European Pain Federation (EFIC) position paper on appropriate use of cannabis-based medicines and medical cannabis for chronic pain management

被引：127

作者：

Haeuser, Winfried ^{[1
,2
]}

Finn, David P. ^{[3
,4
]}

Kalso, Eija ^{[5
,6
]}

Krcevski-Skvarc, Nevenka ^{[7
,8
]}

Kress, Hans-Georg ^{[9
]}

Morlion, Bart ^{[10
]}

Perrot, Serge ^{[11
,12
]}

Schaefer, Michael ^{[13
]}

Wells, Chris ^{[14
]}

Brill, Silviu ^{[15
]}

机构：

[1] Klinikum Saarbrucken gGmbH, Dept Internal Med 1, Saarbrucken, Germany

[2] Tech Univ Munich, Dept Psychosomat Med & Psychotherapy, Munich, Germany

[3] Natl Univ Ireland Galway, NCBES, Galway Neurosci Ctr, Pharmacol & Therapeut,Sch Med, Galway, Ireland

[4] Natl Univ Ireland Galway, NCBES, Ctr Pain Res, Galway, Ireland

[5] Helsinki Univ Hosp, Pain Clin, Dept Perioperat Med Intens Care & Pain Med, Helsinki, Finland

[6] Univ Helsinki, Helsinki, Finland

[7] Univ Maribor, Univ Med Ctr Maribor, Fac Med, Dept Anesthesiol Intens Care & Pain Treatm, Maribor, Slovenia

[8] Inst Palliat Med & Care, Maribor, Slovenia

[9] Med Univ Vienne AKH, Dept Special Anaesthesia & Pain Therapy, Vienna, Austria

[10] Univ Hosp Leuven, Leuven Ctr Algol & Pain Management, Leuven, Belgium

[11] Paris Descartes Univ, Cochin Hosp, AP HP, Dept Pain Ctr, Paris, France

[12] Paris Descartes Univ, Cochin Hosp, AP HP, INSERM,U987, Paris, France

[13] Charite, Dept Anaesthesiol & Intens Care Med, Berlin, Germany

[14] Pain Matters Ltd, Liverpool, Merseyside, England

[15] Sourasky Med Ctr, Pain Ctr, Tel Aviv, Israel

来源：

EUROPEAN JOURNAL OF PAIN | 2018年 / 22卷 / 09期

关键词：

CHRONIC NEUROPATHIC PAIN; SMOKED CANNABIS; FUNCTIONAL EXPRESSION; DRUG-INTERACTIONS; CROHNS-DISEASE; CB2; RECEPTORS; RAT-BRAIN; EFFICACY; TOLERABILITY; METAANALYSIS;

D O I：

10.1002/ejp.1297

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Cannabis-based medicines are being approved for pain management in an increasing number of European countries. There are uncertainties and controversies on the role and appropriate use of cannabis-based medicines for the management of chronic pain. EFIC convened a European group of experts, drawn from a diverse range of basic science and relevant clinical disciplines, to prepare a position paper to empower and inform specialist and nonspecialist prescribers on appropriate use of cannabis-based medicines for chronic pain. The expert panel reviewed the available literature and harnessed the clinical experience to produce these series of recommendations. Therapy with cannabis-based medicines should only be considered by experienced clinicians as part of a multidisciplinary treatment and preferably as adjunctive medication if guideline-recommended first- and second-line therapies have not provided sufficient efficacy or tolerability. The quantity and quality of evidence are such that cannabis-based medicines may be reasonably considered for chronic neuropathic pain. For all other chronic pain conditions (cancer, non-neuropathic noncancer pain), the use of cannabis-based medicines should be regarded as an individual therapeutic trial. Realistic goals of therapy have to be defined. All patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to reach the predefined goals and/or the patient is additionally burdened by an unacceptable level of adverse effects and/or there are signs of abuse and misuse of the drug by the patient, therapy with cannabis-based medicines should be terminated. SignificanceThis position paper provides expert recommendations for nonspecialist and specialist healthcare professionals in Europe, on the importance and the appropriate use of cannabis-based medicines as part of a multidisciplinary approach to pain management, in properly selected and supervised patients.

引用

页码：1547 / 1564

页数：18

共 113 条

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