Cannabinoid products for pain management: recommendations from the São Paulo State Society of Anesthesiology
Produtos canabinoides para tratamento da dor: recomendações da Sociedade de Anestesiologia do Estado de São Paulo
Guilherme Antonio Moreira de Barros, Alexandre Mio Pos, Ângela Maria Sousa, Carla Leal Pereira, Cecília Daniele de Azevedo Nobre, Cláudia Carneiro de Araújo Palmeira, Cristina Aparecida Arrivabene Caruy, Derli Conceição Munhoz, Durval Campos Kraychete, Esthael Cristina Querido Avelar, Fernanda Bono Fukushima, João Batista Santos Garcia, João Nathanael Lima Torres, Karenthan de Abreu Rodrigues, Mariana Palladini, Olympio de Hollanda Chacon Neto, Maria José Carvalho Carmona
Abstract
There is growing interest in using cannabinoids across various clinical scenarios, including pain medicine, leading to the disregard of regulatory protocols in some countries. Legislation has been implemented in Brazil, specifically in the state of São Paulo, permitting the distribution of cannabinoid products by health authorities for clinical purposes, free of charge for patients, upon professional prescription. Thus, it is imperative to assess the existing evidence regarding the efficacy and safety of these products in pain management. In light of this, the São Paulo State Society of Anesthesiology (SAESP) established a task force to conduct a narrative review on the topic using the Delphi method, requiring a minimum agreement of 60% among panelists. The study concluded that cannabinoid products could potentially serve as adjuncts in pain management but stressed the importance of judicious prescription. Nevertheless, this review advises against their use for acute pain and cancer-related pain. In other clinical scenarios, established treatments should take precedence, particularly when clinical protocols are available, such as in neuropathic pain. Only patients exhibiting poor therapeutic responses to established protocols or demonstrating intolerance to recommended management may be considered as potential candidates for cannabinoids, which should be prescribed by physicians experienced in handling these substances. Special attention should be given to individual patient characteristics and the likelihood of drug interactions.
Keywords
Resumo
Há um interesse crescente na utilização de canabinoides em vários cenários clínicos, incluindo medicamentos para a dor, levando ao desrespeito dos protocolos regulamentares em alguns países. A legislação foi implementada no Brasil, especificamente no estado de São Paulo, permitindo a distribuição de produtos canabinoides pelas autoridades de saúde para fins clínicos, gratuitamente para os pacientes, mediante prescrição profissional. Assim, é imperativo avaliar as evidências existentes sobre a eficácia e segurança destes produtos no tratamento da dor. Diante disso, a Sociedade Paulista de Anestesiologia (SAESP) criou uma força-tarefa para realizar uma revisão narrativa sobre o tema utilizando o método Delphi, exigindo concordância mínima de 60% entre os painelistas. O estudo concluiu que os produtos canabinoides poderiam servir potencialmente como adjuvantes no tratamento da dor, mas sublinhou a importância da prescrição criteriosa. No entanto, esta revisão desaconselha o seu uso para dor aguda e dor relacionada ao câncer. Em outros cenários clínicos, os tratamentos estabelecidos devem ter precedência, especialmente quando protocolos clínicos estão disponíveis, como na dor neuropática. Apenas os pacientes que apresentem respostas terapêuticas deficientes aos protocolos estabelecidos ou demonstrem intolerância ao manejo recomendado podem ser considerados como potenciais candidatos aos canabinoides, que devem ser prescritos por médicos com experiência no manuseio dessas substâncias. Deve ser dada especial atenção às características individuais do paciente e à probabilidade de interações medicamentosas.
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Submitted date:
07/21/2023
Accepted date:
04/24/2024
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