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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Assessment of Orally Administered Δ9-Tetrahydrocannabinol When Coadministered With Cannabidiol on Δ9-Tetrahydrocannabinol Pharmacokinetics and Pharmacodynamics in Healthy Adults: A Randomized Clinical Trial

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(2), P. e2254752 - e2254752

Published: Feb. 13, 2023

Importance Controlled clinical laboratory studies have shown that cannabidiol (CBD) can sometimes attenuate or exacerbate the effects of Δ 9-tetrahydrocannabinol ( 9-THC). No evaluated differences in pharmacokinetics (PK) 9-THC and pharmacodynamics (PD) between orally administered cannabis extracts vary with respect to CBD concentrations. Objective To compare PK PD 9-THC-dominant CBD-dominant contained same dose (20 mg). Design, Setting, Participants This randomized trial was a within-participant, double-blind, crossover study conducted from January 2021 March 2022 at Johns Hopkins University Behavioral Pharmacology Research Unit, Baltimore, MD. Eighteen healthy adults completed 3 outpatient experimental test sessions were each separated by least 1 week. Interventions Brownies containing (1) no extract (ie, placebo); (2) mg CBD); (3) + 640 CBD) participants 30 minutes prior administering cytochrome P450 (CYP) probe drug cocktail, which consisted 100 caffeine, 20 omeprazole, 25 losartan, dextromethorphan, 2 midazolam. Main Outcomes Measures Change-from-baseline plasma concentrations for metabolites scores subjective effects, cognitive psychomotor performance, vital signs. The area under vs concentration time curve (AUC) maximum (C max ) determined. Results participant cohort 18 included 11 males (61.1%) 7 females (38.9%) mean (SD) age (7) years who had not used days initiation (mean [SD] day since last use, 86 [66] days). CYP cocktail placebo brownie did affect any assessments. Relative 9-THC, produced higher C 11-OH- 9-THC-COOH. increased self-reported anxiety, sedation, memory difficulty, heart rate, more pronounced impairment performance compared both Δ9-THC placebo. Conclusions Relevance In this oral CBD, stronger adverse elicited dose, contradicts common claims attenuates 9-THC. inhibition metabolism is likely mechanism observed. An improved understanding cannabinoid-cannabinoid cannabinoid-drug interactions are needed inform regulatory decision-making regarding therapeutic nontherapeutic use products. Trial Registration clinicaltrials.gov Identifier: NCT04201197

Language: Английский

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Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

Frontiers in Pharmacology, Journal Year: 2022, Volume and Issue: 13

Published: May 10, 2022

A regulatory framework allowing legal access to medicinal cannabis (MC) products has operated in Australia since November 2016. MC prescribing by healthcare practitioners (HCPs) is primarily conducted through the Special Access Scheme - Category B (SAS-B) pathway, which prescribers apply Therapeutic Goods Administration (TGA-the federal regulator) for approval prescribe a category of product an individual patient suffering from specific indication. The dataset collected TGA provides unique opportunity examine trends over time Australian population. Here we analysed this SAS-B inception with respect age, gender, type (e.g., oil, flower, etc.), CBD content, indication treated, and prescriber location. Results are presented descriptively as well being using non-linear regression models. Relationship between variables were explored via correspondence analyses. Indications classified reference International Statistical Classification Diseases Related Health Problems (10th Revision). As 31 August 2021, total 159,665 approvals had been issued products, 82.4% January 2020. Leading indications pain, anxiety, sleep disorders. Oil most popular type, while CBD-dominant (≥98% CBD) accounted 25.1% approvals. Approvals flower increased markedly during 2020-2021, did involving younger age groups (18-31 years old), male patients, non-CBD dominant products. disproportionate number applications (around 50%) came HCPs state Queensland. Associations gender and/or found. For example, oil commonly associated pain. While, overall dramatically last 2 analysis, stabilization numbers evident some indications, such Current practices do not always reflect provided guidance documents prescribing. While acknowledging limitations around dataset, it valuable resource better understand current utilisation within Australia.

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 Pharmacological Treatment of Chronic Pain: From Guidelines to Daily Clinical Practice

Pharmaceutics, Journal Year: 2023, Volume and Issue: 15(4), P. 1165 - 1165

Published: April 6, 2023

In agreement with the International Association for Study of Pain, chronic pain is an unpleasant sensory and emotional experience associated actual or potential tissue damage. To date, there are several types pain: nociceptive, neuropathic, nociplastic. present narrative review, we evaluated characteristics drugs used each type pain, according to guidelines, their effects in people comorbidity reduce development severe adverse events.

Language: Английский

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Tetrahydrocannabinol and cannabidiol medicines for chronic pain and mental health conditions

Inflammopharmacology, Journal Year: 2022, Volume and Issue: 30(4), P. 1167 - 1178

Published: July 7, 2022

Combination tetrahydrocannabinol (THC)/cannabidiol (CBD) medicines or CBD-only are prospective treatments for chronic pain, stress, anxiety, depression, and insomnia. THC CBD increase signaling from cannabinoid receptors, which reduces synaptic transmission in parts of the central peripheral nervous systems secretion inflammatory factors immune glial cells. The overall effect adding to is enhance analgesic but counteract some adverse effects. There substantial evidence effectiveness THC/CBD combination especially neuropathic nociplastic pain with an component. For medication, there moderate anxiety insomnia, minimal depression pain. have a good tolerability safety profile relative opioid analgesics negligible dependence abuse potential; however, should be avoided patients predisposed psychosis suicide as these conditions appear exacerbated. Non-serious events usually dose-proportional, subject tachyphylaxis rarely dose limiting when commenced on low gradual up-titration. inhibit several Phase I II metabolism enzymes, increases exposure wide range drugs appropriate care needs taken. Low-dose that appears effective mental health has safety, few effects initial treatment.

Language: Английский

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Beyond the Pain: A Systematic Narrative Review of the Latest Advancements in Fibromyalgia Treatment

Cureus, Journal Year: 2023, Volume and Issue: unknown

Published: Oct. 31, 2023

Fibromyalgia is a complex chronic pain disorder that significantly impacts the quality of life affected individuals. The etiology fibromyalgia remains elusive, necessitating effective treatment options. This review aims to provide an overview current options for and highlight recent updates in managing condition. methodology employed this systematic comprised following key steps. We conducted comprehensive search across various databases identify pertinent studies published between 2000 2023. Inclusion criteria were defined specifically target involving adult individuals diagnosed with fibromyalgia, focus on both pharmacological non-pharmacological interventions encompassed range study types, including randomized controlled trials, observational studies, reviews. To ensure selected we appropriate assessment tools, data extraction synthesis adhered established guidelines. rigorous approach allowed robust analysis literature management. In course our review, it became evident spectrum approaches holds significant promise management fibromyalgia. Specifically, interventions, selective serotonin-norepinephrine reuptake inhibitors, anticonvulsants, cannabinoids, tropisetron, sodium oxybate, have exhibited substantial potential alleviating symptoms. Concurrently, strategies, such as cognitive-behavioral therapy, exercise regimens, complementary alternative therapies, yielded positive outcomes improving condition's Recent developments field introduced innovative agents like milnacipran pregabalin, addition mindfulness-based stress reduction aquatic exercise, expanding array available enhance care patient necessitates multidisciplinary treatment, encompassing interventions. offer additional alleviate symptoms improve Healthcare professionals should remain informed about these advancements evidence-based care, addressing associated enhancing outcomes.

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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Recent Approaches of Ocular Disease and Its Herbal Product Treatment: An Updates

Journal for Research in Applied Sciences and Biotechnology, Journal Year: 2023, Volume and Issue: 2(2), P. 102 - 114

Published: April 22, 2023

One of the most common causes permanent vision loss is glaucoma. Damage to optic nerve and retinal ganglion cells, root cause visual field impairment, typically result elevated intraocular pressure. Some patients' illness worsens even when treated with eye medications that reduce The pathophysiology glaucoma not only thought involve mechanical vascular dysfunctions eye, but also oxidative stress, neuroinflammation, excitotoxicity. Therefore, natural compounds antioxidant anti-inflammatory qualities may offer a different strategy for treating This review summarizes up-to-date preclinical clinical research on have been proven contain neuroprotective characteristics cells and, consequently, be useful in treatment Baicalein, forskolin, marijuana, ginsenoside, resveratrol, hesperidin are all effective at lowering On other hand, antioxidant, anti-inflammatory, anti-apoptosis mechanisms among those through which Ginkgo biloba, More needed determine whether items can used as safe

Language: Английский

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Cannabis-Based Medicine for Neuropathic Pain and Spasticity—A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial

Pharmaceuticals, Journal Year: 2023, Volume and Issue: 16(8), P. 1079 - 1079

Published: July 28, 2023

Patients with multiple sclerosis (MS) and spinal cord injury (SCI) commonly sustain central neuropathic pain (NP) spasticity. Despite a lack of consistent evidence, cannabis-based medicine (CBM) has been suggested as supplement treatment. We aimed to investigate the effect CBM on NP spasticity in patients MS or SCI. performed randomized, double-blinded, placebo-controlled trial Denmark. aged ≥18 years (intensity >3, ≤9 numerical rating scale (NRS0-10) and/or (>3 NRS0-10) were randomized treatment consisting either delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), combination THC&CBD maximum doses 22.5 mg, 45 mg 22.5/45 per day, respectively, placebo. A baseline registration was before randomization. Treatment duration six weeks followed by one-week phaseout. Primary endpoints intensity patient-reported Between February 2019 December 2021, 134 (MS n = 119, SCI 15), where 32 assigned THC, 31 CBD, THC&CBD, 40 No significant difference found for: mean (THC 0.42 (-0.54-1.38), CBD 0.45 (-0.47-1.38) 0.16 (-0.75-1.08)), 0.24 (-0.67-1.45), 0.46 (-0.74-1.65), 0.10 (-1.18-1.39), secondary outcomes (patient global impression change quality life), any tertiary outcomes. include 448 trial; however, due COVID-19 recruitment challenges, fewer included. Nevertheless, this four-arm parallel trial, no between placebo active THC alone The registered EU Clinical Trials Register EudraCT (2018-002315-98).

Language: Английский

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