Session Title: Pain: Basic and Clinical Aspects
Session Type: Abstract Submissions (ACR)
Background/Purpose: The endocannabinoid system functions to maintain homeostasis in the human body and thereby has effects on modulation of pain and inflammation. Cannabinoid preparations are available as synthetic or plant derived products and may be effective for the management of pain associated with musculoskeletal conditions. We have conducted a systematic review to examine the evidence on the efficacy and side effects of cannabinoids (phyto- and syntheto-) in the management of rheumatic pain
Methods: A comprehensive literature search of the following databases was conducted in September 2013: MEDLINE; Embase Classic + Embase ; BIOSIS Previews; Scopus; CENTRAL; DARE; CINAHL; PsycINFO; AMED. Additional searches for ongoing clinical trials were also run in ClinicalTrials.gov, International Clinical Trials Registry Platform, Current Controlled Trials, Natural Standard, as well as various Drug and Device Regulatory Approval Sites. Further studies were identified in Web of Science and Scopus (March 2014) by citations searches for studies citing included studies, as well as by examining their reference lists. Randomized controlled trials (RCT’s) with outcomes investigating pain and sleep disturbance in rheumatic conditions, with comparison of an active therapy with placebo were included. Study quality was assessed using the JADAD scale (out of 5). In view of a paucity of studies, heterogeneous populations, and different products, only a systematic review is reported.
Results: Of the 1407 articles screened, 12 underwent full text examination. Excluded were survey reports, observational studies, case series, case reports and commentaries, with 7 remaining articles. Of these 3 were excluded: two included patients with non-rheumatic diseases, 1 was an open-label study of effect of THC on experimentally induced pain. The remaining 4 studies comprised 201 patients (58 RA, 72 FM, and 74 OA). One study examined the effect of nabiximols in RA, two studies examined nabilone in FM (one a non-inferiority study with amitriptyline as comparator), and one examined effect of a fatty acid amide hydrolase-1 (FAAH1) inhibitor in OA. The quality of the trials was good, with a mean 3.75 JADAD score. The study of FAAH1 inhibitor was stopped at interim analysis for futility. For the remaining 3 trials, duration was from 5-8 weeks, with significant analgesic effect in two, significant sleep effect in two, and one in FM reporting improved quality of life. No serious adverse events were reported, with dizziness and drowsiness the most common adverse effects for about a quarter of patients. There were no studies of inhaled herbal cannabis identified.
Conclusion: Small sample sizes, heterogeneity of rheumatic conditions and products, only a single comparative trial and absence of any study of herbal cannabis allow for only limited conclusions. The results suggest that pain relief and positive effect on sleep may have some potential for therapeutic benefit for rheumatic patients, but in view of this small body of current evidence cannabinoid treatments cannot be recommended for management of rheumatic complaints.
M. A. Fitzcharles,
P. A. Ste-Marie,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-cannabinoid-treatments-in-the-rheumatic-diseases-a-systematic-review-of-randomized-controlled-trials/