Medical cannabis for chronic pain
A partir d'une revue systématique de la littérature publiée jusqu'en janvier 2021 (32 essais randomisés, 5 174 patients), cette méta-analyse évalue l'efficacité et la toxicité du cannabis thérapeutique et des cannabinoïdes pour soulager la douleur chronique, notammant la douleur liée au cancer
Patient centred guidance recommends a trial of treatment. Patients with persistent pain continue to search for new therapeutic options and often perceive cannabis as a worthwhile alternative.1 Clinicians need guidance on this option to inform shared decision-making with patients.2 The linked clinical guidance by Busse and colleagues was developed for this purpose and comes from an international panel combining several disciplines, specialties, and patient groups.3 The new guidance is based on a systematic review of the effectiveness of medical cannabis for chronic pain,4 offers an online tool, and has the potential to fill a critical gap in information for decision making, enabling more inclusive management of chronic pain. The guidance offers a weak recommendation for a trial of non-inhaled medical cannabis for the treatment of chronic pain. Its summary indicates moderate evidence of a clinically important decrease in pain for a small to very small proportion of patients. The recommendation for a trial of treatment is based on two meta-analyses of randomised trials within the systematic review4: first, a meta-analysis of 27 randomised controlled trials finding an increase in the proportion of patients reporting an improvement in pain of at least 1 cm on a 10 cm visual analogue scale (although a minimum reduction of 1.5 cm is considered clinically relevant5); second, a meta-analysis of 10 placebo controlled trials reporting a 7% increase in the proportion of people reporting at least a 30% reduction in pain in favour of cannabis compared with placebo.4