Medicamentos derivados da Cannabis no tratamento da Polineuropatia Diabética Dolorosa: Uma Revisão de Escopo.

Abstract

Introduction: Painful diabetic polyneuropathy (PDPN) is a common complication of Diabetes Mellitus (DM), present in approximately 20 to 25% of diabetic patients. A portion of these patients with PDPN are refractory to standard treatments, and cannabis-derived medications (CDM) have been raised as an option. Objective: To evaluate the degree of therapeutic response of currently existing CDM in the pain control of PDPN, the factors associated with this response and the frequency of adverse events (AE). Methodology: Following PRISMA guidelines forscoping reviews, PubMed, Embase and Web of Science were searched for articles reporting improvement of pain scores following the use of CDM, without language or publication date restriction. Studies were included if they objectively reported pain evaluation using validated pain scores at the baseline and at the endpoint, and a follow-up of at least 4 weeks. The main outcome was a reduction of > 30% in pain at the endpoint. Also, AE rates of serious and non-serious events were evaluated. Results: Six studies were included for the eligibility criteria, in a total of 615 participants. Four clinical studies used Nabiximols (THC 27 mg/ mL + CBD 25 mg/ mL); one used Cannabidiol extract oil (CBD 250 mg/ 3 fl. oz.); one used Nabilone 1 mg; one used micronized Palmithoylethanolamide (m-PEA 300 mg). The intervention reduced pain scores in 6 studies, however, there was statistical significance in only 3 of them. Two of these showed > 30% pain reduction in more than half of the participants. 22 participants (3,57%) presented a serious AE. 371 (60,32%) reported a non-serious event and dizziness was the most common, followed by nausea, vomiting, somnolence, dry mouth, disorientation and dysgeusia. Conclusion: The results described in this review were conflicting, with modest or no benefit in patients with PDPN. CDM cannot be recommended as first line therapy since there is limited evidence to support their prescription. Its use could only be indicated in refractory cases, after shared decision with the patient and adequate discussion about the risks and benefits.