PDF(Pubmed)
Abstract：
Background: One in five individuals live with chronic pain globally, which often co-occurs with sleep problems, anxiety, depression, and substance use disorders. Although these conditions are commonly managed with cannabinoid-based medicines (CBM), health care providers report lack of information on the risks, benefits, and appropriate use of CBM for therapeutic purposes. Aims: We present these clinical practice guidelines to help clinicians and patients navigate appropriate CBM use in the management of chronic pain and co-occurring conditions. Materials and Methods: We conducted a systematic review of studies investigating the use of CBM for the treatment of chronic pain. Articles were dually reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical recommendations were developed based on available evidence from the review. Values and preferences and practical tips have also been provided to support clinical application. The GRADE system was used to rate the strength of recommendations and quality of evidence. Results: From our literature search, 70 articles met inclusion criteria and were utilized in guideline development, including 19 systematic reviews and 51 original research studies. Research typically demonstrates moderate benefit of CBM in chronic pain management. There is also evidence for efficacy of CBM in the management of comorbidities, including sleep problems, anxiety, appetite suppression, and for managing symptoms in some chronic conditions associated with pain including HIV, multiple sclerosis, fibromyalgia, and arthritis. Conclusions: All patients considering CBM should be educated on risks and adverse events. Patients and clinicians should work collaboratively to identify appropriate dosing, titration, and administration routes for each individual. Systematic Review Registration: PROSPERO no. 135886.
摘要：
背景：全球五分之一的人患有慢性疼痛，这通常与睡眠问题同时发生，焦虑,抑郁症,和物质使用障碍。尽管这些情况通常是通过基于大麻素的药物（CBM）来管理的，医疗保健提供者报告缺乏关于风险的信息，好处,并适当使用CBM进行治疗。目的：我们提出了这些临床实践指南，以帮助临床医生和患者在慢性疼痛和并发疾病的管理中使用适当的CBM。材料和方法：我们对使用CBM治疗慢性疼痛的研究进行了系统评价。根据系统审查和荟萃分析指南的首选报告项目对文章进行了双重审查。临床建议是根据审查的现有证据制定的。还提供了价值观和偏好以及实用技巧来支持临床应用。评分系统用于对建议的强度和证据质量进行评分。结果：从我们的文献检索中，70篇文章符合纳入标准，并被用于指南开发，包括19项系统综述和51项原创性研究。研究通常表明CBM在慢性疼痛管理中的中度益处。也有证据表明CBM在合并症管理中的功效，包括睡眠问题,焦虑,食欲抑制,以及管理一些与疼痛相关的慢性疾病的症状，包括艾滋病毒，多发性硬化症,纤维肌痛,和关节炎。结论：所有考虑CBM的患者都应接受风险和不良事件的教育。患者和临床医生应协同工作以确定合适的剂量。滴定,和每个人的给药途径。系统审查注册：PROSPERO编号。135886.
