El uso medicinal del Cannabis en el control del dolor crónico no oncológico: una revisión narrativa
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https://doi.org/10.5712/rbmfc21(48)4162Palabras clave:
Cannabis, Dolor crónico, Medicina Familiar y Comunitaria, Atención primaria de salud, CannabinoidesResumen
El uso terapéutico del Cannabis ha sido ampliamente debatido a nivel mundial, con creciente producción de evidencia y avances regulatorios. En el contexto de la Atención Primaria de Salud (APS), su uso sigue siendo poco explorado, a pesar de la relevancia del dolor crónico como queja frecuente. Objetivos: El objetivo de este estudio fue analizar el estado del arte sobre el uso medicinal de extractos de Cannabis, con énfasis en su aplicación en el dolor crónico y el papel estratégico del médico de familia y comunidad en su prescripción. Métodos: Se trata de una revisión narrativa de la literatura, basada en búsquedas en las bases de datos PubMed, Lilacs, Embase y SciELO. Se incluyeron artículos científicos en portugués, inglés y español. Resultados: Los estudios analizados señalan que los cannabinoides actúan sobre receptores del sistema endocannabinoide, modulando la percepción del dolor. Los efectos adversos más comunes incluyen somnolencia, sequedad bucal y alteraciones cognitivas leves. Existe evidencia prometedora sobre la reducción del uso de opioides y psicofármacos en pacientes que utilizan Cannabis con fines terapéuticos, aunque persisten lagunas sobre su seguridad y eficacia a largo plazo, especialmente en el contexto de la APS. Conclusiones: La literatura revisada sugiere que el uso del Cannabis puede representar una alternativa terapéutica viable para el manejo del dolor crónico, con potencial para reducir el uso de psicofármacos. No obstante, se requieren directrices específicas, formación profesional y más estudios clínicos en el ámbito de la APS.
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Zuardi AW. History of cannabis as a medicine: a review. Braz J Psychiatry. 2006;28(2):153-7. https://doi.org/10.1590/s1516-44462006000200015 DOI: https://doi.org/10.1590/S1516-44462006000200015
Vlad RA, Hancu G, Ciurba A, Antonoaea P, Rédai EM, Todoran N, et al. Cannabidiol - therapeutic and legal aspects. Pharmazie. 2020;75(10):463-9. https://doi.org/10.1691/ph.2020.0076
Aviram J, Samuelly-Leichtag G. Efficacy of cannabis-based medicines for pain management: a systematic review and metaanalysis of randomized controlled trials. Pain Physician. 2017;20(6):E755-96. PMID: 28934780 DOI: https://doi.org/10.36076/ppj.20.5.E755
Köstenberger M, Nahler G, Jones TM, Neuwersch S, Likar R. The role of cannabis, cannabidiol and other cannabinoids in chronic pain: the perspective of physicians. J Neuroimmune Pharmacol. 2022;17(1-2):318-33. https://doi.org/10.1007/s11481-021-10010-x DOI: https://doi.org/10.1007/s11481-021-10010-x
Charitos IA, Gagliano-Candela R, Santacroce L, Bottalico L. The cannabis spread throughout the continents and its therapeutic use in history. Endocr Metab Immune Disord Drug Targets. 2021;21(3):407-17. PMID: 32433013. https://doi.org/10.2174/1871530320666200520095900. DOI: https://doi.org/10.2174/1871530320666200520095900
Sazegar P. Cannabis essentials: tools for clinical practice. Am Fam Physician. 2021;104(6):598-608. PMID: 34913644
Notcutt WG. A questionnaire survey of patients and carers of patients prescribed sativex as an unlicensed medicine. Prim Health Care Res Dev. 2013;14(2):192-9. https://doi.org/10.1017/S1463423612000333 DOI: https://doi.org/10.1017/S1463423612000333
Slawek D, Meenrajan SR, Alois MR, Barker PC, Estores IM, Cook R. Medical cannabis for the primary care physician. J Prim Care Community Health. 2019;10:2150132719884838. PMID: 31646929 PMCID. PMC6820188. https://doi.org/10.1177/2150132719884838 DOI: https://doi.org/10.1177/2150132719884838
Cooke AC, Knight KR, Miaskowski C. Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic noncancer pain management in primary care. Int J Drug Policy. 2019;63:23-8. PMID: 30472467. PMCID: PMC6353665. https://doi.org/10.1016/j.drugpo.2018.09.002 DOI: https://doi.org/10.1016/j.drugpo.2018.09.002
Barron L, Gordon D. Cannabis in primary care. Br J Gen Pract. 2019;69(689):594-5. PMID: 31780470. PMCID: PMC6867223. https://doi.org/10.3399/bjgp19X706673 DOI: https://doi.org/10.3399/bjgp19X706673
Bruce D, Grove TJ, Foster E, Shattell M. Gender differences in medical cannabis use: symptoms treated, physician support for use, and prescription medication discontinuation. J Womens Health (Larchmt). 2021;30(6):857-63. PMID: 33090932. https://doi.org/10.1089/jwh.2020.8437 DOI: https://doi.org/10.1089/jwh.2020.8437
Fisher E, et al. Cannabinoids, cannabis, and cannabis-based medicine for pain management: a protocol for an overview of systematic reviews and a systematic review of randomised controlled trials. Pain Rep. 2019;4(3):e741. https://doi.org/10.1097/PR9.0000000000000741 DOI: https://doi.org/10.1097/PR9.0000000000000741
Hendricks O, Andersen TE, Christiansen AA, Primdahl J, Hauge EM, Ellingsen T, et al. Efficacy and safety of cannabidiol followed by an open label add-on of tetrahydrocannabinol for the treatment of chronic pain in patients with rheumatoid arthritis or ankylosing spondylitis: protocol for a multicentre, randomised, placebo-controlled study. BMJ Open. 2019;9(6):e028197. PMID: 31167870. PMCID: PMC6561449. https://doi.org/10.1136/bmjopen-2018-028197 DOI: https://doi.org/10.1136/bmjopen-2018-028197
Cunningham CO, Starrels JL, Zhang C, Bachhuber MA, Sohler NL, Levin FR, et al. Medical marijuana and opioids (MEMO) study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain. BMJ Open. 2020;10(12):e043400. PMID: 33376181; PMCID: PMC7778768. https://doi.org/10.1136/bmjopen-2020-043400 DOI: https://doi.org/10.1136/bmjopen-2020-043400
Haroutounian S, Ratz Y, Ginosar Y, Furmanov K, Saifi F, Meidan R, et al. The effect of medicinal cannabis on pain and quality-of-life outcomes in chronic pain: a prospective open-label study. Clin J Pain. 2016;32(12):1036-43. PMID: 26889611. https://doi.org/10.1097/AJP.0000000000000364 DOI: https://doi.org/10.1097/AJP.0000000000000364
Vasconcelos FH, Araújo GC. Prevalência de dor crônica no Brasil: estudo descritivo. Braz J Pain. 2018;1:176-9. https://doi.org/10.5935/2595-0118.20180034 DOI: https://doi.org/10.5935/2595-0118.20180034
Peterson AM, Le C, Dautrich T. Measuring the change in health-related quality of life in patients using marijuana for pain relief. Med Cannabis Cannabinoids. 2021;4(2):114-20. PMID: 35224431. PMCID: PMC8832252. https://doi.org/10.1159/000517857 DOI: https://doi.org/10.1159/000517857
Browne K, Leyva Y, Malte CA, Lapham GT, Tiet QQ. Prevalence of medical and nonmedical cannabis use among veterans in primary care. Psychol Addict Behav. 2022;36(2):121-30. PMID: 34435834. https://doi.org/10.1037/adb0000725 DOI: https://doi.org/10.1037/adb0000725
World Health Organization. Global patient safety action plan 2021-2030 [Internet]. Geneva: WHO; 2021 [cited on Sep 25, 2021]. Available from: https://www.who.int/publications/i/item/9789240032705
Duncan B, Schmidt MI, Giugliani ERJ, Duncan MS, Giugliani C, Mengue SS. Medicina ambulatorial: condutas de atenção primária baseadas em evidências. 5ª ed. Porto Alegre: Artmed; 2022. v. 2.
Zhu YF, Linher-Melville K, Niazmand MJ, Sharma M, Shahid A, Zhu KL, et al. An evaluation of the anti-hyperalgesic effects of cannabidiolic acid-methyl ester in a preclinical model of peripheral neuropathic pain. Br J Pharmacol. 2020;177(12):2712-25. PMID: 31981216. PMCID: PMC7236066. https://doi.org/10.1111/bph.14997 DOI: https://doi.org/10.1111/bph.14997
Godoy-Matos AF, Guedes EP, de Souza LL, Valério CM. O sistema endocanabinóide: novo paradigma no tratamento da síndrome metabólica. Arq Bras Endocrinol Metabol. 2006;50(2):390-9. https://doi.org/10.1590/S0004-27302006000200025 DOI: https://doi.org/10.1590/S0004-27302006000200025
Abrams DI, Jay CA, Shade SB, Vizoso H, Reda H, Press S, et al. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology. 2007;68(7):515-21. PMID: 17296917. https://doi.org/10.1212/01.WNL.0000253187.66183.9c DOI: https://doi.org/10.1212/01.wnl.0000253187.66183.9c
Vučković S, Srebro D, Vujović KS, Vučetić C, Prostran M. Cannabinoids and pain: new insights from old molecules. Front Pharmacol. 2018;9:1259. PMID: 30542280. PMCID: PMC6277878. https://doi.org/10.3389/fphar.2018.01259 DOI: https://doi.org/10.3389/fphar.2018.01259
Aviram J, Pud D, Gershoni T, Schiff-Keren B, Ogintz M, Vulfsons S, et al. Medical cannabis treatment for chronic pain: outcomes and prediction of response. Eur J Pain. 2021;25(2):359-74. PMID: 33065768. https://doi.org/10.1002/ejp.1675 DOI: https://doi.org/10.1002/ejp.1675
Schlag AK, Lynskey M, Fayaz A, Athanasiou-Fragkouli A, Brandner B, Haja B, et al. Characteristics of people seeking prescribed cannabinoids for the treatment of chronic pain: evidence from project twenty 21. Front Pain Res (Lausanne). 2022;3:891498. PMID: 35775024. PMCID: PMC9237624. https://doi.org/10.3389/fpain.2022.891498 DOI: https://doi.org/10.3389/fpain.2022.891498
Maher DP, Carr DB, Hill K, McGeeney B, Weed V, Jackson WC, et al. Cannabis for the treatment of chronic pain in the era of an opioid epidemic: a symposium-based review of sociomedical science. Pain Med. 2019;20(11):2311-23. PMID: 29016917. PMCID: PMC7963205. https://doi.org/10.1093/pm/pnx143 DOI: https://doi.org/10.1093/pm/pnx143
Graczyk M, Lewandowska AA, Melnyczok P, Zgliński A, Łukowicz M. Cannabinoids – perspectives for individual treatment in selected patients: analysis of the case series. Biomedicines. 2022;10(8):1862. PMID: 36009411. PMCID: PMC9405173. https://doi.org/10.3390/biomedicines10081862 DOI: https://doi.org/10.3390/biomedicines10081862
Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018;3(3):CD012182. PMID: 29513392. PMCID: PMC6494210. https://doi.org/10.1002/14651858.CD012182.pub2 DOI: https://doi.org/10.1002/14651858.CD012182.pub2
Casarett DJ, Beliveau JN, Arbus MS. Benefit of tetrahydrocannabinol versus cannabidiol for common palliative care symptoms. J Palliat Med. 2019;22(10):1180-4. PMID: 31386592. PMCID: PMC6776252. https://doi.org/10.1089/jpm.2018.0658 DOI: https://doi.org/10.1089/jpm.2018.0658
Fanelli G, De Carolis G, Leonardi C, Longobardi A, Sarli E, Allegri M, et al. Cannabis and intractable chronic pain: an explorative retrospective analysis of italian cohort of 614 patients. J Pain Res. 2017;10:1217-24. PMID: 28579820. PMCID: PMC5449133. https://doi.org/10.2147/JPR.S132814 DOI: https://doi.org/10.2147/JPR.S132814
McDonagh MS, Morasco BJ, Wagner J, Ahmed AY, Fu R, Kansagara D, Chou R. Cannabis-based products for chronic pain: a systematic review. Ann Intern Med. 2022;175(8):1143-53. https://doi.org/10.7326/M21-4520. PMID: 35667066 DOI: https://doi.org/10.7326/M21-4520
Reynolds IR, Fixen DR, Parnes BL, Lum HD, Shanbhag P, Church S, et al. Characteristics and patterns of marijuana use in community-dwelling older adults. J Am Geriatr Soc. 2018;66(11):2167-71. PMID: 30291748. PMCID: PMC6476562. https://doi.org/10.1111/jgs.15507 DOI: https://doi.org/10.1111/jgs.15507
Ste-Marie PA, Fitzcharles MA, Gamsa A, Ware MA, Shir Y. Association of herbal cannabis use with negative psychosocial parameters in patients with fibromyalgia. Arthritis Care Res (Hoboken). 2012;64(8):1202-8. PMID: 22730275. https://doi.org/10.1002/acr.21732 DOI: https://doi.org/10.1002/acr.21732
Becker WC, Bair MJ, Picchioni M, Starrels JL, Frank JW. Pain management for primary care providers: a narrative review of high-impact studies, 2014–2016. Pain Med. 2018;19(1):40-9. PMID: 29106649. PMCID: PMC6279259. https://doi.org/10.1093/pm/pnx146 DOI: https://doi.org/10.1093/pm/pnx146
Nugent SM, Morasco BJ, O’Neil ME, Freeman M, Low A, Kondo K, et al. The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. Ann Intern Med. 2017;167(5):319-31. PMID: 28806817. https://doi.org/10.7326/M17-0155 DOI: https://doi.org/10.7326/M17-0155
Gulbransen G, Xu W, Arroll B. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand. BJGP Open. 2020;4(1):bjgpopen20X101010. PMID: 32019776. PMCID: PMC7330185. https://doi.org/10.3399/bjgpopen20X101010 DOI: https://doi.org/10.3399/bjgpopen20X101010
Holman A, Kruger DJ, Lucas P, Ong K, Bergmans RS, Boehnke KF. Healthcare provider and medical cannabis patient communication regarding referral and medication substitution: the Canadian context. J Cannabis Res. 2022;4(1):32. PMID: 35698183. PMCID: PMC9195481. https://doi.org/10.1186/s42238-022-00141-0 DOI: https://doi.org/10.1186/s42238-022-00141-0
Levy C, Galenbeck E, Magid K. Cannabis for symptom management in older adults. Med Clin North Am. 2020;104(3):471-89. PMID: 32312410. https://doi.org/10.1016/j.mcna.2020.01.004 DOI: https://doi.org/10.1016/j.mcna.2020.01.004
Silva RC, Albuquerque GLC. O papel da Medicina de Família e Comunidade no uso medicinal de Cannabis. Rev Bras Med Fam Comunidade. 2023;18(45):3632. https://doi.org/10.5712/rbmfc18(45)3632 DOI: https://doi.org/10.5712/rbmfc18(45)3632
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Derechos de autor 2026 Rômulo Elísio Resende do Amaral, Mayra Gabriela Machado de Souza, Vágner Reis Batista
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