Rev. Soc. Esp. Dolor. 2022; 29(13): 52-57 / DOI: 10.20986/resed.2022.4032/2022
Jesús de Santiago
RESUMEN
Introducción: En España la prescripción de cannabis medicinal está actualmente en proceso de ser regulada. Hasta la fecha no existen estudios respecto a cuál es la actitud y el conocimiento del especialista español en tratamiento del dolor respecto a la utilización del cannabis medicinal en el tratamiento del dolor.
Métodos: Se llevó a cabo una consulta online que estuvo disponible en internet desde julio de 2020 a octubre de 2021. La encuesta constaba de 10 preguntas relacionadas con tres principales áreas de interés: 1) experiencia personal de los especialistas; 2) el papel del cannabis en la medicina del dolor; y 3) la necesidad de formación y legalización del cannabis medicinal.
Resultados: 94 especialistas en tratamiento del dolor respondieron a la encuesta. El 38 % de los que respondieron tenía experiencia en el tratamiento del dolor con cannabis medicinal y lo consideraban eficaz. El 78 % creía que era seguro recetar cannabis medicinal. Las indicaciones comunes son dolor neuropático (72 %), dolor oncológico (56 %), fibromialgia (39 %), artralgias (30 %) y dolor visceral el 29 %. Las principales contraindicaciones son la esquizofrenia (73 %), el embarazo/lactancia (65 %), enfermedad cardiovascular (32 %) y la edad < 18 años (61 %). Solo el 35 % calificó al cannabis como más peligroso que los opiáceos. El 95 % consideró necesaria más formación específica. El 47 % consideró la necesidad de que la prescripción del cannabis medicinal se realizara a través de una unidad específica, mientras que el 34 %, por el contrario, piensa que la prescripción debería realizarla un especialista con formación específica.
Conclusión: A pesar de la falta de experiencia clínica en el tratamiento del dolor con cannabis medicinal en nuestro país, el conocimiento, las actitudes y las creencias de los especialistas en dolor españoles están en línea con el conocimiento médico general actual de países con más experiencia clínica.
ABSTRACT
Introduction: In Spain, the prescription of medical cannabis is currently in the process of being regulated. To date, there are no studies regarding the attitude and knowledge of the Spanish pain treatment specialists regarding the use of medical cannabis in the field of pain treatment.
Methods: An online survey was carried out and was available on internet from July 2020 to October 2021. The survey consisted of 10 questions related to three main areas of interest: 1) personal experience of the specialists; 2; the role of cannabis in pain medicine; and 3) need for training and legalization of medicinal cannabis.
Results: 94 pain treatment specialists responded to the survey. 38 % of those who responded had experience in treating pain with medical cannabis and considered it effective. 78 % believed that it was safe to prescribe medical cannabis. Common indications are neuropathic pain (72 %), cancer pain (56 %), fibromyalgia (39 %), arthralgia (30 %) and visceral pain 29 %. The main contraindications are schizophrenia (73 %), pregnancy/lactation (65 %), cardiovascular disease (32 %), and age < 18 years (61 %). Only 35 % rated cannabis as more dangerous than opioids. 95 % considered more specific training necessary. 47 % considered the need of an specific unit for the prescription of medical cannabis, while 34 %, on the contrary, think that the prescription should be carried out by an specialist with specific training.
Conclusion: Despite the lack of clinical experience in the treatment of pain with medical cannabis in our country, the knowledge, attitudes and beliefs of Spanish pain specialists are in line with current general medical knowledge in countries with more clinical experience.
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1. Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA. 2015;313(24):2474-83.
2. Torralba A, Miquel A, Darba J. Situación actual del dolor crónico en España: iniciativa “Pain Proposal”. Rev Soc Esp Dolor. 2014;21(1):16-22. DOI: 10.4321/S1134-80462014000100003.
3. Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015;313(24):2456-73.
4. Andreae MH, Carter GM, Shaparin N, Suslov K, Ellis RJ, Ware MA, et al. Inhaled Cannabis for Chronic Neuropathic Pain: A Meta-analysis of Individual Patient Data. J Pain. 2015;16(12):1221-32.
5. Goyal H, Singla U, Gupta U, May E. Role of cannabis in digestive disorders. Eur J Gastroenterol Hepatol. 2017;29(2):135-43.
6. Barrie N, Kuruppu V, Manolios E, Ali M, Moghaddam M, Manolios N. Endocannabinoids in arthritis: current views and perspective. Int J Rheum Dis. 2017;20(7):789-97.
7. Romero-Sandoval EA, Kolano AL, Alvarado-Vazquez PA. Cannabis and cannabinoids for chronic pain. Curr Rheumatol Rep. 2017;19(11):67.
8. Kim PS, Fishman MA. Cannabis for pain and headaches: primer. Curr Pain Headache Rep. 2017;21(4):19.
9. Haroutounian S, Arendt-Nielsen L, Belton J, Blyth FM, Degenhardt L, Di Forti M, et al. International Association for the Study of Pain Presidential Task Force on Cannabis and Cannabinoid Analgesia: research agenda on the use of cannabinoids, cannabis, and cannabis-based medicines for pain management. Pain. 2021;162(Suppl 1):S117-S124.
10. Sharon H, Goldway N, Goor-Aryeh I, Eisenberg E, Brill S. Personal experience and attitudes of pain medicine specialists in Israel regarding the medical use of cannabis for chronic pain. J Pain Res. 2018;11:1411-9.
11. Abo Ziad R, Grynbaum MB, Peleg R, Treister-Goltzman Y. The Attitudes and Beliefs of Family Physicians Regarding the Use of Medical Cannabis, Knowledge of Side Effects, and Barriers to Use: A Comparison Between Residents and Specialists. Am J Ther. 2022;29(4):e400-e409.
12. Ziemianski D, Capler R, Tekanoff R, Lacasse A, Luconi F, Ware MA. Cannabis in medicine: a national educational needs assessment among Canadian physicians. BMC Med Educ. 2015;15:52.
13. Karanges EA, Suraev A, Elias N, Manocha R, McGregor IS. Knowledge and attitudes of Australian general practitioners towards medicinal cannabis: a cross-sectional survey. BMJ Open. 2018;8(7):e022101.
14. Crowley D, Collins C, Delargy I, Laird E, Van Hout MC. Irish general practitioner attitudes toward decriminalisation and medical use of cannabis: results from a national survey. Harm Reduct J. 2017;14(1):4.
15. 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.
16. Wallace MS, Marcotte TD, Umlauf A, Gouaux B, Atkinson JH. Efficacy of inhaled cannabis on painful diabetic neuropathy. J Pain. 2015;16(7):616-27.
17. Blake A, Wan BA, Malek L, DeAngelis C, Diaz P, Lao N, et al. A selective review of medical cannabis in cancer pain management. Ann Palliat Med. 2017;6(Suppl 2):S215-S222.
18. Hauser W, Fitzcharles MA, Radbruch L, Petzke F. Cannabinoids in pain management and palliative medicine. Dtsch Arztebl Int. 2017;114(38):627-34.
19. Fitzcharles MA, Baerwald C, Ablin J, Häuser W. Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis): A systematic review of randomized controlled trials. Schmerz. 2016;30(1):47-61.
20. Garry A, Rigourd V, Amirouche A, Fauroux V, Aubry S, Serreau R. Cannabis and breastfeeding. J Toxicol. 2009;2009:596149.
21. Manrique-Garcia E, Zammit S, Dalman C, Hemmingsson T, Andreasson S, Allebeck P. Prognosis of schizophrenia in persons with and without a history of cannabis use. Psychol Med. 2014;44(12):2513-21.
22. Franz CA, Frishman WH. Marijuana use and cardiovascular disease. Cardiol Rev. 2016;24(4):158-62.