A Large-Scale Naturalistic Examination of the Acute Effects of Cannabis on Pain
A Large-Scale Naturalistic Examination of the Acute Effects of Cannabis on Pain
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DOI：
10.1089/can.2020.0068
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发表时间：
2020-10-23
影响因子：
3.8
通讯作者：
Craft, Rebecca M.
中科院分区：
文献类型：
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作者：
Cuttler, Carrie;LaFrance, Emily M.;Craft, Rebecca M.
简介：大麻用于缓解疼痛的报道很常见，但实验室研究和临床试验表明，大麻素是弱镇痛药，目前尚不清楚大麻使用前后疼痛的减轻是否与剂量、给药方法、植物大麻素含量或使用者的年龄或性别等因素有关。我们确定吸入大麻是否会降低自我报告的疼痛评级，以及使用者的性别、年龄、时间、给药方法、四氢大麻酚 (THC)/大麻二酚 (CBD) 含量或大麻剂量是否会导致这些评级的变化。我们还检查了随着时间的推移是否可能对大麻的镇痛作用产生耐受性。 材料和方法：档案数据来自 Strainprint (R)，这是一款医用大麻应用程序，允许患者跟踪使用不同品种和剂量的大麻之前和之后的症状。使用潜在变化评分模型和多级模型分析了 131,582 次使用吸入大麻治疗“肌肉疼痛”、“关节疼痛”或“神经疼痛”的疗程的数据。 结果：对于所有三种疼痛症状，使用大麻后严重程度评分均显着下降。女性报告的基线和大麻后疼痛严重程度高于男性，男性报告的疼痛减轻幅度比女性更大。 THC 和 CBD 含量以及它们的相互作用都不能预测疼痛等级的降低。然而，与吸烟相比，电子烟与关节疼痛等级的降低幅度更大，并且较低剂量与神经疼痛等级的降低幅度更大。此外，对于所有三种疼痛症状，用于控制疼痛的大麻剂量随着时间的推移显着增加。结论：吸入大麻可将自我报告的疼痛严重程度降低约 42-49%。然而，这些减少似乎随着时间的推移而减少，并且患者随着时间的推移使用更大的剂量，这表明镇痛耐受性随着持续使用而发展。
Introduction: Cannabis use for pain relief is commonly reported, yet laboratory studies and clinical trials suggest that cannabinoids are weak analgesics, and it is unclear whether perceived reductions in pain from before to after cannabis use relate to factors such as dose, method of administration, phytocannabinoid content, or the age or gender of the user. We determined whether inhalation of cannabis decreased self-reported pain ratings as well as whether user gender, age, time, method of administration, tetrahydrocannabinol (THC)/cannabidiol (CBD) content, or dose of cannabis contribute to changes in these ratings. We also examined whether tolerance may develop to the analgesic effects of cannabis over time.Materials and Methods: Archival data were obtained from Strainprint (R), a medical cannabis app that allows patients to track symptoms before and after using different strains and doses of cannabis. Latent change score models and multilevel models were used to analyze data from 131,582 sessions in which inhaled cannabis was used to treat "muscle pain," "joint pain," or "nerve pain."Results: For all three pain symptoms, severity ratings decreased significantly after cannabis use. Women reported higher baseline and postcannabis pain severity than did men, and men reported larger decreases in pain than did women. Neither THC nor CBD content nor their interaction predicted reductions in pain ratings. However, vaping was associated with larger reductions in joint pain ratings than was smoking, and lower doses were associated with larger reductions in nerve pain ratings. Additionally, for all three pain symptoms, the dose of cannabis used to manage pain increased significantly over time.Conclusions: Inhaled cannabis reduces self-reported pain severity by similar to 42-49%. However, these reductions appear to diminish across time, and patients use larger doses across time, suggesting that analgesic tolerance develops with continued use.