Use of medical cannabis in the treatment of endometriosis
Utilização da cannabis medicinal no tratamento da endometriose
Patrick Bellelis; Carolina Fernandes Giacometti
Abstract
BACKGROUND AND OBJECTIVES: Endometriosis is a common gynecological condition, which affects 10% to 15% of women in the reproductive period and up to half of women with chronic pelvic pain and/or infertility. It is estimated that the number of women with endometriosis is 8 million in Brazil and more than 190 million worldwide. In industrialized countries, it is one of the main causes of gynecological hospitalization. The objective of this study was to evaluate the medical literature on the use of cannabis in the treatment of endometriosis.
CONTENTS: Cannabis is increasingly available for the treatment of chronic pain, but its effectiveness remains uncertain due to the lack of randomized trials.
CONCLUSION: Limited evidence suggests that cannabis may relieve pain in some patients, but there is insufficient evidence regarding dose, formulations and best route of administration that precludes a definitive recommendation on cannabis for the relief of chronic pelvic pain of gynecological origin.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: A endometriose é uma afecção ginecológica comum que atinge de 10% a 15% das mulheres no período reprodutivo e até metade das mulheres com dor pélvica crônica e/ou infertilidade. Estima-se que o número de mulheres com endometriose seja de 8 milhões no Brasil e de mais de 190 milhões no mundo. Em países industrializados, é uma das principais causas de hospitalização ginecológica. O objetivo deste estudo foi avaliar a literatura médica sobre o uso da cannabis no tratamento da endometriose.
CONTEÚDO: A cannabis está cada vez mais disponível para o tratamento da dor crônica, mas sua eficácia permanece incerta devido à insuficiência de estudos randomizados.
CONCLUSÃO: As evidências limitadas sugerem que a cannabis pode aliviar a dor em alguns pacientes, mas existem evidências insuficientes em relação a dose, formulações e melhor via de administração, o que impede uma recomendação definitiva da cannabis para alívio da dor pélvica crônica de origem ginecológica.
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References
1 Viganò P, Parazzini F, Somigliana E, Vercellini P. Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol. 2004;18(2):177-200.
2 Bellelis P, Dias JA Jr, Podgaec S, Gonzales M, Baracat EC, Abrão MS. Epidemiological and clinical aspects of pelvic endometriosis-a case series. Rev Assoc Med Bras. 2010;56(4):467-71.
3 Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-56.
4 Abrao MS, Podgaec S, Dias JA Jr, Averbach M, Garry R, Ferraz Silva LF, Carvalho FM. Deeply infiltrating endometriosis affecting the rectum and lymph nodes. Fertil Steril. 2006;86(3):543-7
5 Soliman AM, Yang H, Du EX, Kelley C, Winkel C. The direct and indirect costs associated with endometriosis: a systematic literature review. Hum Reprod. 2016;31(4):712-22.
6 Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, Brodszky V, Canis M, Colombo GL, DeLeire T, Falcone T, Graham B, Halis G, Horne A, Kanj O, Kjer JJ, Kristensen J, Lebovic D, Mueller M, Vigano P, Wullschleger M, D’Hooghe T. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod. 2012;27(5):1292-9.
7 Della Corte L, Di Filippo C, Gabrielli O, Reppuccia S, La Rosa VL, Ragusa R, Fichera M, Commodari E, Bifulco G, Giampaolino P. The Burden of Endometriosis on Women’s Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing.Int J Environ Res Public Health. 2020;17(13):4683.
8 Ianieri MM, Mautone D, Ceccaroni M. Recurrence in deep infiltrating endometriosis: a systematic review of the literature. J Minim Invasive Gynecol. 2018;25(5):786-93.
9 Ceccaroni M, Bounous VE, Clarizia R, Mautone D, Mabrouk M. Recurrent endometriosis: a battle against an unknown enemy. Eur J Contracept Reprod Health Care. 2019;24(6):464-74.
10 Dmitrieva N, Nagabukuro H, Resuehr D, Zhang G, McAllister SL, McGinty KA, Mackie K, Berkley KJ. Endocannabinoid involvement in endometriosis. Pain. 2010;151(3):703-10.
11 Leconte M, Nicco C, Ngô C, Arkwright S, Chéreau C, Guibourdenche J, Weill B, Chapron C, Dousset B, Batteux F. Antiproliferative effects of cannabinoid agonists on deep infiltrating endometriosis. Am J Pathol. 2010;177(6):2963-70.
12 Bonfá L, Vinagre RC, de Figueiredo NV. Cannabinoids in chronic pain and palliative care. Rev Bras Anestesiol. 2008;58(3):267-79.
13 Shen X, Duan H, Wang S, Gan L, Xu Q, Li JJ. Decreased expression of cannabinoid receptors in the eutopic and ectopic endometrium of patients with adenomyosis. Biomed Res Int. 2019;20;2019:5468954.
14 Fisher E, Moore RA, Fogarty AE, Finn DP, Finnerup NB, Gilron I, Haroutounian S, Krane E, Rice ASC, Rowbotham M, Wallace M, Eccleston C. Cannabinoids, cannabis, and cannabis-based medicine for pain management: a systematic review of randomised controlled trials. Pain. 2021;162(Suppl 1):S45-S66.
15 Zeng L, Lytvyn L, Wang X, Kithulegoda N, Agterberg S, Shergill Y, Esfahani MA, Heen AF, Agoritsas T, Guyatt GH, Busse JW. Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review. BMJ Open. 2021;11(9):e050831.
Submitted date:
07/20/2023
Accepted date:
02/27/2023
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