กัญชามีประโยชน์ในการระงับปวดจริงหรือไม่
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พ.ค. 6, 2021
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บทคัดย่อ
กัญชา (marijuana) เป็นพืชในกลุ่มที่มีสารออกฤทธิ์ต่อ จิตประสาทที่ได้รับความนิยมมากที่สุดในโลก มีการนำกัญชา มาใช้ทั้งเพื่อสันทนาการและประโยชน์ทางการแพทย์สารที่ สกัดได้จากกัญชามีมากกว่า 100 ชนิด โดยเดลต้า-ไนน์- เตตร้าไฮโดรแคนนาบินอล (ทีเอชซี) เป็นตัวที่รู้จักกันดีที่สุด ส่วนแคนนาบิไดออล (ซีบีดี) เป็นส่วนประกอบหลักของกัญชา ที่ไม่ออกฤทธิ์ต่อจิตประสาท การศึกษาในสัตว์ทดลองได้ผล การระงับปวดที่ดีกว่าการศึกษาในมนุษย์ในปัจจุบันนี้ยังขาด หลักฐานเชิงประจักษ์คุณภาพดีที่แสดงถึงประสิทธิผลของสาร สกัดกัญชาในการระงับปวด
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เอกสารอ้างอิง
1. Fitzcharles MA, Eisenberg E. Medical cannabis: a forward
visionfor theclinician. Eur J Pain2018;22:485-91.
2. Krcevski-Skvarc N, Wells C, Häuser W. Availability and
approval of cannabis-based medicines for chronic pain
management and palliative/supportive care in Europe:
a survey of the status in the chapters of the European Pain
Federation. Eur J Pain2018;22:440-54.
3. Lafaye G, Karila L, Blecha L, Benyamina A. Cannabis,
cannabinoids and health. Dialogues Clin Neurosci 2017;
9:309-16.
4. Mechoulam R, Gaoni Y, HashishIV. HashishIV.Theisolation
andstructureofcannabinolic,cannabidiolicandcannabigerolic
acids.Tetrahedron1965;21:1223-9.
5. Englund A, Freeman TP, Murray RM, McGuire P. Can we
makecannabis safer?Lancet Psychiatry2017;4:643-64.
6. Kraft B. Isthereanyclinicallyrelevantcannabinoid-induced
analgesia? Pharmacology2012;89:237-46.
7. MunroS,ThomasKL,Abu-ShaarM.Molecularcharacterization
of a peripheral receptor for cannabinoids. Nature 1993;
365:61-5.
8. Walter C, Oertel BG, Felden L, et al. Brain mapping-based
model of Δ(9)-tetrahydrocannabinol effects on connectivity
in the pain matrix. Neuropsychopharmacology 2016;41:
1659-69.
9. Lee MC, Ploner M, Wiech K, et al. Amygdala activity
contributes to the dissociative effect of cannabis on pain
perception. Pain2013;154:124-34.
10. Gu X, Mei F, Liu Y, Zhang R, Zhang J, Ma Z. Intrathecal
administrationof thecannabinoid 2receptoragonisJWH015
canattenuatecancer painand decrease mRNA expression
of the2B subunitof N-methyl-D-asparticacid. Anesh Analg
2011;113:405-11.
11. Cui JH, Kim WM, Lee HG, Kim YO, Kim CM, Yoon MH.
Antinociceptive effect of intrathecal cannabinoid receptor
agonist WIN 55,212-2 in a rat bone tumor pain model.
NeurosciLett2011;493:67-71.
12. Curto-Reyes V, Llames S, Hidalgo A, Menéndez L,
Baamonde A. Spinaland peripheralanalgesiceffectsof the
CB2 cannabinoid receptor agonist AM1241 in two models
ofbonecancer-inducedpain.BrJPharmacol2010;160:561-73.
13. Lozano-Ondoua AN, Wright C, Vardanyan A, et al.
A cannabinoid 2 receptor agonist attenuates bone
cancer-induced painand boneloss.Life Sci2010;86:646-53.
14. National Institute on Drug Abuse. 2016 [Internet]. Available
from: https://www.drugabuse.gov/researchers/researchresources/nida-drug-supply-program-dsp/marijuana-plantmaterial-available-nida-drug-supply-program [Cited on 5
March2019].
15. PergolizziJV Jr,Lequang JA,Taylor R Jr, Raffa RB, Colucci
D, NEMA Research Group.Theroleofcannabinoidsin pain
control: the good, the bad,and theugly. Minerva Anestesiol
2018;84:955-69.
16. Huang WJ, Chen WW, Zhang X. Endocannabinoid system:
role in depression, reward and pain control (Review). Mol
Med Rep 2016;14:2899-903.
17. Korem N, Zer-Aviv TM, Ganon-Elazar E, Abush H, Akirav I.
Targeting the endocannabinoid system to treat anxietyrelated disorders. J Basic Clin Physiol Pharmacol 2016;
27:193-202.
18. Babson KA, SottileJ, Morabito D. Cannabis,cannabinoids,
and sleep: a review of the literature. Curr Psychiatry Rep
2017;19:23.
19. Portenoy RK, Ganae-Motan ED, Allende S,etal. Nabiximols
for opioid-treated cancer patients with poorly-controlled
chronic pain:arandomized, placebo-controlled, graded-dose
trial. J Pain2012;13:438-49.
20. JohnsonJR,Burnell-NugentM,LossignolD,GanaeMotan ED,
Potts R, Fallon MT. Multicenter, double-blind, randomized,
placebo-controlled, parallel-group study of the efficacy,
safety,and tolerabilityofTHC:CBD extractand THC extract
in patients with intractable cancer-related pain. J Pain
Symptom Manage2010;39:167-79.
21. Côté M,Trudel M, Wang C,Fortin A. Improving qualityof life
with nabilone during radiotherapy treatments for head and
neck cancers: a randomized double-blind placebocontrolled trial. Ann Otol RhinolLaryngol2016;125:317-24.
22. Johnson JR, Lossignol D, Burnell-Nugent M, Fallon MT. An
open-label extension study to investigate the long-term
safety and tolerability of THC/CBD oromucosal spray and
oromucosalTHCsprayin patientswithterminalcancer-related
painrefractorytostrong opioid analgesics.J Pain Symptom
Manage2013;46:207-18.
23. Welch SP, Eads M. Synergistic interactions of endogenous
opioids and cannabinoid systems. Brain Res 1999;848:
183-90.
24. Welch SP,Thomas C, Patrick GS.Modulationofcannabinoidinduced antinociceptionafter intracerebroventricularversus
intrathecaladministrationto mice: possible mechanismsfor
interaction with morphine. J Pharmacol Exp Ther 1995;
272:310-21.
25. Kaymakçalan S. Pharmacologicalsimilaritiesand interactions
between cannabis and opioids. Adv Biosci 1978;22-23:
591-604.
26. LynchME, Cesar-Rittenberg P, Hohmann AG. A double-blind,
placebo-controlled,crossover pilot trial withextensionusing
an oral mucosal cannabinoid extract for treatment of
chemotherapy-induced neuropathic pain. J Pain Symptom
Manage2014;47:166-73.
27. Ward SJ,McAllister SD, Kawamura R,Murase R, Neelakantan
H, Walker EA. Cannabidiol inhibits paclitaxel-induced
neuropathic pain through 5-HT(1A) receptors without
diminishing nervous system function or chemotherapy
efficacy. Br J Pharmacol2014;171:636-45.
28. FallonMT, AlbertLux E,McQuade R,etal. Sativexoromucosal
spray as adjunctive therapy in advanced cancer patients
withchronic painunalleviated byoptimized opioid therapy:
two double-blind, randomized, placebo-controlled phase 3
studies. Br J Pain2017;11:119-33.
29. Lichtman AH,Lux EA,McQuade R,etal. Resultsofa doubleblind, randomized, placebo-controlled study of nabiximols
oromucosal spray as an adjunctive Therapy in advanced
cancer patients with chronic uncontrolled pain. J Pain
Symptom Manage2018;55:179-88.
30. Roberts JD, Gennings C, Shih M. Synergistic affective
analgesicinteraction between delta-9-tetrahydrocannabinol
and morphine. Eur J Pharmacol2006;530:54-8.
31. Allan GM, Finley CR, Ton J, et al. Systematic review of
systematicreviews for medicalcannabinoids: pain,nausea
and vomiting, spasticity, and harms. Can Fam Physician
2018;64:e78-94.
32. Stockings E, Campbell G, Hall WD, et al. Cannabis and
cannabinoids for the treatment of people with chronic
noncancer pain conditions: a systematic review and
meta-analysis of controlled and observational studies. Pain
2018;159:1932-54.
33. HäuserW, PetzkeF,Fitzcharles MA. Efficacy, tolerabilityand
safety of cannabis-based medicines for chronic pain
management - Anoverview ofsystematicreviews. EurJ Pain
2018;22:455-70.
34. Häuser W; Finnerup NB, Andrew RA. Systematic reviews
with meta-analysis on cannabis-based medicines for
chronic pain:a methodologicaland political minefield. Pain
2018;159:1906-7.
35. Turri M, Teatini F, Donato F, et al. Pain Modulation after
oromucosal cannabinoid spray (sativex®) in patients with
multiple sclerosis: a study with quantitative sensory testing
and laser-evoked potentials.Medicines(Basel)2018;21;5(3).
pii: E59. doi:10.3390/medicines5030059
36. TurcottJG, Del Rocío Guillen Núñez M,Flores-Estrada D,et
al.Theeffectofnabiloneonappetite,nutritional status,and
qualityof lifeinlung cancer patients:arandomized, doubleblind clinical trial. Support Care Cancer2018;26:3029-38.
37. Ware MA, Wang T, Shapiro S, Collet JP; COMPASS study
team. Cannabisfor the managementof pain:assessmentof
safety study (COMPASS). .J Pain2015;16:1233-42.
visionfor theclinician. Eur J Pain2018;22:485-91.
2. Krcevski-Skvarc N, Wells C, Häuser W. Availability and
approval of cannabis-based medicines for chronic pain
management and palliative/supportive care in Europe:
a survey of the status in the chapters of the European Pain
Federation. Eur J Pain2018;22:440-54.
3. Lafaye G, Karila L, Blecha L, Benyamina A. Cannabis,
cannabinoids and health. Dialogues Clin Neurosci 2017;
9:309-16.
4. Mechoulam R, Gaoni Y, HashishIV. HashishIV.Theisolation
andstructureofcannabinolic,cannabidiolicandcannabigerolic
acids.Tetrahedron1965;21:1223-9.
5. Englund A, Freeman TP, Murray RM, McGuire P. Can we
makecannabis safer?Lancet Psychiatry2017;4:643-64.
6. Kraft B. Isthereanyclinicallyrelevantcannabinoid-induced
analgesia? Pharmacology2012;89:237-46.
7. MunroS,ThomasKL,Abu-ShaarM.Molecularcharacterization
of a peripheral receptor for cannabinoids. Nature 1993;
365:61-5.
8. Walter C, Oertel BG, Felden L, et al. Brain mapping-based
model of Δ(9)-tetrahydrocannabinol effects on connectivity
in the pain matrix. Neuropsychopharmacology 2016;41:
1659-69.
9. Lee MC, Ploner M, Wiech K, et al. Amygdala activity
contributes to the dissociative effect of cannabis on pain
perception. Pain2013;154:124-34.
10. Gu X, Mei F, Liu Y, Zhang R, Zhang J, Ma Z. Intrathecal
administrationof thecannabinoid 2receptoragonisJWH015
canattenuatecancer painand decrease mRNA expression
of the2B subunitof N-methyl-D-asparticacid. Anesh Analg
2011;113:405-11.
11. Cui JH, Kim WM, Lee HG, Kim YO, Kim CM, Yoon MH.
Antinociceptive effect of intrathecal cannabinoid receptor
agonist WIN 55,212-2 in a rat bone tumor pain model.
NeurosciLett2011;493:67-71.
12. Curto-Reyes V, Llames S, Hidalgo A, Menéndez L,
Baamonde A. Spinaland peripheralanalgesiceffectsof the
CB2 cannabinoid receptor agonist AM1241 in two models
ofbonecancer-inducedpain.BrJPharmacol2010;160:561-73.
13. Lozano-Ondoua AN, Wright C, Vardanyan A, et al.
A cannabinoid 2 receptor agonist attenuates bone
cancer-induced painand boneloss.Life Sci2010;86:646-53.
14. National Institute on Drug Abuse. 2016 [Internet]. Available
from: https://www.drugabuse.gov/researchers/researchresources/nida-drug-supply-program-dsp/marijuana-plantmaterial-available-nida-drug-supply-program [Cited on 5
March2019].
15. PergolizziJV Jr,Lequang JA,Taylor R Jr, Raffa RB, Colucci
D, NEMA Research Group.Theroleofcannabinoidsin pain
control: the good, the bad,and theugly. Minerva Anestesiol
2018;84:955-69.
16. Huang WJ, Chen WW, Zhang X. Endocannabinoid system:
role in depression, reward and pain control (Review). Mol
Med Rep 2016;14:2899-903.
17. Korem N, Zer-Aviv TM, Ganon-Elazar E, Abush H, Akirav I.
Targeting the endocannabinoid system to treat anxietyrelated disorders. J Basic Clin Physiol Pharmacol 2016;
27:193-202.
18. Babson KA, SottileJ, Morabito D. Cannabis,cannabinoids,
and sleep: a review of the literature. Curr Psychiatry Rep
2017;19:23.
19. Portenoy RK, Ganae-Motan ED, Allende S,etal. Nabiximols
for opioid-treated cancer patients with poorly-controlled
chronic pain:arandomized, placebo-controlled, graded-dose
trial. J Pain2012;13:438-49.
20. JohnsonJR,Burnell-NugentM,LossignolD,GanaeMotan ED,
Potts R, Fallon MT. Multicenter, double-blind, randomized,
placebo-controlled, parallel-group study of the efficacy,
safety,and tolerabilityofTHC:CBD extractand THC extract
in patients with intractable cancer-related pain. J Pain
Symptom Manage2010;39:167-79.
21. Côté M,Trudel M, Wang C,Fortin A. Improving qualityof life
with nabilone during radiotherapy treatments for head and
neck cancers: a randomized double-blind placebocontrolled trial. Ann Otol RhinolLaryngol2016;125:317-24.
22. Johnson JR, Lossignol D, Burnell-Nugent M, Fallon MT. An
open-label extension study to investigate the long-term
safety and tolerability of THC/CBD oromucosal spray and
oromucosalTHCsprayin patientswithterminalcancer-related
painrefractorytostrong opioid analgesics.J Pain Symptom
Manage2013;46:207-18.
23. Welch SP, Eads M. Synergistic interactions of endogenous
opioids and cannabinoid systems. Brain Res 1999;848:
183-90.
24. Welch SP,Thomas C, Patrick GS.Modulationofcannabinoidinduced antinociceptionafter intracerebroventricularversus
intrathecaladministrationto mice: possible mechanismsfor
interaction with morphine. J Pharmacol Exp Ther 1995;
272:310-21.
25. Kaymakçalan S. Pharmacologicalsimilaritiesand interactions
between cannabis and opioids. Adv Biosci 1978;22-23:
591-604.
26. LynchME, Cesar-Rittenberg P, Hohmann AG. A double-blind,
placebo-controlled,crossover pilot trial withextensionusing
an oral mucosal cannabinoid extract for treatment of
chemotherapy-induced neuropathic pain. J Pain Symptom
Manage2014;47:166-73.
27. Ward SJ,McAllister SD, Kawamura R,Murase R, Neelakantan
H, Walker EA. Cannabidiol inhibits paclitaxel-induced
neuropathic pain through 5-HT(1A) receptors without
diminishing nervous system function or chemotherapy
efficacy. Br J Pharmacol2014;171:636-45.
28. FallonMT, AlbertLux E,McQuade R,etal. Sativexoromucosal
spray as adjunctive therapy in advanced cancer patients
withchronic painunalleviated byoptimized opioid therapy:
two double-blind, randomized, placebo-controlled phase 3
studies. Br J Pain2017;11:119-33.
29. Lichtman AH,Lux EA,McQuade R,etal. Resultsofa doubleblind, randomized, placebo-controlled study of nabiximols
oromucosal spray as an adjunctive Therapy in advanced
cancer patients with chronic uncontrolled pain. J Pain
Symptom Manage2018;55:179-88.
30. Roberts JD, Gennings C, Shih M. Synergistic affective
analgesicinteraction between delta-9-tetrahydrocannabinol
and morphine. Eur J Pharmacol2006;530:54-8.
31. Allan GM, Finley CR, Ton J, et al. Systematic review of
systematicreviews for medicalcannabinoids: pain,nausea
and vomiting, spasticity, and harms. Can Fam Physician
2018;64:e78-94.
32. Stockings E, Campbell G, Hall WD, et al. Cannabis and
cannabinoids for the treatment of people with chronic
noncancer pain conditions: a systematic review and
meta-analysis of controlled and observational studies. Pain
2018;159:1932-54.
33. HäuserW, PetzkeF,Fitzcharles MA. Efficacy, tolerabilityand
safety of cannabis-based medicines for chronic pain
management - Anoverview ofsystematicreviews. EurJ Pain
2018;22:455-70.
34. Häuser W; Finnerup NB, Andrew RA. Systematic reviews
with meta-analysis on cannabis-based medicines for
chronic pain:a methodologicaland political minefield. Pain
2018;159:1906-7.
35. Turri M, Teatini F, Donato F, et al. Pain Modulation after
oromucosal cannabinoid spray (sativex®) in patients with
multiple sclerosis: a study with quantitative sensory testing
and laser-evoked potentials.Medicines(Basel)2018;21;5(3).
pii: E59. doi:10.3390/medicines5030059
36. TurcottJG, Del Rocío Guillen Núñez M,Flores-Estrada D,et
al.Theeffectofnabiloneonappetite,nutritional status,and
qualityof lifeinlung cancer patients:arandomized, doubleblind clinical trial. Support Care Cancer2018;26:3029-38.
37. Ware MA, Wang T, Shapiro S, Collet JP; COMPASS study
team. Cannabisfor the managementof pain:assessmentof
safety study (COMPASS). .J Pain2015;16:1233-42.
