Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process

Journal of Cannabis Research, Journal Year: 2021, Volume and Issue: 3(1)

Published: July 2, 2021

Globally, medical cannabis legalization has increased in recent years and is commonly used to treat chronic pain. However, there are few randomized control trials studying indicating expert guidance on how dose administer safely effectively needed.Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations patients with pain.There was consensus that may be considered for experiencing neuropathic, inflammatory, nociplastic, mixed Three treatment protocols were developed. A routine protocol where the clinician initiates patient CBD-predominant variety at of 5 mg CBD twice daily titrates by 10 every 2 3 days until reaches their goals, or up 40 mg/day. At mg/day, clinicians consider adding THC 2.5 titrate 7 maximum mg/day THC. conservative once 1 rapid balanced THC:CBD 2.5-5 each cannabinoid his/her goals mg/day.In summary, using

Language: Английский

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Medical cannabis or cannabinoids for chronic pain: a clinical practice guideline

BMJ, Journal Year: 2021, Volume and Issue: unknown, P. n2040 - n2040

Published: Sept. 8, 2021

Abstract Clinical question What is the role of medical cannabis or cannabinoids for people living with chronic pain due to cancer non-cancer causes? Current practice Chronic common and distressing associated considerable socioeconomic burden globally. Medical increasingly used manage pain, particularly in jurisdictions that have enacted policies reduce use opioids; however, existing guideline recommendations are inconsistent, remains illegal therapeutic many countries. Recommendation The expert panel issued a weak recommendation offer trial non-inhaled cannabinoids, addition standard care management (if not sufficient), pain. How this was created An international development including patients, clinicians content expertise, methodologists produced adherence standards trustworthy guidelines using GRADE approach. MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. applied an individual patient perspective. evidence This informed by linked series four systematic reviews summarising current body benefits harms, as well values preferences, regarding Understanding because close balance between harms It reflects high value placed on small very improvements self reported intensity, physical functioning, sleep quality, willingness accept modest risk mostly limited transient harms. Shared decision making required ensure patients make choices reflect their personal context. Further research warranted may alter recommendation.

Language: Английский

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Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions

Cannabis and Cannabinoid Research, Journal Year: 2023, Volume and Issue: 9(2), P. 669 - 687

Published: March 27, 2023

Background: One in five individuals live with chronic pain globally, which often co-occurs sleep problems, anxiety, depression, and substance use disorders. Although these conditions are commonly managed cannabinoid-based medicines (CBM), health care providers report lack of information on the risks, benefits, appropriate CBM for therapeutic purposes. Aims: We present clinical practice guidelines to help clinicians patients navigate management co-occurring conditions. Materials Methods: conducted a systematic review studies investigating treatment pain. Articles were dually reviewed accordance Preferred Reporting Items Systematic Reviews Meta-Analyses guidelines. Clinical recommendations developed based available evidence from review. Values preferences practical tips have also been provided support application. The GRADE system was used rate strength quality evidence. Results: From our literature search, 70 articles met inclusion criteria utilized guideline development, including 19 reviews 51 original research studies. Research typically demonstrates moderate benefit management. There is efficacy comorbidities, appetite suppression, managing symptoms some associated HIV, multiple sclerosis, fibromyalgia, arthritis. Conclusions: All considering should be educated risks adverse events. Patients work collaboratively identify dosing, titration, administration routes each individual. Review Registration: PROSPERO no. 135886.

Language: Английский

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The Basic Science of Cannabinoids

Anesthesia & Analgesia, Journal Year: 2023, Volume and Issue: 138(1), P. 42 - 53

Published: Dec. 15, 2023

The cannabis plant has been used for centuries to manage the symptoms of various ailments including pain. Hundreds chemical compounds have identified and isolated from elicit a variety physiological responses by binding specific receptors interacting with numerous other proteins. In addition, body makes its own cannabinoid-like that are integrally involved in modulating normal pathophysiological processes. As legal landscape continues evolve within United States throughout world, it is important understand rich science behind effects implications providers patients. This narrative review aims provide an overview basic cannabinoids describing discovery function endocannabinoid system, pharmacology cannabinoids, areas future research therapeutic development as they relate perioperative chronic pain medicine.

Language: Английский

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Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control

International Journal of Clinical Practice, Journal Year: 2020, Volume and Issue: 75(8)

Published: Nov. 29, 2020

Opioid misuse and overuse have contributed to a widespread overdose crisis many patients physicians are considering medical cannabis support opioid tapering chronic pain control. Using five-step modified Delphi process, we aimed develop consensus-based recommendations on: 1) when how safely initiate titrate cannabinoids in the presence of opioids, 2) taper opioids 3) monitor evaluate outcomes treating with cannabinoids.

Language: Английский

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The evolving culture of medical cannabis in Canada for the management of chronic pain

Frontiers in Pharmacology, Journal Year: 2023, Volume and Issue: 14

Published: April 7, 2023

Although used therapeutically for millennia, cannabis has been a prohibited substance worldwide most of the 20th Century. With revision prohibitive regulations in many jurisdictions during past 2 decades, is increasingly available to patients as potential treatment option various symptoms. Pain relief, sleep promotion and alleviation distress, depression anxiety are common reasons use. Canada at forefront medical (MC) legislation revisions enable facilitate access therapeutic initially viewed with caution stigma, attitudes general have changed. Medical identified herbal plant product sourced from grower/producer not present regulated pharmaceutical product. use currently prevalent but bypassed rigorous study required usual drug approval. uptake enthusiastic by patients, community voiced cautions concerns. Access fairly easy once an approval document obtained healthcare professional, without obligation or pharmacy oversight. The greatest concern dearth sound clinical evidence effects harms. Emerging concerns include patient self-management information based on personal research, abundance on-line which may always be accurate, emergence designated “cannabis clinics,” risks society due accidents, high cost legal leading via recreational market. now entrenched Canadian healthcare, physicians must sufficiently knowledgeable provide guidance that evidence-based will ensure societal harm reduction. Examination changing culture insight countries anticipating similar allow their population learn issues created legalization.

Language: Английский

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Medical cannabis for children: Evidence and recommendations

Paediatrics & Child Health, Journal Year: 2024, Volume and Issue: 29(2), P. 104 - 112

Published: April 5, 2024

Abstract Interest in using cannabis products for a medical purpose children under the age of 18 years is increasing. There are many available that can include cannabidiol (CBD) or delta-9-tetrahydrocannabinol (THC), both. Despite therapeutic claims, there few rigorous studies to inform dosing, safety, and efficacy paediatric clinical practice. This statement reviews current evidence provides recommendations children. Longer-term (2-year) reports support sustained tolerability therapy patients with Lennox-Gastaut Dravet syndromes. CBD-enriched extracts containing small amounts THC have been evaluated number patients, further research needed practice guidelines. Given widespread use Canada, paediatricians should be prepared engage open, ongoing discussions families about its potential benefits risks, develop individualized plans monitor efficacy, reduce harms, mitigate drug–drug interactions.

Language: Английский

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Cannabis or Cannabinoids for the Management of Chronic Noncancer Pain: Best Practice Advice From the American College of Physicians

Annals of Internal Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: April 4, 2025

The American College of Physicians' Population Health and Medical Science Committee (PHMSC) developed this best practice advice to inform clinicians about what is currently known the benefits harms cannabis or cannabinoids in management chronic noncancer pain provide for counseling patients seeking therapy. PHMSC considers areas where evidence uncertain emerging does not follow clinical based on a review assessment scientific work, including systematic reviews individual studies. Sources included living cannabinoid treatments series primary Clinicians should counsel when are considering whether start continue use manage their pain. following subgroups that likely outweigh benefits: young adult adolescent patients, with current past substance disorder, serious mental illness, frail those at risk falling. advise against starting continuing who pregnant breastfeeding actively trying conceive. inhaled

Language: Английский

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Acid-Catalyzed Conversion of Cannabidiol to Tetrahydrocannabinols: En Route to Demystifying Manufacturing Processes and Controlling the Reaction Outcomes

Cannabis and Cannabinoid Research, Journal Year: 2025, Volume and Issue: unknown

Published: April 18, 2025

Background: Over the last decade, there has been a significant increase in production of multiple tetrahydrocannabidiol (THC) related products via acid catalysis cannabidiol (CBD). The widespread availability CBD and unregulated or poorly regulated nature its use have flooded market with THC-containing unverifiable provenance frequently contaminated by trace metals residual solvents. Under non-optimized, controlled, harsh reaction conditions, these acid-catalyzed transformations yield cannabinoids including Δ9-THC Δ8-THC, along numerous side products. These are rarely identified quantified accurately, their safety pharmacology remain largely unknown. Aims: This review aims to present an up-to-date understanding one fundamental cannabinoid chemistry: cyclization THC. knowledge will facilitate development safer, cleaner, more affordable, accessible while guiding medical practitioners regulators. Materials Methods: We conducted literature studies published over 5-6 years on interconversion Our focused following key aspects: (1) advances mechanisms optimizing desirable outcomes; (2) new catalysts, "green chemistry" approaches such as solid-supported acids; (3) implementation fit-for-purpose analytical methods better characterize outcomes reassess accuracy cannabis hemp product labeling. Results: Provided strict quality controls materials, isolation techniques, latest research shows that it is feasible access elevated consistently high quality, enriched either THC fractions, cost-effective manner. Among spectrum possible products, easy low-potency compositions may be particularly relevant for serving needs patients consuming hemp-derived dose titration well supporting safe responsible recreational markets now saturated overly potent

Language: Английский

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The Efficacy of Cannabis in Reducing Back Pain: A Systematic Review

Global Spine Journal, Journal Year: 2022, Volume and Issue: 12(2), P. 343 - 352

Published: Feb. 7, 2022

To critically analyze the evidence and efficacy of cannabis to treat surgical nonsurgical back pain via a Systematic Review.We conducted systematic review investigate non-surgical pain. A literature search was performed with MEDLINE Embase databases. Only RCTs prospective cohort studies concurrent control were included in this study. Risk bias quality grading assessed for each study.Database searches returned 1738 non-duplicated results. An initial screening excluded 1716 Twenty-two full text articles eligibility. Four ultimately met pre-determined eligibility Two addressed post-SCI while other two low No specifically examined use The type varied between study THC, dronabinol, Nabilone. total 110 patients four reviewed. In study, there quantifiable advantage therapy alleviating There no serious adverse effects reported.In all articles, shown be effective an acceptable side effect profile. However, long-term follow up is lacking. As medicinal being used more commonly analgesic are "self-prescribing" pain, additional needed healthcare providers confidently recommend pain.Systematic review.

Language: Английский

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