Background: Cannabis is increasingly used for management of chronic pain; however, the benefits and harms of this therapy remain uncertain. We conducted a systematic review to inform harms associated with inhaled cannabis for chronic pain. Methods: We searched MEDLINE, EMBASE, PsychInfo, and Web of Science for non-randomized studies reporting on harms associated with inhaled cannabis use, from inception to October 6, 2021. We used random-effects models for meta-analyses and assessed the certainty of evidence using the GRADE approach. Results: We identified 29 eligible studies enrolling 174,562 participants that reported 145 adverse events. Moderate certainty evidence suggests inhaled cannabis use is probably associated with dry mouth (prevalence: 56%; 95%CI 49 to 64), thirst (prevalence: 44%; 95% CI 33 to 55), fatigue (prevalence: 38%; 95%CI 31 to 45), nausea (prevalence: 17%; 95%CI 8 to 27), increased appetite (prevalence: 13%; 95%CI 9 to 18), dizziness (prevalence: 10%; 95%CI 6 to 14), diarrhea (prevalence: 9%; 95%CI 3 to 18), confusion (prevalence: 9%; 95%CI 5 to 13), mood changes (prevalence: 8%; 95%CI 4 to 15), hallucinations (prevalence: 7%; 95%CI 4 to 10), amnesia (prevalence: 6%; 95%CI 3 to 11), impaired coordination (prevalence: 5%; 95%CI 4 to 6), and disorientation (prevalence: 3%; 95%CI 1 to 7). Moderate certainty evidence shows that, compared to non-users, inhaling cannabis is probably associated with increased risk of shortness of breath (risk difference [RD]: 7%; 95%CI 4 to 10). Conclusions: Our review found moderate certainty evidence that dry mouth, thirst, and fatigue are probably frequently experienced with inhaled cannabis use. Several other adverse events are also probable associated with inhaled cannabis use but were less common. Rigorously conducted cohort studies are needed to inform harms associated with inhaled medical cannabis for chronic pain. / Thesis / Master of Science (MSc) / Increasing recognition of harms associated with long-term opioid therapy for management of chronic pain has generated enthusiasm for alternatives, including medical cannabis which is often consumed through inhalation. This review assesses the harms associated with the use of inhaled cannabis for management of chronic pain. Among serious adverse events, we found that inhaled cannabis is likely associated with amnesia, disorientation, impaired coordination, hallucinations, confusion, dizziness, chronic wheeze, and shortness of breath. Inhaled cannabis may be associated with palpitations, paranoia, anxiety, and cannabis dependence. The effects of inhaled cannabis on lung cancer, depression, and psychosis were uncertain. Among less serious adverse events, we found that inhaled cannabis is likely associated with thirst, fatigue, increased appetite, nausea, mood changes, diarrhea, and dry mouth. Inhaled cannabis may be associated with red eyes, vomiting, phlegm, asthma, and cough. The effects of inhaled cannabis on euphoria and irritability were uncertain.

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Bakgrund: Stress är något som kan vara negativt för människans hälsa om det pågår under en längre tid och fysisk aktivitet kan möjligtvis verka positivt på upplevd stress. Det skulle vara av värde att kartlägga den potentiella effekten av fysisk aktivitet på upplevd stress hos vuxna för att stärka den vetenskapliga evidensbasen och därmed möjliggöra och tillhandahålla en mer preciserad tillämpning av ny kunskap inom fysioterapeutisk klinisk praxis. Syfte: Undersöka effekten av fysisk aktivitet på upplevd stress hos vuxna jämfört med annan eller ingen behandling. Metod: Systematisk litteraturstudie. Sökningarna utfördes i databaserna PubMed, CINAHL samt Web of Science. Sju randomiserade kontrollerade studier inkluderades och sedan granskades med PEDro scale för att bedöma kvalitén. Därefter granskades dem med “Bedömning av den sammanvägda tillförlitligheten i systematiska översikter” för att bedöma resultatets tillförlitlighet. Resultat: Sju studier inkluderades och kvalitén av dessa varierade mellan måttlig till hög kvalitet. Resultaten är motstridiga gällande fysisk aktivitets effekt på upplevd stress. Två studier visade på signifikant minskning av upplevd stress i gruppen med fysisk aktivitet jämfört med kontrollgruppen medan övriga fem studier inte visade någon signifikant minskning mellan interventionsgrupp och kontrollgrupp på utfallsmåttet upplevd stress hos vuxna. Tillförlitligheten av det sammanvägda resultatet visade på mycket låg tillförlitlighet på grund av bristande samstämmighet mellan studierna samt bristande precision i studierna (+). Konklusion: Resultaten är motstridiga och tillförlitligheten av det sammanvägda resultatet visade låg tillförlitlighet. Därför kan inte några slutsatser dras av denna studie gällande fysisk aktivitet och dess effekt på upplevd stress. / Background: Prolonged exposure to stress has been documented to exert detrimental effects on human health. Engaging in regular physical activity may offer potential benefits in mitigating perceived stress levels. Consequently, it is imperative to underscore the significance of investigating the impact of physical activity on perceived stress in regard to clinical value for physiotherapists. Gaining a comprehensive understanding of the association between physical activity and perceived stress could significantly inform clinical practice and enhance the overall well-being of patients.  Method: Systematic review. A comprehensive search was executed across the databases PubMed, CINAHL and Web of Science. The inclusion criteria as well as PICO led to the incorporation of seven randomized controlled studies, which were subsequently reviewed with a quality assessment called PEDro scale. Following this assessment, the findings were further reviewed using “Bedömning av den sammanvägda tillförlitligheten i systematiska översikter” to gauge the overall reliability of the results. Results: Seven studies were included, and the quality of these studies ranged from moderate to high quality. The results are contradictory regarding the effect of physical activity on perceived stress. Two studies demonstrated a significant reduction in perceived stress in the intervention group compared to the control group, while the remaining five studies did not show a significant reduction between the groups regarding perceived stress. The overall strength of evidence was limited due to lack of consistency and lack of precision (+)  Conclusion: The results are conflicting, and the strength of evidence, when combined, is of low evidence. Consequently, no conclusions can be drawn from this study regarding the association between physical activity and its impact on perceived stress in adults.