Study Finds Physical Exercise Increases Body’s Own Cannabis-Type Substances

PainRelief.com Interview with:
Amrita Vijay PhD
Division of Rheumatology
Orthopedics and Dermatology
School of Medicine
University of Nottingham
Nottingham, UK

Dr. Vijay

PainRelief.com:  What is the background for this study? What are the main findings?

Response: We carried out this research as we wanted to see if exercise had an effect on the levels of anti-inflammatory substances produced by gut microbes and on endocannabinoids (i.e cannabis-like substances) produced by our bodies.  

One of the key findings of the study is that physical exercise increases levels of the body’s own cannabis-type substances and highlights a key link between how substances produced by our gut microbes interact with these cannabis-like substances and reduces inflammation.  

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Survey of Medical Cannabis Effects on Anxiety and Depression

PainRelief.com Interview with:
Erin Martin Ph.D. Candidate
Department of Neuroscience
Medical University of South Carolina
Charleston, SC 29425

Erin Martin

PainRelief.com:  What is the background for this study?
Response: Anxiety and depressive disorders are highly prevalent. People with these disorders are increasingly using cannabis products for symptom management, either as an alternative to or in conjunction with traditional antidepressants.

The goal of this study was to examine the effect of medicinal cannabis product use on symptoms of anxiety and depression in a clinical population, and to assess important correlates of anxiety and depression such as chronic pain and quality of life.  

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Study Finds Medical Cannabis Not Likely to Solve Opioid Crisis for Pain Patients

PainRelief.com Interview with:
Carsten Hjorthøj, senior Researcher
Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital
University of Copenhagen, Department of Public Health
Section of Epidemiology, Copenhagen, Denmark.

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Denmark introduced a pilot program of medical cannabis in 2018. Medical cannabis, and cannabis-based medicine, has gained a lot of both attention and controversy as a possible way to treat pain disorders, but the evidence base is still sparse. The Danish nationwide unselected registers allow us to perform a high quality pharmacoepidemiologic study with propensity score matched controls.

The main findings are that medical cannabis and cannabis-based medicine did not reduce the use of opioids in pain patients, and might actually lead to an increase in use of opioids. However, patients with neuropathic pain disorders appeared to reduce their use of gabapentin, their use of overall medication (but not opioids!), and the number of days spent in hospital, compared with controls.

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Medical Cannabis May Be Helpful For Pain Relief in a Minority of People with Chronic Pain, But Will Not Be Effective For Most

PainRelief.com Interview with:
JASON BUSSE DC, PhD
Associate Professor
Associate Director
Michael G. DeGroote Centre for Medicinal Cannabis Research
McMaster University Medical Centre
Ontario, Canada

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Our focused clinical practice guideline was informed by 4 systematic reviews exploring benefits and harms of medical cannabis for chronic pain, the potential for cannabis to help people who live with pain to reduce their use of opioids, and patients values & preferences regarding medical cannabis for chronic pain. We found that non-inhaled medical cannabis provided small to very small improvements in pain relief, physical functioning and sleep quality compared to placebo, but did not improve mental functioning, role functioning or social functioning. Use of medical cannabis, versus placebo, also caused small increases in the risk of several transient, moderate, side effects, such as impaired attention, nausea, and drowsiness, and a larger increase in the risk of dizziness.

There was insufficient evidence to inform the risk of serious adverse events, such as motor vehicle accidents, cannabis use disorder (addiction), or suicide. We also found that patients’ attitudes towards medical cannabis show considerable variation, meaning that when presented with the same evidence different patients are likely to make different decisions about embarking on a trial of medical cannabis. Due to the close balance between modest benefits and harms, and high variability among patients’ attitudes, we made a weak recommendation to consider a trial of medical cannabis for people living with chronic pain who had not achieved sufficient relief with standard care.

A weak recommendation means that clinicians should provide chronic pain patients with the evidence for benefits and harms and help them to make a decision consistent with their patient’s values and preferences.

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Medlab Clinical Developing New Buccal Spray for Chronic Cancer Pain Relief

PainRelief.com Interview with:
Dr.  Jeremy Henson
Director of Medical Affairs
Medlab Clinical Ltd

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: THC and CBD combination medicines have the potential to provide a non-opioid option for chronic pain that does not have the GIT or respiratory adverse reactions of opioids and allows better cognitive functioning.

Delivery across the oro-buccal membrane appears to be best method of administration of cannabinoids for chronic pain. Oro-buccal delivery has pharmacokinetics appropriate for 6-8 hourly maintenance dosing and avoids first pass metabolism and the slow erratic onset of ingestion; and the high serum THC peaks, frequent redosing and toxic oxidation products of vaping.

The problems with using a 50% ethanol vehicle to deliver cannabinoids across the oro-buccal membrane include local irritation, incomplete absorption and significant systemic ethanol levels. These issues could be solved by using a micellular nanoparticle to solubilise the cannabinoids and deliver them across the oro-buccal mucous membrane.

This study was a first in human study of a micellular nanoparticle formulation of 1:1 THC and CBD delivered as an oro-buccal spray for chronic cancer pain.

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Study Identifies Three Patterns of Medical Cannabis Use for Pain

Dr. Deepika Slawek,

PainRelief.com Interview with:
Deepika Slawek, MD, MS, MPH 
(she/hers)
Assistant Professor of Medicine, Division of General Internal Medicine
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, NY 10467

PainRelief.com:  What is the background for this study?

Response: Medical cannabis has become increasingly available in the United States over the past 25 years and is commonly used for the management of pain. Little is known about the patterns of medical cannabis use by patients with chronic pain. This information could help providers anticipate patients’ needs and identify potential disparities in access.

We followed 99 adults in New York State who were newly certified for medical cannabis use and who were prescribed opioids over the course of 1 year. Using a latent class trajectory analysis, we identified clusters of participants based on 14-day frequency of medical cannabis use. We used logistic regression to determine factors associated with cluster membership including sociodemographic characteristics, pain, substance use, and mental health symptoms.

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Study Evaluates Placebo Effect of CBD on Pain Relief

PainRelief.com Interview with:
Martin De Vita, CPT, MS, USA
Doctoral Candidate
Clinical Psychology Department
Syracuse University

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Seemingly out of nowhere, cannabidiol (CBD) products became immensely popular. Cross-sectional studies showed widespread use among the public for various clinical conditions. Pain was by far the most commonly reason cited for using CBD. However, no human experimental pain studies had been conducted to evaluate the analgesic effects of CBD. A lot of people questioned whether CBD effects on pain were just a placebo.

To answer this question, we tested people’s baseline pain responding using sophisticated equipment capable of delivering safe, but painful stimulation that activates and evaluates human nervous system processes. Then we administered either CBD or a placebo and re-tested these pain outcomes to see how they changed. We took it a step further and manipulated the information that participants were given about which substance they received. So in some conditions, participants were told they got CBD, even though it was just a placebo. In other conditions, participants were told they got an inactive substance, despite actually receiving CBD. This way, we could test whether simply telling someone that they had received CBD would have an effect on their pain. These are called expectancy effects and there is a large body of literature that supports this phenomenon.

When we looked at the data, we found that CBD analgesia was actually driven by both expectancies (placebo analgesia) and pharmacological action. We also found that these manipulations affected different pain outcomes. We found that both CBD and expectancies reduced pain unpleasantness but not pain intensity. The results were complex in that CBD and expectancies for receiving CBD differentially affected various outcomes. This was exciting because we are left with even more questions to investigate in future research.

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Peptide May Allow Cannabis to Provide Pain Relief Without Unwanted Side Effects

PainRelief.com Interview with:
David Andreu, PhD
Professor of Chemistry
Department of Experimental & Health Sciences
Pompeu Fabra University
Barcelona Biomedical Research Park
Barcelona, Spain

Prof. David Andreu (right)
Maria Gallo,
(first author)
Prof. Rafael Maldonado

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Background is the (earlier) finding of a cross-talk between CB1 and 5HT2A receptors (two GPCRs forming a heterodimer) that can be acted upon (disrupted) by peptides that allow to dissociate analgesic (CB1-mediated) from (unwanted) cognitive effects ( CB1/5HT2A heterodimer-mediated, memory impairment etc); this is reference 18 of our paper.

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Does Medical Marijuana Prevents Opioid Overdoses?

PainRelief.com Interview with:

Daniel Kaufman, MS Geisinger Commonwealth School of Medicine
Daniel Kaufman

Daniel Kaufman, MS
Geisinger Commonwealth School of Medicine

Brian J. Piper, PhD, MS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA 18510

Dr. Piper










PainRelief.com:  What is the background for this study?

Response: The opioid epidemic has stricken the United States and caused thousands of deaths nationally. Researchers continue to search for a solution to the ongoing escalation in opioid related deaths, with some states turning to medical cannabis as a potential alternative treatment for chronic pain. The objectives of this study were to:

  1. To determine if medical cannabis program implementation had any effect on opioid overdoses at a state-wide level
  2. To contribute to the discussion of researchers searching for a solution to the opioid epidemic facing the United States
  3. Begin the discussion on the standardization of autopsy procedures, including death/overdose determination
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Cognition in Adults Who Use Medical Marijuana for Chronic Pain Relief

PainRelief.com Interview with:
Dr. Sharon R. Sznitman PhD and
Dr. Galit Weinstein, PhD
School of Public Health,
University of Haifa, Haifa, Israel

PainRelief.com:  What is the background for this study?

Response: Due to increased media attention related to the topic of medical cannabis and increasing public demand for the treatment, physicians often find themselves in situations where patients and caregivers request medical cannabis treatment. When this demand is from older patients, there is a dearth of studies of effectiveness and risk-benefit ratio as almost no studies have examined the potential therapeutic effects and potential risks of the treatment in this specific group. One of the main implications of cannabis use that researchers have grappled with is its long-term effect on cognitive function. It is well established that cannabis use has detrimental effects on the developing brain when consumed in early life, but detrimental effects of early-life cannabis use may not translate to use in older ages. Use of cannabis in old ages may have adverse effects on cognition but some evidence also exists showing beneficial effects.