Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study.
Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study.
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DOI：
10.1016/s2468-2667(18)30110-5
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发表时间：
2018-07
期刊：
影响因子：
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通讯作者：
Degenhardt L
中科院分区：
文献类型：
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作者：
Campbell G;Hall WD;Peacock A;Lintzeris N;Bruno R;Larance B;Nielsen S;Cohen M;Chan G;Mattick RP;Blyth F;Shanahan M;Dobbins T;Farrell M;Degenhardt L
人们对使用大麻和大麻素治疗慢性非癌症疼痛（CNCP）的兴趣越来越大。大麻和大麻素引起了人们的关注，因为它们比阿片类药物更安全，并且它们的使用可能通过阿片类药物节省效应减少阿片类药物的剂量需求。这两个因素都被认为有助于减少阿片类药物相关的死亡。我们使用了疼痛和阿片类药物治疗（POINT）研究，这是一项由1，514名使用CNCP处方阿片类药物的人组成的国家队列，以检查大麻使用，阿片类药物使用和疼痛结果之间的关系超过四年。大麻的使用很普遍，在四年的随访中，24.3%的人使用大麻来止痛。使用大麻止痛的兴趣从33%（基线）增加到60%（四年）。我们发现，使用大麻的患者比未使用大麻的患者具有更大的疼痛严重程度和干扰，更低的疼痛自我效能和更大的GAD严重程度。我们没有发现大麻使用与疼痛严重程度或疼痛干扰之间存在时间关系的证据，也没有证据表明大麻使用减少了处方阿片类药物的使用或增加了阿片类药物停药率。大麻的使用在CNCP处方阿片类药物的患者中很常见，但我们没有发现大麻使用改善患者预后的证据。那些使用大麻的人在管理疼痛方面有更大的疼痛和更低的自我效能，没有证据表明大麻的使用减少了疼痛的严重程度或干扰，或产生了阿片类药物的节省效果。
There has been growing interest in the use of cannabis and cannabinoids to treat chronic non-cancer pain (CNCP). Cannabis and cannabinoids have attracted attention because of their greater safety compared with opioids, and the possibility that their use can reduce opioid dose requirements via an opioid-sparing effect. Both factors have been proposed to contribute to fewer opioid-related deaths. We used The Pain and Opioids IN Treatment (POINT) study, a national cohort of 1,514 people living with CNCP prescribed opioids, to examine relationships between cannabis use, opioid use and pain outcomes over four years. Cannabis use was common, and by four-year follow-up, 24.3% had used cannabis for pain. Interest in using cannabis for pain doubled from 33% (baseline) to 60% (four years). We found that patients who had used cannabis had greater pain severity and interference, lower pain self-efficacy, and greater GAD severity than patients who had not used cannabis. We found no evidence of a temporal relationship between cannabis use and pain severity or pain interference, and no evidence that cannabis use reduced prescribed opioid use or increased rates of opioid discontinuation. Cannabis use was common in people living with CNCP prescribed opioids, but we found no evidence that cannabis use improved patient outcomes. Those who used cannabis had greater pain and lower self-efficacy in managing pain and there was no evidence that cannabis use reduced pain severity or interference or exerted an opioid-sparing effect.