Cannabis & Pain (General, Chronic, Neuropathic, and others)


Pain (General)

Title: Cannabinoids in the Management of Difficult to Treat Pain.

Key Findings: “This article will attempt to present information concerning cannabinoid mechanisms of analgesia, review randomized clinical trials (RCTs) of available and emerging cannabinoid agents, and address the many thorny issues that have arisen with clinical usage of herbal cannabis itself (“medical marijuana”). An effort will be made to place the issues in context and suggest rational approaches that may mitigate concerns and indicate how standardized pharmaceutical cannabinoids may offer a welcome addition to the pharmacotherapeutic armamentarium in chronic pain treatment.” …  "Cannabinoids may offer significant “side benefits” beyond analgesia. These include anti-emetic effects, well established with THC, but additionally demonstrated for CBD (Pertwee 2005), the ability of THC and CBD to produce apoptosis in malignant cells and inhibit cancer-induced angiogenesis (Kogan 2005; Ligresti et al 2006), as well as the neuroprotective antioxidant properties of the two substances (Hampson et al 1998), and improvements in symptomatic insomnia (Russo et al 2007)... Given their multi-modality effects upon various nociceptive pathways, their adjunctive side benefits, the efficacy and safety profiles to date of specific preparations in advanced clinical trials, and the complementary mechanisms and advantages of their combination with opioid therapy, the future for cannabinoid therapeutics appears very bright, indeed.”

Information & Links

Link: Cannabinoids in the management of difficult to treat pain. Dr. Ethan B Russ
Year: 2008
Published online 2008 Feb. PMCID: PMC2503660. PMID: 18728714;
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Chronic Pain

Title: Associations Between Medical Cannabis And Prescription Opioid Use In Chronic Pain Patients: A Preliminary Cohort Study

Key Findings: “The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.”

Information & Links

Link: Associations Between Medical Cannabis And Prescription Opioid Use In Chronic Pain Patients: A Preliminary Cohort Study

Year: 2017

DOI: 10.1371/journal.pone.0187795

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Title: Safety And Pharmacokinetics Of Oral Cannabidiol When Administered Concomitantly With Intravenous Fentanyl In Humans

Key Findings: “Cannabidiol does not exacerbate adverse effects associated with intravenous fentanyl administration. Coadministration of CBD and opioids was safe and well tolerated. These data provide the foundation for future studies examining CBD as a potential treatment for opioid abuse.”

Information & Links

Link: Safety And Pharmacokinetics Of Oral Cannabidiol When Administered Concomitantly With Intravenous Fentanyl In Humans

Year: 2015

DOI: 10.1097/ADM.0000000000000118.

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Title: The Pharmacokinetics, Efficacy, Safety, And Ease Of Use Of A Novel Portable Metered-dose Cannabis Inhaler In Patients With Chronic Neuropathic Pain: A Phase 1a Study

Key Findings: “Chronic neuropathic pain is often refractory to standard pharmacological treatments. A significant 45% reduction in pain intensity was noted 20 minutes post inhalation (P = .001), turning back to baseline within 90 minutes. Tolerable, lightheadedness, lasting 15-30 minutes and requiring no intervention, was the only reported adverse event.”

Information & Links

Link: The Pharmacokinetics, Efficacy, Safety, And Ease Of Use Of A Novel Portable Metered-dose Cannabis Inhaler In Patients With Chronic Neuropathic Pain: A Phase 1a Study

Year: 2014

DOI: 10.3109/15360288.2014.941130

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Title: Cannabinoid-opioid Interaction In Chronic Pain

Key Findings: “Vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.”

Information & Links

Link: Cannabinoid-opioid Interaction In Chronic Pain

Year: 2011

DOI: 10.1038/clpt.2011.188

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Neuropathic Pain

Title: Systematic Review Of Systematic Reviews For Medical Cannabinoids: Pain, Nausea And Vomiting, Spasticity, And Harms

Key Findings: “There is reasonable evidence that cannabinoids improve nausea and vomiting after chemotherapy. They might improve spasticity (primarily in multiple sclerosis). There is some uncertainty about whether cannabinoids improve pain, but if they do, it is neuropathic pain and the benefit is likely small.”

Information & Links

Link: Systematic Review Of Systematic Reviews For Medical Cannabinoids: Pain, Nausea And Vomiting, Spasticity, And Harms

Year: 2018

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Title: An Exploratory Human Laboratory Experiment Evaluating Vaporized Cannabis In The Treatment Of Neuropathic Pain From Spinal Cord Injury And Disease

Key Findings: “Using an 11-point numerical pain intensity rating scale as the primary outcome, a mixed effects linear regression model demonstrated a significant analgesic response for vaporized cannabis. When subjective and psychoactive side effects (e.g., good drug effect, feeling high, etc.) were added as covariates to the model, the reduction in pain intensity remained significant above and beyond any effect of these measures.”

Information & Links

Link: An Exploratory Human Laboratory Experiment Evaluating Vaporized Cannabis In The Treatment Of Neuropathic Pain From Spinal Cord Injury And Disease

Year: 2016

DOI: 10.1016/j.jpain.2016.05.010

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Title:  Low Dose Vaporized Cannabis Significantly Improves Neuropathic Pain

Key Findings: "Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. Cannabis has analgesic efficacy with the low dose being, for all intents and purposes, as effective a pain reliever as the medium dose."

Information & Links

Link: Low Dose Vaporized Cannabis Significantly Improves Neuropathic Pain

Year: 2013

DOI: 10.1016/j.jpain.2012.10.009

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Title: A Randomized, Placebo-controlled, Crossover Trial Of Cannabis Cigarettes In Neuropathic Pain

Key Findings: “Positive analgesic effects with peripheral neuropathic pain.”

Information & Links

Link: A Randomized, Placebo-controlled, Crossover Trial Of Cannabis Cigarettes In Neuropathic Pain

Year: 2008

DOI: 10.1016/j.jpain.2007.12.010

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Title:  Efficacy Of Two Cannabis Based Medicinal Extracts For Relief Of Central Neuropathic Pain From Brachial Plexus Avulsion: Results Of A Randomised Controlled Trial

Key Findings: “Mild reduction of neuropathic pain. Improved sleep, no major adverse effects.”

Information & Links

Link: Efficacy Of Two Cannabis Based Medicinal Extracts For Relief Of Central Neuropathic Pain From Brachial Plexus Avulsion: Results Of A Randomised Controlled Trial

Year: 2004

DOI: 10.1046/j.1365-2044.2003.03408_3.x

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Title: A Preliminary Controlled Study To Determine Whether Whole-plant Cannabis Extracts Can Improve Intractable Neurogenic Symptoms

Key Findings: “Significant pain relief.”

Information & Links

Link: A Preliminary Controlled Study To Determine Whether Whole-plant Cannabis Extracts Can Improve Intractable Neurogenic Symptoms

Year: 2003

DOI: 10.1191/0269215503cr581oa

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TitleAnalgesic Effect Of The Synthetic Cannabinoid CT-3 On Chronic Neuropathic Pain: A Randomized Controlled Trial

Key Findings:  “Effective in reducing chronic neuropathic pain compared with placebo. No major adverse effects observed.”

Information & Links

Link: Analgesic Effect Of The Synthetic Cannabinoid CT-3 On Chronic Neuropathic Pain: A Randomized Controlled Trial

Year: 2003

DOI: 10.1001/jama.290.13.1757

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Menstrual Pain

Title: Pain Relief Assessment By Aromatic Essential Oil Massage On Outpatients With Primary Dysmenorrhea: A Randomized, Double-blind Clinical Trial

Key Findings: “This randomized, double-blind clinical trial conducted on 48 women with primary dysmenorrhea and significant associated menstrual pains demonstrated the efficacy of topical application of essential oils containing primarily analgesic plant-based constituents, namely linalyl acetate, linalool, eucalyptol, and β-caryophyllene.”

Information & Links

Link: Pain Relief Assessment By Aromatic Essential Oil Massage On Outpatients With Primary Dysmenorrhea: A Randomized, Double-blind Clinical Trial

Year: 2012. DOI: 10.1111/j.1447-0756.2011.01802.x

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Pain Associated with AIDs

Title: Smoked Medicinal Cannabis For Neuropathic Pain In HIV: A Randomized, Crossover Clinical Trial

Key Findings: 30% reduction in pains when compared to the placebo.

Information & Links

Link: Smoked Medicinal Cannabis For Neuropathic Pain In HIV: A Randomized, Crossover Clinical Trial

Year: 2009

DOI: 10.1038/npp.2008.120

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Title: Cannabis In Painful HIV-associated Sensory Neuropathy: A Randomized Placebo-controlled Trial

Key Findings: “Smoked cannabis reduced daily pain by 34%. “

Information & Links

Link: Cannabis In Painful HIV-associated Sensory Neuropathy: A Randomized Placebo-controlled Trial

Year: 2007

DOI: 10.1212/01.wnl.0000253187.66183.9c

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Post-Surgery Wounds, Inflammation & Cannabis

Title: Cannabinoids, Endocannabinoids, And Related Analogs In Inflammation

Key Findings: “Cannabinoids effective in pain from post-surgery, rheumatism, rheumatoid arthritis, chronic neuropathic pain, and fibromyalgia”

Information & Links

Link: Cannabinoids, Endocannabinoids, And Related Analogs In Inflammation

Year: 2009

DOI: 10.1208/s12248-009-9084-5


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