Tetrahydrocannabinol and cannabidiol medicines for chronic pain and mental health conditions

被引:24
作者
Henson, Jeremy D. [1 ,2 ]
Vitetta, Luis [1 ,3 ]
Hall, Sean [2 ]
机构
[1] Univ NSW, Prince Wales Clin Sch, Sydney, NSW 2052, Australia
[2] Medlab Clin Ltd, Sydney, NSW 2015, Australia
[3] Univ Sydney, Fac Med & Hlth, Sydney, NSW 2006, Australia
关键词
Tetrahydrocannabinol; Cannabidiol; Pain; Stress; Anxiety; Depression; Insomnia; GENERALIZED SOCIAL PHOBIA; DOUBLE-BLIND; OROMUCOSAL SPRAY; CANNABINOID RECEPTORS; COGNITIVE FUNCTION; ANXIETY DISORDER; STRESSED MICE; CB2; RECEPTOR; DELTA-9-TETRAHYDROCANNABINOL; DELTA(9)-TETRAHYDROCANNABINOL;
D O I
10.1007/s10787-022-01020-z
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Combination tetrahydrocannabinol (THC)/cannabidiol (CBD) medicines or CBD-only medicines are prospective treatments for chronic pain, stress, anxiety, depression, and insomnia. THC and CBD increase signaling from cannabinoid receptors, which reduces synaptic transmission in parts of the central and peripheral nervous systems and reduces the secretion of inflammatory factors from immune and glial cells. The overall effect of adding CBD to THC medicines is to enhance the analgesic effect but counteract some of the adverse effects. There is substantial evidence for the effectiveness of THC/CBD combination medicines for chronic pain, especially neuropathic and nociplastic pain or pain with an inflammatory component. For CBD-only medication, there is substantial evidence for stress, moderate evidence for anxiety and insomnia, and minimal evidence for depression and pain. THC/CBD combination medicines have a good tolerability and safety profile relative to opioid analgesics and have negligible dependence and abuse potential; however, should be avoided in patients predisposed to depression, psychosis and suicide as these conditions appear to be exacerbated. Non-serious adverse events are usually dose-proportional, subject to tachyphylaxis and are rarely dose limiting when patients are commenced on a low dose with gradual up-titration. THC and CBD inhibit several Phase I and II metabolism enzymes, which increases the exposure to a wide range of drugs and appropriate care needs to be taken. Low-dose CBD that appears effective for chronic pain and mental health has good tolerability and safety, with few adverse effects and is appropriate as an initial treatment.
引用
收藏
页码:1167 / 1178
页数:12
相关论文
共 132 条
[1]  
Abelev Sarah, 2022, Med Cannabis Cannabinoids, V5, P20, DOI 10.1159/000521492
[2]  
ACMD, 2020, CANN BAS PROD MED US, P1
[3]   Cannabinoids mediate analgesia largely via peripheral type 1 cannabinoid receptors in nociceptors [J].
Agarwal, Nitin ;
Pacher, Pal ;
Tegeder, Irmgard ;
Amaya, Fumimasa ;
Constantin, Cristina E. ;
Brenner, Gary J. ;
Rubino, Tiziana ;
Michalski, Christoph W. ;
Marsicano, Giovanni ;
Monory, Krisztina ;
Mackie, Ken ;
Marian, Claudiu ;
Batkai, Sandor ;
Parolaro, Daniela ;
Fischer, Michael J. ;
Reeh, Peter ;
Kunos, George ;
Kress, Michaela ;
Lutz, Beat ;
Woolf, Clifford J. ;
Kuner, Rohini .
NATURE NEUROSCIENCE, 2007, 10 (07) :870-879
[4]   Unveiling the mechanism of action behind the anti-cancer properties of cannabinoids in ER+ breast cancer cells: Impact on aromatase and steroid receptors [J].
Amaral, Cristina ;
Trouille, Fabien Marc ;
Almeida, Cristina Ferreira ;
Correia-da-Silva, Georgina ;
Teixeira, Natercia .
JOURNAL OF STEROID BIOCHEMISTRY AND MOLECULAR BIOLOGY, 2021, 210
[5]  
American Psychiatric Association, 2013, Diagnostic and statistical manual of mental disorders: DSM-5, V5th ed., DOI [10.1176/appi.books.9780890425596, DOI 10.1176/APPI.BOOKS.9780890425596]
[6]  
[Anonymous], 2020, Directives for standardization-Part 1: Rules for the structure and drafting of standardizing documents: GB/T1.1-2020
[7]   Effects of short-term cannabidiol treatment on response to social stress in subjects at clinical high risk of developing psychosis [J].
Appiah-Kusi, E. ;
Petros, N. ;
Wilson, R. ;
Colizzi, M. ;
Bossong, M. G. ;
Valmaggia, L. ;
Mondelli, V. ;
McGuire, P. ;
Bhattacharyya, S. .
PSYCHOPHARMACOLOGY, 2020, 237 (04) :1121-1130
[8]   Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis [J].
Asbridge, Mark ;
Hayden, Jill A. ;
Cartwright, Jennifer L. .
BMJ-BRITISH MEDICAL JOURNAL, 2012, 344
[9]   Oral cannabidiol does not produce a signal for abuse liability in frequent marijuana smokers [J].
Babalonis, Shanna ;
Haney, Margaret ;
Malcolm, Robert J. ;
Lofwall, Michelle R. ;
Votaw, Victoria R. ;
Sparenborg, Steven ;
Walsh, Sharon L. .
DRUG AND ALCOHOL DEPENDENCE, 2017, 172 :9-13
[10]   Cannabis, Cannabinoids, and Sleep: a Review of the Literature [J].
Babson, Kimberly A. ;
Sottile, James ;
Morabito, Danielle .
CURRENT PSYCHIATRY REPORTS, 2017, 19 (04)