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Trevizani M, Leal LL, Rettore JVP, Macedo GC, Alves CCDS, de Castro SBR, do Carmo AMR, da Silva SA, Maranduba CMDC, Silva FDS. Tumor necrosis factor α, and agonist and antagonists of cannabinoid receptor type 1 and type 2 alter the immunophenotype of stem cells from human exfoliated deciduous teeth. EINSTEIN-SAO PAULO 2023; 21:eAO0405. [PMID: 37970951 PMCID: PMC10631756 DOI: 10.31744/einstein_journal/2023ao0405] [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: 12/01/2022] [Accepted: 03/19/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To verify the involvement of the endocannabinoid system in the immunomodulatory profile of stem cells from human exfoliated deciduous teeth, in the presence or absence of TNF-α, and agonist and antagonists of CB1 and CB2. METHODS Stem cells from human exfoliated deciduous teeth were cultured in the presence or absence of an agonist, anandamide, and two antagonists, AM251 and SR144528, of CB1 and CB2 receptors, with or without TNF-α stimulation. For analysis of immunomodulation, surface molecules linked to immunomodulation, namely human leukocyte antigen-DR isotype (HLA-DR), and programmed death ligands 1 (PD-L1) and 2 (PD-L2) were measured using flow cytometry. RESULTS The inhibition of endocannabinoid receptors together with the proinflammatory effect of TNF-α resulted in increased HLA-DR expression in stem cells from human exfoliated deciduous teeth, as well as, in these cells acquiring an anti-inflammatory profile by enhancing the expression of PD-L1 and PD-L2. CONCLUSION Stem cells from human exfoliated deciduous teeth respond to the endocannabinoid system and TNF-α by altering key immune response molecules. Inhibition of endocannabinoid receptors and TNF-α led to an increase in HLA-DR, PD-L1, and PD-L2 levels in stem cells from human exfoliated deciduous teeth. This study shows the interaction between mesenchymal stromal cells and the immune and endocannabinoid systems.
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Affiliation(s)
- Marizia Trevizani
- Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaMGBrazil Instituto de Ciências Biológicas , Universidade Federal de Juiz de Fora , Juiz de Fora , MG , Brazil .
| | - Laís Lopardi Leal
- Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaMGBrazil Instituto de Ciências Biológicas , Universidade Federal de Juiz de Fora , Juiz de Fora , MG , Brazil .
| | - João Vitor Paes Rettore
- Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaMGBrazil Instituto de Ciências Biológicas , Universidade Federal de Juiz de Fora , Juiz de Fora , MG , Brazil .
| | - Gilson Costa Macedo
- Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaMGBrazil Instituto de Ciências Biológicas , Universidade Federal de Juiz de Fora , Juiz de Fora , MG , Brazil .
| | - Caio César de Souza Alves
- Faculdade de Medicina do MucuriUniversidade Federal dos Vales do Jequitinhonha e MucuriTeófilo OtoniMGBrazil Faculdade de Medicina do Mucuri , Universidade Federal dos Vales do Jequitinhonha e Mucuri , Teófilo Otoni , MG , Brazil .
| | - Sandra Bertelli Ribeiro de Castro
- Faculdade de Medicina do MucuriUniversidade Federal dos Vales do Jequitinhonha e MucuriTeófilo OtoniMGBrazil Faculdade de Medicina do Mucuri , Universidade Federal dos Vales do Jequitinhonha e Mucuri , Teófilo Otoni , MG , Brazil .
| | - Antônio Márcio Resende do Carmo
- Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaMGBrazil Instituto de Ciências Biológicas , Universidade Federal de Juiz de Fora , Juiz de Fora , MG , Brazil .
| | - Silvioney Augusto da Silva
- Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaMGBrazil Instituto de Ciências Biológicas , Universidade Federal de Juiz de Fora , Juiz de Fora , MG , Brazil .
| | - Carlos Magno da Costa Maranduba
- Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaMGBrazil Instituto de Ciências Biológicas , Universidade Federal de Juiz de Fora , Juiz de Fora , MG , Brazil .
| | - Fernando de Sá Silva
- Universidade Federal de Juiz de ForaGovernador ValadaresMGBrazil Universidade Federal de Juiz de Fora , Governador Valadares , MG , Brazil .
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Link K, Knowles LM, Alschuler KN, Ehde DM. Characterizing cannabis use in a sample of adults with multiple sclerosis and chronic pain: An observational study. Mult Scler Relat Disord 2023; 75:104742. [PMID: 37156034 DOI: 10.1016/j.msard.2023.104742] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/02/2023] [Accepted: 04/30/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although cannabis has become an increasingly common method for pain management among people with multiple sclerosis (PwMS), there is a dearth of knowledge regarding the types of cannabis products used as well as the characteristics of cannabis users. The current study aimed to (1) describe the prevalence of cannabis use and the routes of administration of cannabis products in adults with an existing chronic pain condition and MS, (2) to examine differences in demographic and disease-related variables between cannabis users and non-users, and (3) to examine differences between cannabis users and non-users in pain-related variables, including pain intensity, pain interference, neuropathic pain, pain medication use, and pain-related coping. METHODS Secondary analysis of baseline data from participants with multiple sclerosis (MS) and chronic pain (N = 242) enrolled in an RCT comparing mindfulness-based cognitive therapy (MBCT), cognitive-behavioral therapy (CBT), and usual care for chronic pain. Statistical methods included t-tests, Mann-Whitney tests, chi-square tests, and Fisher's exact tests to assess for differences in demographic, disease-related, and pain-related variables between cannabis users and non-users. RESULTS Of the 242 participants included in the sample, 65 (27%) reported the use of cannabis for pain management. The most common route of administration was oil/tincture (reported by 42% of cannabis users), followed by vaped (22%) and edible (17%) products. Cannabis users were slightly younger than non-users (Medage 51.0 vs 55.0, p = .019) and reported higher median pain intensity scores (6.0 vs 5.0, p = .022), higher median pain interference scores (5.9 vs 5.4, p = .027), and higher median levels of neuropathic pain (20.0 vs 16.0, p = .001). CONCLUSIONS The current study identified factors that may intersect with cannabis use for pain management and adds to our current knowledge of the types of cannabis products used by PwMS. Future research should continue to investigate trends in cannabis use for pain management, especially as the legality and availability of products continue to shift. Additionally, longitudinal studies are needed to examine the effects of cannabis use on pain-related outcomes over time.
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Affiliation(s)
- Kara Link
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle WA, USA.
| | - Lindsey M Knowles
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle WA, USA
| | - Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle WA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle WA, USA
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The Lived Experience of Managing HIV and Chronic Pain: Qualitative Interviews with Patients and Healthcare Providers. AIDS Behav 2022; 26:496-511. [PMID: 34350531 PMCID: PMC8827137 DOI: 10.1007/s10461-021-03406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 02/03/2023]
Abstract
People living with HIV (PLWH) experience higher rates of comorbid chronic pain conditions compared to the general population. Managing HIV and chronic pain, two stigmatized health conditions, can exacerbate physical and psychological suffering. The current qualitative study was designed to increase our understanding of the experience of living with HIV and chronic pain. Twenty participants were recruited from a hospital-based immunology center to participate in individual in-depth qualitative interviews. The interviews focused on the experience of living with (or managing) chronic pain for PLWH. All interviews were audio recorded, transcribed and double-coded. Several themes emerged from our applied thematic analysis of the transcripts. The primary theme was that pain remained poorly managed among PLWH. Patients engaged in a variety of pain management strategies and described benefits from both traditional pain management interventions (e.g., pharmacology, physical therapy) as well as non-traditional approaches (e.g., medical marijuana, cannabidiol products, and spirituality). Other themes that emerged included barriers related to health insurance and the need to validate the patient pain experience. PLWH and chronic pain described compounding effects of managing two chronic health conditions, including perceived immune system over-activation, heightened awareness of illness, and negative mindset. More research is needed to improve care for those managing these often co-occurring health conditions.
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Aebischer JH, Dieckmann NF, Jones KD, St John AW. Chronic Pain Clinical and Prescriptive Practices in the Cannabis Era. Pain Manag Nurs 2021; 23:109-121. [PMID: 34973920 DOI: 10.1016/j.pmn.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/20/2021] [Accepted: 11/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND To explore how health care providers in the United States are adapting clinical recommendations and prescriptive practices in response to patient use of medical cannabis (MC) for chronic pain symptoms. DESIGN Literature searches queried MeSH/Subject terms "chronic pain," "clinician," "cannabis," and Boolean text words "practice" and "analgesics" in EBSCOHost, EMBASE, PubMed, and Scopus, published 2010-2021 in the United States. Twenty-one primary, peer-reviewed studies met criteria. METHODS Studies are synthesized under major headings: recommending MC for chronic pain; MC and prescription opioids; and harm reduction of MC. RESULTS MC is increasingly utilized by patients for chronic pain symptoms. Clinical recommendations for or against MC are influenced by scopes of practice, state or federal laws, institutional policies, education, potential patient harm (or indirect harm of others), and perceived confidence. Epidemiologic and cohort studies show downward trajectories of opioid prescribing and consumption in states with legal cannabis. However, clinicians' recommendations and prescription practices are nonuniform. Impacts of cannabis laws are clear between nongovernmental and governmental institutions. Strategies addressing MC and opioid use include frequent visits, and, to reduce harm, suggesting alternative therapies and treating substance use disorders. CONCLUSIONS MC use for chronic pain is increasing with cannabis legalization. Provider practices are heterogenous, demonstrating a balance of treating chronic pain using available evidence, while being aware of potential harms associated with MC and opioids.
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Affiliation(s)
| | - Nathan F Dieckmann
- Oregon Health & Science University, School of Nursing, Portland, OR; Oregon Health & Science University & Portland State University, School of Public Health, Core Faculty, Portland, OR; Oregon Health & Science University, School of Medicine, Division of Psychology & Psychiatry, Portland, OR
| | - Kim D Jones
- Linfield University, School of Nursing, Portland, OR
| | - Amanda W St John
- Oregon Health & Science University, School of Medicine, Division of Anesthesiology & Perioperative Medicine, Portland, OR
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Longo R, Oudshoorn A, Befus D. Cannabis for Chronic Pain: A Rapid Systematic Review of Randomized Control Trials. Pain Manag Nurs 2021; 22:141-149. [PMID: 33353819 DOI: 10.1016/j.pmn.2020.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The high prevalence of inadequately managed chronic pain indicates the need for alternative and multimodal treatment options. Use of cannabinoids in medicine is becoming a growing area of interest, specifically in the context of chronic pain. The efficacy of cannabinoids for the treatment of chronic pain is not well established. AIMS The objectives of this rapid systematic literature review are to summarize the efficacy and secondary effects of cannabinoids for chronic pain management. DESIGN Rapid systematic review of randomized control trials. PARTICIPANTS Individuals with chronic pain (n = 1352). METHODS Embase, Cochrane, PubMed, and CINAHL databases were searched. Inclusion criteria included cannabis of any formulation used to treat chronic pain of any origin. RESULTS Thirteen randomized controlled trials met the inclusion criteria. Five demonstrated moderate analgesic effects of cannabis for chronic pain, and eight concluded there were no significant impacts on pain in the cannabis-treated group versus the control group. CONCLUSIONS Evidence on the efficacy of cannabinoids for chronic pain shows patient-perceived benefit but inconsistent other treatment effects. These findings indicate cannabinoids may have a modest analgesic effect for chronic neuropathic pain conditions, and that the use of cannabinoids is relatively safe, with few severe adverse events. This review concludes that cannabinoids may have a potential role in chronic pain management. Inconsistent evidence on the efficacy of cannabis to treat chronic pain indicates the need for more studies on a larger scale. Clinicians should draw on available evidence and consider cannabinoids as a potential approach to chronic pain management.
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Affiliation(s)
- Riana Longo
- School of Nursing, Western University, London, Ontario, Canada.
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Ontario, Canada
| | - Deanna Befus
- School of Nursing, Western University, London, Ontario, Canada
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Wilson M, Klein T, Bindler RJ, Kaplan L. Shared Decision-Making for Patients Using Cannabis for Pain Symptom Management in the United States. Pain Manag Nurs 2020; 22:15-20. [PMID: 33139204 DOI: 10.1016/j.pmn.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/14/2020] [Accepted: 09/17/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Gaps in research evidence and inconsistent policies regarding use of cannabis for pain and associated symptoms result in confusion for healthcare providers and patients. The objective of this review was to synthesize information on cannabis use for pain with legal and policy implications to create a shared decision-making model that can be used to guide patient care interactions. APPROACH Current cannabis policies, state laws, research, and patient care practices related to medical and recreational cannabis in the United States were reviewed, along with best practices in shared decision-making. Reviewed literature was then synthesized to create a model that can be used by registered nurses and others to address cannabis use, where legal, for pain and related symptoms. RESULT AND CONCLUSIONS Cannabis is a legal option for many patients with pain. To minimize harms and optimize benefits, nurses can play a key role when authorized by law in assisting with decision-making surrounding cannabis use.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington, USA.
| | - Tracy Klein
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Ross J Bindler
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Louise Kaplan
- College of Nursing, Washington State University, Vancouver, Washington, USA
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