Uso de canabidioides no tratamento da fibromialgia
revisão literária
Palavras-chave:
Canabis, tetrahidrocanabidiol (THC), canabidiol (CBD), fibromialgiaResumo
Fibromialgia é uma doença crônica caracterizada por dor generalizada, seu diagnóstico é baseado nos critérios de Fibromialgia do Colégio Americano de Reumatologia. Afeta mais mulheres que homens segundo a Associação Brasileira de Reumatologia. A fisiopatologia dessa enfermidade é pouco conhecida. Um grande corpo de evidências atualmente suporta a presença de canabinóides receptores e ligantes, portanto, um sistema neuromodulador endocanabinóide parece estar envolvido em processos fisiológicos da dor. Existem três tipos de canabidioides: os endocanabidioides, os fitocanabidioides e os canabidioides sintéticos, todos esses se unem aos receptores canabidioides e produzem um efeito positivo na percepção da dor. Artigos das bases de dados: PUBMED, Scielo, BVS e UP TO DATE, no período de 2006 à 2022, ensaios clínicos, artigos de revisão e artigos originais. Foram utilizados 22 estudos sendo: 4 ensaios clínicos randomizados, 11 estudos observacionais e 7 artigos de revisão sistemática. O tratamento da Fibromialgia inclui medidas farmacológicas e não farmacológicas. O tratamento não farmacológico da fibromialgia é realizado com atividade física aeróbica e terapia cognitivo-comportamental. Farmacologicamente, é levado em conta os possíveis mecanismos fisiopatológicos e a sintomatologia e de forma individualizada. Os óleos de canabis, THC e CBD, interagem com o sistema endocanabidiode na redução e manejo da dor. A cannabis medicinal foi considerada segura e bem tolerada em paciente fibromiálgicos. Encontramos vários artigos que relacionam o uso de Cannabis como alternativa no tratamento de tal condição, observamos que existem algumas limitações para inferir na indicação do uso da substância como adequada no tratamento, apesar de encontrar estudos que indicam melhora significativa no controle da dor e dos transtornos associados à doença.
Referências
Doebl S, Macfarlane GJ, Hollick RJ. "No one wants to look after the fibro patient". Understanding models, and patient perspectives, of care for fibromyalgia: reviews of current evidence. Pain. 2020;161(8):1716- 25.
Neumeister MW, Neumeister EL. Fibromyalgia. Clin Plast Surg. 2020;47(2):203-13.
Sumpton JE, Moulin DE. Fibromyalgia. Handb Clin Neurol. 2014;119:513-27.
Tzadok R, Ablin JN. Current and emerging pharmacotherapy for fibromyalgia. Pain Res Manag. 2020: 6541798.
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62:600-10.
Martinez JE, Paiva ES, Rezende MC. EpiFibro (Brazilian Fibromyalgia Registry): Data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation. Rev Bras Reumatol Engl Ed 2017; 57(2):129–33.
Abeles AM, Pillinger MH, Solitar BM, Abeles M. Narrative review: the pathophysiology of fibromyalgia. Ann Intern Med 2007; 146: 726–734.
Martinez-Lavin M. Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther 2007; 9: 216.
Pacher P, Ba´tkai S, Kunos G. The endocannabinoid system as na emerging target of pharmacotherapy. Pharmacol Rev 2006; 58: 389–462.
Ko GD, Bober SL, Mindra S, Moreau JM. Medical cannabis - The Canadian perspective. J Pain Res. 2016;9:735-44.
Burstein SH, Zurier RB. Cannabinoids, endocannabinoids, and related analogs in inflammation. AAPS J. 2009;11(1):109-19.
Correia-da-Silva G, Fonseca B, Soares A, Teixeira N. Canabis e canabinoides para fins medicinais. Rev Portuguesa Farmacoterapia 2019;11(1):21–31.
Berger AA, Keefe J, Winnick A, Gilbert E, Eskander JP, Yazdi C, Kaye AD, Viswanath O, Urits I. Cannabis and cannabidiol (CBD) for the treatment of fibromyalgia. Best Pract Res Clin Anaesthesiol 2020;34(3):617-631.
Fiz J, Durán M, Capellà D, Carbonell J, Farré M. Cannabis use in patients with fibromyalgia: effect on symptoms relief and health-related quality of life. PLoS One. 2011;6(4):e18440.
Van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain 2019;160(4):860-869.
Khurshid H, Qureshi IA, Jahan N, Went TR, Sultan W, Sapkota A, Alfonso M. A Systematic Review of Fibromyalgia and Recent Advancements in Treatment: Is Medicinal Cannabis a New Hope? Cureus 2021;13(8):e17332.
Sagy I, Bar-Lev Schleider L, Abu-Shakra M, Novack V. Safety and Efficacy of Medical Cannabis in Fibromyalgia. J Clin Med 2019;8(6):807.
Kurlyandchik I, Tiralongo E, Schloss J. Safety and Efficacy of Medicinal Cannabis in the Treatment of Fibromyalgia: A Systematic Review. J Altern Complement Med 2021;27(3):198-213.
Habib G, Avisar I. The Consumption of Cannabis by Fibromyalgia Patients in Israel. Pain Res Treat 2018;2018:7829427.
Fitzcharles MA, Rampakakis E, Sampalis JS, Shir Y, Cohen M, Starr M, Häuser W. Use of medical cannabis by patients with fibromyalgia in Canada after cannabis legalisation: a cross-sectional study. Clin Exp Rheumatol 2021;39 Suppl 130(3):115-119.
Habib G, Levinger U. [CHARACTERISTICS OF MEDICAL CANNABIS USAGE AMONG PATIENTS WITH FIBROMYALGIA]. Harefuah 2020;159(5):343-348.
Giorgi V, Bongiovanni S, Atzeni F, Marotto D, Salaffi F, Sarzi-Puttini P. Adding medical cannabis to standard analgesic treatment for fibromyalgia: a prospective observational study. Clin Exp Rheumatol 2020;38 Suppl 123(1):53-59.
Cameron EC, Hemingway SL. Cannabinoids for fibromyalgia pain: a critical review of recent studies (2015-2019). J Cannabis Res 2020;2(1):19.
Yassin M, Oron A, Robinson D. Effect of adding medical cannabis to analgesic treatment in patients with low back pain related to fibromyalgia: an observational cross-over single centre study. Clin Exp Rheumatol 2019;37 Suppl 116(1):13-20.
Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol Product Dosing and Decision-Making in a National Survey of Individuals with Fibromyalgia. J Pain 2022;23(1):45-54.
Ware MA, Fitzcharles MA, Joseph L, Shir Y. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesth Analg 2010;110(2):604-10.
Habib G, Artul S. Medical Cannabis for the Treatment of Fibromyalgia. J Clin Rheumatol 2018;24(5):255-258.
Chaves C, Bittencourt PCT, Pelegrini A. Ingestion of a THC-Rich Cannabis Oil in People with Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Pain Med 2020;21(10):2212-2218.
Walitt B, Klose P, Fitzcharles MA, Phillips T, Häuser W. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev 2016;7(7):CD011694.
Mazza M. Medical cannabis for the treatment of fibromyalgia syndrome: a retrospective, open-label case series. J Cannabis Res 2021;3(1):4.
Rocco M, Rada G. Are cannabinoids effective for fibromyalgia? Medwave 2018;18(1):e7154.
Schley M, Legler A, Skopp G, Schmelz M, Konrad C, Rukwied R. Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Curr Med Res Opin 2006;22(7):1269-76.
Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol Use for Fibromyalgia: Prevalence of Use and Perceptions of Effectiveness in a Large Online Survey. J Pain 2021;22(5):556-566.
Mayorga Anaya HJ, Torres Ortiz MP, Flórez Valencia DH, Gomezese Ribero OF. Efficacy of cannabinoids in fibromyalgia: a literature review. Colomb. J. Anesthesiol 2021;49(4).
Busch AJ, Barber KA.R., Overend TJ, Peloso PMJ, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003786
Garcia-Campayo J, Magdalena J, Magallón R, Fernández-García E, Salas M, Andrés E. A meta-analysis of the efficacy of fibromyalgia treatment according to level of care. Arthritis Res Ther 2008;10(4):R81
