cannabidiol and Cancer-Pain

Topics: Aged; Anorexia; Antineoplastic Agents; Cancer Pain; Cannabidiol; Cannabinoid Receptor Agonists; Cannabinoids; Dizziness; Dose-Response Relationship, Drug; Dronabinol; Humans; Middle Aged; Multiple Sclerosis; Nausea; Neurodegenerative Diseases; Pain; Perceptual Disorders; Randomized Controlled Trials as Topic; Regression Analysis; Self Report; Vomiting

To describe marijuana's clinical role for urologic symptoms.. Studies related to marijuana, voiding dysfunction, lower urinary tract symptoms (LUTS), and pain through January 2019 from PubMed were evaluated for relevance and quality.. Forty-eight studies were reviewed. Cannabinoids have mixed efficacy for neurogenic LUTS and little evidence for non-neurogenic LUTS, chronic non-cancer-related and perioperative pain. For cancer-related pain, high-level studies demonstrate cannabinoids are well-tolerated with unclear benefit.. Cannabinoids appear well-tolerated in the short-term, but their efficacy and long-term impact is unproven and unknown in urologic discomfort. Cannabinoids for urologic symptoms should be further explored with well-designed randomized controlled trials.

Topics: Cancer Pain; Cannabidiol; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Chronic Pain; Cystitis, Interstitial; Dronabinol; Drug Combinations; Humans; Lower Urinary Tract Symptoms; Male; Medical Marijuana; Multiple Sclerosis; Pain, Procedural; Pelvic Pain; Urinary Incontinence

An increasing number of patients are turning to cannabis and cannabinoids for management of their palliative and nonpalliative cancer pain and other cancer-related symptoms. Canadians have a legal framework for access to medical cannabis, which provides a unique perspective in a setting lacking robust clinical evidence. This review seeks to delineate the role of cannabis and cannabinoids in cancer pain management and offers insight into the Canadian practice.. A cohort study using nabiximols on advanced cancer pain in patients already optimized on opioids, over 3 weeks, demonstrated improved average pain score. A large observational study of cancer patients using cannabis over 6 months demonstrated a decreased number of patients with severe pain and decreased opioid use, whereas the number of patients reporting good quality of life increased.. Good preclinical animal data and a large body of observational evidence point to the potential efficacy of cannabinoids for cancer pain management. However, there are relatively weak data pointing to clinical efficacy from clinical trial data to date. In Canada, the burgeoning cannabis industry has driven the population to embrace a medicine before clinical evidence. There remains a need for high-quality randomized controlled trials to properly assess the effectiveness and safety of medical cannabis, compared with placebo and standard treatments for cancer-related symptoms.

Topics: Analgesics, Opioid; Canada; Cancer Pain; Cannabidiol; Chronic Pain; Clinical Trials as Topic; Dronabinol; Drug Combinations; Drug Evaluation, Preclinical; Humans; Medical Marijuana; Pain Management; Palliative Care; Quality of Life; Severity of Illness Index

Cannabidiol (CBD) oils are low tetrahydrocannabinol products derived from Cannabis sativa that have become very popular over the past few years. Patients report relief for a variety of conditions, particularly pain, without the intoxicating adverse effects of medical marijuana. In June 2018, the first CBD-based drug, Epidiolex, was approved by the US Food and Drug Administration for treatment of rare, severe epilepsy, further putting the spotlight on CBD and hemp oils. There is a growing body of preclinical and clinical evidence to support use of CBD oils for many conditions, suggesting its potential role as another option for treating challenging chronic pain or opioid addiction. Care must be taken when directing patients toward CBD products because there is little regulation, and studies have found inaccurate labeling of CBD and tetrahydrocannabinol quantities. This article provides an overview of the scientific work on cannabinoids, CBD, and hemp oil and the distinction between marijuana, hemp, and the different components of CBD and hemp oil products. We summarize the current legal status of CBD and hemp oils in the United States and provide a guide to identifying higher-quality products so that clinicians can advise their patients on the safest and most evidence-based formulations. This review is based on a PubMed search using the terms CBD, cannabidiol, hemp oil, and medical marijuana. Articles were screened for relevance, and those with the most up-to-date information were selected for inclusion.

Topics: Attitude of Health Personnel; Cancer Pain; Cannabidiol; Cannabis; Chronic Pain; Drug Approval; Female; Humans; Male; Medical Marijuana; Oils; Practice Guidelines as Topic; United States; United States Food and Drug Administration

Despite remaining one of the most widely abused drugs worldwide, Cannabis sativa exhibits remarkable medicinal properties. The phytocannabinoids, cannabidiol and Δ-9-tetrahydrocannabinol, reduce nausea and vomiting, particularly during chemotherapy. This is attributed to their ability to reduce the release of serotonin from enterochromaffin cells in the small intestine, which would otherwise orchestrate the vomiting reflex. Although there are many preclinical and clinical studies on the effects of Δ-9-tetrahydrocannabinol during nausea and vomiting, little is known about the role that cannabidiol plays in this scenario. Since cannabidiol does not induce psychotropic effects, in contrast to other cannabinoids, its use as an anti-emetic is of great interest. This review aims to summarize the available literature on cannabinoid use, with a specific focus on the nonpsychotropic drug cannabidiol, as well as the roles that cannabinoids play in preventing several other adverse side effects of chemotherapy including organ toxicity, pain and loss of appetite.

Topics: Analgesics, Non-Narcotic; Antiemetics; Antineoplastic Agents; Appetite; Appetite Stimulants; Cancer Pain; Cannabidiol; Cannabis; Feeding and Eating Disorders; Humans; Nausea; Neoplasms; Vomiting

Cannabinoids have a long record of recreational and medical use and become increasingly approved for pain therapy. This development is based on preclinical and human experimental research summarized in this review. Cannabinoid CB. Cannabinoids consistently produced antinociceptive effects in preclinical models, whereas they heterogeneously influenced the perception of experimentally induced pain in humans and did not provide robust clinical analgesia, which jeopardizes the translation of preclinical research on cannabinoid-mediated antinociception into the human setting.

Topics: Analgesia; Analgesics; Animals; Cancer Pain; Cannabidiol; Cannabinoid Receptor Agonists; Cannabinoids; Dronabinol; Humans; Mice; Mice, Knockout; Neuralgia; Nociception; Pain Management; Receptor, Cannabinoid, CB1; Retrospective Studies

Prior Phase 2/3 studies found that cannabinoids might provide adjunctive analgesia in advanced cancer patients with uncontrolled pain.. Phase 3, double-blind, randomized, placebo-controlled trial in patients with advanced cancer and average pain Numerical Rating Scale scores ≥4 and ≤8 despite optimized opioid therapy. Patients randomized to nabiximols (n = 199) or placebo (n = 198) self-titrated study medications over a two-week period, followed by a three-week treatment period at the titrated dose.. Median percent improvements in average pain Numerical Rating Scale score from baseline to end of treatment in the nabiximols and placebo groups were 10.7% vs. 4.5% (P = 0.0854) in the intention-to-treat population (primary variable) and 15.5% vs. 6.3% (P = 0.0378) in the per-protocol population. Nabiximols was statistically superior to placebo on two of three quality-of-life instruments at Week 3 and on all three at Week 5. In exploratory post hoc analyses, U.S. patients, but not patients from the rest of the world, experienced significant benefits from nabiximols on multiple secondary endpoints. Possible contributing factors to differences in nabiximols efficacy include: 1) the U.S. participants received lower doses of opioids at baseline than the rest of the world and 2) the subgroups had different distribution of cancer pain types, which may have been related to differences in pathophysiology of pain. The safety profile of nabiximols was consistent with earlier studies.. Although not superior to placebo on the primary efficacy endpoint, nabiximols had benefits on multiple secondary endpoints, particularly in the U.S.. Nabiximols might have utility in patients with advanced cancer who receive a lower opioid dose, such as individuals with early intolerance to opioid therapy.

Topics: Analgesics; Analgesics, Opioid; Cancer Pain; Cannabidiol; Chemotherapy, Adjuvant; Chronic Pain; Double-Blind Method; Dronabinol; Drug Combinations; Female; Humans; Male; Middle Aged; Oral Sprays; Pain Measurement; Quality of Life; Treatment Outcome

Topics: Cancer Pain; Cannabidiol; Cannabis; Humans; Medical Marijuana; Neoplasms; Pain

Topics: Anxiety; Cancer Pain; Cannabidiol; Cross-Sectional Studies; Humans; Internet; Plant Oils; Public Opinion

The use of cannabidiol products in pediatric patients is becoming more frequent because of the increased ease of accessibility. This case report illustrates the potential for cannabidiol to interact with stable medication regimens. A 13-year-old girl with metastatic cancer and chronic pain presented with increased sleepiness and fatigue. She had been started on 7.5 mg of methadone by mouth twice daily 4 months earlier. Unbeknownst to her physicians, her parents had commenced her on cannabidiol and subsequently increased the dose leading up to her presentation, thinking it would result in tumor shrinkage. The initial serum methadone level was 271 ng/mL, which decreased to 125 ng/mL 14 days after discontinuing cannabidiol. The reduced serum methadone level coincided with improved sleepiness and fatigue. Cannabidiol inhibits CYP3A4 and CYP2C19, both of which are involved in the metabolism of methadone. Pediatricians should be aware of this potential interaction and inquire if their patients are receiving cannabidiol.

Topics: Adolescent; Analgesics, Opioid; Cancer Pain; Cannabidiol; Drug Interactions; Drug Therapy, Combination; Fatigue; Female; Humans; Methadone

Topics: Animals; Cancer Pain; Cannabidiol; Cannabinoids; Cannabis; Dronabinol; Drug Synergism; Humans; Medical Marijuana; Mice; Reproducibility of Results; Terpenes