Cannabis en dolor crónico/Cannabis for chronic pain

Noviembre 13, 2015. No. 2144

El uso medicinal del cannabis parece ser en gran medida seguro para el tratamiento del dolor crónico, al menos en las personas que cuentan con alguna experiencia en la toma del fármaco. Un equipo de investigación canadiense comprobó que las personas que tomaban cannabis para aliviar su dolor no presentaban un riesgo mayor de sufrir efectos secundarios graves, en comparación con las personas con dolor que no lo consumían. Los investigadores siguieron a 215 pacientes adultos con dolor crónico que tomaron cannabis medicinal (con un contenido del 12,5% de tetrahidrocannabinol) durante un año, y los compararon con un grupo control de 216 pacientes con dolor crónico que no lo consumían. El estudio contó la colaboración de siete centros de tratamiento del dolor de Canadá. Las personas podía consumir la marihuana del modo en que desearan: fumarla, comerla con los alimentos o inhalarla con un vaporizador. Hubo poca diferencia en cuanto a efectos secundarios graves entre ambos grupos, según los investigadores, aunque los usuarios de cannabis presentaron un riesgo un 73% más alto de sufrir efectos secundarios leves, como dolores de cabeza, náuseas, somnolencia y mareos. (neurología.com)   Cannabis para el Manejo del Dolor: Evaluación del Estudio de Seguridad (COMPASS). Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). Ware MA, Wang T, Shapiro S, Collet JP; COMPASS study team. J Pain. 2015 Sep 16. pii: S1526-5900(15)00837-8. doi: 10.1016/j.jpain.2015.07.014. [Epub ahead of print] Abstract Cannabis is widely used as a self-management strategy by patients with a wide range of symptoms and diseases including chronic non-cancer pain. The safety of cannabis use for medical purposes has not been systematically evaluated. We conducted a prospective cohort study to describe safety issues among individuals with chronic non-cancer pain. A standardized herbal cannabis product (12.5% tetrahydrocannabinol) was dispensed to eligible individuals for a 1-year period; controls were individuals with chronic pain from the same clinics who were not cannabis users. The primary outcome consisted of serious adverse events and non-serious adverse events. Secondary safety outcomes included pulmonary and neurocognitive function and standard hematology, biochemistry, renal, liver, and endocrine function. Secondary efficacy parameters included pain and other symptoms, mood, and quality of life. Two hundred and fifteen individuals with chronic pain were recruited to the cannabis group (141 current users and 58 ex-users) and 216 controls (chronic pain but no current cannabis use) from 7 clinics across Canada. The median daily cannabis dose was 2.5 g/d. There was no difference in risk of serious adverse events (adjusted incidence rate ratio = 1.08, 95% confidence interval = .57-2.04) between groups. Medical cannabis users were at increased risk of non-serious adverse events (adjusted incidence rate ratio = 1.73, 95% confidence interval = 1.41-2.13); most were mild to moderate. There were no differences in secondary safety assessments. Quality-controlled herbal cannabis, when used by patients with experience of cannabis use as part of a monitored treatment program over 1 year, appears to have a reasonable safety profile. Longer-term monitoring for functional outcomes is needed. STUDY REGISTRATION: The study was registered with www.controlled-trials.com (ISRCTN19449752). PERSPECTIVE: This study evaluated the safety of cannabis use by patients with chronic pain over 1 year. The study found that there was a higher rate of adverse events among cannabis users compared with controls but not for serious adverse events at an average dose of 2.5 g herbal cannabis per day.  PDF

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