Tag Archives: pain

Cannabinoids for pain management.

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Abstract

“Cannabinoids have been used for thousands of years to provide relief from suffering, but only recently have they been critically evaluated in clinical trials. This review provides an in-depth examination of the evidence supporting cannabinoids in various pain states, along with an overview of potential adverse effects. In summary, there is strong evidence for a moderate analgesic effect in peripheral neuropathic and central pain conditions, and conflicting evidence for their use in nociceptive pain. For spasticity, most controlled studies demonstrate significant improvement. Adverse effects are not uncommon with cannabinoids, though most are not serious and self-limiting. In view of the limited effect size and low but not inconsequential risk of serious adverse events, cannabinoids should be employed as analgesics only when safer and more effective medication trials have failed, or as part of a multimodal treatment regimen.”

http://www.ncbi.nlm.nih.gov/pubmed/21508629

Cannabinoids for the treatment of neuropathic pain: clinical evidence.

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Abstract

“Neuropathic pain is a worldwide epidemic that occurs in 3 to 8% of individuals in industrialized countries and is often refractory to existing treatments. Drugs currently available to target neuropathic pain are, at best, moderately effective and include antidepressants, gabapentin, NMDA receptor antagonists, as well as other anticonvulsants, all of which are limited by their adverse-effect profiles. Cannabinoid drugs are emerging as a promising class of drugs to treat neuropathic pain and have been tested for analgesic effects in a range of chronic pain conditions. Data show that cannabinoids are often effective in individuals with refractory pain receiving concomitant analgesic drugs. Clinical studies on cannabinoids for the treatment of neuropathic pain are reviewed, focusing on clinical trials published within the last five years. Data from large, well-controlled studies show that cannabinoids are moderately effective in reducing chronic pain and that side effects are comparable to existing treatments, suggesting that cannabinoids can play a useful role in the management of chronic pain. Like other drugs for neuropathic pain, cannabinoids have a dose titration that is limited by psychoactive side effects. The development of cannabinoid drugs to target neuropathic pain with improved therapeutic ratios will depend upon the development of cannabinoid treatments with reduced psychoactivity.”

http://www.ncbi.nlm.nih.gov/pubmed/18183533

Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain.

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“OBJECTIVE:

Debilitating pain, occurring in 50-70% of multiple sclerosis (MS) patients, is poorly understood and infrequently studied. We summarized efficacy and safety data of cannabinoid-based drugs for neuropathic pain.

CONCLUSION:

Cannabinoids including the cannabidiol/THC buccal spray are effective in treating neuropathic pain in MS.”

http://www.ncbi.nlm.nih.gov/pubmed/17257464

Cannabinoid mechanisms of pain suppression.

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Abstract

“A large body of literature indicates that cannabinoids suppress behavioral responses to acute and persistent noxious stimulation in animals. This review examines neuroanatomical, behavioral, and neurophysiological evidence supporting a role for cannabinoids in suppressing pain at spinal, supraspinal, and peripheral levels. Localization studies employing receptor binding and quantitative autoradiography, immunocytochemistry, and in situ hybridization are reviewed to examine the distribution of cannabinoid receptors at these levels and provide a neuroanatomical framework with which to understand the roles of endogenous cannabinoids in sensory processing. Pharmacological and transgenic approaches that have been used to study cannabinoid antinociceptive mechanisms are described. These studies provide insight into the functional roles of cannabinoid CB1 (CB1R) and CB2 (CB2R) receptor subtypes in cannabinoid antinociceptive mechanisms, as revealed in animal models of acute and persistent pain. The role of endocannabinoids and related fatty acid amides that are implicated in endogenous mechanisms for pain suppression are discussed. Human studies evaluating therapeutic potential of cannabinoid pharmacotherapies in experimental and clinical pain syndromes are evaluated. The potential of exploiting cannabinoid antinociceptive mechanisms in novel pharmacotherapies for pain is discussed.”

http://www.ncbi.nlm.nih.gov/pubmed/16596786

Recent data on cannabinoids and their pharmacological implications in neuropathic pain.

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Abstract

“Natural cannabinoids have been used for centuries for their psychotropic properties, but their possible therapeutic implications in analgesia have been recently documented. The present review intended to make an analysis of the neuroanatomy and physiology of the cannabinoid system (receptors, functions, agents acting on these receptors) and of its implications in neuropathic pain. There were also described the complex phenomena implicated in the generation and maintenance of neuropathic pain, by high lightening the implications of endogenous cannabinoids in this complex of painful conditions. The pharmacological analgesia test proves of cannabinoid implication in neuropathic pain was sustained by many studies presented in this paper. Therapeutic approaches using natural and synthetic cannabinoid receptor agonists were reviewed. Therapeutic perspectives in neuropathic pain might involve the development of new agents that influence the cannabinoid system. Thus, peripheral acting cannabinoid 1 receptors agonists, selective cannabinoid 2 receptor agonists and also modulators of endocannabinoids metabolism might be a way to success in the treatment of this complex entity called neuropathic pain.”

http://www.ncbi.nlm.nih.gov/pubmed/20108515

Cannabinoids as pharmacotherapies for neuropathic pain: from the bench to the bedside.

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“Neuropathic pain is a debilitating form of chronic pain resulting from nerve injury, disease states, or toxic insults. Neuropathic pain is often refractory to conventional pharmacotherapies, necessitating validation of novel analgesics. Cannabinoids, drugs that share the same target as Delta(9)-tetrahydrocannabinol (Delta(9)-THC), the psychoactive ingredient in cannabis, have the potential to address this unmet need…

In humans, effects of smoked marijuana, synthetic Delta(9)-THC analogs (e.g., Marinol, Cesamet) and medicinal cannabis preparations containing both Delta(9)-THC and cannabidiol (e.g., Sativex, Cannador) in neuropathic pain states are reviewed. Clinical studies largely affirm that neuropathic pain patients derive benefits from cannabinoid treatment…

Evidence for the use of Cannabis sativa as a treatment for pain can be traced back to the beginnings of recorded history…

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755639/

Marijuana Eases Neuropathic Pain

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

These results are important in light of the fact that patients who hear about pain relief from ongoing publicity about medical marijuana have had only a “trickle” of evidence to prove it, explained Henry J. McQuay, DM, of Oxford University, in an accompanying editorial.

This study does offer hope since few drugs have proven effective in these patients, commented Steven P. Cohen, MD, who as director of pain research at Walter Reed Army Medical Center in Washington, D.C., sees chronic pain in most of his patients with major war injuries.”

Marijuana smoking appeared well tolerated…

Patients rarely got high on the single hit they took through a pipe three times a day as part of the study, Ware’s group noted.”

Read more: http://www.medpagetoday.com/Neurology/PainManagement/21939

Smoking Marijuana Eases Chronic Neuropathic Pain.

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“Smoking cannabis reduces chronic neuropathic pain and also improves sleep, according to new research published today in the Canadian Medical Association Journal.

A single inhalation of 25 mg of 9.4% tetrahydrocannabinol herbal cannabis 3 times a day for 5 days was sufficient to achieve these outcomes, lead study author Mark A. Ware, MBBS, from McGill University Health Center, Montreal, Canada, told Medscape Medical News in an interview.

“Patients have been reporting that cannabis helps control their pain, and they have been saying so for a long time,” Dr. Ware said. “At the time that we had secured the funding and began the trial, there had been no clinical trials that had established this or investigated it.”

In addition, a large body of scientific knowledge is emerging abound the role of cannabinoid receptors and cannabinoid ligands in the human body, providing a potential scientific explanation as to why cannabinoids would be analgesic, he added. “So the 2 main supports came together, and in Canada at the time, there was an environment where we were able to secure funding sufficient for studies of this.”

Posttraumatic and Postsurgical Neuropathy

The study included 21 individuals older than 18 years (mean age, 45.4 years) with posttraumatic or postsurgical neuropathic pain lasting for at least 3 months. They were randomly assigned to receive cannabis at 4 potencies — 0%, 2.5%, 6%, and 9.4% tetrahydrocannabinol — during 4 periods in a crossover design. Each period lasted 14 days and began with 5 days of cannabis use followed by a 9-day washout period.

The cannabis doses were delivered in a single smoked inhalation using a titanium pipe. Patients self-administered the first dose of each period under supervision and were instructed to inhale for 5 seconds while the cannabis was lit, hold the smoke in their lungs for 10 seconds, and then exhale. They self-administered the remaining doses for each period at home.

The participants were allowed to continue their routine medications, and the use of acetaminophen as breakthrough analgesia was also permitted.

Pain intensity was measured using an 11-item numeric rating scale that used “no pain” and “worst pain possible” as anchors.

The study found that the higher dose of cannabis was the most efficient in reducing pain. The average daily pain intensity was 5.4 with the 9.4% tetrahydrocannabinol cannabis dose compared with 6.1 with the 0% or placebo dose (95% confidence interval, 0.02 – 1.4; P = .023).

In addition, participants reported significantly more drowsiness and reported getting to sleep more easily, faster, and with fewer periods of wakefulness when taking the 9.4% dose than when taking the 0% dose ( P < .05). The higher dose also improved anxiety and depression compared with the placebo dose.

Blind Held; Studies Feasible

“It was feared that participants would know right away if they were smoking cannabis because of the acute psychoactive effects of the drug, but our results do not support this,” Dr. Ware noted. “They do show that short-term placebo-controlled trials of smoked cannabis are feasible.”

He would like his study to act as a stimulus for other studies on cannabis and pain relief.

“Studies of this kind can be done. Ours was difficult to do because it was the first time we had done anything like this. We were breaking new ground with regard to regulations and so on, but it is possible. Having done it once, it’s not as difficult to do it again. So our results raise the possibility of extending the study for a longer duration, or being able to look at safety issues, and so on. It is possible to do a scientific trial with this compound. Your political views shouldn’t matter. This is just good science,” Dr. Ware said.

In a related commentary, Henry J. McQuay, DM, from Balliol College, Oxford, United Kingdom, writes that the study 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.”

He concludes that the study “adds to the trickle of evidence that cannabis may help some of the patients who are struggling at present.””

http://www.medscape.com/viewarticle/727702

Research: Marijuana can treat chronic pain – ABC

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“SACRAMENTO, CA (KGO) — A program commissioned more than a decade ago by the state Legislature to look into the therapeutic value of medicinal marijuana is expected to release a report on its findings today, a spokeswoman for state Sen. Mark Leno said.

A UC medical marijuana research panel today released the results of a ten year clinical study and according to its report, pot can effectively treat chronic pain.

Volunteers with multiple sclerosis and spinal cord injuries were randomly treated with marijuana or a placebo. Patients given cannabis reported fewer multiple sclerosis muscle spasms, and less spinal injury pain.

In another study, the panel found that pot effectively also treats migraines.

But researchers used marijuana grown by the federal government, not the kinds available to California medical marijuana users.

Medical marijuana has been legal under California law since voters approved Proposition 215, also known as the Compassionate Use Act, in 1996.

The state Legislature clarified in 2004 that the Compassionate Use Act allows qualified patients and their primary caregivers to cultivate marijuana for medicinal use.

Medical marijuana remains illegal under federal law, though, leaving patients and providers open to prosecution in federal court.”

http://abclocal.go.com/kgo/story?section=news/state&id=7283032

Marijuana Relieves HIV Nerve Pain

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“Smoking marijuana effectively relieves chronic HIV-associated nerve pain, including aching, painful numbness, and burning, according to a study published in the February 13, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology.

For the study, 50 people with HIV-associated sensory neuropathy, the most common HIV nerve disorder, were admitted to a California hospital and randomly assigned to smoke either marijuana or identical placebo cigarettes three times a day for five days.

The study found people who smoked marijuana reduced their daily nerve pain by 34 percent compared to 17 percent in the placebo group.

“Smoking marijuana was well tolerated and effectively relieved chronic nerve pain from HIV-associated sensory neuropathy,” said study author Donald Abrams, MD, with San Francisco General Hospital in San Francisco, California. “Our findings show the amount of relief from smoking marijuana is comparable to relief provided by oral drugs currently used for chronic nerve pain.”

Abrams says while some HIV patients with chronic nerve pain are able to take anticonvulsant drugs, such as lamotrigine and gabapentin, to ease pain, some patients don’t respond well to these drugs. He says that’s why there’s heightened interest in evaluating marijuana as a treatment for chronic nerve pain.

The study also found the first marijuana cigarette reduced chronic pain by an average of 72 percent versus 15 percent with placebo. And more than half of the people who smoked marijuana reported more than a 30-percent reduction in pain compared to 24 percent in the placebo group.

Participants in the study reported no serious side effects.

Researchers say similar results were reported in two recent placebo-controlled studies of marijuana-related therapies for nerve pain associated with multiple sclerosis.

The study was supported by the University of California Center for Medicinal Cannabis Research and conducted at the National Institutes of Health-funded General Clinical Research Center at San Francisco General Hospital.”

http://www.medicalnewstoday.com/releases/63333.php