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Zusammenfassung Hintergrund Die Kurkumawurzel (Curcuma longa L.) wird traditionell in der ayurvedischen, indischen und chinesischen Medizin verwendet. Aufgrund ihrer entzündungshemmenden Eigenschaften gelten Curcuminoide, insbesondere Curcumin, als die wichtigsten Wirkstoffe der Kurkumawurzel und stehen im Mittelpunkt der Forschung zur Behandlung von Kniearthrose (medizinisch als Gonarthrose bezeichnet). Methodik Um einen systematischen Überblick über den aktuellen Stand der Evidenz in klinischen Studien zur Wirksamkeit und Sicherheit der Kurkuma- und Curcuminoid-Behandlung bei Kniearthrose zu erhalten, wurde eine systematische Literaturrecherche in mehreren Datenbanken und eine Evidenzbewertung nach den AWMF-Leitlinien durchgeführt. Ergebnisse Neun systematische Übersichtsarbeiten mit Meta-Analyse im Suchzeitraum 2012–2021 auf der Basis von insgesamt 16 randomisiert kontrollierten Studien (RCTs) bewerten die orale Mono- und Komplementärtherapie mit Kurkuma und Curcuminoiden bei Kniearthrose. Curcuminoid-haltige Präparate wurden einvernehmlich als sichere und klinisch wirksame Therapieoption zur Verbesserung von Schmerz und Funktion bei Kniearthrose im Vergleich zu Placebo (11 RCTs, n=850) oder ergänzend zur Schmerztherapie mit nicht steroidalen Antirheumatika (NSAR) (5 RCTs, n=747) bewertet. Es sind jedoch qualitativ hochwertige, groß angelegte RCTs erforderlich, um die therapeutische Wirksamkeit und Sicherheit für eine Langzeitbehandlung zu bestätigen. Zudem sind aktuell Kurkumaextrakte in Deutschland nicht als Arzneimittel erhältlich. Schlussfolgerung In Anbetracht der begrenzten und hohen Nebenwirkungsraten der derzeitigen Schmerzbehandlungsoptionen kann eine orale Phytotherapie auf Kurkumabasis für die symptomatische Behandlung von Kniearthrose und als Ergänzung zur Schmerztherapie empfohlen werden.

®Background and Objective: This systematic review evaluated the effectiveness, tolerability and safety of cannabis-based medicines (CbMs) for chronic non-cancer pain (CNCP) in long-term observational studies. Databases and Data Treatment: CENTRAL, EMBASE and MEDLINE were searched until December 2021. We included prospective observational studies with a study duration ≥26 weeks. Pooled estimates of event rates of categorical data and standardized mean differences (SMD) of continuous variables were calculated using a random effects model. Results: Six studies were included with 2686 participants, with study duration ranging between 26 and 52 weeks. Pain conditions included nociceptive, nociplastic, neuropathic and mixed pain mechanisms. The certainty of evidence for every outcome was very low. The weighted mean difference of mean pain reduction was 1.75 (95% confidence interval [CI] 0.72 to 2.78) on a 0–10 scale. 20.8% (95% CI 10.2% to 34.0%) of patients reported pain relief of 50% or greater. The effect size for sleep problems was moderate and for depression and anxiety was low. Study completions was reported for 53.3% (95% CI 26.8% to 79.9%) of patients, with dropouts of 6.8% (95% CI 4.3% to 9.7%) due to adverse events. Serious adverse events occurred in 3.0% (95 CI 0.02% to 12.8%) and 0.3% (95% CI 0.1% to 0.6%) of patients died. Conclusions: Information included in observational studies should be regarded with caution. Within the context of observational studies. CbMs had positive effects on multiple symptoms for some CNCP patients and were generally well tolerated and safe. Significance: There is very low quality evidence for the long-term effectiveness (pain, sleep, mood, health-related quality of life), tolerability and safety of medical cannabis for chronic non-cancer pain (CNCP) according to reports of prospective observational studies. Predefined criteria of a large magnitude of effect size in these types of studies were not met. Nevertheless, long-term medical cannabis therapy can be considered in some carefully selected and monitored patients with CNCP.

This updated systematic review evaluated the efficacy and safety of opioids compared with placebo for chronic osteoarthritis pain.Clinicaltrials.gov, CENTRAL, MEDLINE and PsycINFO were searched from October 2013 to July 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks double-blinded duration were analysed. Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences or standardized mean differences with 95% confidence intervals. We added two new studies with 397 participants for a total of 22 studies with 8,942 participants. Study duration ranged between 4 and 24 weeks. Studies with a parallel and cross-over design: Based on very low- to low-quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with placebo. There was a clinically relevant harm related to the dropout rate due to adverse events. The frequency of serious adverse events did not differ from placebo. Enriched enrolment randomized withdrawal design: Based on very low- to low-quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with placebo. Dropout rates due to adverse events and frequency of serious adverse events did not differ from placebo.Tolerability of opioids is low and efficacy is not clinically relevant in controlled studies from 4 to 24 weeks for osteoarthritis pain.Within the context of randomized controlled trials (4-24 weeks), opioids provided no clinically relevant pain relief and no clinically relevant reduction in disability compared with placebo in chronic osteoarthritis pain (hip, knee). Number needed to treat for an additional dropout due to side effects was 5 (95% confidence interval 4-7). Two studies found no signals of abuse and addiction. The frequency of serious adverse events including deaths did not differ from placebo.

Hintergrund/Fragestellung: Chronische unspezifische Kreuzschmerzen (CNSLBP) sind ein großes Problem der öffentlichen Gesundheit. Bewegungstherapeutische Methoden sind wirksame Interventionen. Aufgrund des Mangels an direkten Vergleichen verschiedener Bewegungskategorien sprechen die medizinischen[zum vollständigen Text gelangen Sie über die oben angegebene URL], Who cares? – EbM und Transformation im Gesundheitswesen; 22. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin