Tag Archives: cannabis

Cannabis for Pain Management in Sickle Cell Disease Cases

Sickle cell disease, a red blood cell disorder that causes cellular deformation resulting in cells similar in shape to sickles, is the most common inherited blood disorder in the United States and affects approximately 100,000 Americans. The vulnerable cells have a shorter lifespan than normal cells and thus, there is a decreased amount of oxygen being transported through the body. As these cells tend to clog smaller blood vessels as well, they can result in acute or chronic pain, infection, and serious cardiovascular complications.

Currently, the Centers for Disease Control and Prevention recommend over-the-counter analgesics for the treatment of mild pain in cases of sickle cell disease. In more severe cases, clinicians often prescribe opioid medications, such as morphine, which come with serious and potentially fatal side effects. As such, there has been a growing number of research efforts into pain management methods for patients with sickle cell disease that mitigate adverse health outcomes.

Previous research has found that cannabis-based interventions can be effective at mitigating chronic pain, inflammation, and other unwanted symptoms. Emerging evidence published in JAMA Network Open explores the potential benefit of cannabis as an intervention for successful and safe pain management. The proof of principle study found that cannabis was a relatively safe intervention and could improve mood levels in patients who experience chronic pain from sickle cell disease.

Cannabis-Based Interventions

The medicinal indications of cannabis – now legal in 33 states – continue to expand as cannabis becomes increasingly popular as an analgesic within the scientific community. In the latest study, using cannabis as an analgesic was found to have the best evidence base compared to that of other interventions; however, authors of the study note that few human studies have explored the use of cannabis as a treatment for chronic pain in the case of chronic health conditions thus far.

Researchers conducted a double-blind, placebo-controlled, randomized proof of principle study aiming to test the hypothesis that cannabis can be an efficacious pain reliever in adults with sickle cell disease compared with placebo interventions. Participants of the study had all been diagnosed with sickle cell disease and were being treated with opioid analgesics at the time. They were required to have prior experience smoking cannabis to ensure they would administer the medication properly and be able to recognize its effects. Individuals currently using cannabis were asked to discontinue use for a week prior to the initiation of the trial. Out of the 27 total participants, 23 completed the full study and were included in the final analysis.

As part of the study, participants completed two 5-day trips to an inpatient research center – visits were at least 30 days apart – at which they inhaled either vaporized cannabis or vaporized placebo three times per day. Throughout their stay, researchers assessed participants’ pain levels, the interference of pain in a range of daily activities, mood, as well as associated side effects.

Reduced Impact on Mood

The study’s authors report that inhaled, vaporized cannabis did not significantly improve the intensity of pain compared with placebo interventions, however, they found that when participants inhaled cannabis, pain interfered less with their mood. Additionally, the effects were noted without significant adverse side effects implicating the relative safety of the intervention.

Co-author Dr. Kalpna Gupta from the University of California Irvine’s Center for the Study of Cannabis explained in a Medical News Today article: “These trial results show that vaporized cannabis appears to be generally safe. They also suggest that sickle cell patients may be able to mitigate their pain with cannabis — and that cannabis might help society address the public health crisis related to opioids. Of course, we still need larger studies with more participants to give us a better picture of how cannabis could benefit people with chronic pain.”

The latest research paves the way for future studies that are needed to verify these initial findings although, its findings are promising for quality of life improvement in sickle cell disease patients. However, the trial had limitations as a proof of principle design; the cohort was small and larger scale studies are necessary to validate its results. Furthermore, the short treatment duration and follow-up period limits the generalizability of the data as participants only ingested vaporized cannabis three times a day during the study; this may not be reflective of actual use patterns of medicinal cannabis for pain relief. Nonetheless, the latest evidence shows promise for the development of future novel treatments and cannabis-based interventions for chronic pain management and mood improvement.

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The Endocannabinoid System and the Modulation of Pain and Inflammation

The Endocannabinoid System

The recent discovery of the endocannabinoid system (ECS) and its modulatory role in many physiological functions has been very exciting for science. The three major constituents of the ECS include the endocannabinoid signaling molecules; mainly anandamide and 2-AG, G-protein-coupled cannabinoid receptors, and enzymes involved in ligand on-demand synthesis and inactivation.

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Applications of Clinical Cannabis in Medicine

As clinical cannabis is rapidly becoming accepted as a treatment for an array of chronic diseases and disorders, there is a growing and pressing need for clinical education surrounding medical marijuana—and alternative treatments for pain control. The use and acceptance of medical cannabis continues to evolve, as demonstrated by the growing number of states that now permit its use and applications for specific medical indications. 

While the marijuana plant contains over 100 different chemicals—or cannabinoids—each one produces a different effect on the body. Tetrahydrocannabinol (THC) was originally identified by Raphael Mechoulam, who later also described and named anandamide: a naturally occurring endogenous cannabinoid neurotransmitter that binds to cannabinoid receptors. The human endocannabinoid system is a biological system involved in regulating a variety of physiological and cognitive processes, including appetite, pain sensation, mood, memory, fertility, etc. The CB1 receptor (THC) occurs in the central and peripheral nervous system, while the CB2 receptor is located on immune cells, and the peripheral nervous system. Cannabidiol (CBD) does not have the psychotropic effects of THC, nor does it have the memory impairment or appetite effects; the two main chemicals used in medicine are THC and CBD.

The most common use for medical marijuana in the United States is for pain control: while marijuana is not strong enough for severe pain (i.e. post-surgical pain or a broken bone), it is said to be highly effective for the chronic pain that plagues millions of Americans, particularly as they age. Part of its attraction is that it is clearly safer than opiates—almost impossible to overdose, and far less addictive—and it can take the place of NSAIDs such as Advil or Aleve, if people cannot take them due to problems with kidneys, ulcers, or GERD.

Marijuana specifically appears to ease the pain of multiple sclerosis, and nerve pain in general. This is an area in which few other options exist; moreover, those that do—such as Neurontin, Lyrica, or opiates—are highly sedating. Patients claim that marijuana allows them to resume their previous activities without feeling drugged or disengaged. Marijuana is also said to be a highly effective muscle relaxant; many users swear by its ability to lessen tremors in Parkinson’s disease. Other successful clinical applications include fibromyalgia, endometriosis, interstitial cystitis, and most other conditions where the final common pathway is chronic pain.

Further users of marijuana include management of nausea and weight loss, and treatment for glaucoma. A highly promising area of research is its use for PTSD in veterans who return from combat zones. Many veterans and respective therapists have reported drastic improvements, recommending more research and studies, and a loosening of governmental restrictions on its study. Medical marijuana is also reported to help patients suffering from pain and wasting syndrome associated with HIV, as well as irritable bowel syndrome and Crohn’s disease.

Despite lingering controversy, use of botanical cannabis for medicinal purposes represents the revival of a plant with historical significance reemerging in today’s healthcare system. Legislation governing use of medicinal cannabis continues to change quickly, necessitating that pharmacists and other clinicians stay abreast of state regulations and institutional implications. Ultimately, as the medicinal cannabis landscape continues to evolve, hospitals, acute care facilities, clinics, hospices, and long-term care centers must consider the implications, address logistical concerns, and explore the feasibility of permitting patient access to this treatment.

Senior Vice-President of A4M/MMI Joseph Maroon, MD—Clinical Professor and Vice Chairman in the Department of Neurosurgery at the University of Pittsburgh Medical Center, and expert in clinical cannabis therapies—has published a white paper on the neurological benefits of cannabinoids.

SOURCES
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/
https://www.cannabis-med.org/?lng=en

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