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Effective Treatment For Pain

Effective Treatment For Pain

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Are cannabinoids an effective and safe treatment option in
the management of pain? A qualitative systematic review
Fiona A Campbell, Martin R Tramèr, Dawn Carroll, D John M Reynolds, R Andrew Moore,
Henry J McQuay

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Introduction
The recent clamour for wider access to cannabis or
cannabinoids as analgesics in chronic painful conditions has some logic. Humans have cannabinoid
receptors in the central and peripheral nervous
system,1 although the functions of these receptors and
the endogenous ligands may yet be unclear. In animal
testing cannabinoids reduce the hyperalgesia and allodynia associated with formalin, capsaicin, carrageenan,
nerve injury, and visceral persistent pain.2 The hope
then is that exogenous cannabis or cannabinoid may
work as analgesics in pain syndromes that are poorly
managed. The spasms of multiple sclerosis and
resistant neuropathic pain are two obvious targets.
The background to this debate about legitimising
cannabis (also called marijuana)—from the plant
Cannabis sativa—for analgesic use is that the drug has
been used both therapeutically and recreationally for
thousands of years.3 In Britain doctors were able to
prescribe cannabis as recently as 1971,4 and in a 1994
survey 74% of UK doctors wanted cannabis to be available on prescription, as it had been until 1971.5 The
debate has included both the natural chemicals that act
on cannabinoid receptors and the synthetic cannabinoids. The synthetic nabilone is the only legally
available cannabinoid preparation in the United Kingdom and is licensed solely for use in nausea and
vomiting induced by chemotherapy. Delta-9-
tetrahydrocannabinol (THC) is the most potent
cannabinoid, and although it is available in the United
States, it is not licensed for use in the United Kingdom.
The evidence used in the public debate about the
analgesic efficacy of cannabinoids in humans has been
gathered in a less than systematic manner and has often
been taken from low quality study designs, such as anecdotal reports, questionnaires, or case series.4 The
purpose of this systematic review was to find all of the
randomised controlled trials of therapeutic use of
cannabis in the management of human pain and then to
obtain the best estimates of the efficacy of cannabis compared with either conventional analgesics or placebo. We
also sought evidence of adverse effects (safety).
Cannabis is used recreationally because of the
euphoria that it produces. The adverse psychological
effects (including psychomotor and cognitive impairment; anxiety and panic attacks; and acute psychosis and
paranoia) may limit therapeutic use.6 Other adverse
physical effects include dry mouth, blurred vision, palpitations, tachycardia, and postural hypotension.3
Decisions about therapeutic cannabinoids, either
about medical availability or about future research

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