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Cited by 80Cannabis and Cannabinoid ResearchPain Mechanisms and TreatmentsPain Management and Opioid Use

Wirksamkeit, Verträglichkeit und Sicherheit von Cannabinoiden bei neuropathischen Schmerzsyndromen: Eine systematische Übersichtsarbeit von randomisierten, kontrollierten Studien

Petzke, F., Enax-Krumova, E. K., Häuser, W.·2016·Der Schmerz
DOI 10.1007/s00482-015-0089-y
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Abstract

Background Recently published systematic reviews came to different conclusions with respect to the efficacy, tolerability and safety of cannabinoids for treatment of chronic neuropathic pain. Material and methods A systematic search of the literature was carried out in MEDLINE, the Cochrane central register of controlled trials (CENTRAL) and clinicaltrials.gov up until November 2015. We included double-blind randomized placebo-controlled studies (RCT) of at least 2 weeks duration and with at least 9 patients per treatment arm comparing medicinal cannabis, plant-based or synthetic cannabinoids with placebo or any other active drug treatment in patients with chronic neuropathic pain. Clinical endpoints of the analyses were efficacy (more than 30 % or 50 % reduction of pain, average pain intensity, global improvement and health-related quality of life), tolerability (drop-out rate due to side effects, central nervous system and psychiatric side effects) and safety (severe side effects). Using a random effects model absolute risk differences (RD) were calculated for categorical data and standardized mean differences (SMD) for continuous variables. The methodological quality of RCTs was rated by the Cochrane risk of bias tool. Results We included 15 RCTs with 1619 participants. Study duration ranged between 2 and 15 weeks. Of the studies 10 used a plant-derived oromucosal spray with tetrahydrocannabinol/cannabidiol, 3 studies used a synthetic cannabinoid (2 with nabilone and 1 with dronabinol) and 2 studies used medicinal cannabis. The 13 studies with parallel or cross-over design yielded the following results with 95 % confidence intervals (CI): cannabinoids were superior to placebo in the reduction of mean pain intensity with SMD - 0.10 (95 % CI - 0.20- - 0.00, p = 0.05, 13 studies with 1565 participants), in the frequency of at least a 30 % reduction in pain with an RD of 0.10 [95 % CI 0.03-0.16, p = 0.004, 9 studies with 1346 participants, number needed to treat for additional benefit (NNTB) 14, 95 % CI 8-45] and in the frequency of a large or very large global improvement with an RD of 0.09 (95 % CI 0.01-0.17, p = 0.009, 7 studies with 1092 participants). There were no statistically significant differences between cannabinoids and placebo in the frequency of at least a 50 % reduction in pain, in improvement of health-related quality of life and in the frequency of serious adverse events. Patients treated with cannabinoids dropped out more frequently due to adverse events with an RD of 0.04 [95 % CI 0.01-0.07, p = 0.009, 11 studies with 1572 participants, number needed to treat for additional harm (NNTH) 19, 95 % CI 13-37], reported central nervous system side effects more frequently with an RD of 0.38 (95 % CI 0.18-0.58, p = 0.0003, 9 studies with 1304 participants, NNTH 3, 95 % CI 2-4) and psychiatric side effects with an RD of 0.11 (95 % CI 0.06-0.16, p < 0.0001, 9 studies with 1304 participants, NNTH 8, 95 % CI 7-12). Conclusion Cannabinoids were marginally superior to placebo in terms of efficacy and inferior in terms of tolerability. Cannabinoids and placebo did not differ in terms of safety during the study period. Short-term and intermediate-term therapy with cannabinoids can be considered in selected patients with chronic neuropathic pain after failure of first-line and second-line therapies.

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Authors
Petzke, F., Enax-Krumova, E. K., & Häuser, W.
Affiliations
  • Universitätsmedizin Göttingen (DE)
  • Klinikum Saarbrücken (DE)
Corresponding author
Petzke, F.
ORCID
Venue
Der Schmerz
Publisher
Springer Science and Business Media LLC
Published
2016-02
Volume
30
Issue
1
Pages
62-88
ISSN
  • 0932-433X (ISSN-L)
  • 1432-2129
DOI
10.1007/s00482-015-0089-y
OpenAlex
W2285175521
Cited by
80
References
30
Citations by year
2025: 6 · 2024: 8 · 2023: 6 · 2022: 5 · 2021: 17 · 2020: 5 · 2019: 15 · 2018: 9 · 2017: 7 · 2016: 2
FWCI
1.26
Type
journal article
Language
de
Update notices
erratum (2017-09-06)
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Der Schmerz (publishedVersion)
  • PubMed (publishedVersion)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
  • GRO (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
cannabinoids, chronic neuropathic pain, medical cannabis, tetrahydrocannabinol, cannabidiol, nabilone, dronabinol, oromucosal spray, pain intensity, tolerability, safety, adverse effects, health-related quality of life, treatment efficacy, risk of bias, number needed to harm
MeSH terms
Cannabinoids, Humans, Neuralgia, Randomized Controlled Trials as Topic, Chronic Pain

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