Cannabis shows potential for mitigating sickle cell disease pain
July 17, 2020
Science Daily/University of California - Irvine
Cannabis appears to be a safe and potentially effective treatment for the chronic pain that afflicts people with sickle cell disease, according to a new clinical trial co-led by University of California, Irvine researcher Kalpna Gupta and Dr. Donald Abrams of UC San Francisco. The findings appear in JAMA Network Open.
"These trial results show that vaporized cannabis appears to be generally safe," said Gupta, a professor of medicine on the faculty of UCI's Center for the Study of Cannabis. "They also suggest that sickle cell patients may be able to mitigate their pain with cannabis -- and that cannabis might help society address the public health crisis related to opioids. Of course, we still need larger studies with more participants to give us a better picture of how cannabis could benefit people with chronic pain."
Opioids are currently the primary treatment for the chronic and acute pain caused by sickle cell disease. But the rise in opioid-associated deaths has prompted physicians to prescribe them less frequently, leaving sickle cell patients with fewer options.
The double-blind, placebo-controlled, randomized trial was the first to employ such gold-standard methods to assess cannabis's potential for pain alleviation in people with sickle cell disease. The cannabis used in the trial was obtained from the National Institute on Drug Abuse -- part of the National Institutes of Health -- and contained equal parts of THC and CBD.
"Pain causes many people to turn to cannabis and is, in fact, the top reason that people cite for seeking cannabis from dispensaries," Gupta said. "We don't know if all forms of cannabis products will have a similar effect on chronic pain. Vaporized cannabis, which we employed, may be safer than other forms because lower amounts reach the body's circulation. This trial opens the door for testing different forms of medical cannabis to treat chronic pain."
Twenty-three patients with sickle cell disease-related pain completed the trial, inhaling vaporized cannabis or a vaporized placebo during two five-day inpatient sessions that were separated by at least 30 days. This allowed them to act as their own control group.
Researchers assessed participants' pain levels throughout the treatment period and found that the effectiveness of cannabis appeared to increase over time. As the five-day study period progressed, subjects reported that pain interfered less and less with activities, including walking and sleeping, and there was a statistically significant drop in how much pain affected their mood. Although pain levels were generally lower in patients given cannabis than in those given the placebo, the difference was not statistically significant.
https://www.sciencedaily.com/releases/2020/07/200717133236.htm
Legal marijuana products too strong for pain relief
March 26, 2020
Science Daily/Wake Forest Baptist Medical Center
More than 90% of the legal marijuana products offered in medical dispensaries are much stronger than what clinical studies have shown that doctors recommend for chronic pain relief, according to a study published in the March 26 online edition of the journal PLOS ONE.
To many that may seem like a good thing, but just the opposite is true.
"We know that high-potency products should not have a place in the medical realm because of the high risk of developing cannabis-use disorders, which are related to exposure to high THC-content products," said the study's lead author, Alfonso Edgar Romero-Sandoval, M.D., Ph.D., associate professor of anesthesiology at Wake Forest School of Medicine, part of Wake Forest Baptist Health.
"Several earlier studies showed that levels of up to 5% tetrahydrocannabinol (THC) -- the main psychoactive compound in marijuana that provides pain relief as well as intoxication -- were sufficient to reduce chronic pain with minimal side effects."
The goal of this study was to evaluate the advertised THC and CBD content of legal cannabis products to determine their suitability for medicinal use, and to compare the potency of the products offered in medical and recreational programs.
The researchers recorded the concentrations of THC and cannabidiol (CBD) -- the non-euphoric compound in marijuana -- in all plant cannabis products provided by legal dispensary websites and compared them between or within the states in the study: California, Colorado, Maine, Massachusetts, New Hampshire, New Mexico, Rhode Island, Vermont and Washington. A total of 8,505 cannabis products across 653 dispensaries were sampled.
Romero-Sandoval's team found that most of the products offered in the medical dispensaries in the study had more than 10% THC and that many had 15% or more, the same as what is available in products at recreational dispensaries.
This is problematic because between 60% and 80% of people who use medical marijuana use it for pain relief, Romero-Sandoval said. The higher the concentration of THC the greater risk, not only for developing dependency, but also for developing tolerance more quickly, which means higher and higher concentrations might be needed to get the same level of pain relief.
"It can become a vicious cycle," Romero-Sandoval said.
"Better regulation of the potency of medical marijuana products is critical. The FDA regulates the level of over-the-counter pain medications such as ibuprofen that have dose-specific side effects, so why don't we have policies and regulations for cannabis, something that is far more dangerous?"
This study provides the scientific evidence to help policy makers correct mistakes and to create a better framework to protect patients, he said.
https://www.sciencedaily.com/releases/2020/03/200326144354.htm
Focus on opioids and cannabis in chronic pain media coverage
January 17, 2020
Science Daily/University of Otago
New Zealand media reports on chronic pain are focusing on treatments involving opioids and cannabis at the expense of best practice non-drug treatments, researchers have found.
Chronic pain, defined as persistent or recurring pain present for more than three months, is the leading cause of disability worldwide and affects one in five New Zealanders.
The researchers analysed 240 news articles on chronic pain published in the New Zealand news media between January 2015 and June 2019. Their report is published in the latest issue of the New Zealand Medical Journal.
Lead author Dr Hemakumar Devan, a Postdoctoral fellow at the Centre for Health, Activity and Rehabilitation Research at the University of Otago, Wellington's School of Physiotherapy, says few of the news stories included information about non-pharmaceutical treatments for chronic pain, despite these being the preferred option for most chronic pain conditions.
"Pharmacological strategies are only recommended for some chronic pain conditions, such as cancer pain and neuropathic pain. For other pain conditions, drug treatments are recommended to be used with care and caution because of potential side effects and limited long-term effectiveness."
He says media coverage of pharmaceutical treatments for chronic pain focused almost entirely on opioid-based painkillers and cannabis. Stories on opioids mentioned their ineffectiveness in treating chronic pain and their potential for dependence and addiction, while reports about medicinal cannabis portrayed it as an effective and safe treatment with minimal side effects. This was despite the lack of scientific evidence to support its long-term use for chronic pain.
"The personal experience stories about cannabis focused on its positive effects and fewer side effects compared to opioid-based analgesics. There is, however, limited evidence to suggest cannabis as a substitute for opioids and a lack of high-quality evidence to support the use of cannabis for chronic pain.
"There was no reporting on the potential adverse effects of medicinal cannabis use, such as cognitive deficits, dependency and mood changes, which could particularly affect young people."
The researchers also found media coverage was dominated by the struggle associated with living in chronic pain, with little attention given to the resources available to support people to manage pain successfully and live a meaningful life.
"Non-drug based self-management strategies, which include exercise, relaxation and cognitive behavioural treatments, are a key component of managing chronic pain and are proven to be effective in the long term."
Dr Devan says the difficulties faced by patients in accessing pain services because of the lack of trained multidisciplinary health professionals, and inequities in terms of access for Māori and Pasifika, were accurately reflected by the media coverage.
The researchers found the level of media interest in chronic pain had increased in recent years.
"We expect this will continue to rise, with chronic pain becoming increasingly relevant in the lead up to New Zealand's 2020 cannabis referendum; and as the number of people living with chronic pain increases as the population ages."
https://www.sciencedaily.com/releases/2020/01/200117094323.htm
Cannabis pain relief without the 'high'
Mechanism of cannabidiol for safe pain relief without side effects
October 24, 2018
Science Daily/McGill University Health Centre
In the wake of cannabis legalization, a team of scientists at the Research Institute of the McGill University Health Centre (MUHC) and McGill University have delivered encouraging news for chronic pain sufferers by pinpointing the effective dose of marijuana plant extract cannabidiol (CBD) for safe pain relief without the typical "high" or euphoria produced by the THC. The findings of their study have been published in the journal PAIN (The Journal of the International Association for the Study of Pain).
Cannabis indica and sativa are the two main cannabis strains that produce the pharmacological principles known as tetrahydrocannabinol (THC) and cannabidiol (CBD). Dr. Gabriella Gobbi's team demonstrated that CBD does not act on the CB1 cannabinoid receptors like THC but through the mechanism that binds specific receptors involved in anxiety (serotonin 5-HT1A) and pain (vanilloid TRPV1). Researchers were able to extrapolate the exact dosage of CBD displaying analgesic and antianxiety properties without the risk of addiction and euphoria classically produced by the THC.
"We found in animal models of chronic pain that low doses of CBD administered for seven days alleviate both pain and anxiety, two symptoms often associated in neuropathic or chronic pain," says first author of the study Danilo De Gregorio, a post-doctoral fellow at McGill University in Dr. Gobbi's laboratory.
Lead author Dr. Gobbi, a researcher in the Brain Repair and Integrative Neuroscience (BRaIN) Program of the RI-MUHC, sees this as advancement for the evidence-based application of cannabis in medicine with CBD offering a safe alternative to THC and opioids for chronic pain, such as back pain, sciatica, diabetic, cancer and post-trauma pain.
"Our findings elucidate the mechanism of action of CBD and show that it can be used as medicine without the dangerous side effects of the THC," says Dr. Gobbi, who is also Professor of Psychiatry at the Faculty of Medicine at McGill University and staff psychiatrist at the MUHC. "This research is a new advancement for an evidence-based application of cannabis in medicine."
Despite widespread public usage, little clinical studies exist on CBD, which became legal in Canada on October 17, 2018, following the passage of Canada's Cannabis Act.
"There is some data showing that CBD provides pain relief for humans but more robust clinical trials are needed ," says Dr. Gobbi, a recent grant recipient for her study of the pharmalogical effects of CBD.
https://www.sciencedaily.com/releases/2018/10/181024163625.htm