Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.018
Brazilian Journal of Anesthesiology
Narrative Review

Cannabis and pain: a scoping review

Cannabis e dor: uma revisão de escopo

Camila Pantoja-Ruiz; Paula Restrepo-Jimenez; Camilo Castañeda-Cardona; Alexandra Ferreirós; Diego Rosselli

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Abstract

Abstract: For centuries, cannabis has been used with many different purposes, including medicinal use, usually bypassing any formal approval process. However, during the last decade, interest in cannabis in medicine has been increasing, and several countries, including the United States and Canada, have produced their own legislation about marihuana and cannabis-based medicines. Because of this, interest in research has been increasing and evidence about its medical effects is becoming necessary. We conducted a review examining the evidence of cannabis in pain. Cannabis had been shown to be useful in acute and chronic pain, however recently, these results have been controverted. Within the different types of chronic pain, it has a weak evidence for neuropathic, rheumatic pain, and headache, modest evidence for multiple sclerosis related pain, and as adjuvant therapy in cancer pain. There is no strong evidence to recommend cannabis in order to decrease opioids in patients with chronic use. Even though cannabis-based medications appear to be mostly safe, mild adverse effects are common; somnolence, sedation, amnesia, euphoric mood, hyperhidrosis, paranoia, and confusion may limit the use of cannabis in clinical practice. Risks have not been systematically analyzed. Special concern arises on how adverse effect might affect vulnerable population such as elderly patients. More research is needed in order to evaluate benefits and risks, as well as the ideal administration route and dosages. As cannabis use increases in several countries, answers to these questions might be coming soon.

Keywords

Acute pain, Cannabis, Neuralgia, Review, Chronic pain, Cancer pain

Resumo

Por séculos, a cannabis tem sido usada com muitos propósitos diferentes, incluindo o uso medicinal, geralmente contornando qualquer processo de aprovação formal. No entanto, durante a última década, o interesse pela cannabis na medicina tem aumentado, e vários países, incluindo os Estados Unidos e o Canadá, produziram sua própria legislação sobre a maconha e os medicamentos à base de cannabis. Por conta disso, o interesse por pesquisas vem crescendo examinando as evidências de cannabis na dor. A cannabis demonstrou ser útil na dor aguda e crônica, no entanto, recentemente, esses resultados foram controversos. Entre os diferentes tipos de dor crônica, tem uma evidência fraca para dor neuropática, reumática e cefaleia, evidência modesta para dor relacionada à esclerose múltipla e como terapia adjuvante na dor oncológica. Não há evidências fortes para recomendar cannabis a fim de diminuir os opioides em pacientes com uso crônico. Embora os medicamentos à base de cannabis pareçam ser em sua maioria seguros, efeitos adversos leves são comuns; sonolência, sedação, amnésia, humor eufórico, hiperidrose, paranoia e confusão podem limitar o uso de cannabis na prática clínica. Os riscos não foram analisados sistematicamente. Uma preocupação especial surge sobre como o efeito adverso pode afetar a população vulnerável, como pacientes idosos. Mais pesquisas são necessárias para avaliar benefícios e riscos, bem como a via e dosagens ideais de administração. Como o uso de cannabis aumenta em vários países, as respostas a essas perguntas podem chegar em breve.


 

Palavras-chave

Dor aguda, Cannabis, Neuralgia, Análise, Dor crônica, Dor de câncer

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Submitted date:
04/23/2020

Accepted date:
06/26/2021

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