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Cannabis e CBD para a dor

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What the evidence does and doesn't show for cannabis and CBD in musculoskeletal pain, and practical and safety considerations.

Uma folha de cannabis.
A cannabis e o CBD são cada vez mais questionados para a dor musculoesquelética; as evidências e regulamentações ainda estão em evolução. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O que é

O canabidiol (CBD) é um composto não psicoativo encontrado na cannabis. É frequentemente utilizado como parte de um plano multimodal de manejo da dor após a cirurgia. Por exemplo, estudos sobre a reparação artroscópica do manguito rotador demonstram que o uso de CBD não causa déficits nos desfechos relatados pelos pacientes ou na recuperação funcional no seguimento de um ano, em comparação com um placebo. O CBD de absorção bucal também mostra promessa para a redução da dor no período imediato após esse tipo de cirurgia.

Você pode considerar a cannabis medicinal para a dor musculoesquelética crônica ou neuropática. A neuropatia periférica é um dano nervoso que causa dor, dormência ou formigamento. Os medicamentos à base de cannabis são aplicáveis para o tratamento dessa condição. Pacientes com dor na coluna estimam que a cannabis medicinal poderia tratar mais da metade de sua dor. Um em cada três pacientes com dor na coluna já utilizava cannabis medicinal. Além disso, 79% desses pacientes acreditam que a cannabis poderia reduzir o uso de opioides.

O interesse pela cannabis medicinal também é elevado entre pacientes com queixas na mão e no membro superior. A maioria dos pacientes deste grupo consideraria o uso de cannabis medicinal (80,9%). Eles a percebem como uma opção de tratamento segura para condições ortopédicas comuns. Um grande número de pacientes com osteoartrite da articulação basal do polegar teria interesse em experimentar formulações orais ou tópicos. No entanto, o custo é identificado como uma grande barreira ao uso para muitos pacientes.

Embora a maioria dos respondentes de pesquisas na comunidade de medicina ortopédica esportiva acredite que o CBD tenha um papel no manejo da dor pós-operatória e crônica, conclusões definitivas para condições da mão e do membro superior exigem investigação contínua. O uso regular de cannabis pode estar associado ao aumento do uso de opioides na artroplastia total de articulações. Pacientes com dependência de cannabis documentada apresentaram maiores chances de desenvolver complicações na ferida cirúrgica após procedimentos cirúrgicos de tecidos moles da mão e do pulso. Seu médico pode ajudá-lo a ponderar esses fatores.

Funciona?

A resposta depende da sua condição específica e do tipo de cirurgia que você está realizando. Para alguns procedimentos, os produtos à base de cannabis mostram promessa. Para outros, não oferecem benefício claro ou podem até causar problemas.

Se você está realizando uma reparação artroscópica do manguito rotador, evidências recentes sugerem que o canabidiol (CBD) é seguro para uso. Ele não causa déficits nos desfechos relatados pelo paciente ou na recuperação funcional no seguimento de 1 ano em comparação com um placebo. De fato, o CBD absorvido por via bucal mostra promessa significativa na redução da dor no período perioperatório imediato após essa cirurgia. Seu médico pode considerar adicioná-lo ao seu regime multimodal de manejo da dor pós-operatória sem efeitos prejudiciais a longo prazo.

No entanto, as evidências são mistas para outras condições. Para pacientes com lesões traumáticas do plexo braquial, a medicina à base de cannabis não proporcionou melhora clínica na dor ou na qualidade do sono em comparação com um placebo. Não há benefício clinicamente importante em usá-la como complemento à terapia medicamentosa padrão para esse tipo de lesão nervosa.

Suas expectativas também devem ser realistas em relação às artroplastias articulares. O uso regular de cannabis pode estar associado ao aumento do uso de opioides no contexto da artroplastia total de articulação. O uso de cannabis após a artroplastia total de articulação está associado a riscos aumentados. Embora uma forma sintética de canabinoide (THC) não pareça limitar a ingestão de opioides após a artroplastia total de joelho primária, estudos de nível superior são necessários para compreender totalmente o impacto. Nenhuma orientação específica pode ser sugerida atualmente com base nessas associações.

Muitos pacientes acreditam em seu potencial. Os pacientes estimaram que a cannabis médica poderia tratar mais da metade de sua dor na coluna. Um em cada três pacientes com dor na coluna já usa cannabis médica. Setenta e nove por cento dos pacientes com dor na coluna acreditam que a cannabis poderia reduzir o uso de opioides. Nos cuidados com a mão e o membro superior, a maioria dos pacientes consideraria o uso de cannabis médica, e um grande número de pacientes com osteoartrite da articulação basal do polegar estaria interessado em testá-la.

Apesar desse interesse, o custo é identificado como uma grande barreira para o uso de cannabis médica entre pacientes que procuram atendimento por queixas de mão e membro superior. Você deve discutir esses resultados mistos abertamente com seu médico para determinar se é uma parte segura e adequada do seu plano de recuperação.

É adequado para você?

Muitos pacientes consideram a cannabis útil para tipos específicos de dor. Pode ser uma boa opção se você tiver dor neuropática nos membros ou artrite por desgaste na articulação do polegar. A maioria das pessoas com dor na coluna acredita que pode ajudar, e muitas já estão utilizando. Na verdade, 79% dos pacientes com dor na coluna acreditam que ela poderia reduzir sua necessidade de analgésicos opioides. Se você tem problemas na mão ou no braço, 80,9% dos pacientes como você considerariam experimentar a cannabis medicinal. A maioria a vê como uma escolha segura para esses problemas comuns.

Para as artroplastias, o cenário é misto. O uso de cannabis após a artroplastia de quadril ou joelho não parece alterar os resultados finais. No entanto, o uso regular pode levar ao consumo de mais opioides após essas cirurgias. É por isso que seu médico não pode fornecer orientações simples sobre o uso dessa substância no período em torno de uma cirurgia articular de grande porte. Mais pesquisas são necessárias para estabelecer recomendações claras para esses procedimentos.

O custo é uma barreira importante para muitos pacientes que consideram esse tratamento. A disponibilidade varia conforme a localização e a legislação. Como as evidências ainda estão em crescimento, especialmente para as artroplastias, essa deve ser uma decisão compartilhada com seu médico. Ele pode ajudá-lo a ponderar os benefícios potenciais em relação aos riscos e aos custos. Para cirurgias menores, como a reparação do manguito rotador, o canabidiol (CBD) parece ser seguro e não prejudica sua recuperação em um ano. Sempre converse com sua equipe de saúde antes de iniciar qualquer novo tratamento.

A conclusão

Você pode considerar o canabidiol (CBD) como parte do seu plano de controle da dor após a reparação do manguito rotador. Não há evidências de danos a longo prazo, e ele pode ajudar no controle da dor imediata. Para dores na coluna ou na mão, muitos pacientes o utilizam para gerenciar os sintomas ou reduzir o uso de opioides. No entanto, o uso regular de cannabis pode aumentar a necessidade de opioides após a artroplastia de articulação. Seu médico orientará sobre a segurança, os custos e se o CBD é adequado para o seu procedimento específico.


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