Der Schmerz

, Volume 30, Issue 1, pp 47–61 | Cite as

Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis)

A systematic review of randomized controlled trials
  • M.-A. Fitzcharles
  • C. Baerwald
  • J. Ablin
  • W. Häuser
Schwerpunkt

Abstract

Background

In the absence of an ideal treatment for chronic pain associated with rheumatic diseases, there is interest in the potential effects of cannabinoid molecules, particularly in the context of global interest in the legalization of herbal cannabis for medicinal use.

Methods

A systematic search until April 2015 was conducted in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, www.cannabis-med.org and clinicaltrials.gov for randomized controlled trials with a study duration of at least 2 weeks and at least ten patients per treatment arm with herbal cannabis or pharmaceutical cannabinoid products in fibromyalgia syndrome (FMS), osteoarthritis (OA), chronic spinal pain, and rheumatoid arthritis (RA) pain. Outcomes were reduction of pain, sleep problems, fatigue and limitations of quality of life for efficacy, dropout rates due to adverse events for tolerability, and serious adverse events for safety. The methodology quality of the randomized controlled trials (RCTs) was evaluated by the Cochrane Risk of Bias Tool.

Results

Two RCTs of 2 and 4 weeks duration respectively with nabilone, including 71 FMS patients, one 4-week trial with nabilone, including 30 spinal pain patients, and one 5-week study with tetrahydrocannbinol/cannabidiol, including 58 RA patients were included. One inclusion criterion was pain refractory to conventional treatment in three studies. No RCT with OA patients was found. The risk of bias was high for three studies. The findings of a superiority of cannabinoids over controls (placebo, amitriptyline) were not consistent. Cannabinoids were generally well tolerated despite some troublesome side effects and safe during the study duration.

Conclusions

Currently, there is insufficient evidence for recommendation for any cannabinoid preparations for symptom management in patients with chronic pain associated with rheumatic diseases.

Keywords

Cannabinoids Fibromyalgia syndrome Osteoarthritis Chronic spinal pain Rheumatoid arthritis Systematic review 

Wirksamkeit, Verträglichkeit und Sicherheit von Cannabinoiden bei chronischen Schmerzen bei rheumatischen Erkrankungen (Fibromyalgiesyndrom, Rückenschmerz, Arthrose, rheumatoide Arthritis): Eine systematische Übersicht von randomisierten kontrollierten Studien

Zusammenfassung

Hintergrund

Bei Fehlen einer optimalen Behandlung von chronischen Schmerzen bei rheumatischen Erkrankungen besteht ein Interesse in dem Potential von Cannabinoiden, insbesondere auf dem Hintergrund eines weltweiten Interesses der Legalisierung von Cannabis für medizinische Zwecke.

Methoden

Systematische Literatursuche bis April 2015 in CENTRAL, Pubmed, www.cannabis-med.org und clinicaltrials.gov nach randomisierten kontrollierten Studien (RCT) mit einer Studiendauer von mindestens zwei Wochen und mindestens 10 Patienten pro Behandlungsarm mit pflanzlichem Cannabis oder pharmazeutisch hergestellten Cannabisprodukten beim Fibromyalgiasyndrom (FMS), bei Arthrose (OA), beim Rückenschmerz und bei rheumatoider Arthritis (RA). Zielvariablen waren Reduktion von Schmerz, Müdigkeit, Schlafstörungen und Einschränkungen der Lebensqualität als Indikatoren der Wirksamkeit, Abbruchraten wegen Nebenwirkungen für Verträglichkeit und schwerwiegende Nebenwirkungen für Sicherheit. Die methodische Qualität der RCTs wurde mit dem Cochrane Risk of Bias Tool bewertet.

Ergebnisse

Zwei RCTs mit Nabilon und einer Dauer von 2 bzw. 6 Wochen mit 71 FMS –Patienten, eine 4-wöchige Studie mit Nabilon und 30 Rückenschmerzpatienten und eine 5-wöchige mit Tetrahydrocannbinol/Cannabidiol mit 58 RA-Patienten wurden eingeschlossen. Ein Einschlusskriterium in drei Studien waren Schmerzen, die auf eine konventionelle Therapie nicht ansprachen. Keine RCT mit OA-Patienten wurde gefunden. Das Verzerrungsrisiko war hoch in drei Studien. Die Ergebnisse einer Überlegenheit von Cannabinoiden gegenüber Kontrollsubstanzen (Placebo, Amitriptylin) waren nicht konsistent. Cannabinoide wurden trotz einiger unangenehmer Nebenwirkungen gut toleriert und waren sicher während der Studiendauer.

Schlussfolgerungen

Aktuell besteht keine ausreichende Evidenz, eine symptomatische Behandlung von Patienten mit chronischen Schmerzen bei rheumatischen Erkrankungen mit Cannabispräparaten zu empfehlen.

Schlüsselwörter

Cannabinoide Fibromyalgiesyndrom Arthrose Chronischer Rückenschmerz Rheumatoide Arthritis Systematische Übersicht 

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Copyright information

© Deutsche Schmerzgesellschaft e.V. Published by Springer-Verlag Berlin Heidelberg - all rights reserved 2015

Authors and Affiliations

  • M.-A. Fitzcharles
    • 1
    • 2
  • C. Baerwald
    • 3
  • J. Ablin
    • 4
  • W. Häuser
    • 5
    • 6
  1. 1.Division of RheumatologyMcGill University Health CentreQuebecCanada
  2. 2.Alan Edwards Pain Management UnitMcGill University Health CenterQuebecCanada
  3. 3.Department Internal Medicine, Neurology and Dermatology, Clinic for Gastroenterology and RheumatologyUniversitätsklinikum LeipzigLeipzigGermany
  4. 4.Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  5. 5.Department Internal Medicine IKlinikum SaarbrückenSaarbruckenGermany
  6. 6.Department of Psychosomatic Medicine and PsychotherapyTechnische Universität MünchenMunichGermany

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