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Mick G, Douek P. Clinical Benefits and Safety of Medical Cannabis Products: A Narrative Review on Natural Extracts. Pain Ther 2024:10.1007/s40122-024-00643-0. [PMID: 39096481 DOI: 10.1007/s40122-024-00643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024] Open
Abstract
Interest in medical cannabis and cannabis-based medicinal products (CBMPs) has increased greatly in recent years. Two cannabinoids are of principal importance; delta-9-tetrahydrocannabinol (∆9-THC), the primary psychoactive component, and also cannabidiol (CBD), considered non-intoxicating. Each has distinct mechanisms of action and different therapeutic potentials. CBMPs differ in their ∆9-THC and CBD components; predominantly ∆9-THC, balanced formulations with equivalent ∆9-THC and CBD elements, and CBD-predominant products. In this narrative review, we evaluate the published evidence for the clinical benefits of CBMPs and overall benefits in well-being. We also review the overall safety profile and discuss the potential for dependence with CBMPs. Evidence can be drawn from a wide range of randomized and other controlled studies and from observational real-world studies. Most data from observational registry studies are supportive of ∆9-THC-based products (∆9-THC-predominant or balanced CBMPs) in the management of chronic neuropathic pain. Balanced products are also effective in reducing spasticity in multiple sclerosis. Most CBMPs show benefit in providing symptomatic benefits in reducing anxiety, nausea, and in improving sleep, but the place of specific products is more subtle, and choice guided by specific circumstances. Symptomatic improvements are accompanied by improved quality of life and well-being. Safety data indicate that CBMPs are generally well tolerated in most patients without specific contraindications. The majority of adverse effects are non-serious, and transient; most are principally associated with ∆9-THC and are dose-dependent. In contrast to recreational cannabis use, there is little evidence from clinical studies that CBMPs have any potential for dependence.
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Affiliation(s)
- Gérard Mick
- Pain Center, Voiron Hospital, CHU Grenoble-Alpes-Voiron, Voiron, 38500, Grenoble, France.
- CETD, Hôpital Neurologique Pierre Wertheimer, CHU de Lyon-Hospices Civils de Lyon (HCL), 69500, Bron, France.
- Health Systemic Process (P2S) Laboratory, Research Unit 4129, Université Claude Bernard Lyon 1, 69008, Lyon, France.
- THEMAS Team, TIMC Laboratory, Université Grenoble Alpes, 38000, Grenoble, France.
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Doucette ML, Hemraj D, Bruce D, Fisher E, Macfarlan DL. Medical Cannabis Patients Under the Age of 21 in the United States: Description of Demographics and Conditions from a Large Patient Database, 2019-2023. Adolesc Health Med Ther 2024; 15:63-72. [PMID: 39076412 PMCID: PMC11284137 DOI: 10.2147/ahmt.s460560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/19/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Existing research on medical cannabis patients has often overlooked those younger than 21. This study aimed to detail the frequency and rate of pediatric medical cannabis patients in the US using a large patient database. Methods Utilizing Leafwell Patient Database data from 2019 to mid-2023, we described demographics and qualifying conditions, employing descriptive statistics and χ2 tests to discern differences between minors (0-17 years) and young adults (18-20 years). We calculated rates per 100,000 population by state. Results Analyzing 13,855 patients, 5.7% were minors and 94.3% were young adults. Anxiety emerged as the primary self-reported condition for both groups, yet differences were seen for other conditions. Differences were observed by race/ethnicity, health insurance status, residency in adult-use states, and number of reported conditions. Notably, both groups reported a similar average number of conditions. Conclusion This study underscores demographic distinctions between minor-aged medical cannabis patients and young adults. There is a need for comprehensive clinical research addressing efficacy, safety, and tailored guidelines specific for pediatric medical cannabis patients. Such insights are pivotal for healthcare providers and policymakers in navigating medical cannabis treatment protocols.
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Affiliation(s)
| | - Dipak Hemraj
- Health Economics and Outcomes Research, Leafwell, Miami, FL, USA
| | - Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, IL, USA
| | - Emily Fisher
- Health Economics and Outcomes Research, Leafwell, Miami, FL, USA
| | - D Luke Macfarlan
- Health Economics and Outcomes Research, Leafwell, Miami, FL, USA
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Karst M. Overview: Chronic Pain and Cannabis-Based Medicines. PHARMACOPSYCHIATRY 2024; 57:152-159. [PMID: 38198809 PMCID: PMC11076105 DOI: 10.1055/a-2231-6630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
Chronic pain is primarily conceptualized as a disease in its own right when it is associated with emotional distress and functional impairment. Pathophysiologically, dysfunction of the cortico-mesolimbic connectome is of major importance, with overlapping signals in the nociceptive and stress systems. The endocannabinoid system plays an important role in the central processing of nociceptive signals and regulates the central stress response. Clinically, there is moderate evidence that cannabis-based medicines (CBM) can contribute to a significant reduction in pain, especially the associated pain affect, and improvement in physical function and sleep quality in a proportion of patients with chronic pain. The analgesic effect appears to be largely independent of the cause of pain. In this context, CBM preferentially regulates stress-associated pain processing.
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Affiliation(s)
- Matthias Karst
- Anesthesiology, Pain Clinic, Hannover Medical School, Hannover,
Germany
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Mohammed SYM, Leis K, Mercado RE, Castillo MMS, Miranda KJ, Carandang RR. Effectiveness of Cannabidiol to Manage Chronic Pain: A Systematic Review. Pain Manag Nurs 2024; 25:e76-e86. [PMID: 37953193 DOI: 10.1016/j.pmn.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Cannabidiol (CBD), a component in Cannabis, is used to treat seizures, anxiety, and pain. Little is known about how effectively CBD works in managing chronic pain, a condition characterized by discomfort that persists beyond 3-6 months or beyond expected normal healing. Therefore, this systematic review aimed to synthesize evidence on the effectiveness of CBD in chronic pain management. DESIGN A systematic review of literature utilizing PRISMA 2020 guidelines. DATA SOURCES PubMed/MEDLINE, Web of Science, CINAHL, Academic Search Complete, PsycArticles, PsycINFO, SocINDEX, and CENTRAL. The gray literature search was performed through the World Health Organization, the Centers for Disease Control and Prevention, and the European Centre for Disease Prevention and Control. REVIEW/ANALYSIS METHODS We searched eight databases and gray literature for relevant studies until August 30, 2022. We gathered original research articles with various study designs published in English that looked at patients who used CBD to manage their chronic pain. Two authors assessed the risk of bias and certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used narrative synthesis to analyze the results. RESULTS We included 15 studies among 1,516 identified articles. The majority of the studies indicated pain reduction ranging from 42% - 66% with CBD alone and CBD with Tetrahydrocannabinol. Three studies showed no significant improvement in reducing pain, and one had mixed findings in pain control. The included studies had various methods of measuring pain reduction, mostly through self-reporting and scales such as visual analog scales and verbal numerical scales, among others. CONCLUSION CBD may be useful in treating chronic pain. Findings should be interpreted with caution due to the small number of included studies and heterogeneity brought about by different study designs and outcome measures. More studies with robust study designs are warranted to evaluate CBD's effectiveness in treating chronic pain.
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Affiliation(s)
| | - Kaizielyn Leis
- College of Pharmacy, Adamson University, Ermita, Manila, Philippines
| | | | | | | | - Rogie Royce Carandang
- College of Pharmacy, Adamson University, Ermita, Manila, Philippines; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT.
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Arantes ALF, Carvalho MC, Brandão ML, Prado WA, Crippa JADS, Lovick TA, Genaro K. Antinociceptive action of cannabidiol on thermal sensitivity and post-operative pain in male and female rats. Behav Brain Res 2024; 459:114793. [PMID: 38048909 DOI: 10.1016/j.bbr.2023.114793] [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: 07/21/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023]
Abstract
This study investigated the antinociceptive potential of cannabidiol (CBD) in male and female Wistar rats. The assessment and analysis included tail withdrawal to thermal stimulation (tail flick test) and mechanical allodynia induced by plantar incision injury (von Frey test). CBD reduced acute thermal sensitivity in uninjured animals and post-operative mechanical allodynia in males and females. In the tail flick test, CBD 30 mg/kg i.p. was required to induce antinociception in males. During the proestrus phase, females did not show a statistically significant antinociceptive response to CBD treatment despite a noticeable trend. In contrast, in a separate group of rats tested during the late diestrus phase, antinociception varied with CBD dosage and time. In the post-operative pain model, CBD at 3 mg/kg decreased mechanical allodynia in males. Similarly, this dose reduced allodynia in females during proestrus. However, in females during late diestrus, the lower dose of CBD (0.3 mg/kg) reduced mechanical allodynia, although the latency to onset of the effect was slower (90 min). The effectiveness of a 10-fold lower dose of CBD during the late diestrus stage in females suggests that ovarian hormones can influence the action of CBD. While CBD has potential for alleviating pain in humans, personalized dosing regimens may need to be developed to treat pain in women.
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Affiliation(s)
- Ana Luisa Ferreira Arantes
- Institute of Neurosciences and Behavior and Laboratory of Neuropsychopharmacology of Faculty of Philosophy, Sciences and Letters of University of São Paulo, Ribeirao Preto, SP 14040-900, Brazil
| | - Milene Cristina Carvalho
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, SP 14040-900, Brazil; Institute of Neurosciences and Behavior and Laboratory of Neuropsychopharmacology of Faculty of Philosophy, Sciences and Letters of University of São Paulo, Ribeirao Preto, SP 14040-900, Brazil
| | - Marcus Lira Brandão
- Institute of Neurosciences and Behavior and Laboratory of Neuropsychopharmacology of Faculty of Philosophy, Sciences and Letters of University of São Paulo, Ribeirao Preto, SP 14040-900, Brazil
| | - Wiliam Alves Prado
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, SP 14040-900, Brazil
| | - José Alexandre de Souza Crippa
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, SP 14040-900, Brazil; National Institute of Science and Technology for Translational Medicine, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (INCT-TM, CNPq), Brasília, DF 71605-001, Brazil
| | - Thelma Anderson Lovick
- Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol BS8 1TD, United Kingdom
| | - Karina Genaro
- Department of Anesthesiology, School of Medicine, University of California, Irvine, CA 92617, USA.
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Thurgur H, Lynskey M, Schlag AK, Croser C, Nutt DJ, Iveson E. Feasibility of a cannabidiol-dominant cannabis-based medicinal product for the treatment of long COVID symptoms: A single-arm open-label feasibility trial. Br J Clin Pharmacol 2023. [PMID: 38105651 DOI: 10.1111/bcp.15988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023] Open
Abstract
AIMS To conduct a single-arm open-label feasibility trial of the safety and tolerability of a full-spectrum cannabidiol (CBD)-dominant cannabis-based medicinal product for treating the symptoms of long COVID. METHODS The treatment phase ran for a total of 21 weeks, followed by ~3 weeks without the study drug. Participants received up to 3 mL of MediCabilis 5% CBD Oil (50 mg CBD/mL, <2 mg δ-9-tetrahydrocannabinol/mL) per day orally. Monthly patient-reported outcome measures of common symptoms and daily self-report of symptoms were collected via a smartphone app. Key measures of heart rate, activity, sleep and oxygen saturation were assessed using wearable technology. RESULTS Twelve (1 male, 11 female) individuals diagnosed with long COVID were recruited into the trial. All participants adhered to the treatment protocol for the duration of the study and there were no serious adverse events. Response rates for the research assessments were high with over 90% completion of patient-reported outcome measures and daily self-report. CONCLUSION The study drug was safe and well-tolerated, demonstrating feasibility of CBD-dominant cannabis-based medicinal products in individuals diagnosed with long COVID. However, there were limitations in research design related to recruitment strategy demonstrating a lack of feasibility in the approach implemented in this study. Future work with larger samples and incorporating a control group are required to test the efficacy of this treatment.
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Affiliation(s)
| | | | - Anne Katrin Schlag
- Drug Science, London, UK
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | | | - David John Nutt
- Drug Science, London, UK
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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Gething K, Erku D, Scuffham P. Stakeholders' Decisions and Preferences for the Provision and Use of Medicinal Cannabis: A Scoping Review. Cannabis Cannabinoid Res 2023; 8:986-998. [PMID: 36888538 DOI: 10.1089/can.2022.0115] [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] [Indexed: 03/09/2023] Open
Abstract
Background: The aim of this scoping review was to examine the extent that stakeholder's decisions about and preferences for the provision and use of medicinal cannabis (MC) had been investigated. We sought to identify which populations were examined, the methods used for eliciting preferences and exploring decisions, and the reported outcomes of studies. Methods: Electronic databases (PubMed, CINAHL, Embase, BSC and PsycINFO) and the reference lists of relevant articles were searched for studies published up to March 2022. Studies were included if stakeholder preferences for MC were (1) the primary focus of the research, or (2) an aspect of a larger preference focus. Studies that (3) described the decisions to use MC were also included. Results: Thirteen studies were reviewed. The population focus of these was primarily patient, with seven studies focused on general patient populations and five studies targeting specific patient populations such as cancer survivors, and people experiencing depression. Methods included health economics preference methods, qualitative interviews, and a single multicriteria decision-making study. Four categories of outcomes were defined and included comparisons of MC with a therapeutic alternative (n=5), preferences for MC attributes (n=5), administration preferences (n=4), and the decision process of users (n=2). Motivation differences in preference were found. Purely medicinal users and novice users place more importance on cannabidiol (CBD) than tetrahydrocannabinol. Overall, inhalation methods of administration were preferred due to quick onset of symptom relief. Price was the greatest influence on choice for recreational/medicinal users, whereas purely medicinal users were less price sensitive for products with higher CBD content. Conclusion: Studies examining public preferences for the provision and use of MC were absent. Revealed preference methods are a useful technique for understanding preferences for characteristics that are difficult to visibly assess such as cannabinoid or strain. The outcomes of symptom-specific multicriteria decision method studies that compare the benefit-safety profiles of commonly used treatments and MC may be a useful decision support tool for health practitioners. Studies with representative samples are needed to understand the impact of age, gender, and race on preferences for MC.
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Affiliation(s)
- Katrina Gething
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Daniel Erku
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Paul Scuffham
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Sokolaj E, Assareh N, Anderson K, Aubrey KR, Vaughan CW. Cannabis constituents for chronic neuropathic pain; reconciling the clinical and animal evidence. J Neurochem 2023. [PMID: 37747128 DOI: 10.1111/jnc.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
Chronic neuropathic pain is a debilitating pain syndrome caused by damage to the nervous system that is poorly served by current medications. Given these problems, clinical studies have pursued extracts of the plant Cannabis sativa as alternative treatments for this condition. The vast majority of these studies have examined cannabinoids which contain the psychoactive constituent delta-9-tetrahydrocannabinol (THC). While there have been some positive findings, meta-analyses of this clinical work indicates that this effectiveness is limited and hampered by side-effects. This review focuses on how recent preclinical studies have predicted the clinical limitations of THC-containing cannabis extracts, and importantly, point to how they might be improved. This work highlights the importance of targeting channels and receptors other than cannabinoid CB1 receptors which mediate many of the side-effects of cannabis.
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Affiliation(s)
- Eddy Sokolaj
- Pain Management Research Institute, Kolling Institute of Medical Research, Northern Clinical School, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Neda Assareh
- Pain Management Research Institute, Kolling Institute of Medical Research, Northern Clinical School, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Kristen Anderson
- Pain Management Research Institute, Kolling Institute of Medical Research, Northern Clinical School, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Karin R Aubrey
- Pain Management Research Institute, Kolling Institute of Medical Research, Northern Clinical School, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher W Vaughan
- Pain Management Research Institute, Kolling Institute of Medical Research, Northern Clinical School, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
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9
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Dekeseredy P, Brownstein H, Haggerty T, Sedney CL. Using Medical Cannabis for Chronic Pain: A Social-Ecological Framework. Cannabis Cannabinoid Res 2023. [PMID: 37155681 DOI: 10.1089/can.2023.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Early studies suggest medical cannabis (MC) has the potential to benefit people who suffer from chronic pain by offering a less addictive alternative to opioids; however, most investigators agree more research is indicated. Today, in 2023, cannabis remains a Schedule I drug and is an illegal substance in the United States under the Controlled Substances Act of 1970. Despite this designation, as of February 2022, 37 states, three territories, and the District of Columbia allowed using cannabis products to treat certain painful medical conditions. The contradictory status of federal and state legislation regarding cannabis use has resulted in delays and restrictions on relevant research. As a result, an inadequate foundation of knowledge exists needed to inform policy, program, and practice decisions concerning MC to treat pain. Implementing and controlling access to MC is influenced by overlapping individual, interpersonal, community, and organizational influences that all fall under the umbrella of federal and state policies. Increasingly, the legalization and expanded access to MC necessitates the integration of evidence, policy, and social-ecological reality. To adequately delineate these complex factors to anticipate and plan future interventions at multiple levels, we propose a social-ecological framework (SEF) for using MC to treat pain. This SEF assumes the transactional relationship between the individual and the environment and that no single factor can predict behavior or health outcomes. Our framework illustrates five dynamic levels of analysis that interact between dimensions. Key elements and intersections are discussed at the intrapersonal, interpersonal, institutional, community, and policy levels.
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Affiliation(s)
- Patricia Dekeseredy
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Henry Brownstein
- Sociology and Anthropology, West Virginia University, Morgantown, West Virginia, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Cara L Sedney
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
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Schmiedhofer P, Vogel FD, Koniuszewski F, Ernst M. Cys-loop receptors on cannabinoids: All high? Front Physiol 2022; 13:1044575. [PMID: 36439263 PMCID: PMC9682269 DOI: 10.3389/fphys.2022.1044575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
Endocannabinoids (eCBS) are endogenously derived lipid signaling molecules that serve as tissue hormones and interact with multiple targets, mostly within the endocannabinoid system (ECS). The ECS is a highly conserved regulatory system involved in homeostatic regulation, organ formation, and immunomodulation of chordates. The term “cannabinoid” evolved from the distinctive class of plant compounds found in Cannabis sativa, an ancient herb, due to their action on CB1 and CB2 receptors. CB1/2 receptors are the primary targets for eCBs, but their effects are not limited to the ECS. Due to the high interest and extensive research on the ECS, knowledge on its constituents and physiological role is substantial and still growing. Crosstalk and multiple targeting of molecules are common features of endogenous and plant compounds. Cannabimimetic molecules can be divided according to their origin, natural or synthetic, including phytocannabinoids (pCB’s) or synthetic cannabinoids (sCB’s). The endocannabinoid system (ECS) consists of receptors, transporters, enzymes, and signaling molecules. In this review, we focus on the effects of cannabinoids on Cys-loop receptors. Cys-loop receptors belong to the class of membrane-bound pentameric ligand gated ion channels, each family comprising multiple subunits. Mammalians possess GABA type A receptors (GABAAR), glycine receptors (GlyR), serotonin receptors type 3 (5-HT3R), and nicotinic acetylcholine receptors (nAChR). Several studies have shown different modulatory effects of CBs on multiple members of the Cys-loop receptor family. We highlight the existing knowledge, especially on subunits and protein domains with conserved binding sites for CBs and their possible pharmacological and physiological role in epilepsy and in chronic pain. We further discuss the potential for cannabinoids as first line treatments in epilepsy, chronic pain and other neuropsychiatric conditions, indicated by their polypharmacology and therapeutic profile.
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Affiliation(s)
- Philip Schmiedhofer
- SBR Development Holding, Vienna, Austria
- *Correspondence: Philip Schmiedhofer, ; Margot Ernst,
| | - Florian Daniel Vogel
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Filip Koniuszewski
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Margot Ernst
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
- *Correspondence: Philip Schmiedhofer, ; Margot Ernst,
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Shalev N, Kendall M, Anil SM, Tiwari S, Peeri H, Kumar N, Belausov E, Vinayaka AC, Koltai H. Phytocannabinoid Compositions from Cannabis Act Synergistically with PARP1 Inhibitor against Ovarian Cancer Cells In Vitro and Affect the Wnt Signaling Pathway. Molecules 2022; 27:7523. [PMID: 36364346 PMCID: PMC9653955 DOI: 10.3390/molecules27217523] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 10/16/2023] Open
Abstract
Ovarian cancer (OC) is the single most lethal gynecologic malignancy. Cannabis sativa is used to treat various medical conditions, and is cytotoxic to a variety of cancer types. We sought to examine the effectiveness of different combinations of cannabis compounds against OC. Cytotoxic activity was determined by XTT assay on HTB75 and HTB161 cell lines. Apoptosis was determined by flow cytometry. Gene expression was determined by quantitative PCR and protein localization by confocal microscopy. The two most active fractions, F5 and F7, from a high Δ9-tetrahydrocannabinol (THC) cannabis strain extract, and their standard mix (SM), showed cytotoxic activity against OC cells and induced cell apoptosis. The most effective phytocannabinoid combination was THC+cannabichromene (CBC)+cannabigerol (CBG). These fractions acted in synergy with niraparib, a PARP inhibitor, and were ~50-fold more cytotoxic to OC cells than to normal keratinocytes. The F7 and/or niraparib treatments altered Wnt pathway-related gene expression, epithelial-mesenchymal transition (EMT) phenotype and β-catenin cellular localization. The niraparib+F7 treatment was also effective on an OC patient's cells. Given the fact that combinations of cannabis compounds and niraparib act in synergy and alter the Wnt signaling pathway, these phytocannabinoids should be examined as effective OC treatments in further pre-clinical studies and clinical trials.
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Affiliation(s)
- Nurit Shalev
- The Mina and Everard Goodman, Faculty of Life Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel
- Institute of Plant Science, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | | | - Seegehalli M. Anil
- Institute of Plant Science, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | - Sudeep Tiwari
- Institute of Plant Science, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | - Hadar Peeri
- The Mina and Everard Goodman, Faculty of Life Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel
- Institute of Plant Science, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | - Navin Kumar
- Institute of Plant Science, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | - Eduard Belausov
- Institute of Plant Science, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | - Ajjampura C. Vinayaka
- Institute of Plant Science, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | - Hinanit Koltai
- Institute of Plant Science, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
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Nutraceuticals: A source of benefaction for neuropathic pain and fibromyalgia. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Kan H, Fan L, Gui X, Li X, Yang S, Huang Y, Chen L, Shen W. Stem Cell Therapy for Neuropathic Pain: A Bibliometric and Visual Analysis. J Pain Res 2022; 15:1797-1811. [PMID: 35769691 PMCID: PMC9236174 DOI: 10.2147/jpr.s365524] [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: 03/22/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Neuropathic pain is intractable and current treatment modalities are ineffective to cure this intractable pain, which has become a global problem. In recent years, there have been an increasing number of studies on stem cell therapy for neuropathic pain that have shown enormous potential. Using a visual analysis approach of the existing literature on stem cell therapy for neuropathic pain, we hope to understand the current research status and hot issues in this field and to provide valuable predictions for future research in this field. Methods We used Citespace software to visually analyze 291 articles and reviews indexed by the Web of Science Core Collection Database exploring stem cell-based treatment of neuropathic pain from 1995 to 2021. The Gunnmap online world map evaluated the number of countries and regional articles separately. Microsoft Excel 2016 was used to generate a graph of trends in annual publications. Results Visualization analysis revealed that the number of publications has increased yearly. The top three countries in terms of number of articles published are United States, China, and Japan. Analysis of highly co-cited articles revealed that the contents of these articles primarily involved the expression of IL-1β, IL-10, NPY, TRPA1, p-p38, p-ERK1/2, TGF-β, PKCδ, CaMKIIɑ, P2X4, P2X7 and TNF-ɑ. Keywords and citation burst analysis demonstrated that activation, regeneration, chemotherapy, and expression are likely the research hotspots and future directions of stem cell research in neuropathic pain. Conclusion Stem cell therapy may be a potential means of future treatment of neuropathic pain. The study of the mechanisms underlying stem cell therapy for neuropathic pain is still a focus of future research.
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Affiliation(s)
- Houming Kan
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.,NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu, People's Republic of China
| | - Lijun Fan
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.,NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu, People's Republic of China
| | - Xiaodie Gui
- Department of Pain, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Xiaoqiang Li
- Department of Pain, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Sen Yang
- Department of Pain, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Yuting Huang
- Department of Pain, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Liping Chen
- Department of Pain, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Wen Shen
- Department of Pain, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
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14
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Schlag AK, Lynskey M, Fayaz A, Athanasiou-Fragkouli A, Brandner B, Haja B, Iveson E, Nutt DJ. Characteristics of People Seeking Prescribed Cannabinoids for the Treatment of Chronic Pain: Evidence From Project Twenty 21. FRONTIERS IN PAIN RESEARCH 2022; 3:891498. [PMID: 35775024 PMCID: PMC9237624 DOI: 10.3389/fpain.2022.891498] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/16/2022] [Indexed: 12/11/2022] Open
Abstract
Background Prescribed cannabinoids are now legal in the UK and increasingly being used for a variety of conditions, with one of the most frequent conditions being chronic pain. This paper describes the characteristics of individuals seeking prescribed cannabinoids for the treatment of chronic pain in Project Twenty 21, a UK based real world data registry of prescribed cannabis patients. Method By 1st November 2021 data were available for 1,782 people who had sought treatment with medical cannabis as part of Project Twenty 21. The most common diagnosis among this cohort was chronic pain with 949 (53.5%) of the cohort reporting a primary condition related to chronic pain. Medical and self-report data on the characteristics of these patients, their health status and type/s of cannabinoid/s prescribed are summarized in this report. Results Of the 949 people reporting chronic pain as a primary condition 54.7% were male and their average age was 42.0 years (range = 18–84). Patients reported a low quality of life and high levels of comorbidity: people reported an average of 4.6 comorbid conditions with the most common comorbid conditions including anxiety, depression, insomnia and stress. A range of cannabinoid products were prescribed with the most common products being classified as high THC flower (48.5%). The majority of patients also reported using at least one other prescribed medication (68.7%). Conclusions Consistent with findings in other national and international databases, chronic pain was the most common primary condition in this real world study of prescribed cannabinoids. There was considerable variation in the types of chronic pain, comorbid pathology and in the characteristics of products being prescribed to treat these conditions. Together, this evidence supports the utility of real world evidence, as opposed to clinical trial approaches to studying the potential benefits of prescribed cannabinoids in treating chronic pain.
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Affiliation(s)
- Anne Katrin Schlag
- Drug Science, London, United Kingdom
- Department of Psychiatry, Imperial College London, London, United Kingdom
- *Correspondence: Anne Katrin Schlag
| | | | - Alan Fayaz
- Anaesthesia and Pain Medicine, University College London Hospital National Health Service (NHS) Foundation Trust, University College London, London, United Kingdom
| | | | - Brigitta Brandner
- Anaesthesia and Pain Medicine, University College London Hospital National Health Service (NHS) Foundation Trust, University College London, London, United Kingdom
| | | | - Elizabeth Iveson
- Stroke and Neurorehabilitation, Nuffield Health, London, United Kingdom
| | - David J. Nutt
- Drug Science, London, United Kingdom
- Department of Psychiatry, Imperial College London, London, United Kingdom
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15
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Aviram J, Lewitus GM, Vysotski Y, Amna MA, Ouryvaev A, Procaccia S, Cohen I, Leibovici A, Akria L, Goncharov D, Mativ N, Kauffman A, Shai A, Bar-Sela G, Meiri D. The Effectiveness and Safety of Medical Cannabis for Treating Cancer Related Symptoms in Oncology Patients. FRONTIERS IN PAIN RESEARCH 2022; 3:861037. [PMID: 35669038 PMCID: PMC9163497 DOI: 10.3389/fpain.2022.861037] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/25/2022] [Indexed: 12/12/2022] Open
Abstract
The use of medical cannabis (MC) to treat cancer-related symptoms is rising. However, there is a lack of long-term trials to assess the benefits and safety of MC treatment in this population. In this work, we followed up prospectively and longitudinally on the effectiveness and safety of MC treatment. Oncology patients reported on multiple symptoms before and after MC treatment initiation at one-, three-, and 6-month follow-ups. Oncologists reported on the patients' disease characteristics. Intention-to-treat models were used to assess changes in outcomes from baseline. MC treatment was initiated by 324 patients and 212, 158 and 126 reported at follow-ups. Most outcome measures improved significantly during MC treatment for most patients (p < 0.005). Specifically, at 6 months, total cancer symptoms burden declined from baseline by a median of 18%, from 122 (82-157) at baseline to 89 (45-138) at endpoint (-18.98; 95%CI= -26.95 to -11.00; p < 0.001). Reported adverse effects were common but mostly non-serious and remained stable during MC treatment. The results of this study suggest that MC treatment is generally safe for oncology patients and can potentially reduce the burden of associated symptoms with no serious MC-related adverse effects.
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Affiliation(s)
- Joshua Aviram
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil M. Lewitus
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yelena Vysotski
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Anton Ouryvaev
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | - Shiri Procaccia
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
| | - Idan Cohen
- Cancer Center, HaEmek Medical Center, Afula, Israel
| | - Anca Leibovici
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | - Luiza Akria
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | | | - Neomi Mativ
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | - Avia Kauffman
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
| | - Ayelet Shai
- Department of Oncology, Galilee Medical Center, Nahariya, Israel
- Azrielly Faculty of Medicine, Bar Ilan University, Zafed, Israel
| | - Gil Bar-Sela
- Cancer Center, HaEmek Medical Center, Afula, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - David Meiri
- Faculty of Biology, Biology Department, Technion-Israel Institute of Technology, Haifa, Israel
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16
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Bar-Lev Schleider L, Mechoulam R, Sikorin I, Naftali T, Novack V. Adherence, Safety, and Effectiveness of Medical Cannabis and Epidemiological Characteristics of the Patient Population: A Prospective Study. Front Med (Lausanne) 2022; 9:827849. [PMID: 35223923 PMCID: PMC8864967 DOI: 10.3389/fmed.2022.827849] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/10/2022] [Indexed: 12/31/2022] Open
Abstract
Background Despite the absence of rigorous prospective studies, there has been an increase in the use of cannabis-based medicinal products. During the study period, the use of medical cannabis in Israel was tightly regulated by national policy. Through a prospective study of approximately 10,000 patients, we aimed to characterize the medical cannabis patient population as well as to identify treatment adherence, safety, and effectiveness. Methods and Findings In this study of prescribed medical cannabis patients, adherence, safety, and effectiveness were assessed at 6 months. Treatment adherence was assessed by the proportion of patients purchasing the medication out of the total number of patients (excluding deceased cases and patients transferred to another cannabis clinic). Safety was assessed by the frequency of the side-effects, while effectiveness was defined as at least moderate improvement in the patient condition without treatment cessation or serious side-effects. The most frequent primary indications requiring therapy were cancer (49.1%), followed by non-specific pain (29.3%). The average age was 54.6 ± 20.9 years, 51.1% males; 30.2% of the patients reported prior experience with cannabis. During the study follow-up, 1,938 patients died (19.4%) and 1,735 stopped treatment (17.3%). Common side-effects, reported by 1,675 patients (34.2%), were: dizziness (8.2%), dry mouth (6.7%), increased appetite (4.7%), sleepiness (4.4%), and psychoactive effect (4.3%). Overall, 70.6% patients had treatment success at 6 months. Multivariable logistic regression analysis revealed that the following factors were associated with treatment success: cigarette smoking, prior experience with cannabis, active driving, working, and a young age. The main limitation of this study was the lack of data on safety and effectiveness of the treatment for patients who refused to undergo medical assessment even at baseline or died within the first 6 months. Conclusions We observed that supervised medical-cannabis treatment is associated with high adherence, improvement in quality of life, and a decrease in pain level with a low incidence of serious adverse events.
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Affiliation(s)
- Lihi Bar-Lev Schleider
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Research Department, Tikun Olam - Cannbit Pharmaceuticals, Tel Aviv, Israel
| | - Raphael Mechoulam
- Institute for Drug Research, Medical Faculty Hebrew University, Jerusalem, Israel
| | - Inbal Sikorin
- Geriatric Department, Hadarim Nursing Home, Naan, Israel
| | - Timna Naftali
- Department of Gastroenterology and Hepatology, Meir Medical Center, Kfar Saba and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, United States
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17
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Karst M. [Cannabis- Summing it all up!]. Anaesthesist 2021; 70:549-550. [PMID: 34232325 DOI: 10.1007/s00101-021-01004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Matthias Karst
- Klinik für Anästhesiologie und Intensivmedizin, Schmerzambulanz, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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18
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Schlag AK, O'Sullivan SE, Zafar RR, Nutt DJ. Current controversies in medical cannabis: Recent developments in human clinical applications and potential therapeutics. Neuropharmacology 2021; 191:108586. [PMID: 33940011 DOI: 10.1016/j.neuropharm.2021.108586] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022]
Abstract
Knowledge about the therapeutic potential of medical cannabis has greatly improved over the past decade, with an ever-increasing range of developments in human clinical applications. A growing body of scientific evidence supports the use of medical cannabis products for some therapeutic indications, whilst for others, the evidence base remains disputed. For this narrative review, we incorporate areas where the current evidence base is substantial, such as intractable childhood epilepsy and multiple sclerosis, as well as areas where the evidence is still controversial, such as PTSD and anxiety. We provide a high-level summary of current developments using findings from recent major reviews, as well as real world evidence (RWE), including global database registries and other patient reported outcomes (PROs). On the one hand, our strongest empirical data supports the use of cannabis-based medicinal products (CBMPs) for conditions with relatively small patient numbers. Yet on the other hand, the conditions, where the highest patient numbers present, often have debatable clinical evidence but good RWE, incorporating PROs of 1000s of patients. The discord between PROs and the respective strength of the evidence from randomised controlled trials (RCTs) highlights the urgent need for further research. The scientific literature examining the efficacy of medical cannabis for many conditions is still developing, whilst large numbers of patients globally have been successfully using medical cannabis to treat a broad range of conditions. We conclude on the importance of systematically developing RWE databases to supplement RCTs and to bridge the current evidence gaps.
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Affiliation(s)
- Anne Katrin Schlag
- Drug Science, London, UK; Imperial College London, Du Cane Road, London, W12 0NN, UK.
| | | | - Rayyan R Zafar
- Drug Science, London, UK; Imperial College London, Du Cane Road, London, W12 0NN, UK.
| | - David J Nutt
- Drug Science, London, UK; Imperial College London, Du Cane Road, London, W12 0NN, UK.
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