Marijuana Eases Neuropathic Pain
Medical News: Marijuana Eases Neuropathic Pain - in Neurology, Pain Management from MedPage Today
Smoking marijuana modestly reduced pain and other symptoms of chronic neuropathic pain, results of a small randomized, placebo-controlled trial showed.
The most potent dose used reduced average daily pain scores by 0.7 points on an 11-point scale (5.4 versus 6.1 with placebo, 95% confidence interval for difference 0.02 to 1.4), according to Mark A. Ware, MBBS, of McGill University in Montreal, and colleagues.
Those who smoked weed with 9.4% of the active ingredient tetrahydrocannabinol (THC) also reported sleeping better, the researchers reported online in CMAJ.
These results are important in light of the fact that patients who hear about pain relief from ongoing publicity about medical marijuana have had only a "trickle" of evidence to prove it, explained Henry J. McQuay, DM, of Oxford University, in an accompanying editorial.
"If medical cannabis is not available where a patient lives, then obtaining it will take the patient outside of the law, often for the first time in his or her life," he wrote. "Good evidence would at least buttress that decision."
These quality results along with three other trials of smoked cannabis for neuropathic pain do support an analgesic effect that, "though not great, may be of use to some patients," McQuay concluded.
This study does offer hope since few drugs have proven effective in these patients, commented Steven P. Cohen, MD, who as director of pain research at Walter Reed Army Medical Center in Washington, D.C., sees chronic pain in most of his patients with major war injuries.
However, the magnitude of the pain relief from smoking marijuana was less than expected compared with those few effective drugs, Cohen noted in an e-mail toMedPage Today and ABC News.
"When considered in the context of the higher incidence of minor and serious side effects with medical marijuana, cannabinoids should remain a third or fourth line drug for neuropathic pain," he wrote.
A bigger concern remains the "delivery system," which is substantially worse than tobacco cigarettes due to prolonged exposure to marijuana smoke from holding it in the lungs, commented Timothy A. Collins, MD, of Duke University's Pain and Palliative Care Clinic.
"As a physician, I don't think I would ever encourage a patient to smoke anything," he said in an e-mail.
Some states, such as California and New Jersey, have made marijuana "legal" for medical use, but this conflicts with federal law, and the U.S. Drug Enforcement Agency doesn't recognize its legality in those states.
"In states where there is no 'medical marijuana law' patients buy marijuana from criminals (drug dealers)," Collins added. "For pain patients this becomes a problem, as they are already on desirable prescription pain medications and subject to pressure to trade prescription narcotics for marijuana."
For the new study, Ware's group randomized 23 adults with chronic post-traumatic or postsurgical neuropathic pain to receive cannabis at a potency of 0%, 2.5%, 6% or 9.4% THC over four 14-day periods in a crossover trial.
The patients inhaled a single 25-mg dose through a pipe three times a day for the first five days in each cycle, then had a nine-day washout period before going on to the next randomized potency.
The intermediate doses yielded pain relief between the 0% THC placebo and the full-strength 9.4% dose. However, none were significantly effective compared with placebo.
Among the secondary effects, patients reported falling asleep more easily (P=0.001) and more quickly (P<0.001) with a greater feeling of drowsiness (P=0.003) and less wakefulness (P=0.01) while on 9.4% THC compared with placebo.
Mood and quality of life overall, though were unaffected.
Marijuana smoking appeared well tolerated, although the researchers noted that this may have been affected by the fact that most patients reported prior experience -- although not recent or extensive -- with the drug as an early ethics requirement to enter the study.
Patients rarely got high on the single hit they took through a pipe three times a day as part of the study, Ware's group noted.
None of the analgesic doses got plasma levels even halfway to the typical level seen among recreational users, they explained.
The most common drug-related adverse events associated with the most potent dose included headache, dry eyes, burning sensation in areas of neuropathic pain, dizziness, numbness, and cough.
Collins cautioned that marijuana bought on the street, not through medical-use prescription, varies widely in potency, making the study results of unclear generalizability to the average user.
Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ:cmaj.091414. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial -- Ware et al., 10.1503/cmaj.091414 -- Canadian Medical Association Journal
Background: Chronic neuropathic pain affects 1%-2% of the adult population and is often refractory to standard pharmacologic treatment. Patients with chronic pain have reported using smoked cannabis to relieve pain, improve sleep and improve mood.
Methods: Adults with post-traumatic or postsurgical neuropathic pain were randomly assigned to receive cannabis at four potencies (0%, 2.5%, 6% and 9.4% tetrahydrocannabinol) over four 14-day periods in a crossover trial. Participants inhaled a single 25-mg dose through a pipe three times daily for the first five days in each cycle, followed by a nine-day washout period. Daily average pain intensity was measured using an 11-point numeric rating scale. We recorded effects on mood, sleep and quality of life, as well as adverse events.
Results: We recruited 23 participants (mean age 45.4 [standard deviation 12.3] years, 12 women [52%]), of whom 21 completed the trial. The average daily pain intensity, measured on the 11-point numeric rating scale, was lower on the prespecified primary contrast of 9.4% v. 0% tetrahydrocannabinol (5.4 v. 6.1, respectively; difference = 0.7, 95% confidence interval [CI] 0.02-1.4). Preparations with intermediate potency yielded intermediate but nonsignificant degrees of relief. Participants receiving 9.4% tetrahydrocannabinol reported improved ability to fall asleep (easier, p = 0.001; faster, p < 0.001; more drowsy, p = 0.003) and improved quality of sleep (less wakefulness, p = 0.01) relative to 0% tetrahydrocannabinol. We found no differences in mood or quality of life. The most common drug-related adverse events during the period when participants received 9.4% tetrahydrocannabinol were headache, dry eyes, burning sensation in areas of neuropathic pain, dizziness, numbness and cough.
Conclusion:: A single inhalation of 25 mg of 9.4% tetrahydrocannabinol herbal cannabis three times daily for five days reduced the intensity of pain, improved sleep and was well tolerated. Further long-term safety and efficacy studies are indicated. (International Standard Randomised Controlled Trial Register no. ISRCTN68314063)
Medical News: Marijuana Eases Neuropathic Pain - in Neurology, Pain Management from MedPage Today
Smoking marijuana modestly reduced pain and other symptoms of chronic neuropathic pain, results of a small randomized, placebo-controlled trial showed.
The most potent dose used reduced average daily pain scores by 0.7 points on an 11-point scale (5.4 versus 6.1 with placebo, 95% confidence interval for difference 0.02 to 1.4), according to Mark A. Ware, MBBS, of McGill University in Montreal, and colleagues.
Those who smoked weed with 9.4% of the active ingredient tetrahydrocannabinol (THC) also reported sleeping better, the researchers reported online in CMAJ.
These results are important in light of the fact that patients who hear about pain relief from ongoing publicity about medical marijuana have had only a "trickle" of evidence to prove it, explained Henry J. McQuay, DM, of Oxford University, in an accompanying editorial.
"If medical cannabis is not available where a patient lives, then obtaining it will take the patient outside of the law, often for the first time in his or her life," he wrote. "Good evidence would at least buttress that decision."
These quality results along with three other trials of smoked cannabis for neuropathic pain do support an analgesic effect that, "though not great, may be of use to some patients," McQuay concluded.
This study does offer hope since few drugs have proven effective in these patients, commented Steven P. Cohen, MD, who as director of pain research at Walter Reed Army Medical Center in Washington, D.C., sees chronic pain in most of his patients with major war injuries.
However, the magnitude of the pain relief from smoking marijuana was less than expected compared with those few effective drugs, Cohen noted in an e-mail toMedPage Today and ABC News.
"When considered in the context of the higher incidence of minor and serious side effects with medical marijuana, cannabinoids should remain a third or fourth line drug for neuropathic pain," he wrote.
A bigger concern remains the "delivery system," which is substantially worse than tobacco cigarettes due to prolonged exposure to marijuana smoke from holding it in the lungs, commented Timothy A. Collins, MD, of Duke University's Pain and Palliative Care Clinic.
"As a physician, I don't think I would ever encourage a patient to smoke anything," he said in an e-mail.
Some states, such as California and New Jersey, have made marijuana "legal" for medical use, but this conflicts with federal law, and the U.S. Drug Enforcement Agency doesn't recognize its legality in those states.
"In states where there is no 'medical marijuana law' patients buy marijuana from criminals (drug dealers)," Collins added. "For pain patients this becomes a problem, as they are already on desirable prescription pain medications and subject to pressure to trade prescription narcotics for marijuana."
For the new study, Ware's group randomized 23 adults with chronic post-traumatic or postsurgical neuropathic pain to receive cannabis at a potency of 0%, 2.5%, 6% or 9.4% THC over four 14-day periods in a crossover trial.
The patients inhaled a single 25-mg dose through a pipe three times a day for the first five days in each cycle, then had a nine-day washout period before going on to the next randomized potency.
The intermediate doses yielded pain relief between the 0% THC placebo and the full-strength 9.4% dose. However, none were significantly effective compared with placebo.
Among the secondary effects, patients reported falling asleep more easily (P=0.001) and more quickly (P<0.001) with a greater feeling of drowsiness (P=0.003) and less wakefulness (P=0.01) while on 9.4% THC compared with placebo.
Mood and quality of life overall, though were unaffected.
Marijuana smoking appeared well tolerated, although the researchers noted that this may have been affected by the fact that most patients reported prior experience -- although not recent or extensive -- with the drug as an early ethics requirement to enter the study.
Patients rarely got high on the single hit they took through a pipe three times a day as part of the study, Ware's group noted.
None of the analgesic doses got plasma levels even halfway to the typical level seen among recreational users, they explained.
The most common drug-related adverse events associated with the most potent dose included headache, dry eyes, burning sensation in areas of neuropathic pain, dizziness, numbness, and cough.
Collins cautioned that marijuana bought on the street, not through medical-use prescription, varies widely in potency, making the study results of unclear generalizability to the average user.
Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ:cmaj.091414. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial -- Ware et al., 10.1503/cmaj.091414 -- Canadian Medical Association Journal
Background: Chronic neuropathic pain affects 1%-2% of the adult population and is often refractory to standard pharmacologic treatment. Patients with chronic pain have reported using smoked cannabis to relieve pain, improve sleep and improve mood.
Methods: Adults with post-traumatic or postsurgical neuropathic pain were randomly assigned to receive cannabis at four potencies (0%, 2.5%, 6% and 9.4% tetrahydrocannabinol) over four 14-day periods in a crossover trial. Participants inhaled a single 25-mg dose through a pipe three times daily for the first five days in each cycle, followed by a nine-day washout period. Daily average pain intensity was measured using an 11-point numeric rating scale. We recorded effects on mood, sleep and quality of life, as well as adverse events.
Results: We recruited 23 participants (mean age 45.4 [standard deviation 12.3] years, 12 women [52%]), of whom 21 completed the trial. The average daily pain intensity, measured on the 11-point numeric rating scale, was lower on the prespecified primary contrast of 9.4% v. 0% tetrahydrocannabinol (5.4 v. 6.1, respectively; difference = 0.7, 95% confidence interval [CI] 0.02-1.4). Preparations with intermediate potency yielded intermediate but nonsignificant degrees of relief. Participants receiving 9.4% tetrahydrocannabinol reported improved ability to fall asleep (easier, p = 0.001; faster, p < 0.001; more drowsy, p = 0.003) and improved quality of sleep (less wakefulness, p = 0.01) relative to 0% tetrahydrocannabinol. We found no differences in mood or quality of life. The most common drug-related adverse events during the period when participants received 9.4% tetrahydrocannabinol were headache, dry eyes, burning sensation in areas of neuropathic pain, dizziness, numbness and cough.
Conclusion:: A single inhalation of 25 mg of 9.4% tetrahydrocannabinol herbal cannabis three times daily for five days reduced the intensity of pain, improved sleep and was well tolerated. Further long-term safety and efficacy studies are indicated. (International Standard Randomised Controlled Trial Register no. ISRCTN68314063)
I will still train, cardio and lifting but I am not nearly as strict as I was for a long time.
