HEALTH A-Z & MARIJUANA NEWS

HOW PAIN HAPPENS & WHAT TO DO ABOUT IT

CHRONIC PAIN - 25 MARIJUANA RESEARCH REPORTS - 2017

HOW PAIN HAPPENS & WHAT TO DO ABOUT IT

 

The following papers reveal important, need to know knowledge about cannabis and pain on many levels, in the clinic, patient surveys, animal studies, laboratory testing among other studies.

 

The consensus opinion of these 28 medical papers is that marijuana's main components, THC and CBD,  have outstanding pain killing properties, which are superior in many ways to dangerously addictive opiates.  

 

1 Marijuana in painful HIV-associated sensory neuropathy: a randomized, placebo-controlled trial. Abrams et-al the year of 2007. Neurology 68: 515-521.

1 Conclusion: Smoked marijuana was well tolerated and efficaciously killed chronic neuropathic pain from HIV-AIDS-associated sensory neuropathy. The findings are similar to oral medications used for chronic neuropathic pain.

1 Objective: To prove the effect of inhaled marijuana on the neuropathic - shooting or burning pain of HIV-AIDS-associated sensory neuropathy and an experimental pain model.

1 Protocol: Prospective randomized placebo-fake drug-controlled trial finished in the inpatient General Clinical Research Centre involving mature adults with painful HIV-AIDS-associated sensory neuropathy. Patients were randomly designated to inhale either marijuana - three to four percent d9THC - or identical placebo-fake cigarettes with the phyto-cannabinoids omitted - three times daily for five days. Primary result measures included ratings of chronic pain and the percentage achieving >thirty percent reduction in pain intensity. Acute analgesic - pain killer -  and anti-hyperalgesic effects of inhaled marijuana were assessed using a cutaneous heat stimulation protocol and the heat/capsaicin sensitization model.

1 Deliverables: The first marijuana cigarette reduced chronic pain by a median of seventy two percent vs fifteen percent with placebo. Marijuana reduced experimentally induced hyperalgesia to both brush and von Frey hair stimuli, but appeared to have little effect on the painfulness of noxious heat stimulation. No serious adverse events were reported.


 

2 Smoked medicinal marijuana for neuropathic - shooting or burning - shooting or burning pain in HIV: a randomized, crossover clinical trial.Ellis et-al the year of 2008.  Neuropsychopharmacology 34: 672-80.

2 Among the completers, pain relief was larger with marijuana than a placebo-fake non-drug.

2 We finished a clinical trial to assess the impact of inhaled marijuana on neuropathic - shooting or burning pain in HIV-AIDS. This was a phase II, double-blind, placebo-controlled, crossover trial of analgesia - pain killer with inhaled marijuana in HIV-AIDS-associated distal sensory predominant polyneuropathy - DSPN -. Eligible patients had neuropathic - shooting or burning - shooting or burning pain refractory to at least two previous analgesic - pain killer -  classes; they continued on their pre inquiry analgesic regimens throughout the trial. Regulatory considerations dictated that subjects inhale under direct observation in a hospital setting.

2 Treatments were placebo-fake and active marijuana, ranging in potency between one and eight percent d9THC, four times daily for five consecutive days during each of two treatment wks., separated by a fortnight washout. The primary result was change in pain level as measured by the Descriptor Differential Scale - DDS - from a pretreatment baseline to the end of each treatment wk.. Secondary measures included measurement of mental state and daily functioning. Of one hundred twenty seven volunteers screened, 34 eligible subjects enrolled and twenty eight  finished both marijuana and placebo-fake therapies. Among the completers, pain relief was larger with marijuana than placebo-fake drug.

 

 

3 Dose-dependent effects of inhaled marijuana on Capsaicin-induced pain & hyperalgesia in healthy volunteers Wallace et-al the year of 2007.  Anesthesiology 107: 785-796.

3 Deliverables: This inquiry suggests that there is a window of modest analgesia - pain killer for inhaled marijuana, with lower doses decreasing pain and larger doses increasing pain.

3 Forework: Although the preclinical literature suggests that phyto-cannabinoids produce antinociception and antihyperalgesic effects, efficacy in the human pain state remains unclear. Using a human experimental pain model, the authors hypothesized that inhaled marijuana would dial down the pain and hyperalgesia induced by intradermal capsaicin.
 

3 Protocol: In a randomized, double-blinded, placebo-fake-controlled, crossover trial in 15 healthy volunteers, the authors evaluated concentration–response effects of low-, medium-, and inhaled marijuana - respectively 2 percent, 4 percent, and 8 percent 9-- d9THC by weight - on pain and cutaneous hyperalgesia induced by intradermal capsaicin. Capsaicin was injected into opposite forearms 5 and 45 min after drug exposure,and pain, hyperalgesia, d9THC plasma levels, and adverse side effects were assessed.
 

3 Deliverables: Five min. after marijuana exposure, there was no effect on capsaicin-induced pain at any dose. By 45 min after marijuana exposure, however, there was a major decrease in capsaicin-induced pain with the medium dose and a significant increase in capsaicin-induced pain with the large dose. There was no effect seen with the low dose, nor was there an effect on the area of hyperalgesia at any dose. Significant non-supporting correlations between pain perception and plasma -9-d9THC levels were found after adjusting for the overall dose effects. There was no major difference in performance on the neuropsychological tests.
 

3 Deliverables: This inquiry suggests that there is a window of modest analgesia - pain killer for inhaled marijuana, with lower doses decreasing pain and larger doses increasing pain.

 

 

4 A randomized, placebo-controlled, crossover trial of marijuana cigarettes in neuropathic - shooting or burning - shooting or burning pain.Wilsey et-al the year of 2008.  Journal of Pain 9: 506-521.

4 This inquiry adds to a growing body of data that marijuana may be efficacious at ameliorating neuropathic - shooting or burning pain, and may be an alternative for subjects who do not respond to, or cannot tolerate, other medications. However, the use of cannabis as medicine may be limited by its method of administration - smoking - and modest acute cognitive effects, particularly at larger doses.

 

 

5 Study says 1 in 5 Americans suffers from chronic pain. New York Times. October 21, the year of 1994.

5 In the survey, randomly selected adult Americans were asked about chronic pain. The interviewers questioned patients until they had found one thousand who had suffered for at least six months from migraine headaches, arthritis pain, lower back pain or nerve pain and who had visited a doctor seeking relief. To find those one thousand patients, the interviewers had to survey nearly five thousand, leading them to estimate that seventeen percent of Americans, or thirty four million patients, have chronic pain.

5 People in pain reported that they were often unable to sleep, that they were less efficacious at work and that their relationships with friends and family suffered. Forty-four percent also said their doctors were unable to help.  The investigators questioned 400 doctors about how they treated chronic pain and found that most were dissatisfied with the medications available to pain sufferers.

5 The medical association sought comment on the findings from David E. Joranson, a director of the World Health Organization - WHO. He said in a telephone interview that it was "startling to learn that chronic pain is suffered by so many with such devastating effects."  

 

420EVALUATIONSONLINE:  In California, to purchase cannabis based medicines, patients need a licensed medical doctor's recommendation.  Fortunately. the California Medical Board has endorsed the use of Telemedicine -  which is functionally, online medical services - and these services extend to 420 evaluations for medical marijuana.  Our online process is designed to take the minimum of patient and doctor's time, while complying with the established medical requirements - to judge if marijuana is recommended.  Documents are used at California dispensaries, cannabis clubs, cooperatives, delivery services and at other points of access.  In 2018, medical marijuana card holders will pay about 35% less than recreational marijuana users.  

 

6 Smoked marijuana for chronic neuropathic - shooting or burning pain: a randomized controlled trial. Ware et-al the year of 2010. CMAJ 182: 694-701.

6 Forework: Chronic neuropathic - shooting or burning pain affects 1 percent–2 percent of the adult population and is often refractory to standard pharmacologic treatment. Patients with chronic pain have reported using inhaled marijuana to dull pain, improve sleep and improve mood.
 

6 Protocol: Adults with posttraumatic or postsurgical neuropathic - shooting or burning pain were randomly designated to receive marijuana at four potencies - 0 percent, 2.5 percent, 6 percent and 9.4 percent d9THC - over four 14-day periods in a crossover trial. Participants inhaled a single 25-milligram dose through a pipe three times daily for the first five days in each cycle, followed by a nine-day washout period. The daily average pain level was measured using an 11-point numeric rating scale. We documented effects on mood, sleep and life quality, including adverse events.
 

6 Deliverables: We recruited 23 people with pain of whom 21 finished the trial. The average daily pain intensity, measured on the 11-point numeric rating scale, was lower on the prespecified primary contrast of 9.4 percent v. 0 percent d9THC.  Preparations with intermediate potency yielded intermediate, but nonmajor degrees of relief. Participants receiving 9.4 percent d9THC reported improved ability to fall asleep relative to 0 percent d9THC.
 

6 We found no differences in mental state or life quality. The most common drug-related adverse events during the period when subjects received 9.4 percent d9THC were headache, dry eyes, burning sensation in areas of neuropathic - shooting or burning pain, dizziness, numbness and cough.
 

Conclusion: A single inhalation of 25 milligram of 9.4 percent d9THC herbal marijuana three times daily for five days reduced the level of pain, improved sleep and was well tolerated. Additional Long-term safety and efficacy investigations are indicated.

 

 

7 Comparison of the analgesic - pain killer -  effects of Dronabinol - Marinol, synthetic -d9THC & inhaled cannabis in daily cannabis smokers. Cooper et-al the year of 2013.  Neuropsychopharmacology 38: 1984-1992.

7 Recent investigations have demonstrated the therapeutic potential of phyto-cannabinoids to treat pain, yet none have compared the analgesic - pain killer -  efficaciousness of inhaled cannabis to orally administered d9THC.  This randomized, placebo-fake drug-controlled, double-dummy, double-blind inquiry compared the magnitude and period of time of analgesic effects of inhaled cannabis and Dronabinol - Marinol, synthetic -d9THC under well-controlled conditions using a validated experimental model of pain.

7 Healthy male and female daily cannabis smokers participated in this outpatient inquiry comparing the analgesic - pain killer - , subjective, and physiological effects of cannabis - 3.56 percent d9THC to Dronabinol - Marinol, synthetic -d9THC - 0, 10, or 20 milligram -. Pain response was assessed using the cold-pressor test : subjects immersed their left hand in cold water - 4 °C -, and the time to report pain and withdraw the hand from the water - pain tolerance - were recorded.

7 Subjective pain and drug effect ratings were also measured including cardiovascular effects. Compared with placebo-fake drug, cannabis and Dronabinol (Marinol, THC) decreased pain sensitivity - 3.56 percent; 20 milligram -, increased pain tolerance - 1.98 percent; 20 milligram -, and decreased subjective ratings of pain level- 1.98, 3.56 percent; 20 milligram -. The magnitude of peak change in pain sensitivity and tolerance did not differ between cannabis and Dronabinol - Marinol, synthetic -d9THC, although Dronabinol - Marinol, synthetic -d9THC produced analgesia - pain killer that was of a longer period of time.

7 Marijuana - 1.98, 3.56 percent - and Dronabinol - Marinol, synthetic -d9THC - 20 milligram - also increased abuse-related subjective ratings relative to placebo-fake drug; these ratings were larger with cannabis. These data indicate that under controlled conditions, cannabis and Dronabinol - Marinol, synthetic -d9THC decreased pain, with Dronabinol - Marinol, synthetic -d9THC producing longer-lasting decreases in pain sensitivity and lower ratings of abuse-related subjective effects than cannabis.

 

8 Pharmacokinetics, Efficacy, Safety, & Ease of Use of a Novel Portable Metered-Dose Marijuana Inhaler in Patients With Chronic Neuropathic Pain: A Phase 1a Study. Eisenberg et-al the year of 2014.  Journal of Pain & Palliative Care Pharmacotherapy 28: 216-225.

8 Chronic neuropathic - shooting or burning pain is often refractory to standard pharmacological treatments. Although growing data supports the use of inhaled marijuana for neuropathic - shooting or burning pain, the lack of standard inhaled dosing plays a major obstacle in marijuana becoming a "mainstream" pharmacological treatment for neuropathic pain.

8 The objective of this inquiry was to explore the pharmacokinetics, safety, tolerability, efficacy, and ease of use of a novel portable thermal-metered-dose inhaler for marijuana in a cohort of eight subjects suffering from chronic neuropathic - shooting or burning pain and on a stable analgesic - pain killer -  regimen including medicinal marijuana. In a single-dose, open-label study, subjects inhaled a single 15.1 ± 0.1 milligram dose of marijuana using the Syqe Inhaler device. Blood samples for d9THC and 11-hydroxy-d9THC were taken at baseline and up to 120 min.. Pain level adverse events, and satisfaction score were monitored following the inhalation.

8 A uniform pharmacokinetic profile was exhibited across all subjects - d9THC plasma Cmax ± Standard Deviation was 38 ± 10 nanogram/milliliter, Tmax ± Standard Deviation was 3 ± 1 min., AUC?→infinity ± Standard Deviation was 607 ± 200 nano-gram·min/milliliter -. Higher plasma Cmax increase per milligram d9THC administered - 12.3 nanogram/milliliter/milligram d9THC - and lower interindividual variability of Cmax - 25.3 percent -, compared with reported alternative modes of d9THC delivery, were measured.

8 A major 45 percent reduction in pain level was noted 20 min. post inhalation turning back to baseline within 90 min.. Tolerable, lightheadedness, lasting 15-30 min. and requiring no intervention, was the only reported adverse event. This trial suggests the potential use of the Syqe Inhaler device as a inhale less delivery system of medicinal marijuana, producing a d9THC pharmacokinetic profile with low interindividual variation of Cmax, achieving pharmaceutical standards for inhaled medications.

 

 

9  Efficacy of inhaled marijuana in painful diabetic neuropathy. Wallace et-al, the year of 2015. Journal of Pain 7: 616-627.

9 A randomized, double-blinded, placebo-fake drug controlled crossover inquiry was compiled in sixteen subjects with painful diabetic peripheral neuropathy to assess the immediate-term efficacy and tolerability of inhaled marijuana. In a crossover design, each participant was exposed to 4 single dosing sessions of placebo-fake drug or too low - 1 percent d9THC -, medium - 4 percent d9THC - or large - 7 percent d9THC - doses of marijuana.

9 Baseline spontaneous pain, evoked pain, and cognitive measurements were performed. Subjects were then administered aerosolized marijuana or placebo-fake drug and the pain level and subjective "highness" scores were measured at 5, 15, 30, 45, and 60 min. and then every 30 min. for an extra 3 hours. Cognitive lab measurements were performed at 5 and 30 min. and then every 30 min. for an extra 3 hours. The primary analysis compared differences in spontaneous pain over time, between doses using linear mixed effects models. There was a major difference in spontaneous pain scores between doses.

9 There was a major effect of the large dose on foam brush and von Frey evoked pain. There was a major non-supporting effect of the large dose on 2 of the 3 neuropsychological tests.

9 OVERVIEW: This small, immediate-term, placebo-fake drug-controlled trial of inhaled marijuana demonstrated a dose-dependent reduction in diabetic peripheral neuropathy pain in subjects with treatment-refractory pain. This adds preliminary data to support further research on the efficacy of the phyto-cannabinoids in neuropathic - shooting or burning pain.

 

 

10 An exploratory human laboratory experiment evaluating vaporized marijuana in the treatment of neuropathic - shooting or burning pain from spinal cord insult & disease. Wilsey et-al the year of 2016.  The Journal of Pain.

10 Using 8-hour human laboratory experiments, we evaluated the analgesic - pain killer -  efficacy of vaporized marijuana in subjects with neuropathic - shooting or burning pain - related to insult or conditions of the spinal cord, most of whom were experiencing pain despite traditional treatment. After obtaining baseline data, forty two subjects underwent a standardized protocol for inhaling four puffs of vaporized marijuana containing either placebo-fake drug, 2.9 percent, or 6.7 percent d9THC on three separate occasions.

10 A second dosing occurred three hours later; subjects chose to inhale four to eight puffs. This flexible dosing was used to attempt to dial down the placebo-fake drug effect. Using an 11-point numerical pain level rating scale as the primary result, a mixed effects linear regression model showed a major analgesic - pain killer -  response for vaporized marijuana. When subjective and psychoactive adverse side effects - e.g, good drug effect, feeling high, etc - were added as covariates to the model, the reduction in pain level remained major above and beyond any effect of these measures.

10 Psychoactive and subjective effects were dose-dependent. Measurement of neuropsychological performance proved challenging because of various disabilities in the population studied. Because the two active doses did not significantly differ from each other in terms of analgesic - pain killer -  potency, the lower dose appears to offer the best risk-benefit ratio in subjects with neuropathic - shooting or burning pain associated with insult or conditions of the spinal cord.
 

10 OVERVIEW:A crossover, randomized, placebo-fake drug-controlled human laboratory experiment involving administration of vaporized marijuana was performed in subjects with neuropathic - shooting or burning pain related to spinal cord insult and conditions. This inquiry supports consideration of future research that would include longer duration investigations over wks. to months to evaluate the efficacy of medicinal marijuana in subjects with central neuropathic pain.

 

 

11 Cannabinoids for treatment of chronic non-cancer related pain; a systematic inquiry of randomized trials. Lynch & Campbell. the year of 2011. British Journal of Clinical Pharmacology 72: 735-744.

11 Effective therapeutic options for subjects living with chronic pain are limited. The pain dialing down effect of phyto-cannabinoids remains unclear. A systematic inquiry of randomized controlled trials - RCTs - examining phyto-cannabinoids in the treatment of chronic non-cancer related pain was compiled according to the PRISMA statement update on the QUORUM guidelines for reporting systematic reviews that evaluate healthcare interventions. Cannabinoids studied included inhaled marijuana, oromucosal concentrates of marijuana based medicine, nabilone, Dronabinol - Marinol, synthetic -d9THC and a novel d9THC analogue.

11 Chronic non-cancer related pain conditions included neuropathic - shooting or burning pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Overall the quality of trials was excellent. Fifteen of the eighteen trials that met the inclusion criteria demonstrated a major analgesic - pain killer -  effect of phyto-cannabinoid as compared with placebo-fake drug and several reported major improvements in sleep. There were no serious adverse effects. Adverse effects most commonly reported were generally well tolerated, mild to moderate in severity and led to withdrawal from the investigations in only a few cases.

11 Overall there is data that phyto-cannabinoids are safe and modestly efficacious in neuropathic - shooting or burning pain with preliminary data of efficacy in fibromyalgia and rheumatoid arthritis. The context of the need for extra treatments for chronic pain is reviewed. Additional Large investigations of longer period of time examining specific phyto-cannabinoids in homogeneous populations are required.

 

 

12 Cannabinergic pain medicine: a concise clinical primer & survey of randomized-controlled trial results. Sunil Aggarwal. the year of 2012. The Clinical Journal of Pain

12 OBJECTIVES: This article attempts to cover pragmatic clinical considerations involved in the use of cannabinergic medicines in pain practice, including geographical and historical considerations, pharmacokinetics, pharmacodynamics, adverse effects, drug interactions, indications, and contraindications. Topics include molecular considerations such as the 10-fold larger abundance of phyto-cannabinoid type 1 receptors compared to µ-opioid receptors in the central nervous system and anatomic distributions of phyto-cannabinoid receptors in pain circuits.
 

12 METHODS: The article uses a narrative inquiry methodology, drawing from authoritative textbooks and journals of phyto-cannabinoid medicine, Food and Drug Administration-approved cannabinoid drug labels, and current and historical pain medicine literature to address core clinical considerations. To survey the current data base for pain management with cannabinergic medicines, a targeted PubMed search was performed to survey, the percentage of supporting and non-supporting published randomized-controlled trial - RCT -  results with this class of pain medicines, using appropriate search limit parameters and the keyword search string "cannabinoid OR marijuana-based AND pain."
 

12 RESULTS: Of the 56 hits generated, 38 published RCTs met the survey criteria. Of these, 71 percent - 27 -  concluded that phyto-cannabinoids had empirically demonstrable and statistically major pain-dialing down effects, whereas 29 percent - 11 -  did not.
 

12 ANALYSIS::Marijuana and other cannabinergic medicines' efficacies for dialing down pain have been studied in RCTs, most of which have demonstrated a beneficial effect for this indication, although most trials are immediate-term. Adverse effects are generally non serious and well tolerated. Incorporating cannabinergic medicine topics into pain medicine education seems warranted and continuing clinical research and empiric treatment trials are appropriate.

 

 

13 Cannabinoids for the treatment of chronic non-cancer related pain: An updated systematic inquiry of randomized controlled trials. Lynch & Ware. the year of 2015. Journal of Neuroimmune Pharmacology 10: 293 to 301.

13 An updated systematic inquiry of randomized controlled trials examining phyto-cannabinoids in the treatment of chronic non-cancer related pain was compiled according to PRISMA guidelines for systematic reviews reporting on health care results. Eleven trials published since our last inquiry met inclusion criteria. The quality of the trials was excellent. Seven of the trials demonstrated a major analgesic - pain killer -  effect.

13 Several trials also demonstrated improvement in secondary results - e.g., sleep, muscle stiffness and spasticity - . Adverse effects most frequently reported such as fatigue and dizziness were mild to moderate in severity and generally well tolerated. This inquiry adds further support that currently available phyto-cannabinoids are safe, modestly efficacious analgesics that provide a reasonable therapeutic option in the management of chronic non-cancer related pain.

 

14 Marijuana for the Management of Pain: Assessment of Safety Study. Ware et-al the year of 2015. Journal of Pain. In print.

  • Medical marijuana used for chronic pain over one year appears to have a reasonable safety profile.

  • The detail This inquiry aimed to give a rationale for the use of phytocannabinoid formulations to treat neuropathic - shooting or burning pain.

  • It was found that a controlled marijuana concentrate, containing multiple phyto-cannabinoids, in a defined ratio, and other non-cannabinoid fractions - terpenes and flavonoids -  provided better antinociceptive efficacy than the single phyto-cannabinoid given alone, when tested in a rat model of neuropathic - shooting or burning pain.

  • The results also demonstrated that such an antihyperalgesic effect did not involve the phyto-cannabinoid CB1 and CB2 receptors, whereas it was mediated by vanilloid receptors TRPV1.

  • The non-psychoactive compound, cannabidiol, is the only component present at a high level in the concentrate able to bind to this receptor: thus cannabidiol was the drug responsible for the antinociceptive behaviour observed.

  • Moreover, the results showed that after chronic oral treatment with marijuana concentrate the hepatic total content of cytochrome P450 was greatly mitigated including the intestinal P-glycoprotein activity. It is suggested that the inhibition of hepatic metabolism proved an increased bioavailability of cannabidiol resulting in a larger effect.

  • However, in the light of the well known antioxidant and antiinflammatory properties of terpenes and flavonoids, which could significantly contribute to the therapeutic effects, it cannot be excluded that the synergism observed might be achieved also in the absence of the cytochrome P450 inhibition.led listing of adverse events to medicinal marijuana will enhance clinical decision-making.

  • The average daily dose of dried herbal marijuana used by subjects with chronic pain was 2.5gram/day.

  • Medical marijuana use over one year was associated with improvements in pain, function, life quality and cognitive function.

 

15 Antihyperalgesic effect of a Marijuana sativa concentrate in a rat model of neuropathic - shooting or burning pain.Comelli et-al the year of 2008.  Phytotherapy Research 22: 1017 to 1024.

15 This inquiry aimed to give a rationale for the use of phytocannabinoid formulations to treat neuropathic - shooting or burning pain. It was found that a controlled marijuana concentrate, containing multiple phyto-cannabinoids, in a defined ratio, and other non-phytocannabinoid fractions - terpenes and flavonoids -  provided better antinociceptive efficacy than the single phyto-cannabinoid given alone, when tested in a rat model of neuropathic - shooting or burning pain.

15 The results also demonstrated that such an antihyperalgesic effect did not involve the cannabinoid CB1 and CB2 receptors, whereas it was mediated by vanilloid receptors TRPV1. The non-psychoactive compound, cannabidiol, is the only component present at a high level in the concentrate able to bind to this receptor: thus cannabidiol was the drug responsible for the antinociceptive behaviour observed.

15 Moreover, the results showed that after chronic oral treatment with marijuana concentrate the hepatic total content of cytochrome P450 was greatly mitigated including intestinal P-glycoprotein activity. It is suggested that the inhibition of hepatic metabolism proved an increased bioavailability of cannabidiol resulting in a larger effect.

15 However, in the light of the well known antioxidant and antiinflammatory properties of terpenes and flavonoids, which could significantly contribute to the therapeutic effects, it cannot be excluded that the synergism observed might be achieved also in the absence of the cytochrome P450 inhibition.

 

16 Multicenter, double-blind, randomized, placebo-controlled, parallel-group inquiry of the efficacy, safety & tolerability of d9THC: Cannabidiol-CBD concentrate in subjects with intractable cancer-related pain. Johnson et-al the year of 2009. Journal of Symptom Management 39: 167-179.

16 This inquiry compared the efficacy of a d9THC:cannabidiol - THC:Cannabidiol-CBD -  concentrate, a nonopioid analgesic endocannabinoid-body's own system modulator, and a d9THC concentrate, with placebo-fake drug, in dialing down pain in subjects with advanced cancer. In total, 177 subjects with cancer related pain, who experienced inadequate analgesia - pain killer despite chronic opioid dosing, entered a two-wk., multicenter, double-blind, randomized, placebo-controlled, parallel-group trial.

16 Patients were randomized to d9THC:CBD concentrate - n = 60 - , d9THC concentrate - n = 58 -, or placebo - n = 59. The primary analysis of change from baseline in average pain Numerical Rating Scale - NRS - score was statistically significantly in favor of d9THC:CBD compared with placebo - improvement of -1.37 vs. -0.69 -, whereas the d9THC group showed a non major change -1.01 vs. -0.69 -. Twice as many subjects taking d9THC:Cannabidiol-CBD showed a reduction of more than 30 percent from baseline pain NRS score as compared with placebo - 23 [43 percent] vs. 12 [21 percent].

16 The associated odds ratio was statistically significant, whereas the number of d9THC group responders was similar to placebo-fake drug - 12 [23 percent] vs. 12 [21 percent] - and did not reach statistical significance. There was no change from baseline in median dose of opioid background medication or average number of doses of breakthrough medication across treatment groups. No major group differences were found in the NRS sleep quality or nausea scores or the pain control measurement.

16 However, the results from the European Organisation for Research and Treatment of Cancer Quality of Life Cancer Questionnaire showed a worsening in nausea and vomiting with d9THC:Cannabidiol-CBD compared with placebo whereas d9THC had no difference.  Most drug-related adverse events were mild/moderate in severity. This inquiry shows that d9THC:Cannabidiol-Cannabidiol-CBD concentrate is efficacious for relief of pain in subjects with advanced cancer related pain not fully killed by strong opioids.

 

 

17 Cannabinoid to opioid interaction in chronic pain.  Abrams et-al the year of 2011.  Clinical Pharmacology & Therapeutics 90: 844 to 851.

17 Cannabinoids and opioids share several pharmacologic properties and may act synergistically. The potential pharmacokinetics and the safety of the combination in humans are unknown. We therefore undertook an inquiry to answer these queries. Twenty-one individuals with chronic pain, on a regimen of twice-daily doses of sustained-release morphine or oxycodone (synthetic poppy narcotic) were enrolled in the inquiry and admitted for a 5-day inpatient stay.

17 Participants were asked to inhale vaporized marijuana in the evening of day 1, three times a day on days 2-4, and in the morning of day 5. Blood sampling was performed at 12-h intervals on days 1 and 5. The extent of chronic pain was also assessed daily.

17 Pharmacokinetic investigations revealed no major change in the area under the plasma concentration-time curves for either morphine or oxycodone (synthetic poppy narcotic) after exposure to marijuana. Pain was significantly decreased -average 27 percent, 95 percent confidence interval -CI - 9, 46 - after the addition of vaporized marijuana. We therefore concluded that vaporized marijuana augments the analgesic - pain killer - effects of opioids without significantly altering plasma opioid levels. The combination may permit for opioid treatment at lower doses with fewer adverse side effects.

 

 

18 The effect of medicinal marijuana on pain & life quality results in chronic pain: A prospective open-label study. Haroutounian et-al the year of 2016.  The Clinical Journal of Pain .

18 OBJECTIVES: The objective of this prospective, open-label inquiry was to prove the long-term effect of medicinal marijuana treatment on pain and functional results in subjects with treatment-resistant chronic pain.
 

18 PATIENTS AND METHODS: The primary result was the change in the pain symptom score on the S-TOPS -Treatment Outcomes in Pain Survey-Short Form - questionnaire at the 6-month follow-up in an intent-to-treat population. Secondary results included the change in S-TOPS physical, social, and emotional disability scales, the pain severity, and pain interference on the Brief Pain Inventory, sleep problems, and the change in opioid consumption.

18 RESULTS: A total of 274 subjects were approved for treatment; complete baseline data were available for 206 -intent-to-treat -, and complete follow-up data for 176 subjects. At follow-up, the pain symptom score improved significantly.  

18 Together with most social and emotional disability scores. Opioid consumption at follow-up decreased by forty-four percent. Serious adverse effects led to treatment discontinuation in two subjects.
Analysis: The treatment of chronic pain with medicinal marijuana in this open-label, prospective cohort resulted in improved pain and functional results, and a major reduction in opioid use. Deliverables suggest long-term benefit of marijuana treatment in this group of subjects, but the study's noncontrolled nature should be considered when extrapolating the results.

 

19 Medical marijuana use is associated with decreased opiate (abuse) medication use in a retrospective cross-sectional survey of subjects with chronic pain. Boehnke et-al the year of 2016. The Journal of Pain 17: 739 to 744

19 OVERVIEW: This article suggests that using medical marijuana for CP- chronic pain therapy may benefit some CP subjects. The reported improvement in life quality, better side effect profile, and decreased opioid use should be confirmed by stringent,  investigations that also assess how CP subjects use medicinal marijuana for pain management.

19 Summary Opioids are commonly used to treat subjects with chronic pain -CP -, though there is little data that they are efficacious for long term CP treatment. Previous investigations reported strong associations between passage of medicinal marijuana legislation and decrease in opioid overdose statewide. Our aim was to examine whether using medicinal marijuana for CP changed individual patterns of opioid use.

19 Using an internet questionnaire, we delivered a cross-sectional retrospective survey of 244 medical marijuana subjects with CP- chronic pain who patronized a medicinal marijuana dispensary in Michigan between November the year of 2013 and February 2015. Data collected included demographic information, changes in opioid use, life quality, medication classes used, and medication adverse side effects before and after initiation of marijuana dosage.

19 Among inquiry people with pain, medicinal marijuana use was associated with a 64 percent decrease in opioid use -n = 118 - decreased number and adverse adverse side effects of medications, and an improved life quality -45 percent. This inquiry suggests that many CP- chronic pain subjects are essentially substituting medicinal marijuana for opioids and other medications for CP treatment, and finding the benefit and side effect profile of marijuana to be larger than these other classes of medications. More research is needed to validate this finding.
 

 

20 Do medical cannabis legislation dial down addictions & deaths related to pain killers?  Powell et-al the year of 2015.  

20 Although the present inquiry provides data that medicinal marijuana legislation are associated with reductions in opioid analgesic - painkiller - overdose mortality on a population level, proposed mechanisms for this association are speculative and rely on indirect data.

20 Additional rigorous evaluation of medicinal marijuana policies, including provisions that vary among states,14,42 is required before their wide adoption may be recommended. If the relationship between medicinal marijuana legislation and opioid analgesic - painkiller - overdose mortality is substantiated in further work, enactment of legislation to permit for use of medicinal marijuana may be advocated as part of a comprehensive package of policies to dial down the population risk of opioid analgesics.

 

 

 

21 Prescribing marijuana for harm reduction. Mark Collen. the year of 2012. Harm Reduction Journal 9: 1.

21 A 9.4 percent d9THC dose significantly decreased pain as compared to placebo-fake drug. Patients also experienced improved sleep, decreased depression and anxiety as compared to placebo. Both the 3.5 percent and 7 percent d9THC marijuana produced equal and major analgesia - pain killer compared to placebo. Pain was more tolerable at larger doses compared to placebo. Both doses had no effect on evoked pain or allodynia.
 

21 Pain reduction was significantly larger compared to placebo-fake drug. Mood, physical disability, life quality and sleep improved during all inquiry therapies. The majority of subjects titrated to the largest d9THC dose of eight percent.
 

21 Patients experienced a major decrease in pain compared to placebo-fake drug. Marijuana decreased induced hyperalgesia but had little impact on heat stimulation.



 

FURTHER READING

 

22 Cannabinoids and Nerve Regeneration

23 How Marijuana Medicines Reduce Inflammation of Nerves

24 Marijuana Helps Heal Broken Bones

25 Cannabinoids for Treatment of Chronic Pain

26 WEB-MD - Three Puffs a Day keeps the Doctor Away

27 Marijuana and Pain

28 Marijuana in the Treatment of Chronic Pain

Labels: PAIN CHRONIC PAIN  

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