Efficacy of two cannabis‐based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial
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Notice bibliographique
Résumé
Avulsion of nerve rootlets from the spinal cord following traction injuries to the brachial plexus frequently produces a highly characteristic pain syndrome. Constant spontaneous crushing and burning pain is felt in the distal part of the anaesthetic limb, frequently accompanied by shooting pain. It is not uncommon for the pain to persist for many years. The consistency of description between subjects coupled with the anatomical precision of the diagnosis provides a remarkable human model of central neuropathic pain. Opioids, anticonvulsants and tricyclic antidepressants are all used in the empirical management of this condition. They are partially effective at best and there is only anecdotal evidence to support their use. Many of our patients have given us spontaneous reports of the efficacy of ‘street’ cannabis. This has led us to test two cannabis-based whole plant medicinal extracts administered via oromucosal spray to patients with this condition. Forty-eight patients were enrolled. They all had at least one brachial plexus root avulsion for at least 18 months. They also had pain of at least 4 out of an 11-point box scale at the time of enrolment. The study was a randomised double-blind crossover trial consisting of three 2-week periods following a run-in period of 7–24 days. Patients continued on all previous stable medications including analgesics. During each 2-week period, subjects received in random order either placebo, delta-9-tetrahydrocannabinol (THC) 25 mg.ml or delta-9-tetrahydrocannabinol 25 mg.ml with cannabidiol (THC:CBD) 25 mg.ml, given as patient-activated oromucosal 100-μl sprays. Eleven-point box scales for pain and sleep, short form McGill, visual analogue scale, general health questionnaire-12, sleep disturbance and pain disability index were all recorded. Table 1 shows a summary of the results at week two of each of the study periods. Both the THC and THC:CBD extracts decreased pain and improved sleep. The effects were moderate although mostly statistically significant. Patients had not maximally titrated their doses at the end of the 2-week study periods. In addition, they remained on their pre-existing analgesic therapy throughout the study. A longer study period and use of cannabis-based medicinal extracts as the sole analgesic may well show a bigger analgesic effect. However, given the refractory nature of the pain in this patient group, this study shows that cannabis-based medicinal extracts represent a significant advance in treatment.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle