8 (6-12). Conclusions. Currently available evidence suggests that cannabis treatment is moderately efficacious for treatment of chronic pain, but beneficial effects may be partially (or completely) offset by potentially serious harms. More evidence from larger, well-designed trials is needed to clarify the true balance of benefits to harms. © American Academy of Pain Medicine.

Systematic review

Unclassified

Adverse effects of medical cannabinoids: a systematic review

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Authors Wang T , Collet JP , Shapiro S , Ware MA
Journal CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
Year 2008
Links Pubmed DOI PubMed Central www.cochranelibrary.com

This article is included in 1 Structured summary of systematic reviews 29 Structured summaries of systematic reviews (1 reference) 6 Broad syntheses 29 Broad syntheses (6 references)

This article includes 32 Primary studies 29 Primary studies (32 references)

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BACKGROUND: The therapeutic use of cannabis and cannabis-based medicines raises safety concerns for patients, clinicians, policy-makers, insurers, researchers and regulators. Although the efficacy of cannabinoids is being increasingly demonstrated in randomized controlled trials, most safety information comes from studies of recreational use. METHODS: We performed a systematic review of safety studies of medical cannabinoids published over the past 40 years to create an evidence base for cannabis-related adverse events and to facilitate future cannabis research initiatives. We critically evaluated the quality of published studies with a view to identifying ways to improve future studies. RESULTS: A total of 321 articles were eligible for evaluation. After excluding those that focused on recreational cannabis use, we included 31 studies (23 randomized controlled trials and 8 observational studies) of medical cannabis use in our analysis. In the 23 randomized controlled trials, the median duration of cannabinoid exposure was 2 weeks (range 8 hours to 12 months). A total of 4779 adverse events were reported among participants assigned to the intervention. Most (4615 [96.6%]) were not serious. Of the 164 serious adverse events, the most common was relapse of multiple sclerosis (21 events [12.8%]), vomiting (16 events [9.8%]) and urinary tract infection (15 events [9.1%]). The rate of nonserious adverse events was higher among participants assigned to medical cannabinoids than among controls (rate ratio [RR] 1.86, 95% confidence interval [CI] 1.57-2.21); the rates of serious adverse events did not differ significantly between these 2 groups (RR 1.04, 95% CI 0.78-1.39). Dizziness was the most commonly reported nonserious adverse event (714 events [15.5%]) among people exposed to cannabinoids. INTERPRETATION: Short-term use of existing medical cannabinoids appeared to increase the risk of nonserious adverse events. The risks associated with long-term use were poorly characterized in published clinical trials and observational studies. High-quality trials of long-term exposure are required to further characterize safety issues related to the use of medical cannabinoids.