背景:在全球范围内,近年来,医用大麻合法化有所增加,医用大麻通常用于治疗慢性疼痛。然而,很少有研究医用大麻的随机对照试验表明,需要专家指导如何安全有效地给药和管理医用大麻。
方法:使用多级修改的Delphi过程,来自9个国家的20位全球专家就如何给慢性疼痛患者服用和使用医用大麻提出了基于共识的建议。
结果:人们一致认为,医用大麻可用于患有神经病的患者,炎症,有害塑料,和混合的疼痛。开发了三种治疗方案。常规方案,临床医生以5mgCBD的剂量每天两次启动患者的CBD主要品种,并每2至3天滴定10mg的CBD主要剂量,直到患者达到目标,或高达40毫克/天。在40毫克/天的CBD主要剂量,临床医生可考虑加入2.5mg四氢大麻酚,每2~7天滴定2.5mg,直至最大日剂量为40mg/天的四氢大麻酚.保守方案,临床医生以每天5mg的剂量启动患者的CBD主要品种,并每2至3天滴定10mg的CBD主要剂量,直到患者达到目标,或高达40毫克/天。在40毫克/天的CBD主要剂量,临床医生可考虑以1mg/天的剂量添加THC,并每7天滴定1mg,直至最大日剂量为40mg/天的THC.一种快速方案,临床医生每天一次或两次以2.5-5mg的每种大麻素开始平衡的THC:CBD品种,每2至3天滴定2.5-5mg的每种大麻素,直到患者达到他/她的目标或达到40mg/天的最大THC剂量。
结论:总之,使用修改后的Delphi过程,关于如何给药和使用医用大麻治疗慢性疼痛患者,我们提出了基于专家共识的建议.
BACKGROUND: Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed.
METHODS: Using a multistage modified Delphi process, twenty global experts across nine countries developed
consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain.
RESULTS: There was
consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day.
CONCLUSIONS: In summary, using a modified Delphi process, expert
consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.