Category Archives: Chronic Pain

Experience with the synthetic cannabinoid nabilone in chronic noncancer pain.

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“Chronic noncancer pain includes a heterogeneous group of disorders and is often refractory to treatment. Cannabis products have historically been used for chronic pain and are attracting renewed pharmaceutical interest. Nabilone is a synthetic cannabinoid licensed in Canada for the treatment of severe nausea and vomiting associated with cancer chemotherapy. We have used nabilone off-label for the treatment of chronic noncancer pain since 1999. In this article, we review our clinical experience of 20 adult patients with chronic noncancer pain who had been treated with nabilone and followed up for an average of 1.5 years. Prior to nabilone therapy, patients had used a wide range of therapies, including 11 who had used cannabis. Fifteen patients reported subjective overall improvement with nabilone, and nine reported reduced pain intensity. Beneficial effects on sleep and nausea were the main reasons for continuing use. Intolerable side effects were experienced in three patients (palpitations, urinary retention, dry mouth). Nabilone may be a useful addition to pain management and should be further evaluated in randomized controlled trials.”

http://www.ncbi.nlm.nih.gov/pubmed/16533193

Smoked cannabis proven effective in treating neuropathic pain.

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UC San Diego Health

“Smoked cannabis eased pain induced in healthy volunteers, according to a study by researchers at the University of California, San Diego (UCSD) Center for Medical Cannabis Research (CMCR.) However, the researchers found that less may be more.”

“The results, showing a medium-dose (4% THC by weight) of cannabis to be an effective analgesic, converged with results from the CMCR’s first published study, a paper by UCSF researcher Donald Abrams, M.D. published in the journal Neurology in February 2007. In that randomized placebo-controlled trial, patients smoking the same dose of cannabis experienced a 34% reduction in HIV-associated sensory neuropathy pain—twice the rate experienced by patients receiving a placebo.”

““This study helps to build a case that cannabis does have therapeutic value at a medium-dose level,” said Grant. “It also suggests that higher doses aren’t necessarily better in certain situations – something also observed with other medications, such as antidepressants.””

Read more: http://phys.org/news112456382.html

“Smoked Cannabis Proven Effective In Treating Neuropathic Pain”  https://www.sciencedaily.com/releases/2007/10/071024141745.htm

“Smoked cannabis proven effective in treating neuropathic pain”  https://medicalxpress.com/news/2007-10-cannabis-proven-effective-neuropathic-pain.html

“Smoked Cannabis Proven Effective in Treating Neuropathic Pain”  https://health.ucsd.edu/news/2007/pages/10-24-medical-cannabis.aspx

Smoked Medical Cannabis May Be Beneficial as Treatment for Chronic Neuropathic Pain, Study Suggests.

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“Medicinal marijuana. A new study provides evidence that cannabis may offer relief to patients suffering from chronic neuropathic pain. (Credit: iStockphoto)”
 

“The medicinal use of cannabis has been debated by clinicians, researchers, legislators and the public at large for many years as an alternative to standard pharmaceutical treatments for pain, which may not always be effective and may have unwanted side effects. A new study by McGill University Health Centre (MUHC) and McGill University researchers provides evidence that cannabis may offer relief to patients suffering from chronic neuropathic pain.”

“This is the first trial to be conducted where patients have been allowed to smoke cannabis at home and to monitor their responses, daily,” says Dr. Mark Ware, lead author of the study, who is also Director of Clinical Research at the Alan Edwards Pain Management Unit at the MUHC and an assistant professor of anesthesia in McGill University’s Faculty of Medicine, and neuroscience researcher at the Research Institute of the MUHC.

In this study, low doses (25mg) of inhaled cannabis containing approximately 10% THC (the active ingredient in cannabis), smoked as a single inhalation using a pipe three times daily over a period of five days, offered modest pain reduction in patients suffering from chronic neuropathic pain (pain associated with nerve injury) within the first few days. The results also suggest that cannabis improved moods and helped patients sleep better. The effects were less pronounced in cannabis strains containing less than 10% THC.

“The patients we followed suffered from pain caused by injuries to the nervous system from post-traumatic (e.g. traffic accidents) or post-surgical (e.g. cut nerves) events, and which was not controlled using standard therapies” explains Dr. Ware. “This kind of pain occurs more frequently than many people recognize, and there are few effective treatments available. For these patients, medical cannabis is sometimes seen as their last hope.”

“This study marks an important step forward because it demonstrates the analgesic effects of cannabis at a low dose over a shot period of time for patients suffering from chronic neuropathic pain,” adds Dr. Ware. The study used herbal cannabis from Prairie Plant Systems (under contract to Health Canada to provide cannabis for research and medical purposes), and a 0% THC ‘placebo’ cannabis from the USA.”

Read more:http://www.sciencedaily.com/releases/2010/08/100830094926.htm

Marijuana May Be Effective For Neuropathic Pain.

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“The growing body of evidence that marijuana (cannabis) may be effective as a pain reliever has been expanded with publication of a new study in The Journal of Pain reporting that patients with nerve pain showed reduced pain intensity from smoking marijuana.

Researchers at University of California Davis examined whether marijuana produces analgesia for patients with neuropathic pain. Thirty-eight patients were examined. They were given either high-dose (7%), low-dose (3.5%) or placebo cannabis.

The authors reported that identical levels of analgesia were produced at each cumulative dose level by both concentrations of the agent. As with opioids, cannabis does not rely on a relaxing or tranquilizing effect, but reduces the core component of nociception and the emotional aspect of the pain experience to an equal degree. There were undesirable consequences observed from cannabis smoking, such as feeing high or impaired, but they did not inhibit tolerability or cause anyone to withdraw from the study. In general, side effects and mood changes were inconsequential.

It was noted by the authors that since high and low dose cannabis produced equal analgesic efficacy, a case could be made for testing lower concentrations to determine if the analgesic profile can be maintained while reducing potential cognitive decline.

In addition, the authors said further research could probe whether adding the lowest effective dose of cannabis to another analgesic drug might lead to more effective neuropathic pain treatment for patients who otherwise are treatment-resistant.”

http://www.sciencedaily.com/releases/2008/06/080626150628.htm

Marijuana Eases Chronic Pain, Researchers Say – ABC News

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“Smoking marijuana modestly reduced pain and other symptoms of chronic neuropathic pain, results of a small trial showed.

The most potent dose used reduced average daily pain scores by 0.7 points on an 11-point scale, according to Mark A. Ware of McGill University in Montreal, Canada and colleagues.

Those who smoked weed with 9.4 percent of the active ingredient tetrahydrocannabinol (THC) also reported sleeping better, the researchers reported online in CMAJ.”

Read more: http://abcnews.go.com/Health/PainManagement/smoking-marijuana-ease-chronic-pain-researchers/story?id=11515566

Marijuana may relieve nerve pain when other drugs don’t – USAToday

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“Smoking cannabis, also known as marijuana, reduced pain in patients with nerve pain stemming from injuries or surgical complications, new research shows.

Twenty-one adults with chronic nerve pain were taught to take a single inhalation of 25 milligrams of cannabis through a pipe, three times a day, for five days. The cannabis contained one of three levels of potency of tetrahydrocannabinol (THC), the active ingredient in marijuana, as well as a placebo dosage containing no THC.

All of the patients rotated through each of the four dosages, with nine days of no smoking in between.

Patients smoking the highest potency marijuana (9.4%) reported less pain than those smoking samples containing no THC. Patients also reported better sleep and less anxiety, according to the Canadian study. 

On an 11-point scale, the average daily pain intensity was 6.1 for those smoking 9.4% THC concentration, compared to 5.4 for those smoking cannabis containing no THC.

“Patients have repeatedly made claims that smoked cannabis helps to treat pain, but the issue for me had always been the lack of clinical research to support that claim,” said Dr. Mark Ware, director of clinical research at the Alan Edwards Pain Management Unit of the McGill University Health Centre in Montreal. In this small but randomized, controlled trial, “the pain reductions were modest, but significant,” he said. “And it was in people for whom nothing else worked.”

Read more: http://usatoday30.usatoday.com/yourlife/health/medical/2010-09-05-marijuana-pain_N.htm

Self-medication of a cannabinoid CB2 agonist in an animal model of neuropathic pain.

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“Neuropathic pain is caused by injury to the peripheral or central nervous system (CNS)…”

“…novel approaches for identifying safe and effective analgesics with limited abuse liability are necessary.”

“Cannabinoids share the same target as the psychoactive ingredient in maijuana. Cannabinoids suppress neuropathic nociception through CB1 and CB2 mechanisms. CB1 is predominantly located within the CNS… CB2 activation is not associated with CNS side-effects linked to CB1. However, abuse potential of CB2 agonists is unknown.”

“We used a drug self-administration approach to ask whether rats with a spared nerve injury (SNI) would self-medicate with a CB2 agonist to attenuate a neuropathic pain state…”

 “Our results suggest that cannabinoid CB2 agonists may be exploited to treat neuropathic pain with limited drug abuse liability and central nervous system (CNS) side-effects. These studies validate the use of drug self-administration methods for identifying nonpsychotropic analgesics possessing limited abuse potential…”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157548/

Role of cannabinoids in the management of neuropathic pain.

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Abstract

“The treatment of pain, particularly neuropathic pain, is one of the therapeutic applications of cannabis and cannabinoids that is currently under investigation and that stimulates interest among clinicians and basic researchers. Animal pain models, including models of acute, antinociceptive, inflammatory and neuropathic pain, have demonstrated the antinociceptive efficacy of cannabinoids without causing serious alterations in animal behaviour. These data, together with the historic and current empiric use of cannabinoids, support the interest in the analysis of their effectiveness in treating neuropathic pain. The evaluation of controlled trials that focus on the effect of cannabinoids on neuropathic pain reveals that this class of drugs is able to significantly reduce pain perception. Nevertheless, this effect is generally weak and clinical relevance remains under evaluation. Moreover, there is a lack of controlled trials and, in particular, comparisons with other drugs generally used in the treatment of neuropathic pain. Despite the fact that further research is required to achieve a definitive assessment, current data obtained from basic research and from analysis of the available controlled trials indicate that cannabinoids can be accepted as a useful option in the treatment of neuropathic pain.”

http://www.ncbi.nlm.nih.gov/pubmed/18601303

More evidence cannabis can help in neuropathic pain.

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“It’s good to see the trial of smoked cannabis in neuropathic pain reported by Ware and colleagues because smoking is the most common way in which patients try this drug. The authors should be congratulated for tackling the question of whether cannabis helps in neuropathic pain, particularly given that the regulatory hurdles for their trial must have been a nightmare. The question is worth investigating because of the ongoing publicity — which patients see, hear and read — that suggests an analgesic activity of cannabis in neuropathic pain, and because of the paucity of robust evidence for such an analgesic effect. If patients are not achieving a good response with conventional treatment of their pain, then they may, reasonably, wish to try cannabis. If medical cannabis is not available where a patient lives, then obtaining it will take the patient outside of the law, often for the first time in his or her life. Good evidence would at least buttress that decision.”

“This trial adds to the three previous studies of smoked cannabis in neuropathic pain that I could find using PubMed and reference lists…”

“Putting together the four trials of smoked cannabis, the provisional conclusions are that an analgesic effect is evident, that this effect, though not great, may be of use to some patients, and that it often carries with it some adverse effects on the central nervous system (though not obviously so in this trial). These conclusions make biological sense, given that cannabinoids taken orally have shown the same sorts of effects. Interestingly, the “moderate” analgesic effect shown here for neuropathic pain seems to hold true for nociceptive pain.”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950178/

Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial.

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“1′,1’dimethylheptyl-Delta8-tetrahydrocannabinol-11-oic acid (CT-3), a potent analog of THC-11-oic acid, produces marked antiallodynic and analgesic effects in animals without evoking the typical effects described in models of cannabinoids. Therefore, CT-3 may be an effective analgesic for poorly controlled resistant neuropathic pain.”

 

“OBJECTIVE: To examine the analgesic efficacy and safety of CT-3 in chronic neuropathic pain in humans.”

 

“CONCLUSIONS: In this preliminary study, CT-3 was effective in reducing chronic neuropathic pain compared with placebo. No major adverse effects were observed.”

 

http://www.ncbi.nlm.nih.gov/pubmed/14519710