Category Archives: Chronic Pain

Restored Self: A Phenomenological Study of Pain Relief by Cannabis.

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Pain Medicine

“OBJECTIVE:

To explore the subjective experience of pain relief by cannabis.

RESULTS:

Three key themes that emerged from the analysis were explored: 1) the Sigh of Relief, describing the corporal sensation of using cannabis, including a sense of relaxation and reduction in pain; 2) the Return to Normality, describing the comprehensive effect of using cannabis, including an increased ability to sleep, focus, and function; and 3) the Side Effects of using cannabis.

CONCLUSIONS:

We propose the term Restored Self to conceptualize the effect of medical cannabis. Restored Self is the experience of regaining one’s sense of self, sense of normality, and sense of control over one’s life.”

 https://www.ncbi.nlm.nih.gov/pubmed/30215782
https://academic.oup.com/painmedicine/advance-article-abstract/doi/10.1093/pm/pny176/5095910?redirectedFrom=fulltext

Cannabis analgesia in chronic neuropathic pain is associated with altered brain connectivity.

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“To characterize the functional brain changes involved in δ-9-tetrahydrocannabinol (THC) modulation of chronic neuropathic pain.

RESULTS:

THC significantly reduced patients’ pain compared to placebo. THC-induced analgesia was correlated with a reduction in functional connectivity between the anterior cingulate cortex (ACC) and the sensorimotor cortex. Moreover, the degree of reduction was predictive of the response to THC. Graph theory analyses of local measures demonstrated reduction in network connectivity in areas involved in pain processing, and specifically in the dorsolateral prefrontal cortex (DLPFC), which were correlated with individual pain reduction.

CONCLUSION:

These results suggest that the ACC and DLPFC, 2 major cognitive-emotional modulation areas, and their connections to somatosensory areas, are functionally involved in the analgesic effect of THC in chronic pain. This effect may therefore be mediated through induction of functional disconnection between regulatory high-order affective regions and the sensorimotor cortex. Moreover, baseline functional connectivity between these brain areas may serve as a predictor for the extent of pain relief induced by THC.”

https://www.ncbi.nlm.nih.gov/pubmed/30185448

http://n.neurology.org/content/early/2018/09/05/WNL.0000000000006293

Should Cannabinoids Be Added to Multimodal Pain Regimens After Total Hip and Knee Arthroplasty?

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Journal of Arthroplasty Home

“This study investigated the effects of dronabinol on pain, nausea, and length of stay following total joint arthroplasty (TJA).

CONCLUSION:

These findings suggest that further investigation into the role of cannabinoid medications for non-opioid pain control in the post-arthroplasty patient may hold merit.”

https://www.ncbi.nlm.nih.gov/pubmed/30170713

“In conclusion, our study suggests that cannabinoids may have a role in post-arthroplasty pain management and may reduce patient’s need for opioid-containing pain medications. Further randomized, prospective clinical trials are warranted to shed more light onto the possible beneficial effects of cannabinoid medications in the orthopedic surgery patient population.” https://www.arthroplastyjournal.org/article/S0883-5403(18)30670-3/fulltext

Effect of Cannabidiol on Medial Temporal, Midbrain, and Striatal Dysfunction in People at Clinical High Risk of Psychosis: A Randomized Clinical Trial.

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“Cannabidiol (CBD) has antipsychotic effects in humans, but how these are mediated in the brain remains unclear.

OBJECTIVE:

To investigate the neurocognitive mechanisms that underlie the therapeutic effects of CBD in psychosis.

CONCLUSIONS AND RELEVANCE:

Cannabidiol may partially normalize alterations in parahippocampal, striatal, and midbrain function associated with the CHR state. As these regions are critical to the pathophysiology of psychosis, the influence of CBD at these sites could underlie its therapeutic effects on psychotic symptoms.”

https://www.ncbi.nlm.nih.gov/pubmed/30167644

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2697762

“Psychosis: Cannabis extract normalizes brain function” https://www.medicalnewstoday.com/articles/322926.php
“Cannabis extract helps reset brain function in psychosis” https://medicalxpress.com/news/2018-08-cannabis-reset-brain-function-psychosis.html
“Cannabis extract helps reset brain function in psychosis” https://www.eurekalert.org/pub_releases/2018-08/kcl-ceh082818.php
“Cannabidiol Reduces Symptoms of Psychosis. A new study found that the chemical extracted from cannabis has antipsychotic effects.” https://www.usnews.com/news/health-care-news/articles/2018-08-29/one-dose-of-cannabidiol-reduces-symptoms-of-psychosis
“MEDICAL MARIJUANA: CANNABIS EXTRACT CBD USED TO SUCCESSFULLY TREAT PSYCHOSIS.” https://www.newsweek.com/cannabidiol-cannabis-extract-could-treat-symptoms-psychosis-1094353

 “Single dose of the cannabis compound CBD reduces psychotic symptoms by normalising brain activity” http://www.dailymail.co.uk/health/article-6110591/Single-dose-cannabis-compound-CBD-reduces-psychotic-symptoms-normalising-brain-activity.html

“British scientists have unraveled how a non-intoxicating component of cannabis acts in key brain areas to reduce abnormal activity in patients at risk of psychosis, suggesting the ingredient could become a novel anti-psychotic medicine.” https://www.theglobeandmail.com/cannabis/article-scientists-unravel-how-cannabis-component-may-fight-psychosis/

“Science proves component in weed actually helps fight psychosis” https://nypost.com/2018/08/29/science-proves-component-in-weed-actually-helps-fight-psychosis/
“We Now Have Evidence That a Marijuana Compound Can Help People With Psychosis” https://futurism.com/cbd-psychosis/

Reprint of: Efficacy, tolerability, and safety of non-pharmacological therapies for chronic pain: An umbrella review on various CAM approaches.

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Progress in Neuro-Psychopharmacology and Biological Psychiatry

“Complementary and alternative medicine (CAM) therapies may be used as a non-pharmacological approach to chronic pain management.

Inhaled cannabis, graded motor imagery, and Compound Kushen injection (a form of Chinese medicine) were found the most efficient and tolerable for chronic pain relief.”

https://www.ncbi.nlm.nih.gov/pubmed/30107944

https://www.sciencedirect.com/science/article/pii/S027858461830602X?via%3Dihub

Personal experience and attitudes of pain medicine specialists in Israel regarding the medical use of cannabis for chronic pain.

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“The scientific study of the role of cannabis in pain medicine still lags far behind the growing use driven by public approval. Accumulated clinical experience is therefore an important source of knowledge. However, no study to date has targeted physicians who actually use cannabis in their daily practice.

RESULTS:

Sixty-four percent of all practicing pain specialists in Israel responded. Almost all prescribe cannabis. Among them, 63% find cannabis moderately to highly effective, 56% have encountered mild or no side effects, and only 5% perceive it as significantly harmful. Common indications are neuropathic pain (65%), oncological pain (50%), arthralgias (25%), and any intractable pain (29%). Leading contraindications are schizophrenia (76%), pregnancy/breastfeeding (65%), and age <18 years (59%). Only 12% rated cannabis as more hazardous than opiates. On a personal note, 45% prefer cannabis for themselves or a family member. Lastly, 54% would like to see cannabis legalized in Israel.

CONCLUSION:

In this survey, pain clinicians experienced in prescribing cannabis over prolonged periods view it as an effective and relatively safe treatment for chronic pain, based on their own experience. Their responses suggest a possible change of paradigm from using cannabis as the last resort.”

 https://www.ncbi.nlm.nih.gov/pubmed/30104896
https://www.dovepress.com/personal-experience-and-attitudes-of-pain-medicine-specialists-in-isra-peer-reviewed-article-JPR

Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis.

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College of Psychiatric and Neurologic Pharmacists

“Medical cannabis (MC) is commonly claimed to be an effective treatment for chronic or refractory pain. With interest in MC in the United States growing, as evidenced by the 29 states and 3 US districts that now have public MC programs, the need for clinical evidence supporting this claim has never been greater.

METHODS:

This was a retrospective, mirror-image study that investigated MC’s effectiveness in patients suffering from chronic pain associated with qualifying conditions for MC in New York State. The primary outcome was to compare European Quality of Life 5 Dimension Questionnaire (EQ-5D) and Pain Quality Assessment Scale (PQAS) scores at baseline and 3 months post-therapy. The secondary outcomes included comparisons of monthly analgesic prescription costs and opioid consumption pre- and post-therapy. Tolerability was assessed by side effect incidence.

RESULTS:

This investigation included 29 subjects. Quality of life and pain improved, measured by change in EQ-5D (Pre 36 - Post 64, P < .0001) and change in PQAS paroxysmal (Pre 6.76 - Post 2.04, P < .0001), surface (Pre 4.20 - Post 1.30, P < .0001), deep (Pre 5.87 - Post 2.03, P < .0001), unpleasant (Pre “miserable” - Post “annoying”, P < .0001). Adverse effects were reported in 10% of subjects.

DISCUSSION:

After 3 months treatment, MC improved quality of life, reduced pain and opioid use, and lead to cost savings. Large randomized clinical trials are warranted to further evaluate the role of MC in the treatment of chronic pain.”

https://www.ncbi.nlm.nih.gov/pubmed/29955555

http://mhc.cpnp.org/doi/10.9740/mhc.2018.05.110

Role of the cannabinoid signaling in the brain orexin- and ghrelin-induced visceral antinociception in conscious rats.

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Journal of Pharmacological Sciences

“We hypothesized that the cannabinoid (CB) system may mediate the brain orexin- or ghrelin-induced visceral antinociception. Intraperitoneal injection of either CB1/2 agonist, WIN 55212 or O-Arachidonoyl ethanolamine increased the threshold volume of colonic distension-induced abdominal withdrawal reflex in rats, suggesting CB could induce visceral antinociception. Pretreatment with either the CB1 or CB2 antagonist potently blocked the centrally injected orexin-A-induced antinociceptive action against colonic distension while CB2 but not CB1 antagonist blocked the brain ghrelin-induced visceral antinociception. These results suggest that the cannabinoid signaling may be involved in the central orexin- or ghrelin-induced antinociceptive action in a different mechanistic manner.”

 https://www.ncbi.nlm.nih.gov/pubmed/29958814
https://www.sciencedirect.com/science/article/pii/S1347861318301002?via%3Dihub

Medical Cannabis in Patients with Chronic Pain: Effect on Pain Relief, Pain Disability, and Psychological aspects. A Prospective Non randomized Single Arm Clinical Trial.

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“There is an increasing interest in the medical use of cannabis, particularly in the treatment of chronic pain.

OBJECTIVES:

The aim is to evaluate the effects of cannabis use and the associated benefits reported by patients with various chronic pain diagnoses.

RESULTS:

Pain intensity records a statistically significant reduction from Baseline to 12 months follow up (X² 61.375; P<0,001); the im- provements from Baseline to 12 months follow up are also recorded in pain disability (X² 39.423; P<0,001) and in anxiety and depression symptoms (X²30.362; P<0,001; X²27.786; P<0,001).

CONCLUSIONS:

Our study suggest that Cannabis therapy, as an adjun- ct a traditional analgesic therapy, can be an efficacious tool to make more effective the management of chronic pain and its consequences on functional and psychological dimension. Further randomized, controlled trials are needed to confirm our conclusions.”

https://www.ncbi.nlm.nih.gov/pubmed/29938740

The relationship of endocannabinoidome lipid mediators with pain and psychological stress in women with fibromyalgia – a case control study.

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“Characterized by chronic widespread pain, generalized hyperalgesia, and psychological stress fibromyalgia (FM) is difficult to diagnose and lacks effective treatments.

The endocannabinoids – arachidonoylethanolamide (AEA), 2-arachidonoylglycerol (2-AG), and the related oleoylethanolamide (OEA), palmitoylethanolamide (PEA), and stearoylethanolamide (SEA) – are endogenous lipid mediators with analgesic and anti-inflammatory characteristics, in company with psychological modulating properties (e.g., stress and anxiety), and are included in a new emerging “ome”, the endocannabinoidome.

This case -control study compared the concentration differences of AEA, OEA, PEA, SEA, and 2-AG in 104 women with FM and 116 healthy controls (CON). All participants OEArated their pain, anxiety, depression, and current health status. The relationships between the lipid concentrations and the clinical assessments were investigated using powerful multivariate data analysis and traditional bivariate statistics. The concentrations of OEA, PEA, SEA, and 2-AG were significantly higher in FM than in CON; significance remained for OEA and SEA after controlling for BMI and age. 2-AG correlated positively with FM duration and BMI, and to some extent negatively with pain, anxiety, depression, and health status. In FM, AEA correlated positively with depression ratings.

The elevated circulating levels of endocannabinoidome lipids suggest that these lipids play a role in the complex pathophysiology of FM and might be signs of ongoing low-grade inflammation in FM. Although the investigated lipids are significantly altered in FM their biological roles are uncertain with respect to the clinical manifestations of FM. Thus, plasma lipids alone are not good biomarkers for FM.

PERSPECTIVE:

This study reports about elevated plasma levels of endocannabinoidome lipid mediators in FM. The lipids suitability to work as biomarkers for FM in the clinic were low, however their altered levels indicate that a metabolic asymmetry is ongoing in FM, which could serve as basis during explorative FM pain management.”

https://www.ncbi.nlm.nih.gov/pubmed/29885369

https://www.jpain.org/article/S1526-5900(18)30197-4/fulltext