Uso de canabinóides na dor crônica e em cuidados paliativos

Laura Bonfá; Ronaldo Contreiras de Oliveira Vinagre; Núbia Verçosa de Figueiredo

doi:10.1590/S0034-70942008000300010

Miscellaneous

Uso de canabinóides na dor crônica e em cuidados paliativos

Cannabinoids in chronic pain and palliative care

Laura Bonfá; Ronaldo Contreiras de Oliveira Vinagre; Núbia Verçosa de Figueiredo

http://dx.doi.org/10.1590/S0034-70942008000300010 Braz J Anesthesiol, vol.58, n3, p.267-279, 2008

PDF

Downloads: 2

Resumo

JUSTIFICATIVA E OBJETIVOS: Muitos estudos têm chamado atenção para a Cannabis sativa (Cs), pelo seu potencial analgésico e pela sua capacidade de aliviar sintomas relacionados com doenças do sistema nervoso central. Porém, a maconha, como é popularmente conhecida, por ser a mais popular das drogas ilegais em todo o mundo, gera preconceito tanto entre leigos como entre profissionais que atuam na área da saúde. Objetivou-se pesquisar o nível de conhecimento atual e suas perspectivas de utilização para compreender melhor suas ações e seus efeitos, na pesquisa experimental e na prática médica, em pacientes com doenças degenerativas neurológicas ou naqueles que não tenham possibilidades de cura, atendidos em programas de cuidados paliativos. CONTEÚDO: Seu uso terapêutico não é recente. O presente estudo fornece uma revisão do histórico e farmacologia da Cs, o desenvolvimento de seu uso terapêutico por meio dos canabinóides sintéticos, o conhecimento científico atual, suas conseqüências orgânicas e psíquicas, demonstrando suas opções de uso clínico e perspectivas futuras. CONCLUSÕES: O delta-9-tetrahidrocanabinol (delta9-THC) puro e seus análogos apresentam aplicabilidade clínica, demonstrando benefícios. O desenvolvimento das substâncias sintéticas puras, buscando a atenuação de efeitos psicoativos indesejáveis aponta para perspectivas favoráveis a sua utilização no futuro. Estudos mais detalhados deverão ser realizados. Debates amplos serão necessários para criar normas de formulação e disponibilização com a finalidade médica, por se tratar de uma substância que gera preconceito pela sua comercialização e utilização ilegal e a seu uso ser atribuído misticismo.

Palavras-chave

DOR, Crônica, DROGAS, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: Several studies have focused on Cannabis sativa (Cs) due to its analgesic potential and its ability to alleviate symptoms of disorders of the central nervous system. However, since marijuana, one of its popular names, is the most common illicit drug throughout the world, it breeds prejudice both among lay people and health care professionals. The objective of this study was to determine the current level of knowledge about this drug and the perspectives for its use, to better understand its actions and effects, both in experimental studies and clinical use, in patients with degenerative neurological disorders or in those who do not have the possibility of cure and are being followed by palliative care programs. CONTENTS: The therapeutic use of Cannabis sativa is not recent. The present study presents the historical background and pharmacology of Cs, the development of its therapeutic use through synthetic cannabinoids, the current scientific knowledge, and its organic and psychological consequences, demonstrating the options for its clinical use and future perspectives. CONCLUSIONS: Pure delta-9-tetrahydrocannabinol (delta9-THC) and its analogues have clinical applicability, being beneficial in selected individuals. The development of pure synthetic substances, in an attempt to attenuate undesirable psychoactive effects, indicates that perspectives for its use in the future are favorable. More detailed studies should be undertaken. Ample debates will be necessary to create standards for its formulation and clinical availability, since it is a substance that generates prejudice, due to its illegal commercialization and use, and also because its use has been attributed to mysticism.

Keywords

DRUGS, DRUGS, PAIN, Chronic

Referencias

Bloomquist ER. Marijuana. 1968:19.

Zuardi AW. History of cannabis as a medicine: a review. Rev Bras Psiquiatr. 2006;28:153-157.

Kalant H. Medicinal use of cannabis: history and current status. Pain Res Manag. 2001;6:80-91.

Pertwee RG. Pharmacology of cannabinoids CB1 and CB2 receptors. Pharmacol Ther. 1997;74:129-180.

Honório KM, Arroio A, Silva ABF. Therapeutical aspects of compounds of the plant Cannabis sativa.. Quím Nova. 2006;29:318-325.

Iversen L. Cannabis and the brain. Brain. 2003;126:1252-1270.

Hillard CJ, Jarrahian A. Cellular accumulation of anandamide: consensus and controversy. Br J Pharmacol. 2003;140:802-808.

Howlett AC, Breivogel CS, Childers SR. Cannabinoid physiology and pharmacology: 30 years of progress. Neuropharmacol. 2004;47:345-358.

Cox SL. Rimonabant hydrochloride: an investigational agent for the management of cardiovascular risk factors. Drugs Today. 2005;41:499-508.

Walker JM, Huang SM. Cannabinoid analgesia. Pharmacol Ther. 2002;95:127-35.

Duran M, Laporte JR, Capellà D. Novedades sobre las potencialidades terapéuticas del Cannabis y el sistema cannabinoide. Med Clin. 2004;122:390-398.

Siegling A, Hofmann HA, Denzer D. Cannabinoid CB1 receptor upregulation in a rat model of chronic neuropathic pain. Eur J Pharmacol. 2001;415:5-7.

Julien RM. A Primer of Drug Action: a Concise, Nontechnical Guide to the Actions, Uses, and Side Effects of Psychoactive Drugs. 1997:548.

Cerro JCL. Drogodependencias: Cannabis. 1998:191-214.

MacRae EJBN. Redução de Danos para o Uso da Cannabis: Panorama Atual de Drogas e Dependências. 2006:361-370.

Mercolini L, Musenga A, Comin I. Determination of plasma and urine levels of Delta (9)-tetrahydrocannabinol and its main metabolite by liquid chromatography after solid-phase extraction. J Pharm Biomed Anal. 2007;47:156-163.

Kauert GF, Ramaekers JG, Schneider E. Pharmacokinetic properties of delta9-Tetrahydrocannabinol in serum and oral fluid. J Anal Toxicol. 2007;31:288-293.

Ribeiro M, Marques ACPR, Laranjeira R. Abuso e dependência da maconha. Rev Assoc Med Bras. 2005;51:247-249.

Barnes MP. Sativex ®: Clinical efficacy and tolerability in the treatment of symptoms of multiple sclerosis and neuropathic pain. Exp Opin Pharm. 2006;7:607-615.

Plange N, Arend KO, Kaup M. Dronabinol and retinal hemodynamics in humans. Am J Ophthalmol. 2007;143:173-174.

Beal JE, Olson R, Laubenstein I. Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. J Pain Sympton Manage. 1995;10:89-97.

Berlach DM, Shir Y, Ware MA. Experience with the synthetic cannabinoid nabilone in chronic noncancer pain. Pain Med. 2006;7:25-29.

Chochinov HM, Breitbart W. Handbook of Psychiatry in Palliative Medicine. 2000:124-125.

Buggy DJ, Toogood L, Maric S. Lack of analgesic efficacy of oral delta-9-tetrahydrocannabinol in postoperative pain. Pain. 2003;106:169-172.

Beaulieu P. Effects of nabilone, a synthetic cannabinoid on postoperative pain. Can J Anaesth. 2006;53:769-775.

Holdcroft A, Maze M, Doré C. A muticenter dose-escalation study of the analgesic and adverse effects of an oral cannabis extract (Cannador) for postoperative pain management. Anesthesiology. 2006;104:1040-1046.

Russo E, Guy GW. A tail of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. Med Hypotheses. 2006;66:234-246.

Karst M, Salim K, Burstein S. Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial. JAMA. 2003;290:1757-1762.

Woolridge E, Barton S, Samuel J. Cannabis use in HIV for pain and other medical symptoms. J Pain Symptom Manage. 2005;29:358-367.

Mackie K. Cannabinoid receptors as therapeutic targets. Annu Rev Pharmacol Toxicol. 2006;46:101-122.

Carter G, Rosen BS. Marijuana in the management of amyotrophic lateral sclerosis. Am J Hosp Pall Care. 2001;18:264-269.

Wade DT, Makela PM, House H. Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. Mult Scler. 2006;12:639-647.

Tomida I, Azuara-Blanco A, House H. Effect of sublingual application of cannabinoids on intraocular pressure: a pilot study. J Glaucoma. 2006;15:349-353.

De Petrocellis L, Melck D, Bisogno T. Endocannabinoids and fatty acid amides in cancer: inflammation and related disorders. Chem Phys Lipids. 2000;108:191-209.

Kalant H, Corrigal WA, Hall W. The Health Effects of Cannabis. 1999:145.

Jungerman FS, Laranjeira R, Bressan RA. Maconha: Qual a amplitude de seus prejuízos?. Rev Bras Psiquiatr. 2005;27:5-6.

Kalant H. Adverse effects of cannabis on health: an update of the literature since 1996. Prog Neuropsychopharmacol Biol Psychiatry. 2004;28:849-863.

Hazekamp A, Ruhaak R, Zuurman L. Evaluation of a vaporizing device (Volcano) for the pulmonary administration of tetrahydrocannabinol. J Pharm Sci. 2006;95:1308-1317.

Taylor DR, Poulton R, Moffitt TE. The respiratory effects of cannabis dependence in young adults. Addiction. 2000;95:1669-1677.

Abel EL. Marihuana, Tabaco, Alcohol y Reproduccion. 1986:8.

Smith AM, Fried PA, Hogan MJ. Effects of prenatal marijuana on response inhibition: an MRI study of young adults. Neurotoxicol Teratol. 2004;26:533-542.

Diagnostic and Statistical Manual of Mental Disorders, DSM-IV. 1994.

Holdcroft A, Maze M, Doré C. A multicenter dose-escalation study of the analgesic and adverse effects of an oral cannabis extract (Cannador) for postoperative pain management. Anesthesiology. 2006;104:1040-1046.

Uso de canabinóides na dor crônica e em cuidados paliativos

Cannabinoids in chronic pain and palliative care

Laura Bonfá; Ronaldo Contreiras de Oliveira Vinagre; Núbia Verçosa de Figueiredo

Resumo

Palavras-chave

Abstract

Keywords

Referencias

Links

compartir

Braz J Anesthesiol