However, the prohibition of cannabis cultivation, supply and possession from the middle of the 20th century (due to its psychoactivity and potential for producing dependence), has impeded cannabis research ( ElSohly et al., 2017). Preparations of the cannabis plant, which are taken by smoking or oral ingestion, have been observed to produce analgesic, anti-anxiety, anti-spasmodic, muscle relaxant, anti-inflammatory and anticonvulsant effects ( Andre et al., 2016). The role of cannabis plant and its components, called cannabinoids, as adjuvant analgesics in the treatment of chronic pain, has been the subject of longstanding controversy ( NASEM, 2017).įlowering plants within the genus Cannabis (also known as marijuana) in the family Cannabaceae have been cultivated for thousands of years in many parts of the world for spiritual, recreational and medicinal purposes. However, new approaches to targeting the pain pathway have been developed and adjuvant analgesics continue to attract both scientific and medical interest as constituents of a multimodal approach to pain management ( Yaksh et al., 2015). Some of these drugs have been known for some time, but their acceptance has waxed and waned over time ( Vučković et al., 2015 Srebro et al., 2016 Tomić et al., 2018). An adjuvant is a drug that is not primarily intended to be an analgesic but can be used to reduce pain either alone or in combination with other pain medications ( Bair and Sanderson, 2011). et al., 2006 Vučković et al., 2009, Vučković et al., 2016), but chronic pain is often difficult to treat and can be very disabling ( Gatchel et al., 2014). Acute pain is usually successfully managed with non-steroidal anti-inflammatory drugs (NSAIDs) and/or opioids ( Vučković S. Pain is one of the most common symptoms of disease. Careful follow-up and monitoring of patients using cannabis/cannabinoids are mandatory. In conclusion, the evidence from current research supports the use of medical cannabis in the treatment of chronic pain in adults. Larger well-designed studies of longer duration are mandatory to determine the long-term efficacy and long-term safety of cannabis/cannabinoids and to provide definitive answers to physicians and patients regarding the risk and benefits of its use in the treatment of pain.
However, there are scant data regarding the long-term safety of medical cannabis use.
Adverse effects in the short-term medical use of cannabis are generally mild to moderate, well tolerated and transient. The main limitations of these studies are short treatment duration, small numbers of patients, heterogeneous patient populations, examination of different cannabinoids, different doses, the use of different efficacy endpoints, as well as modest observable effects. Recent meta-analyses of clinical trials that have examined the use of medical cannabis in chronic pain present a moderate amount of evidence that cannabis/cannabinoids exhibit analgesic activity, especially in neuropathic pain. The mechanisms of the analgesic effect of cannabinoids include inhibition of the release of neurotransmitters and neuropeptides from presynaptic nerve endings, modulation of postsynaptic neuron excitability, activation of descending inhibitory pain pathways, and reduction of neural inflammation. Preclinical studies in animals using both pharmacological and genetic approaches have increased our understanding of the mechanisms of cannabinoid-induced analgesia and provided therapeutical strategies for treating pain in humans. Cannabinoids act via cannabinoid receptors, but they also affect the activities of many other receptors, ion channels and enzymes. Chronic pain is the most commonly cited reason for using medical cannabis. The term ‘medical cannabis’ refers to physician-recommended use of the cannabis plant and its components, called cannabinoids, to treat disease or improve symptoms. In recent years there is a growing debate about the use of cannabis for medical purposes. The prohibition of cannabis in the middle of the 20th century has arrested cannabis research.
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