Practical aspects of the use of medicinal cannabis in chronic pain
Aspectos práticos do uso da cannabis medicinal em dor crônica
Wellington Briques; Carla Leal Pereira; Paulo Sergio Feliz
Abstract
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: As evidências têm revelado um papel importante sobre o uso da cannabis medicinal e da interação do sistema endocanabinoide com outros fármacos para o tratamento de dor crônica neuropática e nociplástica. O objetivo deste estudo foi prover atualização sobre os dados publicados quanto a doses e cuidados com o uso dos canabinoides que mostrem interação na fisiopatologia da dor crônica e seu tratamento.
CONTEÚDO: Foi realizada uma revisão baseada em pesquisa na base de dados Medline, Pubmed com uso dos unitermos “cannabis e dor”, “endocannabinoid”, “neuropathic pain”, “nociplastic pain” e “drug interactions”.
CONCLUSÃO: A interação farmacológica com os canabinoides requer aprofundamento do conhecimento científico e as doses são individuais, o que dificulta a criação de um protocolo para tratamento.
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References
1 Aguiar DP, Souza CP, Barbosa WJ, Santos-Júnior FF, Oliveira AS. Prevalência de dor crônica no Brasil: revisão sistemática. BrJP. 2021;4(3):257-26.
2 Maione S, Costa B, Di Marzo V. Endocannabinoids: a unique opportunity to develop multitarget analgesics. Pain. 2013;154(Suppl 1):S87-S93.
3 Russo EB, Marcu J. Cannabis pharmacology: the usual suspects and a few promising leads. Adv Pharmacol. 2017;80:67-134.
4 Blake A, Wan BA, Malek L, DeAngelis C, Diaz P, Lao N, Chow E, O’Hearn S. A selective review of medical cannabis in cancer pain management. Ann Palliat Med. 2017;6(Suppl 2):S215-S22.
5 Freynhagen R, Parada HA, Calderon-Ospina CA, Chen J, Rakhmawati Emril D, Fernández-Villacorta FJ, Franco H, Ho KY, Lara-Solares A, Li CC, Mimenza Alvarado A, Nimmaanrat S, Dolma Santos M, Ciampi de Andrade D. Current understanding of the mixed pain concept: a brief narrative review. Curr Med Res Opin. 2019;35(6):1011-8.
6 Mücke ok M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018;3(3):CD012182.
7 MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49(1):12-9.
8 Bhaskar ok A, Bell A, Boivin M, Briques W, Brown M, Clarke H, Cyr C, Eisenberg E, de Oliveira Silva RF, Frohlich E, Georgius P, Hogg M, Horsted TI, MacCallum CA, Müller-Vahl KR, O’Connell C, Sealey R, Seibolt M, Sihota A, Smith BK, Sulak D, Vigano A, Moulin DE. Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Cannabis Res. 2021;3(1):22.
9 Health Canada. Information for Health Care Professionals. [cited 2014 Nov 25]; Available from:
10 Sihota A, Smith BK, Ahmed SA, Bell A, Blain A, Clarke H, Cooper ZD, Cyr C, Daeninck P, Deshpande A, Ethans K, Flusk D, Le Foll B, Milloy MJ, Moulin DE, Naidoo V, Ong M, Perez J, Rod K, Sealey R, Sulak D, Walsh Z, O’Connell C. Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control. Int J Clin Pract. 2021;75(8):e13871.
11 Naik H, Trojian TH. Therapeutic potential for cannabinoids in sports medicine: current literature review. Curr Sports Med Rep. 2021;20(7):345-50.
12 Miller GF, DePadilla L, Jones SE, Bartholow BN, Sarmiento K, Breiding MJ. The association between sports- or physical activity-related concussions and suicidality among US high school students, 2017. Sports Health. 2021;13(2):187-97.
13 Fitzcharles MA, Petzke F, Tölle TR, Häuser W. Cannabis-based medicines and medical cannabis in the treatment of nociplastic pain. Drugs. 2021;81(18):2103-16.
14 Luckett T, Phillips J, Lintzeris N, Allsop D, Lee J, Solowij N, Martin J, Lam L, Aggarwal R, McCaffrey N, Currow D, Chye R, Lovell M, McGregor I, Agar M. Clinical trials of medicinal cannabis for appetite-related symptoms from advanced cancer: a survey of preferences, attitudes and beliefs among patients willing to consider participation. Intern Med J. 2016;46(11):1269-75.
15 Nugent SM, Morasco BJ, O’Neil ME, Freeman M, Low A, Kondo K, Elven C, Zakher B, Motu’apuaka M, Paynter R, Kansagara D. The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. Ann Intern Med. 2017;167(5):319-31.
16 Busse JW, Vankunkelsven P, Zeng L, Heen AF, Marglen A, Campbell F, Granan LP, Artgeerts B, Buchbinder R, Coen M, Juurlink D, Samer C, Siemieniuk B, Nimisha K, Cooper L, Brown J, Lytvyn L, Zaraatkar D, Wang L, Guyatt GH, Vandvik PO, Agoritsas T. Medical cannabis or cannabinoids for chronic pain: a clinical practice guideline. BJM. 2021;374:n2040.
17 Sugiura T, Kondo S, Sukagawa A, Nakane S, Shinoda A, Itoh K, Yamashita A, Waku K. 2-Arachidonoylglycerol: a possible endogenous cannabinoid receptor ligand in brain. Biochem Biophys Res Commun. 1995;215(1):89-97.
18 Häuser W, Petzke F, Fitzcharles MA. Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management – an overview of systematic reviews. Eur J Pain. 2018;22(3):455-70.
19 Serrano A, Parsons LH. Endocannabinoid influence in drug reinforcement, dependence and addiction-related behaviors. Pharmacol Ther. 2011;132(3):215-41.
20 Castaneto MS, Gorelick DA, Desrosiers NA, Hartman RL, Pirard S, Huestis MA. Synthetic cannabinoids: epidemiology, pharmacodynamics, and clinical implications. Drug Alcohol Depend. 2014;144(1):12-41.
21 Aizpurua-Olaizola O, Elezgarai I, Rico-Barrio I, Zarandona I, Etxebarria N, Usobiaga A. Targeting the endocannabinoid system: future therapeutic strategies. Drug Discov Today. 2017;22(1):105-10.
Submitted date:
09/08/2022
Accepted date:
07/21/2023