Cannabis Decreases Neuropathic Pain

Abstract

A randomized, placebo-controlled crossover trial utilizing vaporized cannabis containing placebo and 6.7% and 2.9% delta-9-tetrahydrocannabinol (THC) was performed in 42 subjects with central neuropathic pain related to spinal cord injury and disease. Subjects received two administrations of the study medication in a 4-hour interval. Blood samples for pharmacokinetic evaluation were collected, and pain assessment tests were performed immediately after the second administration and 3 hours later. Pharmacokinetic data, although limited, were consistent with literature reports, namely dose-dependent increase in systemic exposure followed by rapid disappearance of THC. Dose-dependent improvement in pain score was evident across all pain scale elements. Using mixed model regression, an evaluation of the relationship between plasma concentrations of selected cannabinoids and percent change in items from the Neuropathic Pain Scale was conducted. Changes in the concentration of THC and its nonpsychotropic metabolite, 11-nor-9-carboxy-THC, were related to percent change from baseline of several descriptors (eg, itching, burning, and deep pain). However, given the large number of multiple comparisons, false-discovery-rate-adjusted P-values were not significant. Plans for future work are outlined to explore the relationship of plasma concentrations with the analgesic response to different cannabinoids. Such an appraisal of descriptors might contribute to the identification of distinct pathophysiologic mechanisms and, ultimately, the development of mechanism-based treatment approaches for neuropathic pain, a condition that remains difficult to treat.

Authors: BL Wilsey, R Deutsch, E Samara, TD Marcotte, AJ Barnes, MA Huestis, D Le

Journal of Pain Research (2016) 9:587

Clinical Trials, Studies and Publications (click to access):

A preliminary evaluation of the relationship of cannabinoid blood concentrations with the analgesic response to vaporized cannabis.

Cannabis in Pain Treatment: Clinical and Research Considerations

In this article important considerations in the use of cannabis are presented to better prepare clinicians to care for patients who use if and needed directions for research are identified.

Abstract: Cannabinoids show promise as therapeutic agents, particularly as analgesics, but theirdevelopment and clinical use has been complicated by recognition of their botanical source, cannabis,as a substance of misuse. Although research into endogenous cannabinoid systems and potential cannabinoidpharmaceuticals is slowly increasing, there has been intense societal interest in making herbal(plant) cannabis available for medicinal use; 23 U.S. States and all Canadian provinces currently permituse in some clinical contexts. Whether or not individual professionals support the clinical use of herbalcannabis, all clinicians will encounter patients who elect to use it and therefore need to be prepared to

advise them on cannabis-related clinical issues despite limited evidence to guide care. Expanded
research on cannabis is needed to better determine the individual and public health effects of increasing
use of herbal cannabis and to advance understanding of the pharmaceutical potential of cannabinoids
as medications. This article reviews clinical, research, and policy issues related to herbal cannabis to support
clinicians in thoughtfully advising and caring for patients who use cannabis, and it examines obstacles
and opportunities to expand research on the health effects of herbal cannabis and cannabinoids.
Perspective: Herbal cannabis is increasingly available for clinical use in the United States despite
continuing controversies over its efficacy and safety. This article explores important considerations
in the use of plant Cannabis to better prepare clinicians to care for patients who use it, and identifies
needed directions for research.
ยช 2016 by the American Pain Society

Authors: SR Savage, A Romero-Sandoval, M Schatman, M Wallace, G Fanciullo, B McCarberg and M Ware

The Journal of Pain (2016) 17:654-668

 

Clinical Trials, Studies and Publications (click to access):

Cannabis in Pain Treatment: Clinical and Research Considerations

 

 

 

 

THC/CBD, an endocannabinoid system modulator, has demonstrated efficacy in the treatment of Central Neuropathic Pain in patients with Multiple Sclerosis

Abstract

Central neuropathic pain (CNP), pain initiated or caused by a primary lesion or dysfunction of the central nervous system, occurs in ~28% of patients with multiple sclerosis (MS). Delta(9)-Tetrahydrocannabinol/cannabidiol (THC/CBD), an endocannabinoid system modulator, has demonstrated efficacy for up to 4 weeks in randomized controlled trials in the treatment of CNP in patients with MS.

Clinical Trials, Studies and Publications:

Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial

Smoked cannabis relieved neuropathic pain in patients with HIV

Abstract

“In a double-blind, randomized, clinical trial of the short-term adjunctive treatment of neuropathic pain in HIV-associated distal sensory polyneuropathy, participants received either smoked cannabis or placebo cannabis cigarettes…

Among completers, pain relief was significantly greater with cannabis than placebo. The proportion of subjects achieving at least 30% pain relief was again significantly greater with cannabis (46%) compared to placebo (18%). It was concluded that smoked cannabis was generally well-tolerated and effective when added to concomitant analgesic therapy in patients with medically refractory pain due to HIV-associated neuropathy.”

Clinical Trials, Studies and Publications:

Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial