Cannabinoid products for pain management: recommendations from the São Paulo State Society of Anesthesiology
Guilherme Antonio Moreira de Barros 1, Alexandre Mio Pos 2, Ângela Maria Sousa 3, Carla Leal Pereira 4, Cecília Daniele de Azevedo Nobre 5, Cláudia Carneiro de Araújo Palmeira 6, Cristina Aparecida Arrivabene Caruy 7, Derli Conceição Munhoz 7, Durval Campos Kraychete 8, Esthael Cristina Querido Avelar 9, Fernanda Bono Fukushima 10, João Batista Santos Garcia 11, João Nathanael Lima Torres 12, Karenthan de Abreu Rodrigues 3, Mariana Palladini 13, Olympio de Hollanda Chacon Neto 14, Maria José Carvalho Carmona 6
1Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil. Electronic address: guilherme.am.barros@unesp.br.
2Regenerar Clínica de Dor do Gama, Brasília, DF, Brazil.
3Universidade de São Paulo (USP), Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil.
4Unidade Brasil do Hospital São Luiz, São Paulo, SP, Brazil.
5Casa de Saúde São José (Rede Santa Catarina), Rio de Janeiro, RJ, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
6Universidade de São Paulo (USP), São Paulo, SP, Brazil.
7Faculdade de Medicina da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.
8Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
9Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
10Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil.
11Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil.
12Instituto Doutor José Frota (IJF), Fotaleza, CE, Brazil.
13Centro Paulista de Dor, São Paulo, SP, Brazil.
14Hospital Pro Matre Paulista, São Paulo, SP, Brazil.
Affiliationer
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.
