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Chen HH, Mohsin M, Ge JY, Feng YT, Wang JG, Ou YS, Jiang ZJ, Hu BY, Liu XJ. Optogenetic Activation of Peripheral Somatosensory Neurons in Transgenic Mice as a Neuropathic Pain Model for Assessing the Therapeutic Efficacy of Analgesics. ACS Pharmacol Transl Sci 2024; 7:236-248. [PMID: 38230281 PMCID: PMC10789130 DOI: 10.1021/acsptsci.3c00254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
Optogenetics is a novel biotechnology widely used to precisely manipulate a specific peripheral sensory neuron or neural circuit. However, the use of optogenetics to assess the therapeutic efficacy of analgesics is elusive. In this study, we generated a transgenic mouse stain in which all primary somatosensory neurons can be optogenetically activated to mimic neuronal hyperactivation in the neuropathic pain state for the assessment of analgesic effects of drugs. A transgenic mouse was generated using the advillin-Cre line mated with the Ai32 strain, in which channelrhodopsin-2 fused to enhanced yellow fluorescence protein (ChR2-EYFP) was conditionally expressed in all types of primary somatosensory neurons (advillincre/ChR2+/+). Immunofluorescence and transdermal photostimulation on the hindpaws were used to verify the transgenic mice. Optical stimulation to evoke pain-like paw withdrawal latency was used to assess the analgesic effects of a series of drugs. Injury- and pain-related molecular biomarkers were investigated with immunohistofluorescence. We found that the expression of ChR2-EYFP was observed in many primary afferents of paw skin and sciatic nerves and in primary sensory neurons and laminae I and II of the spinal dorsal horns in advillincre/ChR2+/+ mice. Transdermal blue light stimulation of the transgenic mouse hindpaw evoked nocifensive paw withdrawal behavior. Treatment with gabapentin, some channel blockers, and local anesthetics, but not opioids or COX-1/2 inhibitors, prolonged the paw withdrawal latency in the transgenic mice. The analgesic effect of gabapentin was also verified by the decreased expression of injury- and pain-related molecular biomarkers. These optogenetic mice provide a promising model for assessing the therapeutic efficacy of analgesics in neuropathic pain.
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Affiliation(s)
- Hao-Hao Chen
- School
of Pharmacy, Nantong University, Nantong, Jiangsu Province 226001, China
- Pain
and Related Diseases Research Laboratory, Shantou University Medical College, Shantou, Guangdong Province 515041, China
| | - Muhammad Mohsin
- Pain
and Related Diseases Research Laboratory, Shantou University Medical College, Shantou, Guangdong Province 515041, China
| | - Jia-Yi Ge
- School
of Pharmacy, Nantong University, Nantong, Jiangsu Province 226001, China
| | - Yu-Ting Feng
- School
of Pharmacy, Nantong University, Nantong, Jiangsu Province 226001, China
| | - Jing-Ge Wang
- School
of Pharmacy, Nantong University, Nantong, Jiangsu Province 226001, China
| | - Yu-Sen Ou
- Pain
and Related Diseases Research Laboratory, Shantou University Medical College, Shantou, Guangdong Province 515041, China
| | - Zuo-Jie Jiang
- Pain
and Related Diseases Research Laboratory, Shantou University Medical College, Shantou, Guangdong Province 515041, China
| | - Bo-Ya Hu
- Pain
and Related Diseases Research Laboratory, Shantou University Medical College, Shantou, Guangdong Province 515041, China
| | - Xing-Jun Liu
- School
of Pharmacy, Nantong University, Nantong, Jiangsu Province 226001, China
- Pain
and Related Diseases Research Laboratory, Shantou University Medical College, Shantou, Guangdong Province 515041, China
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Baral A, Morales V, Diggs BNA, Tagurum Y, Desai M, Alhazmi N, Ramsey WA, Martinez C, Vidot DC. Perceptions, Attitudes, and Knowledge of Cannabis and its Use: A Qualitative Study among Herbal Heart Study Young Adult Cannabis Consumers in South Florida. Prev Med Rep 2024; 37:102574. [PMID: 38268618 PMCID: PMC10805657 DOI: 10.1016/j.pmedr.2023.102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
Growing cannabis use among young adults in the United States surpasses research and public understanding, raising health concerns despite potential benefits. Limited research focuses on their knowledge, attitudes, risks, and motivations, especially in states with limited legalization. This study explores cannabis knowledge and attitudes among healthy young adult cannabis consumers to understand their risk and benefit perceptions. Data include a subsample of participants in the Herbal Heart Study, a cohort to examine subclinical cardiovascular risk among healthy young adult (18-35 years old) cannabis consumers and non-consumers. A qualitative thematic analysis of the interviews was performed using a deductive approach driven by the theory of the Health Belief Model to generate categories and codes. Dedoose was used to organize transcripts and coding. A total of 22 young adult cannabis consumers (M age = 25.3, SD = 4.4) were interviewed between May 5, 2021- September 23, 2022. Participants were predominantly female (n = 13) and Hispanic (n = 9) or non-Hispanic Black (n = 7). Five themes were identified: perceived health benefits and risks associated with cannabis use, motivation for cannabis use, knowledge of cannabis, and perceived barriers to cannabis use. Participants discussed knowledge, positive/negative attitudes toward cannabis, and perceived risks/benefits based on personal experience and gathered information. Some showed knowledge deficits, and most wanted more health-related cannabis research. Given the current climate of rising cannabis legalization, availability of novel cannabis products, and societal acceptance, further research and evidence-based cannabis literacy for young adults are essential to keep pace with liberalization trends.
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Affiliation(s)
- Amrit Baral
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida, the United States of America
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, the United States of America
| | - Vanessa Morales
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida, the United States of America
| | - Bria-Necole A. Diggs
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida, the United States of America
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, the United States of America
| | - Yetunde Tagurum
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida, the United States of America
| | - Meghal Desai
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida, the United States of America
| | - Nawaf Alhazmi
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida, the United States of America
| | - Walter A. Ramsey
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida, the United States of America
| | - Claudia Martinez
- Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, FL, the United States of America
| | - Denise C. Vidot
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida, the United States of America
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, the United States of America
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Kuzu D, Valentine TR, Kratz AL. Temporal associations between use of psychoactive substances and somatic symptoms in the daily lives of people with fibromyalgia. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1176-1182. [PMID: 37243707 PMCID: PMC10546481 DOI: 10.1093/pm/pnad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Consumption of psychoactive substances-alcohol, nicotine, caffeine, opioids, and cannabis-is common among people with fibromyalgia. Associations between the use of substances and somatic symptoms could reflect efforts to cope with symptoms, aggravation or alleviation of symptoms after the use of substances, or a combination of these. To date, no study has provided insight into temporal associations between the consumption of psychoactive substances and fluctuations in somatic symptoms. We explored whether changes in ratings of pain and fatigue (mental and physical) predicted the later use of psychoactive substances or vice versa (substance use predicting later change in symptoms). DESIGN Micro-longitudinal design. SETTING/SUBJECTS Fifty adults (88% female, 86% White, mean age of 44.9 years) with fibromyalgia. METHODS Participants completed ecological momentary assessments of substance use, pain intensity, and physical/mental fatigue 5 times per day for 8 days. RESULTS Results of multilevel models indicated that momentary increases in fatigue showed a consistent association with greater odds of later use of psychoactive substances, whereas momentary increases in pain were related to lower odds of later cannabis and nicotine use and higher odds of later alcohol use. Only nicotine use predicted later mental fatigue. CONCLUSION Findings highlight the importance of individualized interventions for symptom management or problems related to the use of psychoactive substances. We observed that although somatic symptoms predicted later use of substances, use of substances did not show appreciable effects with regard to alleviating somatic symptoms in people with fibromyalgia.
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Affiliation(s)
- Duygu Kuzu
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI 48109,United States
| | - Thomas R Valentine
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI 48109,United States
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI 48109,United States
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Gliksberg O, Kushnir T, Sznitman SR, Lev-Ran S, Brill S, Amit BH, Feingold D. Negative experiences of patients using medicinal cannabis: A systematic review of qualitative studies. J Clin Nurs 2023; 32:5607-5618. [PMID: 36807590 DOI: 10.1111/jocn.16653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Abstract
AIMS AND OBJECTIVES In this study, we systematically reviewed qualitative studies concerning patients' experience with medicinal cannabis (MC) use, to gain insight into the negative effects of MC. BACKGROUND Over the past decades, the use of MC for therapeutic purposes has increased. However, there is conflicting and insufficient data on possible negative physiological and psychological effects of MC treatment. DESIGN A systematic review was conducted and the PRISMA guidelines were adopted. Literature searches were conducted using PubMed, PsycINFO and EMBASE. Critical Appraisal Skills Programme (CASP) qualitative checklist used to assess risk of bias in the included studies. METHODS We included studies focusing on conventional medical treatment using cannabis-based products, approved by a physician for a particular health issue. RESULTS Of the 1230 articles identified in the initial search, eight articles were included in the review. Following the compilation of themes in the eligible studies, six themes were identified: (1) MC approval; (2) administrative barriers; (3) social perception; (4) MC misuse/widespread effect; (5) adverse effects; and (6) dependence or addiction. These were grouped into two meta-themes: (1) administrative and social aspects of MC use; and (2) experiences of the effects of medicinal cannabis. CONCLUSIONS Our findings call for specific attention to unique consequences associated with MC use. Further research is needed in order to assess the degree to which negative experiences associated with MC use may affect various aspects of patients' medical condition. RELEVANCE TO CLINICAL PRACTICE Describing the complex experience of MC treatment and its spectrum of consequences for patients may enable physicians, therapists and researchers to provide more attentive and accurate MC treatment to their patients. PATIENT OR PUBLIC CONTRIBUTION In this review, patients' narratives were explored, yet the research methods did not directly involve patients or the public.
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Affiliation(s)
- Or Gliksberg
- Doctoral Program, Department of Psychology, Ariel University, Ariel, Israel
| | - Talma Kushnir
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Psychology, Ariel University, Ariel, Israel
| | | | - Shaul Lev-Ran
- Israel Center on Addiction, Netanya, Israel
- Lev Hasharon Medical Center, Netanya, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silviu Brill
- Institute of Pain Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ben H Amit
- Cannabis Clinic, Reuth Rehabilitation Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Román-Vargas Y, Porras-Arguello JD, Blandón-Naranjo L, Pérez-Pérez LD, Benjumea DM. Evaluation of the Analgesic Effect of High-Cannabidiol-Content Cannabis Extracts in Different Pain Models by Using Polymeric Micelles as Vehicles. Molecules 2023; 28:molecules28114299. [PMID: 37298776 DOI: 10.3390/molecules28114299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
Currently, cannabis is considered an attractive option for the treatment of various diseases, including pain management. Thus, developing new analgesics is paramount for improving the health of people suffering from chronic pain. Safer natural derivatives such as cannabidiol (CBD) have shown excellent potential for the treatment of these diseases. This study aimed to evaluate the analgesic effect of a CBD-rich cannabis extract (CE) encapsulated in polymeric micelles (CBD/PMs) using different pain models. The PEG-PCL polymers were characterized by gel permeation chromatography and 1H-NMR spectroscopy. PMs were prepared by solvent evaporation and characterized by dynamic light scattering (DLS) and transmission electron microscopy. The analgesic activity of CBD/PMs and nonencapsulated CE rich in CBD (CE/CBD) was evaluated using mouse thermal, chemical, and mechanical pain models. The acute toxicity of the encapsulated CE was determined by oral administration in mice at a dose of 20 mg/kg for 14 days. The release of CBD from the nanoparticles was assessed in vitro using a dialysis experiment. CBD/PMs with an average hydrodynamic diameter of 63.8 nm obtained from a biocompatible polyethylene glycol-block-polycaprolactone copolymer were used as nanocarriers for the extract formulations with 9.2% CBD content, which corresponded with a high encapsulation efficiency of 99.9%. The results of the pharmacological assays indicated that orally administered CBD/PMs were safe and exerted a better analgesic effect than CE/CBD. The micelle formulation had a significant analgesic effect in a chemical pain model, reaching a percentage of analgesia of 42%. CE was successfully encapsulated in a nanocarrier, providing better stability. Moreover, it proved to be more efficient as a carrier for CBD release. The analgesic activity of CBD/PMs was higher than that of free CE, implying that encapsulation is an efficient strategy for improving stability and functionality. In conclusion, CBD/PMs could be promising therapeutics for pain management in the future.
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Affiliation(s)
- Yoreny Román-Vargas
- Grupo de Toxinología y Alternativas Farmacéuticas y Alimentarias, Departamento de Farmacia, Facultad de Ciencias Farmacéuticas y Alimentarias, Universidad de Antioquia, Medellín 1226, Colombia
| | - Julián David Porras-Arguello
- Grupo de Investigación Macromoléculas, Departamento de Química, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-03, Edif. 476, Bogotá 11001, Colombia
| | - Lucas Blandón-Naranjo
- Grupo Interdisciplinario de Estudios Moleculares-GIEM, Instituto de Química, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín 1226, Colombia
| | - León Darío Pérez-Pérez
- Grupo de Investigación Macromoléculas, Departamento de Química, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-03, Edif. 476, Bogotá 11001, Colombia
| | - Dora María Benjumea
- Grupo de Toxinología y Alternativas Farmacéuticas y Alimentarias, Departamento de Farmacia, Facultad de Ciencias Farmacéuticas y Alimentarias, Universidad de Antioquia, Medellín 1226, Colombia
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Nelson EUE, Kitchen C. Cannabis use for pain relief in the context of health service barriers: Accounts of street-involved Nigerian women suffering chronic pain. Drug Alcohol Rev 2023; 42:309-317. [PMID: 36193548 DOI: 10.1111/dar.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This study explored cannabis use for pain relief among socially marginalised Nigerian women in the context of barriers to pain management. METHODS The study was designed as a qualitative exploratory study of pain experience and management. Sixteen in-depth, individual interviews were conducted with street-involved women who use drugs and had chronic pain. Transcripts were coded and analysed thematically. RESULTS Pain was experienced as a pervasive feature of everyday life that disrupted daily routines, affected economic activities, strained social relationships and had adverse effects on health and wellbeing. Participants sought treatment in health facilities, but faced social and health system barriers to service utilisation including financial cost of services, dismissal of symptoms by providers, stigma due to physical appearance, substance use and lack of social support. These barriers encouraged disengagement from services and reliance on cannabis (along with heroin and diverted prescription opioids) for pain management. Cannabis use relieved pain and improved daily functioning, enabling participants to undertake economic activities. However, using cannabis to enhance the effects of opioids and heavy and long-term use owing to pain chronicity and disability generated concerns about harms. DISCUSSION AND CONCLUSIONS Findings show the therapeutic benefits of cannabis in the face of barriers to pain management. This support calls to explore the potentials of cannabis for pain management for socially marginalised populations and to develop medical guidelines to reduce the risk of adverse health consequences. Therapeutic cannabis, provided based on medical guidance, could improve pain management for socially marginalised populations.
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Affiliation(s)
- Ediomo-Ubong E Nelson
- Global Drug Policy Observatory, Swansea University, Swansea, UK
- Centre for Research and Information on Substance Abuse, Uyo, Nigeria
| | - Chenai Kitchen
- School of Pharmacy, Xi'an Jiaotong University, Shaanxi, China
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Salmasi V, Nelson LM, Hong J, Mackey SC. Association of cannabis and/or opioid with quality of life and healthcare utilization in patients with chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1015605. [PMID: 36506271 PMCID: PMC9729730 DOI: 10.3389/fpain.2022.1015605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022]
Abstract
Background Opioids have been commonly used to treat chronic pain, but they are associated with significant morbidity and mortality. Cannabis has been advocated as an alternative; however, a growing number of patients are now using a combination of opioid and cannabis and the impact of this combination is not well-studied. Aim We characterized use of opioid and/or cannabis in patients with chronic pain; and compared utilization of healthcare resources. Methods We conducted a cross-sectional study to determine if measures of physical, psychological and social functioning differed among patients according to whether they used opioids and/or cannabis. We used our learning healthcare system - CHOIR - to capture NIH Patient Reported Outcomes Measure Information System surveys, and legacy pain and treatment specific questions. Results Patients who report use of opioid and/or cannabis experience higher levels of physical, psychological and social distress. After adjusting for inversed weight of propensity scores, they have higher odds of visiting an emergency room, staying overnight at the hospital, and visiting a physician. Conclusion Our results show that use of opioid and/or cannabis is associated with worse baseline characteristics and outcomes. Our study however cannot determine if worse outcomes are due to the opioids and/or cannabis or simply that these patients are worse off before using opioids and/or cannabis. Thus, it is important to characterize the trajectory of these patients in a prospective longitudinal study.
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Affiliation(s)
- Vafi Salmasi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States,Correspondence: Vafi Salmasi
| | - Lorene M. Nelson
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Juliette Hong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Sean C. Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Caudillo ML, Villarreal A, Cohen PN. The Opioid Epidemic and Children's Living Arrangements in the United States, 2000-2018. THE ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE 2022; 703:162-187. [PMID: 39036709 PMCID: PMC11259247 DOI: 10.1177/00027162221142648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Although the detrimental effects of the opioid epidemic on health and wellbeing have been well documented, we know little about how it has affected the family contexts in which children live. Using data from the 2000 Census, the 2005-2018 American Community Survey (ACS) and restricted Vital Statistics, we assess how the opioid epidemic, as measured by a rise in the opioid overdose death rate, affected the rates of children living in different family arrangements: two married parents, two cohabiting parents, single mother, single father, or another configuration. According to local fixed-effects models, a higher opioid overdose death rate is associated with fewer children living with two married parents and an increase in children living in family structures that tend to be less stable, such as those led by cohabiting parents or a single father. These changes in family arrangements have potential long-term implications for the wellbeing of future generations.
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Practical Considerations for the Use of Cannabis in Cancer Pain Management—What a Medical Oncologist Should Know. J Clin Med 2022; 11:jcm11175036. [PMID: 36078963 PMCID: PMC9457511 DOI: 10.3390/jcm11175036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/29/2022] Open
Abstract
Pain is a highly debilitating emotional and sensory experience that significantly affects quality of life (QoL). Numerous chronic conditions, including cancer, are associated with chronic pain. In the setting of malignancy, pain can be a consequence of the tumor itself or of life-saving interventions, including surgery, chemotherapy, and radiotherapy. Despite significant pharmacological advances and awareness campaigns, pain remains undertreated in one-third of patients. To date, opioids have been the mainstay of cancer pain management. The problematic side effects and unsatisfactory pain relief of opioids have revived patients’ and physicians’ interest in finding new solutions, including cannabis and cannabinoids. The medical use of cannabis has been prohibited for decades, and it remains in Schedule 1 of the Misuse of Drugs Regulations. Currently, the legal context for its usage has become more permissive. Various preclinical and observational studies have aimed to prove that cannabinoids could be effective in cancer pain management. However, their clinical utility must be further supported by high-quality clinical trials.
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D'Souza RS, Langford B, Wilson RE, Her YF, Schappell J, Eller JS, Evans TC, Hagedorn JM. The State-of-the-art Pharmacotherapeutic Options for the Treatment of Chronic Non-Cancer Pain. Expert Opin Pharmacother 2022; 23:775-789. [PMID: 35354341 DOI: 10.1080/14656566.2022.2060741] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Pharmacotherapeutic options continue to expand for the treatment of chronic non-cancer pain. There has been an increasing emphasis on multimodal analgesia. This strategy employs use of multiple analgesic medications each with a distinct mechanism of action, which when administered concomitantly may provide profound analgesia. AREAS COVERED The authors describe evidence from randomized controlled trials and systematic reviews on a variety of established medications including anti-inflammatory agents, opioids, anti-convulsants, anti-depressants, N-methyl-D-aspartate receptor antagonists, sodium channel blockers, cannabinoids, and alpha-2-receptor blockers. Furthermore, they provide developing evidence on more novel pharmacotherapeutics including alpha lipoic acid, acetyl-L-carnitine, low dose naltrexone, calcitonin gene-related peptide antagonists, targeted toxin therapy, Nav1.7 inhibitors, neurotensin agonists, purinoceptor antagonists, and sigma-1 receptor antagonists. Furthermore, the authors review the safety and adverse effect profile for these agents. EXPERT OPINION In this era of the opioid epidemic, clinicians should first offer non-opioid analgesics and employ a multimodal analgesic strategy. Current guidelines recommend a personalized approach to the chronic pain treatment, in each case accounting for type, location, severity, and chronicity of pain. Clinicians should also carefully consider the risk-to-benefit ratio to the patient based on the drug side effect profile, patient age, and comorbidities.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Brendan Langford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Rachel E Wilson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Yeng F Her
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Justin Schappell
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Rochester, MN, USA
| | - Jennifer S Eller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Timothy C Evans
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
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11
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Khoury M, Cohen I, Bar-Sela G. “The Two Sides of the Same Coin”—Medical Cannabis, Cannabinoids and Immunity: Pros and Cons Explained. Pharmaceutics 2022; 14:pharmaceutics14020389. [PMID: 35214123 PMCID: PMC8877666 DOI: 10.3390/pharmaceutics14020389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023] Open
Abstract
Cannabis, as a natural medicinal remedy, has long been used for palliative treatment to alleviate the side effects caused by diseases. Cannabis-based products isolated from plant extracts exhibit potent immunoregulatory properties, reducing chronic inflammatory processes and providing much needed pain relief. They are a proven effective solution for treatment-based side effects, easing the resulting symptoms of the disease. However, we discuss the fact that cannabis use may promote the progression of a range of malignancies, interfere with anti-cancer immunotherapy, or increase susceptibility to viral infections and transmission. Most cannabis preparations or isolated active components cause an overall potent immunosuppressive impact among users, posing a considerable hazard to patients with suppressed or compromised immune systems. In this review, current knowledge and perceptions of cannabis or cannabinoids and their impact on various immune-system components will be discussed as the “two sides of the same coin” or “double-edged sword”, referring to something that can have both favorable and unfavorable consequences. We propose that much is still unknown about adverse reactions to its use, and its integration with medical treatment should be conducted cautiously with consideration of the individual patient, effector cells, microenvironment, and the immune system.
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Affiliation(s)
- Mona Khoury
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel; (M.K.); (I.C.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200002, Israel
| | - Idan Cohen
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel; (M.K.); (I.C.)
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel; (M.K.); (I.C.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200002, Israel
- Oncology & Hematology Division, Emek Medical Center, Yitshak Rabin Boulevard 21, Afula 1834111, Israel
- Correspondence: ; Tel.: +972-4-6495725; Fax: +972-4-6163992
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Adler L, Zacay G, Schonmann Y, Azuri J, Yehoshua I, Vinker S, Shani M, Heymann AD, Hoffman R. Primary care physicians' attitudes and knowledge regarding medical cannabis and willingness to prescribe it: the Israeli experience. Fam Pract 2022; 39:59-64. [PMID: 34476478 DOI: 10.1093/fampra/cmab108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Use of medical cannabis (MC) in Israel has increased since its regulatory approval in 2016. Currently, more than 1% of Israeli adults are treated with MC; this requires primary care physicians (PCPs) to be familiar with this treatment option. OBJECTIVES We assessed the attitudes and knowledge of Israeli PCPs toward MC and evaluated their willingness to prescribe it for different medical conditions. METHODS A cross-sectional survey which was distributed to PCPs in Israel. Physicians were asked about their opinions, knowledge, and willingness to prescribe MC. RESULTS Two hundred and one PCPs answered the questionnaire. Their average age was 47 years (±11.2), 71% were specialists. 51% of the respondents thought that MC is an effective treatment. 63% replied that they had little knowledge and 75% indicated that they would like to deepen it. 61% of the respondents were willing to initiate an MC treatment for a dying patient, while less than 50% were willing to initiate MC treatment for various other conditions. Most respondents indicated that they were willing to renew a prescription for any approved medical condition. Willingness to prescribe MC increased for physicians who agreed that MC was effective (odds ratio [OR] 21.9, 95% confidence interval [CI] 2.40-200.85), for physicians who strongly agreed with the statement that they had sufficient knowledge (OR 5.0, 95% CI 1.58-15.83) and for residents compared with specialists (OR 4.0, 95% CI 1.52-10.73). CONCLUSIONS Our survey revealed PCPs' differing opinions and insufficient knowledge regarding treatment with MC. These findings suggest that continuing medical education regarding MC is needed.
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Affiliation(s)
- Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Galia Zacay
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Joseph Azuri
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Ilan Yehoshua
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Leumit Health Services, Headquarters, Medical Division, Tel Aviv, Israel
| | - Michal Shani
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine Central District, Clalit Health Services, Rehovot, Israel
| | - Anthony D Heymann
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - Robert Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
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13
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New approaches to treatments for sleep, pain and autonomic failure in Parkinson's disease - Pharmacological therapies. Neuropharmacology 2022; 208:108959. [PMID: 35051446 DOI: 10.1016/j.neuropharm.2022.108959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/08/2022] [Accepted: 01/13/2022] [Indexed: 01/07/2023]
Abstract
Non-motor symptoms (NMSs) are highly prevalent throughout the course of Parkinson's disease (PD). Pain, autonomic dysfunction and sleep disturbances remain at the forefront of the most common NMSs; their treatment is challenging and their effect on the quality of life of both patients and caregivers detrimental. Yet, the landscape of clinical trials in PD is still dominated by therapeutic strategies seeking to ameliorate motor symptoms; subsequently, effective strategies to successfully treat NMSs remain a huge unmet need. Wider awareness among industry and researchers is thus essential to give rise to development and delivery of high-quality, large-scale clinical trials in enriched populations of patients with PD-related pain, autonomic dysfunction and sleep. In this review, we discuss recent developments in the field of pharmacological treatment strategies designed or re-purposed to target three key NMSs: pain, autonomic dysfunction and sleep disturbances. We focus on emerging evidence from recent clinical trials and outline some exciting and intriguing findings that call for further investigations.
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14
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El-Hammadi MM, Small-Howard AL, Jansen C, Fernández-Arévalo M, Turner H, Martín-Banderas L. Potential Use for Chronic Pain: Poly(Ethylene Glycol)-Poly(Lactic-Co-Glycolic Acid) Nanoparticles Enhance the Effects of Cannabis-Based Terpenes on Calcium Influx in TRPV1-Expressing Cells. Int J Pharm 2022; 616:121524. [DOI: 10.1016/j.ijpharm.2022.121524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 01/11/2023]
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15
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Pritchett CE, Flynn H, Wang Y, Polston JE. Medical Cannabis Patients Report Improvements in Health Functioning and Reductions in Opiate Use. Subst Use Misuse 2022; 57:1883-1892. [PMID: 36168127 DOI: 10.1080/10826084.2022.2107673] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Purpose: Opioid use rates have dropped as North American patients gain access to medical cannabis, indicating a harm reduction role, yet health outcomes remain mostly unexplored. This study presents self-reported medical cannabis use, perceptions of health functioning, and changes in opioid pain medication use in Florida medical cannabis patients.Methods: Patients (n = 2,183) recruited from medical dispensaries across Florida completed a 66-item cross-sectional survey that included demographic, health, and medication usage items, along with items from the Medical Outcomes Survey (SF-36) to assess health functioning before and after cannabis initiation.Results: Most participants were between the ages of 20 and 70 years of age (95%), over 54% were female, 47% were employed, and most (85%) were white. Commonly reported ailment groups were Pain and Mental Health combined (47.92%), Mental Health (28.86%) or Pain (9.07%). Health domains of bodily pain, physical functioning, and social functioning improved while limitations due to physical and emotional problems were unchanged. Most patients rated medical cannabis as being important to their quality of life. Many (60.98%) reported using pain medications prior to medical cannabis, 93.36% of these reported a change in pain medication after medical cannabis. The majority of participants (79%) reported either cessation or reduction in pain medication use following initiation of medical cannabis and 11.47% described improved functioning.Conclusions: The findings suggest that some medical cannabis patients decreased opioid use without harming quality of life or health functioning, soon after the legalization of medical cannabis. The public health implications of medical cannabis as an alternative pain medication are discussed.
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Affiliation(s)
| | - Heather Flynn
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Yuxia Wang
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
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16
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Harris M, Erridge S, Ergisi M, Nimalan D, Kawka M, Salazar O, Ali R, Loupasaki K, Holvey C, Coomber R, Usmani A, Sajad M, Hoare J, Rucker JJ, Platt M, Sodergren MH. UK Medical Cannabis registry: an analysis of clinical outcomes of medicinal cannabis therapy for chronic pain conditions. Expert Rev Clin Pharmacol 2021; 15:473-485. [PMID: 34937477 DOI: 10.1080/17512433.2022.2017771] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore pain-specific, general health-related quality of life (HRQoL), and safety outcomes of chronic pain patients prescribed cannabis-based medicinal products (CBMPs). METHODS A case series was performed using patients with chronic pain from the UK Medical Cannabis Registry. Primary outcomes were changes in Brief Pain Inventory short-form (BPI), Short-form McGill Pain Questionnaire-2 (SF-MPQ-2), Visual Analogue Scale-Pain (VAS), General Anxiety Disorder-7 (GAD-7), Sleep Quality Scale (SQS), and EQ-5D-5L, at 1, 3, and 6 months from baseline. Statistical significance was defined at p-value<0.050. RESULTS 190 patients were included. Median initial Δ9-tetrahydrocannabinol and cannabidiol daily doses were 2.0mg (range:0.0-442.0mg) and 20.0mg (range:0.0-188.0mg) respectively. Significant improvements were observed within BPI, SF-MPQ-2, GAD-7, SQS, EQ-5D-5 L index, and VAS measures at all timepoints (p<0.050). Seventy-five adverse events (39.47%) were reported, of which 37 (19.47%) were rated as mild, 23 (12.11%) as moderate, and 14 (7.37%) as severe. Nausea (n=11; 5.8%) was the most frequent adverse event. CONCLUSION An association was identified between patients with chronic pain prescribed CBMPs and improvements in pain-specific and general HRQoL outcomes. Most adverse events were mild to moderate in severity, indicating CBMPs were well tolerated. Inherent limitations of study design limit its overall applicability.
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Affiliation(s)
| | - Simon Erridge
- Imperial College London, London, UK.,Sapphire Medical Clinics, London, UK
| | | | | | | | | | | | | | | | - Ross Coomber
- Sapphire Medical Clinics, London, UK.,St. George's Hospital NHS Trust, London, UK
| | - Azfer Usmani
- Sapphire Medical Clinics, London, UK.,Dartford and Gravesham Nhs Trust, Kent, UK
| | - Mohammed Sajad
- Sapphire Medical Clinics, London, UK.,Dudley Group of Hospitals Nhs Trust, West Midlands, UK
| | - Jonathan Hoare
- Imperial College London, London, UK.,Sapphire Medical Clinics, London, UK
| | - James J Rucker
- Sapphire Medical Clinics, London, UK.,Department of Psychological Medicine, Kings College London, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - Michael Platt
- Imperial College London, London, UK.,Sapphire Medical Clinics, London, UK
| | - Mikael H Sodergren
- Imperial College London, London, UK.,Sapphire Medical Clinics, London, UK
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17
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Balant M, Gras A, Ruz M, Vallès J, Vitales D, Garnatje T. Traditional uses of Cannabis: An analysis of the CANNUSE database. JOURNAL OF ETHNOPHARMACOLOGY 2021; 279:114362. [PMID: 34171396 DOI: 10.1016/j.jep.2021.114362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/31/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Cannabis is one of the most versatile genera in terms of plant use and has been exploited by humans for millennia. Nowadays, Cannabis is the centre of many scientific studies, most of them focusing on chemical composition and medicinal values. While new and varied applications are continuously being developed, the knowledge surrounding less common uses of the plant is slowly disappearing. AIM OF THE REVIEW We have analysed diversity of global data of Cannabis traditional uses, to investigate if certain plant parts are significantly associated with particular Cannabis use. We wanted to uncover potential associations between the plant parts used for the treatment of different body systems and ailments. MATERIALS AND METHODS We have analysed the extensive database of Cannabis traditional uses (CANNUSE). This database contains 2330 data entries of Cannabis ethnobotanical uses from over 40 countries across the world. The dataset was divided into five general groups based on the type of use: medicinal, alimentary, psychoactive, fibre and other uses. Given the abundance of human medicinal uses, detailed analysis was done on the subset of 1167 data entries. We analysed the relationship between 16 body system categories and ailments treated with Cannabis plant parts. We used a Pearson's chi-square and Fisher's exact test, to determine which Cannabis parts are characteristic of treatment for specific ailments. RESULTS In this dataset, the majority of reports were represented by medicinal (75.41%), followed by psychoactive (8.35%) and alimentary (7.29%) use. The most commonly used plant parts were leaf (50.51%), seed (15.38%) and inflorescence (11.35%). We found that different Cannabis plant parts were significantly associated with different uses; the leaf was typically used for medicinal, seed for alimentary and inflorescence for psychoactive use. Regarding the human medicinal uses, most common were reports for treatments of the digestive system and nutritional disorders (17.66%), nervous system and mental disorders (16.24%), followed by pain and inflammations (12.21%). We found a significant relationship between the use of certain Cannabis parts and treatment of ailments and body systems categories; leaf was significantly associated with treatment of two categories: skin and subcutaneous tissue disorders and circulatory system and blood disorders; seed use was associated with musculoskeletal system disorders and traumas; while inflorescence use shows a statistical support for treatment of nervous system and mental disorders. CONCLUSION Several pharmaceutical companies are intensely working on developing new drugs with isolated chemical compounds or crude extracts, almost exclusively from Cannabis inflorescences. However, our review revealed that use of leaf or seed in traditional medicine is often more important than use of inflorescence for the treatment of certain ailments. A review of traditional medicine provides a body of knowledge and an initial pathway to identify landraces and plant parts that could have an important role in future medicinal research. We are confident that traditional medicine still has a large potential for modern medicine. As more information on Cannabis diversity (genetics, biochemistry, and clinical studies) becomes available, ethnobotanical data are poised to be of much greater significance.
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Affiliation(s)
- Manica Balant
- Institut Botànic de Barcelona (IBB, CSIC - Ajuntament de Barcelona), Passeig del Migdia s/n, 08038, Barcelona, Catalonia, Spain.
| | - Airy Gras
- Institut Botànic de Barcelona (IBB, CSIC - Ajuntament de Barcelona), Passeig del Migdia s/n, 08038, Barcelona, Catalonia, Spain.
| | - Mario Ruz
- Laboratori de Botànica (UB), Unitat Associada Al CSIC, Facultat de Farmàcia i Ciències de l'Alimentació - Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Av. Joan XXIII 27-31, 08028, Barcelona, Catalonia, Spain.
| | - Joan Vallès
- Laboratori de Botànica (UB), Unitat Associada Al CSIC, Facultat de Farmàcia i Ciències de l'Alimentació - Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Av. Joan XXIII 27-31, 08028, Barcelona, Catalonia, Spain; Institut d'Estudis Catalans (IEC), Carrer del Carme, 47, 08001, Barcelona, Catalonia, Spain.
| | - Daniel Vitales
- Institut Botànic de Barcelona (IBB, CSIC - Ajuntament de Barcelona), Passeig del Migdia s/n, 08038, Barcelona, Catalonia, Spain; Laboratori de Botànica (UB), Unitat Associada Al CSIC, Facultat de Farmàcia i Ciències de l'Alimentació - Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Av. Joan XXIII 27-31, 08028, Barcelona, Catalonia, Spain.
| | - Teresa Garnatje
- Institut Botànic de Barcelona (IBB, CSIC - Ajuntament de Barcelona), Passeig del Migdia s/n, 08038, Barcelona, Catalonia, Spain.
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18
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Kawka M, Erridge S, Holvey C, Coomber R, Usmani A, Sajad M, Platt MW, Rucker JJ, Sodergren MH. Clinical Outcome Data of First Cohort of Chronic Pain Patients Treated With Cannabis-Based Sublingual Oils in the United Kingdom: Analysis From the UK Medical Cannabis Registry. J Clin Pharmacol 2021; 61:1545-1554. [PMID: 34473850 PMCID: PMC9292210 DOI: 10.1002/jcph.1961] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/27/2021] [Indexed: 12/20/2022]
Abstract
Cannabis-based medicinal products (CBMPs) are an emerging therapeutic option in the management of primary chronic pain, using the role of the endocannabinoid system in modulating central and peripheral pain processes. Despite promising preclinical data, there is a paucity of high-quality evidence to support the use of CBMPs for chronic pain. This study aimed to investigate the health-related quality-of-life outcomes of patients with chronic pain who were prescribed CBMP oil preparations (Adven, Curaleaf International, Guernsey, UK). This study is a case series of patients from the UK Medical Cannabis Registry, who were treated with CBMP oils for an indication of chronic pain. The primary outcomes were the changes in Brief Pain Inventory short form, Short-Form McGill Pain Questionnaire-2, Visual Analog Scale Pain, General Anxiety Disorder-7, Sleep Quality Scale, and EQ-5D-5L, at 1, 3, and 6 months. One hundred ten patients were included. Significant improvements in Sleep Quality Scale, EQ-5D-5L pain and discomfort subscale, and Brief Pain Inventory Interference Subscale (P < .05) at 1, 3, and 6 months were demonstrated. There were no notable differences between cannabis-naïve and previous cannabis users in quality-of-life outcomes. The adverse event incidence was 30.0%, with most (n = 58; 92.1%) adverse events being mild or moderate in intensity. Treatment of chronic pain with Adven CBMP oils was associated with an improvement in pain-specific outcomes, health-related quality of life, and self-reported sleep quality. Relative safety was demonstrated over medium-term prescribed use. While these findings must be treated with caution considering the limitations of study design, they can inform future clinical trials.
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Affiliation(s)
- Michal Kawka
- Imperial College Medical Cannabis Research Group, Imperial College London, London, UK
| | - Simon Erridge
- Imperial College Medical Cannabis Research Group, Imperial College London, London, UK.,Sapphire Medical Clinics, London, UK
| | | | - Ross Coomber
- Sapphire Medical Clinics, London, UK.,St George's Hospital NHS Trust, London, UK
| | - Azfer Usmani
- Sapphire Medical Clinics, London, UK.,Dartford and Gravesham NHS Trust, Kent, UK
| | - Mohammad Sajad
- Sapphire Medical Clinics, London, UK.,Dudley Group of Hospitals NHS Trust, Dudley, UK
| | - Michael W Platt
- Imperial College Medical Cannabis Research Group, Imperial College London, London, UK.,Sapphire Medical Clinics, London, UK
| | - James J Rucker
- Sapphire Medical Clinics, London, UK.,Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, Kings College London, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Imperial College London, London, UK.,Sapphire Medical Clinics, London, UK
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19
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Pantoja-Ruiz C, Restrepo-Jimenez P, Castañeda-Cardona C, Ferreirós A, Rosselli D. Cannabis and pain: a scoping review. Braz J Anesthesiol 2021; 72:142-151. [PMID: 34280454 PMCID: PMC9373074 DOI: 10.1016/j.bjane.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/16/2021] [Accepted: 06/26/2021] [Indexed: 11/05/2022] Open
Abstract
For centuries, cannabis has been used with many different purposes, including medicinal use, usually bypassing any formal approval process. However, during the last decade, interest in cannabis in medicine has been increasing, and several countries, including the United States and Canada, have produced their own legislation about marihuana and cannabis-based medicines. Because of this, interest in research has been increasing and evidence about its medical effects is becoming necessary. We conducted a review examining the evidence of cannabis in pain. Cannabis had been shown to be useful in acute and chronic pain, however recently, these results have been controverted. Within the different types of chronic pain, it has a weak evidence for neuropathic, rheumatic pain, and headache, modest evidence for multiple sclerosis related pain, and as adjuvant therapy in cancer pain. There is no strong evidence to recommend cannabis in order to decrease opioids in patients with chronic use. Even though cannabis-based medications appear to be mostly safe, mild adverse effects are common; somnolence, sedation, amnesia, euphoric mood, hyperhidrosis, paranoia, and confusion may limit the use of cannabis in clinical practice. Risks have not been systematically analyzed. Special concern arises on how adverse effect might affect vulnerable population such as elderly patients. More research is needed in order to evaluate benefits and risks, as well as the ideal administration route and dosages. As cannabis use increases in several countries, answers to these questions might be coming soon.
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Affiliation(s)
- Camila Pantoja-Ruiz
- Pontificia Universidad Javeriana, Medical School, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Paula Restrepo-Jimenez
- Pontificia Universidad Javeriana, Medical School, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Diego Rosselli
- Pontificia Universidad Javeriana, Medical School, Bogotá, Colombia.
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20
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Lee C, Round JM, Klarenbach S, Hanlon JG, Hyshka E, Dyck JRB, Eurich DT. Gaps in evidence for the use of medically authorized cannabis: Ontario and Alberta, Canada. Harm Reduct J 2021; 18:61. [PMID: 34103058 PMCID: PMC8186125 DOI: 10.1186/s12954-021-00509-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With legal access to medical cannabis in Canada since 2001, there is a need to fully characterize its use at both the individual and population levels. We draw on data from Canada's largest cohort study of medical cannabis to identify the primary reasons for medical cannabis authorization in Canada from 2014 to 2019 in two major provinces: Alberta (AB) and Ontario (ON), and review the extent that evidence supports each indication. METHODS Self-reported baseline assessments were collected from adult patients in ON (n = 61,835) and AB (n = 3410) who were authorized medical cannabis. At baseline, sociodemographic, primary medical information, and validated clinical questionnaires were completed by patients as part of an individual assessment. Patients' reasons for seeking medical cannabis were compared to published reviews and guidelines to assess the level of evidence supporting medical cannabis use for each condition. RESULTS Medical cannabis use in both AB and ON was similar in both demographic and reason for authorization. The most common reasons for medical cannabis authorization were: (1) pain (AB = 77%, ON = 76%) primarily due to chronic musculoskeletal, arthritic, and neuropathic pain, (2) mental health concerns (AB = 32.9%, ON = 38.7%) due to anxiety and depression, and (3) sleep problems (AB = 28%, ON = 25%). More than 50 other conditions were identified as reasons for obtaining authorization. CONCLUSION In both AB and ON, the majority of reasons for medical cannabis authorization are not substantiated by clinical evidence to fully support its efficacy for long-term use. Ongoing epidemiological studies on medical cannabis on these treatments are warranted to fully outline its treatment benefits or risks.
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Affiliation(s)
- Cerina Lee
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Jessica M Round
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Scott Klarenbach
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada.
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21
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Luque JS, Okere AN, Reyes-Ortiz CA, Williams PM. Mixed methods study of the potential therapeutic benefits from medical cannabis for patients in Florida. Complement Ther Med 2021; 57:102669. [PMID: 33460744 DOI: 10.1016/j.ctim.2021.102669] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To evaluate medical marijuana patients' perceptions of therapeutic benefits for self-reported medical conditions. DESIGN The study was a concurrent mixed methods study with adult medical marijuana patients. Survey data were collected using a web-based survey, and interviews were conducted in person or over the phone. SETTING The study recruited 196 medical marijuana patients to complete surveys and 13 patients to participate in qualitative interviews in Florida. MEASURES A validated patient survey was distributed via Florida medical marijuana social media groups to examine the therapeutic benefits of the cannabis plant for medical conditions and overall well-being. Concurrently, qualitative interviews were conducted to understand barriers and facilitators to accessing medical cannabis and explore preferences for different forms and strains, as well as any unexpected side effects. RESULTS Patients used medical cannabis for relief of chronic pain or depression, followed by arthritis and nausea. Survey results indicated 89 % of patients reported "great relief" for their medical condition. Over 76 % of patients reported a score of 8 or higher on a 10-point scale that their medical condition had improved, and over 68 % reported a score of 8 or higher that medical cannabis had reduced their pain. Interviews indicated medical cannabis was effective for pain relief and reducing the use of prescription medicines, but the drug was perceived as too expensive. CONCLUSIONS Medical marijuana patients were positive about the health benefits they received and the fact they were able to reduce or eliminate many prescription medications; however, there were concerns about the costs.
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Affiliation(s)
- John S Luque
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, United States.
| | - Arinze Nkemdirim Okere
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, United States
| | - Carlos A Reyes-Ortiz
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, United States
| | - Paula M Williams
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, United States
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22
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Johal H, Vannabouathong C, Chang Y, Zhu M, Bhandari M. Medical cannabis for orthopaedic patients with chronic musculoskeletal pain: does evidence support its use? Ther Adv Musculoskelet Dis 2020; 12:1759720X20937968. [PMID: 32655704 PMCID: PMC7333482 DOI: 10.1177/1759720x20937968] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022] Open
Abstract
The treatment of chronic, non-cancer musculoskeletal pain has become a topic growing interest as it is believed to be one of the reasons for the current opioid epidemic. The medicinal use of cannabis has a long history as a number of active compounds in cannabis have been shown to interact with the body's endocannabinoid system to reduce pain. This position paper provides a history on the evolution of cannabis, the science behind its therapeutic effects, and review of the evidence and current guideline recommendations on its use as a treatment for patients with chronic, non-cancer musculoskeletal pain. Results from systematic reviews have demonstrated a statistically significant reduction in chronic pain conditions with cannabinoids, compared with placebo, although the effects might be considered small and did not reach the minimally important difference. More adverse events were reported in the cannabinoid group than in the placebo group with longer than 2 weeks of treatment. There is a lack of evidence on dependence. With changes to policies, patients' perception has changed to be more positive toward the use of medical cannabis. Current recommendations from North America, Latin America, Europe, Australia and Iran support the use of medical cannabis for chronic, non-cancer pain. Based on the current evidence, it is our position that cannabinoids may be considered as an adjunctive therapy after recommended first- and second-line therapies have failed to provide sufficient efficacy or tolerability. Patients should consider the balance between the desirable and undesirable effects of taking cannabis for chronic pain, and comprehensively consider their own values and preferences, as well as cost-effectiveness factors, based on the information provided by their physician.
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Affiliation(s)
- Herman Johal
- Department of Surgery, McMaster University, 237 Barton Street East, Floor 5N, Hamilton, ON L8L 2X2, Canada
| | | | - Yaping Chang
- OrthoEvidence Inc., 3228 South Service Road, Suite 206, Burlington, ON L7N 3J6, Canada
| | - Meng Zhu
- OrthoEvidence Inc., Burlington, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- OrthoEvidence Inc., Burlington, ON, Canada
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Arboleda MF, Prosk E, Cyr C, Gamaoun R, Vigano A. Medical cannabis in supportive cancer care: lessons from Canada. Support Care Cancer 2020; 28:2999-3001. [PMID: 32172409 DOI: 10.1007/s00520-020-05403-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/04/2020] [Indexed: 01/24/2023]
Abstract
Medical cannabis, or cannabinoid-based products, continues to grow in popularity globally, driving the evolution of regulatory access frameworks; cancer patients and caregivers often rely on guidance from their physicians regarding cannabinoid-based treatments. But the majority of healthcare practitioners still feel unprepared and insufficiently informed to make reasonable, evidence-based recommendations about medical cannabis. More than 30 countries worldwide have now legalized access to medical cannabis; yet various nations still face arduous regulatory challenges to fulfill the needs of patients, healthcare practitioners, and other medical stakeholders. This has affected the deployment of comprehensive medical cannabis access programs adapted to cultural and social realities. With a 20-year history of legal medical cannabis access and nearly 400,000 registered patients under its federal access program, Canada serves as a model for countries which are developing their regulatory frameworks. The Canadian clinical experience in cannabinoid-based treatments is also a valuable source of lessons for healthcare professionals who wish to better understand the current evidence examining medical cannabis for oncology patients.
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Affiliation(s)
- Maria Fernanda Arboleda
- Research Department, Santé Cannabis, 4150 Saint-Catherine St W Suite 225, Montreal, Quebec, H3Z 2Y5, Canada.
| | - Erin Prosk
- Research Department, Santé Cannabis, 4150 Saint-Catherine St W Suite 225, Montreal, Quebec, H3Z 2Y5, Canada
| | - Claude Cyr
- Department of Family Medicine, McGill University, 5858 Ch de la Côte des Neiges, Montreal, Quebec, H3S 1Z1, Canada
| | - Rihab Gamaoun
- Research Department, Santé Cannabis, 4150 Saint-Catherine St W Suite 225, Montreal, Quebec, H3Z 2Y5, Canada.,Division of Supportive and Palliative Care, Department of Oncology, McGill University Health Center, 1001 Decarie Boulevard, D02.7523, Montreal, Quebec, H4A 3J1, Canada
| | - Antonio Vigano
- Research Department, Santé Cannabis, 4150 Saint-Catherine St W Suite 225, Montreal, Quebec, H3Z 2Y5, Canada.,Division of Supportive and Palliative Care, Department of Oncology, McGill University Health Center, 1001 Decarie Boulevard, D02.7523, Montreal, Quebec, H4A 3J1, Canada
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