humulene and Pain--Intractable

This article discusses current trends in managing cancer pain, with specific regard to opioid transmission, descending pathway inhabitation, and ways to facilitate the endogenous antinociceptive chemicals in the human body. Various techniques for opioid and nonopioid control of potential pain situations of patients with cancer are discussed. The benefits of using pharmacogenetics to assess the appropriate medications are addressed. Finally, specific treatment of abdominal cancer pain using radiofrequency lesioning is discussed.

Topics: Analgesics, Opioid; Cannabis; Female; Humans; Injections, Spinal; Male; Neoplasms; Pain Management; Pain Measurement; Pain, Intractable; Prognosis; Risk Assessment; Severity of Illness Index; Transcranial Magnetic Stimulation; Treatment Outcome

Cannabis preparations have been used as a remedy for thousands of years in traditional medicine. Clinical use of cannabinoid substances is restricted, due to legal and ethical reasons, as well as limited evidence showing benefits.. To assess the efficacy and harms of cannabis preparations in the treatment of chronic pain.. Systematic review and meta-analysis of double-blind randomized controlled trials that compared any cannabis preparation to placebo among subjects with chronic pain. An electronic search was made in Medline/Pubmed, Embase, and The Cochrane Controlled Trials Register (TRIALS CENTRAL) of all literature published until February 2008, as well as specific web pages devoted to cannabis. Studies were cross-checked, selected, and assessed.. Eighteen trials were included. The efficacy analysis (visual analog scales) displayed a difference in standardized means in favor of the cannabis arm of -0.61 (-0.84 to -0.37), with statistical homogeneity (I(2) = 0.0%; P = 0.50). For the analysis of harms, the following Odds Ratios (OR) and number needed to harm (NNH) were obtained: for events linked to alterations to perception, OR: 4.51 (3.05-6.66), NNH: 7 (6-9); for events affecting motor function, 3.93 (2.83-5.47), NNH: 5 (4-6); for events that altered cognitive function, 4.46 (2.37-8.37), NNH: 8 (6-12).. Currently available evidence suggests that cannabis treatment is moderately efficacious for treatment of chronic pain, but beneficial effects may be partially (or completely) offset by potentially serious harms. More evidence from larger, well-designed trials is needed to clarify the true balance of benefits to harms.

Topics: Analgesics; Cannabinoids; Cannabis; Chronic Disease; Clinical Trials as Topic; Humans; Pain, Intractable; Phytotherapy; Receptors, Cannabinoid; Risk Assessment; Treatment Outcome

Cannabis is the most widely consumed illicit drug in the United States. Its use, particularly in early initiates, is associated with subsequent development of other drug and alcohol use disorders.. The authors examined the prevalence of cannabis use and the association between cannabis use and aberrant opioid-related behaviors in patients prescribed chronic opioid therapy for persistent pain.. PubMed was queried for studies of chronic opioid therapy in which aberrant opioid-related behaviors were quantitatively examined and in which cannabis use data (as determined by cannabinoid-positive urine drug tests) were extricable from that of other substances of abuse.. The prevalence of cannabis use among patients prescribed chronic opioid therapy in these studies ranged from 6.2% to 39%, compared with 5.8% in the general United States population. Furthermore, cannabis use in chronic opioid patients shows statistically significant associations with present and future aberrant opioid-related behaviors.. Cannabis use is prevalent in patients prescribed chronic opioid therapy and is associated with opioid misuse. Further research is necessary to clarify the strength and the nature of the association between cannabis use and opioid misuse, and to address additional questions about the consequences of cannabis use in the context of chronic opioid therapy.

Topics: Analgesics, Opioid; Cannabis; Chronic Disease; Comorbidity; Drug Prescriptions; Humans; Marijuana Abuse; Opioid-Related Disorders; Pain, Intractable; Prevalence; United States

Despite the progress that has occurred in recent years in the development of therapy, there is still a need for effective and potent analgesics, especially for the treatment of chronic pain. One of the most important analgesic drugs employed in clinical practice today continues to be the alkaloid morphine. In this review, emphasis will be given to the important contribution and the history of Papaver somniferum, Salix species, Capsicum species and Cannabis sativa in the development of new analgesics and their importance in the understanding of the complex pathways related to electrophysiological and molecular mechanisms associated with pain transmission. Recently discovered antinociceptive substances include alkaloids, terpenoids and flavonoid. Plant-derived substances have, and will certainly continue to have, a relevant place in the process of drug discovery, particularly in the development of new analgesic drugs.

Topics: Analgesics; Cannabis; Capsicum; Humans; Pain, Intractable; Papaver; Phytotherapy; Plant Extracts; Plants, Medicinal; Salix; Structure-Activity Relationship

This pilot study aimed to assess the safety, tolerability, pharmacokinetics and exploratory analgesic effect of a novel water-soluble oro-buccal nanoparticle spray of a cannabis-based medicine (MDCNS-01) in patients with advanced incurable malignancy with unrelieved pain from opioid analgesic. The study was a non-blinded single arm 2 stage study. Stage I was a single escalating dose (n = 5) [2.5 mg Δ9-THC and 2.5 mg CBD) versus a 3-fold escalated dose. Stage II was an up-titrated dose in patients with advanced cancers and intractable pain (n = 25). During Stage I with an increased cannabis-based medicine dose, maximum observed plasma concentrations of cannabinoids were dose dependant. The water-soluble formulation in the current study resulted in a higher median (min, max) systemic exposure of Δ9-THC than CBD (AUC from 2.5 mg each of Δ9-THC and CBD, was 1.71 ng mL.h-1 (1.1, 6.6) and 0.65 ng mL.h-1 (0.49, 4.1), respectively). During stage II a subgroup of patients diagnosed with breast and prostate cancers with bone metastases, had the highest mean pain score improvement from baseline of 40% (unadjusted) and 33% (adjusted for rescue medication use). For all patients the most reported adverse events were mild or moderate drowsiness affecting 11 (44%) and 4 (6%) patients, respectively, and nausea and vomiting that affected 18 (72%) patients. The water-soluble cannabis-based medicine provided acceptable bioavailability for Δ9-THC/CBD, appeared safe and tolerable in advanced incurable cancers with uncontrolled pain with preliminary evidence of analgesic efficacy.

Topics: Analgesics; Analgesics, Opioid; Cannabidiol; Cannabinoids; Cannabis; Dronabinol; Humans; Male; Nanoparticles; Neoplasms; Pain, Intractable; Pilot Projects; Water

Topics: Analgesics; Cannabis; Drug Therapy, Combination; Female; Humans; Ketamine; Middle Aged; Neuralgia; Pain, Intractable; Ulnar Nerve Compression Syndromes

Topics: California; Cannabis; Drug and Narcotic Control; Federal Government; Humans; Pain, Intractable; Phytotherapy; Plants, Medicinal; State Government; Supreme Court Decisions; United States

During the last few years, the debate over the use of marijuana for medical purposes has moved from the legislative arena into the public forum. Thirty six states and the District of Columbia have had statutes that address the medical utility of marijuana within the past 26 years. However, several of those states have either repealed the laws or allowed them to sunset. Since 1996, 11 states have enacted laws that allow individuals to use marijuana with a doctor's consent.

Topics: Analgesics, Non-Narcotic; Cannabinoids; Cannabis; Dronabinol; Drug and Narcotic Control; Federal Government; Health Policy; Humans; Legislation, Drug; Marijuana Smoking; Pain, Intractable; Psychotropic Drugs; State Government; United States

The Supreme Court's recent decisions in United States v. Lopez and United States v. Morrison articulate a vision of federalism under which Congress's regulatory authority under the Commerce Clause is severely limited in favor of returning traditional areas of state concern, particularly criminal law enforcement, to local or state control. The Court's decisions in these cases coincide with ballot initiatives legalizing the medical use of marijuana garnering a majority of the vote in California, Arizona, Alaska, Colorado, Nevada, Oregon, Washington, Maine, and Washington D.C. Those who use marijuana for medical purposes under sanction of state law, however, still face the threat of federal prosecution under the Controlled Substances Act. Medical marijuana proponents have traditionally, and unsuccessfully, contested federal prosecution using individual rights arguments under theories of equal protection or substantive due process. This Comment argues that after Lopez and Morrison, the federal government's authority to regulate intrastate use of marijuana for medicinal purposes is not the foregone conclusion it once was. The author suggests that proponents of medical marijuana use should invoke the federalism arguments of Lopez and Morrison and argue for state legislative independence from the federal government on this issue.

Topics: Cannabis; Drug Approval; Humans; Jurisprudence; Pain, Intractable; Phytotherapy; State Government; United States

Marijuana has been used for recreational, ceremonial, and medicinal purposes for thousands of years. Because marijuana is classified as an illegal drug and, little research has been done on its potential medical benefits. In May 1999, it became legal for the National Institute on Drug Abuse (NIDA), the only legal source for marijuana, to sell marijuana to privately funded researchers. This move may make research on marijuana more feasible. Many people believe marijuana is effective in treating pain, AIDS wasting syndrome (AWS), and nausea and vomiting, among other ailments. However, even doctors who recommend marijuana use do not advise smoking it. Other ways of taking marijuana, as well as possible side effects of marijuana use, are discussed.

Topics: Cannabis; HIV Wasting Syndrome; Humans; Nausea; Pain, Intractable; Vomiting

In 1998, Washington State passed a law, Initiative 692 (I-692), that gives individuals who are charged with possession of marijuana for medical purposes a possible affirmative defense. The law lets these individuals provide a note from their doctor or a copy of their medical records stating they have a condition that may benefit from the use of marijuana. I-692 does not legalize the medical use of marijuana and does not affect Federal law, which makes obtaining, possessing, and growing marijuana illegal. The Washington law limits the amount of marijuana a patient can possess to a 60-day supply and defines the conditions for which medical marijuana may be used. These conditions include HIV, cancer, multiple sclerosis, and epilepsy.

Topics: Cannabis; Epilepsy; Glaucoma; HIV Infections; Humans; Legislation, Drug; Multiple Sclerosis; Muscle Spasticity; Neoplasms; Pain, Intractable; United States