This review examines evidence cannabinoids in chronic non-cancer 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 RCTs and 57 observational studies. Forty-eight studies examined neuropathic pain, seven studies examined fibromyalgia, one rheumatoid arthritis, and 48 other CNCP (13 MS-related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). Across RCTs, PERs for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo), significant effect for cannabinoids, number needed to treat to benefit (NNTB): 24 (95%CI 15-61); for 50% reduction in pain, PERs were 18.2% vs. 14.4%; no significant difference. Pooled change in pain intensity (standardised mean difference: -0.14, 95%CI -0.20, -0.08) was equivalent to 3mm on a 100mm visual analogue scale greater than placebo. In RCTs, PERs for all-cause AEs were 81.2% vs. 66.2%; number needed to treat to harm (NNTH): 6 (95%CI 5-8). There were no significant impacts upon 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 NNTB are high, and NNTH low, with limited impact on other domains. It appears unlikely that cannabinoids are highly effective medicines for CNCP.
Antecedentes: El dolor abdominal es frecuentemente reportado por personas con enfermedad inflamatoria intestinal (EII), incluso en remisión. El dolor es un síntoma poco tratado. OBJETIVO: Revisar sistemáticamente las pruebas sobre las intervenciones (excluyendo las intervenciones modificadoras de la enfermedad) para el tratamiento del dolor abdominal en la EII. MÉTODOS: Se realizaron búsquedas en bases de datos (MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Cochrane Library) (febrero de 2016). Dos investigadores seleccionaron independientemente las referencias y extrajeron los datos. RESULTADOS: Se incluyeron 15 trabajos: 13 estudios de intervención y 2 estudios transversales. Se informó de una variedad de intervenciones psicológicas, dietéticas y farmacológicas. Cuatro de seis estudios informaron reducción del dolor con intervención psicológica incluyendo relajación individualizada y en grupo, terapia cognitiva conductual relacionada con la ansiedad de la enfermedad y manejo del estrés. Tanto el manejo del estrés dirigido por el psicólogo como el autodirigido en la enfermedad de Crohn inactiva redujeron el dolor en comparación con los controles (índice de reducción de la frecuencia de los síntomas = -26,7, -11,3 y 17,2 a los 6 meses de seguimiento, respectivamente). Dos intervenciones dietéticas (bebidas alcohólicas con alto contenido de azúcar y carbohidratos fermentables con propiedades prebióticas) tuvieron un efecto sobre el dolor abdominal. Los antibióticos (para los pacientes con sobrecrecimiento bacteriano) y parches transdérmicos de nicotina redujeron el dolor abdominal. Los usuarios de cannabis actuales y pasados informan que alivia el dolor. Un ensayo controlado de cannabis redujo las puntuaciones de dolor SF-36 y EQ-5D (1,84 y 0,7, respectivamente). Estos resultados deben ser tratados con precaución: los datos se obtuvieron a partir de estudios predominantemente pequeños no controlados de moderada a baja calidad. Conclusiones: Pocas intervenciones han sido probadas para el dolor abdominal IBD. La limitada evidencia sugiere que la relajación y las cogniciones cambiantes son prometedoras, posiblemente con cambios dietéticos individualizados. Existe la necesidad de desarrollar intervenciones para el manejo del dolor abdominal en la EII.
This review examines evidence cannabinoids in chronic non-cancer 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 RCTs and 57 observational studies. Forty-eight studies examined neuropathic pain, seven studies examined fibromyalgia, one rheumatoid arthritis, and 48 other CNCP (13 MS-related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). Across RCTs, PERs for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo), significant effect for cannabinoids, number needed to treat to benefit (NNTB): 24 (95%CI 15-61); for 50% reduction in pain, PERs were 18.2% vs. 14.4%; no significant difference. Pooled change in pain intensity (standardised mean difference: -0.14, 95%CI -0.20, -0.08) was equivalent to 3mm on a 100mm visual analogue scale greater than placebo. In RCTs, PERs for all-cause AEs were 81.2% vs. 66.2%; number needed to treat to harm (NNTH): 6 (95%CI 5-8). There were no significant impacts upon 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 NNTB are high, and NNTH low, with limited impact on other domains. It appears unlikely that cannabinoids are highly effective medicines for CNCP.
