Κάνναβη και πόνος

Κάνναβη και πόνος

Όλο και περισσότερα άτομα κάθε χρόνο ενδιαφέρονται για την ιατρική χρήση της κάνναβης και ιδιαιτερα για τη χρήση στο χρόνιο πόνο. Και στο διαδίκτυο αυξάνονται ολοένα οι πηγές που παροτρύνουν τους ασθενείς στη χρήση προϊόντων φυτικής κάνναβης για την αντιμετώπιση του χρόνιου πόνου. Πολλοί από αυτούς τους διαδικτυακούς τόπους έχουν απόψεις που τεκμηριώνονται από επιστημονικά δεδομένα και από αξιόπιστες πηγές, ενώ άλλοι μιλούν με γενικόλογα και με ασάφεια, ενώ οι πηγές τους είναι αμφίβολης αξιοπιστίας. Κάνναβη και πόνος.

Φιλοδοξούμε σ’ αυτό το άρθρο να παρουσιάσουμε τα πραγματικά δεδομένα από τις πιό αξιόπιστες πηγές που βρήκαμε για το θέμα με τρόπο σαφή και κατανοητό. Βέβαια, όπως συμβαίνει πάντα σε όλα τα κείμενα, όσο “αντικειμενικά” κι άν είναι, χρωματίζονται πάντα από τις υποκειμενικές απόψεις αυτού που τα γράφει. Πρέπει επομένως να δηλώσουμε ότι προσωπικά βλέπουμε με ιδιαίτερο σκεπτικισμό την πρόταση για ιατρική χρήση της κάνναβης. Τον ίδιο σκεπτικισμό, θα διαπιστώσει ο αναγνώστης και στις πηγές που παραθέτουμε. Κάνναβη και πόνος.

Η κύρια πηγή που βασίζεται αυτό το άρθρο είναι μία πολύ μεγάλη και σοβαρή ανασκόπηση όλης της υπαρχουσας βιβλιογραφίας που δημοσιεύτηκε τον Σεπτέμβρη του 2017 σε ένα από τα πλέον αξιόπιστα ιατρικά περιοδικά. (Annals of Internal Medicine) 1

1. Νευροπαθητικός πόνος

Ο νευροπαθητικός πόνος είναι συνήθως σαν σουβλιά (διαξιφιστικός) ή σαν κάψιμο (καυσαλγία) και μπορεί να διαρκεί από λίγα λεπτά ώς πολλούς μήνες να είναι με διακυμάνσεις άλλοτε έντονος κι άλλοτε ήπιος είναι να είναι -μερικές φορές- ανυπόφορος. Οπως το λέει και το όνομά του οφείλεται σχεδόν πάντα σε βλάβη κάποιου νεύρου. Αιτίες νευροπαθητικού πόνου μπορεί να είναι:

  • Μεταβολικά νοσήματα: Διαβήτης, Αλκοολισμός, διατ. θυρεοειδούς
  • Θεραπευτικές μέθοδοι: χημειοθεραπεία, ακτινοθεραπεία, ακρωτηριασμοί
  • Λοιμώδη ή αυτοάνοσα νοσήματα: AIDS, σύφιλη, έρπης, πολλαπλή σκλήρυνση
  • Παθήσεις νευρικών ριζών: οσφυοϊσχιαλγία, ριζίτιδες, νευραλγίες

Τί έδειξαν τα αποτελέσματα των εργασιών που εξετάστηκαν: Συνοπτικά οι ενδείξεις ότι η κάνναβη μπορεί να μειώσει τον νευροπαθητικό πόνο ησαν πολύ αδύναμες. Σύμφωνα με τους συγγραφείς ο αριθμός των ασθενών στους οποίους μειώθηκε ο πόνος δεν ήταν τελικά κλινικά σημαντικός.

2. Πόνοι της Πολλαπλής Σκλήρυνσης

Ο πόνος δεν είναι το πιό συνηθισμένο χαρακτηριστικό της πολλαπλής σκήρυνσης.  Συνήθως υπάρχει στα πολύ προχωρημένα στάδια της νόσου τότε είναι ιδιαίτερα έντονος και δύσκολα διαχειρίσμος. Οι πόνοι της Πολλαπλής Σκλήρυνσης μπορεί να είναι του τύπου των νευροπαθητικών πόνων που αναφέραμε πιό πάνω ή και του τύπου των “κεντρικών” πόνων, που οφείλονται δηλαδή σε κάποια εγκεφαλική βλάβη που προκάλεσε η νόσος.

Αποτελέσματα Κι εδώ οι ενδείξεις δεν είναι επαρκείς για να στηρίξουν κάποια άποψη. Τα αναφερόμενα περιστατικά είναι λίγα, οι διάρκειες των θεραπειών μικρές αλλά και οι αξιολογήσεις έχουν υψηλό ποσοστό κινδύνου προκατάληψης. (Risk of Bias).

3. Πόνοι καρκίνου

Εξετάζονται 3 έρευνες που αφορούσαν συνολικά 547 άτομα που είχαν αφόρητους πόνους επειδή έπασχαν από διάφορες μορφές καρκίνου.

Τα αποτελέσματα και εδώ δεν είναι αξιόπιστα. Η μία από τις εργασίες είχε πολύ υψηλό “κίνδυνο προκατάληψης” (Risk of Bias) ενώ οι άλλες δύο εμφάνιζαν μεθοδολογικά ή άλλα προβλήματα, σύμφωνα με τους αξιολογητές.

Κάνναβη και πόνος - Συμπεράσματα
Γενικά οι μελέτες που εξετάστηκαν αφορούσαν μικρό αριθμό ατόμων, είχαν μεθοδολογικά λάθη και υψηλό κίνδυνο προκατάληψης. Μία από αυτές 2 υποστηρίζει ότι η κάνναβη είναι πράγματι αποτελεσματική σε πληθυσμούς ατόμων με χρόνιο πόνο νευροπαθητικό ή Πολλαπλής Σκλήρυνσης, όχι όμως σε άλλου είδους πόνους. Και άλλες εργασίες επίσης διαπιστώνουν ότι είναι πολύ πιθανό η κάνναβη να ανακουφίζει τον πόνο (κυρίως τον νευροπαθητικό) αλλά όλες στα συμπεράσματά τους είναι πολύ επιφυλακτικές και εκφράζουν την ανάγκη για καλύτερη επιστημονική διερεύνηση του θέματος με πιό αξιόπιστες εργασίες.

Παραπομπές
  1. https://www.ncbi.nlm.nih.gov/pubmed/28806817 (περίληψη), https://www.cannabisskunksense.co.uk/uploads/site-files/AIME201709050-M170155.pdf (όλο το άρθρο), Access date 9.6.2018
  2. http://www.health.state.mn.us/topics/cannabis/intractable/medicalcannabisreport.pdf, Access date 9.6.2018
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