Medical Marijuana & Chronic Pain

Survey data and several recent FDA-designed chemical trials have indicated that inhaled marijuana could significantly alleviate neuropathic pain. A pair of randomized, placebo-controlled clinical trials had demonstrated that neuropathy in patients with HIV could be reduced with cannabis by more than 30 percent compared to placebo.

A 2007 University of California at San Diego double-blind, placebo-controlled trial reported that inhaled cannabis has the potential of significantly reducing capsaicin-induced pain in healthy volunteers. Both high and low doses of inhaled cannabis reduced neuropathic pain of diverse causes in subjects unresponsive to standard pain therapies, according to a 2008 University of California at Davis double-blind, randomized clinical trial. A 2010 McGill University study has revealed that smoked cannabis significantly improved measures of pain, sleep quality and anxiety in participants with refractory pain for which conventional therapies had failed.

In 2008, investigators at the University of Milan concluded: “[T]he use of a standardized extract of Cannabis sativa … evoked a total relief of thermal hyperalgesia, in an experimental model of neuropathic pain, … ameliorating the effect of single cannabinoids,” investigators concluded. … “Collectively, these findings strongly support the idea that the combination of cannabinoid and non-cannabinoid compounds, as present in [plant-derived] extracts, provide significant advantages in the relief of neuropathic pain compared with pure cannabinoids alone.”

References:
[1] New York Times. October 21, 1994. “Study says 1 in 5 Americans suffers from chronic pain.”
[2] Cone et al. 2008. Urine drug testing of chronic pain patients: licit and illicit drug patterns. Journal of Analytical Toxicology 32: 532-543.
[3] Abrams et al. 2007. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68: 515-521.
[4] Ellis et al. 2008. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 34: 672-80.
[5] Wallace et al. 2007. Dose-dependent effects of smoked cannabis on Capsaicin-induced pain and hyperalgesia in healthy volunteers Anesthesiology 107: 785-796.
[6] Wilsey et al. 2008. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. Journal of Pain 9: 506-521.
[7] Ware et al. 2010. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 182: 694-701.
[8] Comelli et al. 2008. Antihyperalgesic effect of a Cannabis sativa extract in a rat model of neuropathic pain. Phytotherapy Research 22: 1017-1024.
[9] Johnson et al. 2009. Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety and tolerability of THC: CBD extract in patients with intractable cancer-related pain. Journal of Symptom Management 39: 167-179.
[10] University of San Diego Health Sciences, Center for Medicinal Cannabis Research. February 11, 2010. Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding.

Marijuana And Multiple Sclerosis

A chronic degenerative disease of the central nervous system, multiple sclerosis (MS), causes inflammation, muscular weakness, and a loss of motor coordination. Over a period of time, patients afflicted with the disease typically become permanently disabled and the disease could be fatal in some cases. According to the US National Multiple Sclerosis Society, nearly 200 people are diagnosed every week with the disease that often strikes those 20 to 40 years of age.

Clinical and anecdotal reports of the ability of cannabinoids to minimize MS-related symptoms such as pain, spasticity, depression, fatigue, and incontinence are plentiful in the scientific literature. In 2008, investigators at the University of California at San Diego reported inhaled cannabis significantly reduced objective measures of pain intensity and spasticity in patients with MS in a placebo-controlled, randomized clinical trial. Investigators concluded that “smoked cannabis was superior to placebo in reducing spasticity and pain in patients with multiple sclerosis and provided some benefit beyond currently prescribed treatment.”

It should therefore comes as no surprise that patients with multiple sclerosis typically report engaging in cannabis therapy, with one survey indicating that almost one in two MS patients use the drug therapeutically.

Investigators at the University College of London’s Institute of Neurology, writing in the July 2003 issue of the journal Brain, reported that administration of the synthetic cannabinoid agonist WIN 55,212-2 provided “significant neuroprotection” in an animal model of multiple sclerosis. “The results of this study are important because they suggest that in addition to symptom management, … cannabis may also slow the neurodegenerative processes that ultimately lead to chronic disability in multiple sclerosis and probably other disease,” researchers concluded.

Investigators at the Netherland’s Vrije University Medical Center, Department of Neurology, also reported that oral THC could boost immune function in patients with multiple sclerosis.

References:
[1] Chong et al. 2006. Cannabis use in patients with multiple sclerosis. Multiple Sclerosis 12: 646-651.
[2] Rog et al. 2005. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 65: 812-819.
[3] Wade et al. 2004. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Multiple Sclerosis 10: 434-441.
[4] Brady et al. 2004. An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Multiple Sclerosis 10: 425-433.
[5] Vaney et al. 2004. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Multiple Sclerosis 10: 417-424.
[6] Zajicek et al. 2003. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis: multicentre randomized placebo-controlled trial [PDF]. The Lancet 362: 1517-1526.
[7] Page et al. 2003. Cannabis use as described by people with multiple sclerosis [PDF]. Canadian Journal of Neurological Sciences 30: 201-205.
[8] Wade et al. 2003. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clinical Rehabilitation 17: 21-29.
[9] Consroe et al. 1997. The perceived effects of smoked cannabis on patients with multiple sclerosis. European Journal of Neurology 38: 44-48.
[10] Meinck et al. 1989. Effects of cannabinoids on spasticity and ataxia in multiple sclerosis. Journal of Neurology 236: 120-122.
[11] Ungerleider et al. 1987. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. Advances in Alcohol and Substance Abuse 7: 39-50.
[12] Denis Petro. 1980. Marijuana as a therapeutic agent for muscle spasm or spasticity. Psychosomatics 21: 81-85.
[13] Jody Corey-Bloom. 2010. Short-term effects of cannabis therapy on spasticity in multiple sclerosis. In: University of San Diego Health Sciences, Center for Medicinal Cannabis Research. Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding. op. cit.
[14] Clark et al. 2004. Patterns of cannabis use among patients with multiple sclerosis. Neurology 62: 2098-2010.
[15] Reuters News Wire. August 19, 2002. “Marijuana helps MS patients alleviate pain, spasms.”
[16] Pryce et al. 2003. Cannabinoids inhibit neurodegeneration in models of multiple sclerosis. Brain 126: 2191-2202.
[17] Killestein et al. 2003. Immunomodulatory effects of orally administered cannabinoids in multiple sclerosis. Journal of Neuroimmunology 137: 140-143.
[18] Wade et al. 2006. Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms of multiple sclerosis. Multiple Sclerosis 12: 639-645.
[19] Rog et al. 2007. Oromucosal delta-9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clinical Therapeutics 29: 2068-2079.
[20] Canada News Wire. June 20, 2005. “Sativex: Novel cannabis derived treatment for MS pain now available in Canada by prescription.”
[21] Daily Finance. June 22, 2010. “U.K. approves pot-based drug.”

[22] GW Pharmaceuticals press release. July 28, 2010. ” Spanish Sativex approval.”

[23] http://www.gwpharm.com/Sativex6.aspx

Research Shows Marijuana Has Promise

Marijuana or cannabis has the potential of a promising treatment for specific, pain-related medical conditions, according to California researchers who presented an update of their findings to the California Legislature and also released them to the public.

‘I think the evidence is getting better and better that marijuana, or the constituents of cannabis, are useful at least in the adjunctive treatment of neuropathy,” Igor Grant, MD, executive vice-chairman of the department of psychiatry at the University of California San Diego School of Medicine and director of the Center for Medicinal Cannabis Research at the University of California.

”We don’t know if it’s a front-line treatment. I’m hoping the results of our studies will prompt larger-scale studies that involve a much more varied population.” ”This [report given to the Legislature] sets the stage of larger-scale studies,” he says.

The researchers said in the report that five studies that have been published in peer-reviewed medical journals demonstrate the usefulness of marijuana for pain-related conditions.

•    According to a study appearing in Neuropsychopharmacology, pain in HIV patients can be significantly reduced with smoked cannabis.

•    A study on the similar lines appeared in the journal Neurology and indicated that cannabis offered more benefits than placebo.

•    A study appearing in the Journal of Pain suggested that marijuana was useful for reducing neuropathic pain in people suffering spinal cord injury and other conditions.

•    A study that was published in Anesthesiology suggested that medium doses of marijuana may be effective in minimizing pain perception and it was found that the higher the dose, the greater the pain relief.

•    In a study appearing in the Clinical Pharmacology & Therapeutics, it was revealed that vaporized marijuana can be safe.

All in all, the five studies suggested that the use of marijuana has merit and marijuana could be an effective drug for treating specific, pain-related medical conditions.

Cannabis influences blood levels of appetite hormones in HIV patients

Scientists of the Center for Medicinal Cannabis Research (CMCR) of the University of California in San Diego, USA, have investigated among others the effects of cannabis on appetite hormones in the course of a placebo-controlled trial with HIV patients, who suffered from pain.

Twenty-eight patients had been included to investigate the effects of smoked cannabis on their pain in the original already published clinical study. Seven of these patients selected for investigating the blood levels of the hormones leptin, ghrelin, peptide YY, and insulin after exposition with cannabis and placebo in a cross-over design.

Cannabis administration, compared to placebo, was associated with significant increases in plasma levels of ghrelin and leptin, and decreases in peptide YY. It however did not significantly influence insulin levels. Authors stated that “cannabis-related changes in these hormones had a magnitude similar to what has been observed with food intake over the course of a day in normal volunteers, suggesting physiological relevance. “They concluded that “these findings are consistent with modulation of appetite hormones mediated through endogenous cannabinoid receptors, independent of glucose metabolism.”

Reference:

Riggs PK, Vaida F, Rossi SS, Sorkin LS, Gouaux B, Grant I, Ellis RJ. A pilot study of the effects of cannabis on appetite hormones in HIV-infected adult men. Brain Res. 2011 Nov 7. [in press])

Same Level Of THC and Fewer Toxins with Marijuana Vaporizer

marijuana-vaporizerAccording to researchers from the University of California San Francisco, a smokeless cannabis-vaporizing device delivers the same level of active therapeutic chemical and produces the same biological effect as smoking cannabis.

Results of a UCSF study that focuses on delivery of the active ingredient delta-9-tertrahydrocannibinol, or THC, are reported in the online issue of the journal “Clinical Pharmacology and Therapeutics.”

“We showed in a recent paper in the journal ‘Neurology’ that smoked cannabis can alleviate the chronic pain caused by HIV-related neuropathy, but a concern was expressed that smoking cannabis was not safe. This study demonstrates an alternative method that gives patients the same effects and allows controlled dosing but without inhalation of the toxic products in smoke,” said study lead author Donald I. Abrams, MD, UCSF professor of clinical medicine.

The team of researchers looked at the effectiveness of a device that heats cannabis to a temperature between 180 and 200 degrees C, just short of combustion, which occurs at 230 degrees C. Eighteen individuals were enrolled as inpatients for six days under supervision in the General Clinical Research Center at San Francisco General Hospital Medical Center. The participants received three different strengths of cannabis on different days by two delivery methods–smoking or vaporization–three times a day, under the study protocol.

THC plasma concentrations were measured along with the exhaled levels of carbon monoxide, or CO, which served as a marker for the many other combustion-generated toxins inhaled when smoking.

“Using CO as an indicator, there was virtually no exposure to harmful combustion products using the vaporizing device. Since it replicates smoking’s efficiency at producing the desired THC effect using smaller amounts of the active ingredient as opposed to pill forms, this device has great potential for improving the therapeutic utility of THC,” said study co-author Neal L. Benowitz, MD, UCSF professor of medicine, psychiatry and biopharmaceutical sciences.

Benowitz added that pills tend to provide patients with more THC than they need for optimal therapeutic effect and increase side effects.

“By a significant majority, patients preferred vaporization to smoking, choosing the route of delivery with the fewest side effects and greatest efficiency,” said Benowitz.

Co-authors include Cheryl A. Jay, MD, UCSF neurology; and Starley B. Shade, MPH; Hector Vizoso, RN; and Mary Ellen Kelly, MPH, UCSF Positive Health Program at San Francisco General Hospital Medical Center.

The study was funded by the University of California’s Center for Medicinal Cannabis Research.

Reference:

University of California – San Francisco

Spasticity In Multiple Sclerosis Marijuana Treatment

Multiple-Sclerosis-MarijuanaAccording to recent clinical and anecdotal reports, cannabinoids have the ability to minimize symptoms of multiple sclerosis like pain, depression, fatigue, spasticity and incontinence.

The benefits of cannabis in treating multiple sclerosis (MS) are thoroughly discussed in the scientific literature since the last two decades. According to investigators at the University of California at San Diego, inhaled cannabis was useful in significantly reducing objective measures of pain intensity and spasticity in patients with multiple sclerosis in a placebo-controlled, randomized clinical trial.

It was concluded by the involved researchers that “smoked cannabis was superior to placebo in reducing spasticity and pain in patients with multiple sclerosis and provided some benefit beyond currently prescribed treatment.” The fact that patients with multiple sclerosis typically report engaging in cannabis therapy is therefore not surprising by any standards.

Multiple sclerosis (MS) is a chronic degenerative disease of the central nervous system that leads to muscular weakness, inflammation, and loss of motor coordination. Patients suffering from this complication usually become permanently disabled and the disease can be fatal in some cases. It is worth a mention that about 200 people (mostly in the age group of 20-40 years) are diagnosed every week with the disease, according to the US National Multiple Sclerosis Society.

Investigators at the University College of London’s Institute of Neurology reported in an issue of the journal Brain that cannabinoids could inhibit progression of the disease in addition to offering symptom management. Administration of the synthetic cannabinoid agonist WIN 55,212-2 provided “significant neuroprotection” in an animal model of multiple sclerosis. “The results of this study are important because they suggest that in addition to symptom management, … cannabis may also slow the neurodegenerative processes that ultimately lead to chronic disability in multiple sclerosis and probably other disease,” researchers concluded.

The administration of oral THC can boost immune function in patients with MS, according to investigators at the Netherland’s Vrije University Medical Center, Department of Neurology. “These results suggest pro-inflammatory disease-modifying potential of cannabinoids [for] MS,” they concluded.

Health regulators in Canada, the United Kingdom, Spain, and New Zealand have approved the prescription use of plant cannabis extracts in recent years for treating symptoms of multiple sclerosis.

Reference:

  • Chong et al. 2006. Cannabis use in patients with multiple sclerosis. Multiple Sclerosis 12: 646-651.
  • Rog et al. 2005. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 65: 812-819.
  • Wade et al. 2004. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Multiple Sclerosis 10: 434-441.
  • Brady et al. 2004. An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Multiple Sclerosis 10: 425-433.
  • Vaney et al. 2004. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Multiple Sclerosis 10: 417-424.
  • Vaney et al. 2004. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Multiple Sclerosis 10: 417-424.