Clinical benefit of cannabinoids to treat chronic non-cancer pain
Keywords:
CANNABIS, MEDICAL MARIJUANA, CANNABIDIOL, CHRONIC PAIN, TETRAHIDROCANNABINOL, CLINICAL BENEFIT
Abstract
Introduction: Cannabinoids can be a valid option for the treatment of chronic non-cancer pain, according to the studies published to date and our clinical experience.
Objectives: To evaluate the clinical benefit of medicinal cannabis preparations (MCPs) for chronic non-cancer pain in patients seen at the Endocannabinology Clinic of Uruguay (CEDU). Method: Descriptive, observational, longitudinal study of a population treated at a private healthcare center. This involves a cohort of 438 patients who spontaneously consulted at CEDU from September 2016 to March 2020. The reason for consultation was chronic non-cancer pain that did not respond to standard treatment.
Results: in the studied cohort, women prevailed and accounted for 74% of patients. Average age was 69 years old and 95% of them sought care within the private healthcare system. Most women had completed secondary school education. The most frequent type of pain was osteoarticular pain. The most used chemovar of Medicinal Cannabis (MC) was 5% cannabidiol (CBD), showing a favorable treatment response in reducing pain levels and the discontinuation or reduction of opioid and non-steroidal anti-inflammatory drug (NSAID) usage. Few and mild adverse effects (AE) were observed in the vast majority of patients. Twelve patients (less than 3%) discontinued the treatment.
Conclusions: This retrospective study demonstrated a reduction in pain level of 3.14 (p-value ≤ 0.0001) indicating that MC could be an option for the treatment of non-oncological chronic pain. Further studies are needed to demonstrate the effectiveness and safety of cannabinoids. This depends on many factors (laws facilitating accessibility to a variety of medical-grade MC products, incentives for science and research). Nevertheless, we can assert that the presented results are promising in consideration of their therapeutic potential.
References
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27) Maayah Z, Takahara S, Ferdaoussi M, Dyck J. The molecular mechanisms that underpin the biological benefits of full-spectrum cannabis extract in the treatment of neuropathic pain and inflammation. Biochim Biophys Acta Mol Basis Dis 2020; 1866(7):165771. doi: 10.1016/j.bbadis.2020.165771.
28) Gertsch J, Leonti M, Raduner S, Racz I, Chen J, Xie X, et al. Beta-caryophyllene is a dietary cannabinoid. Proc Natl Acad Sci USA 2008; 105(26):9099-104. doi: 10.1073/ pnas.0803601105.
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30) Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000; 32(4):1008-15. doi: 10.1046/j.1365-2648.2000.t01-1-01567.x.
31) Ware M, Wang T, Shapiro S, Collet J. Cannabis for the management of pain: assessment of safety study (COMPASS). J Pain 2015; 16(12):1233-42. doi: 10.1016/j.jpain.2015.07.014.
2) Ley 19.172. Regulación y control del cannabis. Montevideo, 7 de enero de 2014. Montevideo. IMPO, 2014. Disponible en: https://www.impo.com.uy/bases/leyes/19172-2013. [Consulta: 20 abril 2022].
3) Decreto N° 46/015. Reglamentación de la Ley 19172 relativa a la regulación y control del cannabis. Montevideo, 10 de febrero de 2015. Montevideo: IMPO, 2015. Disponible en: https:// www.impo.com.uy/bases/decretos/46-2015. [Consulta: 20 abril 2022].
4) Decreto 298/017. Autorización de “venta bajo receta profesional” para las especialidades farmaceúticas con cannabidiol como principio activo. Montevideo, 24 de octubre de 2017. Montevideo: IMP, 2017. Disponible en: https://www.impo.com. uy/bases/decretos/298-2017. [Consulta: 20 abril 2022].
5) Ley 19847. Declaración de interés público a las acciones tendientes a proteger, promover y mejorar la salud pública mediante productos de calidad controlada y accesibles, en base a cannabis o cannabinoides, así como el asesoramiento médico e información sobre beneficios y riesgos de su uso. Montevideo, 8 de enero de 2020. Montevideo, IMPO, 2020. Disponible en: https://www.impo.com.uy/bases/leyes/19847-2019. [Consulta: 20 abril 2022].
6) Raja S, Carr D, Cohen M, Finnerup N, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020; 161(9):1976-82. doi: 10.1097/j.pain.0000000000001939.
7) Pascual D, Goicochea C. Los cannabinoides en el tratamiento del dolor. En: Ramos Atance J, coord. Efectos terapéuticos de los cannabinoides. Madrid: Universidad Complutense de Madrid. Instituto Universitario de Investigación en Neuroquímica, 2017:155-68. Disponible en: https://www.seic.es/ wp-content/uploads/2013/10/EFECTOS-TERAP%C3%89UTICOS-DE-LOS-CANNABINOIDES.pdf. [Consulta: 24 junio 2022].
8) Maione S, Piscitelli F, Gatta L, Vita D, De Petrocellis L, Palazzo E, et al. Non-psychoactive cannabinoids modulate the descending pathway of antinociception in anaesthetized rats through several mechanisms of action. Br J Pharmacol 2011; 162(3):584-96. doi: 10.1111/j.1476-5381.2010.01063.x.
9) Martin W, Coffin P, Attias E, Balinsky M, Tsou K, Walker J. Anatomical basis for cannabinoid-induced antinociception as revealed by intracerebral microinjections. Brain Res 1999; 822(1-2):237-42. doi: 10.1016/s0006-8993(98)01368-7.
10) Lichtman A, Martin B. Spinal and supraspinal components of cannabinoid-induced antinociception. J Pharmacol Exp Ther 1991; 258(2):517-23.
11) Abrams D. The therapeutic effects of cannabis and cannabinoids: an update from the National Academies of Sciences, Engineering and Medicine report. Eur J Intern Med 2018; 49:7- 11. doi: 10.1016/j.ejim.2018.01.003.
12) Fitzcharles M, Ste-Marie P, Häuser W, Clauw D, Jamal S, Karsh J, et al. Efficacy, Tolerability, and Safety of Cannabinoid Treatments in the Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials. Arthritis Care Res (Hoboken) 2016; 68(5):681-8. doi: 10.1002/acr.22727.
13) Notcutt W, Price M, Miller R, Newport S, Phillips C, Simmons S, et al. Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 ‘N of 1’ studies. Anaesthesia 2004; 59(5):440-52. doi: 10.1111/j.1365- 2044.2004.03674. x.
14) Okusanya B, Asaolu I, Ehiri J, Kimaru L, Okechukwu A, Rosales C. Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review. Syst Rev 2020; 9(1):167. doi: 10.1186/s13643-020-01425-3.
15) Abrams D, Couey P, Shade S, Kelly M, Benowitz N. Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther 2011; 90(6):844-51. doi: 10.1038/clpt.2011.188.
16) Vicente Herrero M, Delgado Bueno S, Bandrés F, Ramírez M, Capdevila L. Valoración del dolor: revisión comparativa de escalas y cuestionarios. Rev Soc Esp Dolor 2018: 25(4):228-36. doi: 10.20986/resed.2018.3632/2017.
17) National Cancer Institute. National Institutes of Health. Department of Health and Human Services. Common terminology criteria for adverse events (CTCAE) version 5.0. Bethesda, MD: NCI, 2017. Disponible en: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_ reference_8.5x11.pdf. [Consulta: 20 marzo 2018].
18) A fifth amendment for the Declaration of Helsinki. Lancet 2000; 356(9236):1123. doi: 10.1016/S0140-6736(00)02746-X.
19) Asociación Médica Mundial, Declaración de Taipei: investigación sobre las bases de datos, datos masivos y biobancos. Taipei: AMM, 2016. Disponible en: https://www.wma.net/es/ que-hacemos/etica-medica/declaracion-de-taipei/. [Consulta: 30 junio 2022].
20) Gewandter J, Dworkin R, Turk D, Devine E, Hewitt D, Jensen M, et al. Improving Study Conduct and Data Quality in Clinical Trials of Chronic Pain Treatments: IMMPACT recommendations. J Pain 2020; 21(9-10):931-42. doi: 10.1016/j. jpain.2019.12.003.
21) Smith S, Dworkin R, Turk D, McDermott M, Eccleston C, Farrar J, et al. Interpretation of chronic pain clinical trial outcomes: IMMPACT recommended considerations. Pain 2020; 161(11):2446-61. doi: 10.1097/j.pain.0000000000001952.
22) Galzerano J, Orellana C, Ríos M, Coitiño A, Velázquez P, Cannabis medicinal como recurso terapeútico: estudio preliminar. Rev Méd Urug 2019; 35(4):289-97. doi: 10.29193/ RMU.35.4.5.
23) Nunberg H, Kilmer B, Pacula R, Burgdorf J. An analysis of applicants presenting to a medical marijuana specialty practice in California. J Drug Policy Anal 2011; 4(1):1. doi: 10.2202/1941-2851.1017.
24) Fitzcharles M, Baerwald C, Ablin J, Häuser W. Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis): a systematic review of randomized controlled trials. Schmerz 2016; 30(1):47-61. doi: 10.1007/s00482-015-0084-3.
25) Romero-Sandoval E, Fincham J, Kolano A, Sharpe B, Alvarado-Vázquez P. Cannabis for chronic pain: challenges and considerations. Pharmacotherapy 2018; 38(6):651-62. doi: 10.1002/phar.2115.
26) Chang Y, Zhu M, Vannabouathong C, Mundi R, Chou R, Bhandari M. Medical cannabis for chronic noncancer pain: a systematic review of health care recommendations. Pain Res Manag 2021; 2021:8857948. doi: 10.1155/2021/8857948.
27) Maayah Z, Takahara S, Ferdaoussi M, Dyck J. The molecular mechanisms that underpin the biological benefits of full-spectrum cannabis extract in the treatment of neuropathic pain and inflammation. Biochim Biophys Acta Mol Basis Dis 2020; 1866(7):165771. doi: 10.1016/j.bbadis.2020.165771.
28) Gertsch J, Leonti M, Raduner S, Racz I, Chen J, Xie X, et al. Beta-caryophyllene is a dietary cannabinoid. Proc Natl Acad Sci USA 2008; 105(26):9099-104. doi: 10.1073/ pnas.0803601105.
29) Bhaskar A, Bell A, Boivin M, Briques W, Brown M, Clarke H, et al. Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Cannabis Res 2021; 3(1):22. doi:19.1186/ s42238-021-00073-1.
30) Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000; 32(4):1008-15. doi: 10.1046/j.1365-2648.2000.t01-1-01567.x.
31) Ware M, Wang T, Shapiro S, Collet J. Cannabis for the management of pain: assessment of safety study (COMPASS). J Pain 2015; 16(12):1233-42. doi: 10.1016/j.jpain.2015.07.014.
Published
2023-10-06
How to Cite
1.
Galzerano J, Ríos Pérez MD, Velázquez PM. Clinical benefit of cannabinoids to treat chronic non-cancer pain. Rev. Méd. Urug. [Internet]. 2023Oct.6 [cited 2024Nov.24];39(3):e201. Available from: https://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/1040
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