Study Evaluates Effects of Inhaled Cannabis for Pain Relief in Adults With Sickle Cell Disease

PainRelief.com Interview with:

Donald I. Abrams, MD
Division of Hematology-Oncology
Department of Medicine,
Zuckerberg San Francisco General Hospital
University of California, San Francisco

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

Response: A number of years ago, Kalpna Gupta, PhD, an investigator then at the University of Minnesota, came and told me about her mice with Hemoglobin SS who experienced pain that responded to laboratory cannabinoids. She was going to apply for a grant from the National Heart, Lung and Blood Institute to continue her studies and sought us out because of our prior clinical trials with cannabis and pain. Dr. Gupta wanted to include a pilot proof of principle human study in her application and asked if we could design one. As cannabidiol (CBD) was just becoming known at that time, we suggested to do a study in patients with sickle cell disease and pain looking at a delta-9-tetrahydrocannabinol (THC)-dominant strain of inhaled cannabis, a CBD-dominant strain, a balanced 1:1 strain and placebo. She said that we would only have funds to do a two-arm study, one of which needed to be placebo. As we had already shown that there was a trend for vaporized cannabis that was predominantly THC to add to the analgesic effect of sustained-release opioids in patients with chronic pain, we chose to investigate a 4.4% THC:4.9% CBD product obtained from the National Institute on Drug Abuse.

We designed a crossover trial so that each participant would spend two 5-day inpatient stays separated by at least a month in our Clinical Research Center at Zuckerberg San Francisco General Hospital. During one stay they would add vaporized cannabis to their stable ongoing analgesic regimen and during the other stay they would inhale placebo cannabis three times a day. We use the Volcano vaporizer device that heats the plant material and not an oil as has become popular in the recent “vaping” craze. Our target was to enroll 35 patients with sickle cell disease and chronic ongoing pain on an opioid-containing regimen. Our primary endpoint was change in pain as measured by way of a visual analog scale and the Brief Pain Inventory as well as safety.

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Which Older Adults Use Cannabis for Chronic Pain Relief?

PainRelief.com Interview with:
Julie Bobitt, PhD

Director, Interdisciplinary Health Sciences
University of Illinois at Urbana Champaign
Champaign, IL. 61820

Dr. Julie Bobitt
Dr. Julie Bobitt

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

Response: Our previous research found that older adults, who we interviewed, used cannabis primarily for pain related reasons and that they were reporting using cannabis to reduce or altogether stop their use of opioids.  We wanted to further study this and we wanted to see if there were any differences between self-reported pain in non-cannabis users vs. cannabis users and then if there were differences between groups who used cannabis alone versus those who used opioids alone, versus cannabis in combination with opioids. 

Short and Long-Term Effects of Cannabis For Headache and Migraine Pain Relief

PainRelief.com Interview with:
Carrie Cuttler, Ph.D.
Assistant Professor
Washington State University
Department of Psychology
Pullman, WA, 99164-4820

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

Response: Use of cannabis for headache and migraine is relatively common yet there have been few studies examining the effectiveness of medical cannabis for these purposes.

PainRelief.com: What should readers take away from your report?

Response: We analyzed data from nearly 20,000 cannabis use sessions tracked using the medical cannabis app Strainprint. The results show that headache and migraine severity ratings were reduced by nearly 50% from before to immediately after cannabis use. The results further revealed that men report larger reductions in headache severity following cannabis use than do women and that use of cannabis concentrates was associated with larger reductions in headache severity ratings than use of more traditional cannabis flower.

We also demonstrate that dose of cannabis used to manage these conditions increases across time and that efficacy of cannabis in reducing headache decreases across time. This indicates that there is some evidence of tolerance to the acute effects of cannabis on ameliorating headache across time. More encouragingly we found that baseline ratings of headache and migraine remained stable across time/cannabis use sessions which indicates that cannabis is not associated with the medication overuse headaches (i.e., increases in baseline headache and migraine severity across time as a function of the use of medications to treat these conditions) that more conventional treatments tend to produce.

Chronic Pain the Most Common Reason People Use Medical Cannabis

PainRelief.com Interview with:

cannabis wikipedia image

Kevin Boehnke, Ph.D. Research investigator
Department of Anesthesiology and the Chronic Pain and Fatigue Research Center
University of Michigan

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

Response: Medical cannabis is legal in 33 states, and people can obtain medical cannabis licenses to treat a wide swath of conditions, including cancer, anxiety, irritable bowel syndrome, chronic pain, complications of Alzheimer’s disease, and nausea. Many observational surveys have found that many people use cannabis for chronic pain, but whether these surveys were representative of national trends was uncertain. To our knowledge, this was the first study that examined nationwide trends of patient-reported qualifying conditions based on medical cannabis state registries.

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Many Patients Prescribed Medical Marijuana for Pain Relief, Use the Cannabis for Recreational Use

PainRelief.com Interview with:
Meghan Rabbitt Morean, Ph.D.

Assistant Professor of Psychology
Oberlin College
Adjunct Assistant Professor of Psychiatry
Department of Psychiatry 
Yale School of Medicine
New Haven, CT 04519

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

Response: Currently, medical marijuana is legal in 33 states and the District of Columbia and recreational marijuana is legal in 10 states and the District of Columbia (although it remains a Schedule I drug at the federal level).

Chronic pain is an approved condition for medical marijuana in all states in which medical marijuana is legal. However, there is concern that a sizeable percentage of medical marijuana patients also are using their medicine recreationally.

In the current study, we found that more than half (55.5%) of medical marijuana patients also reported using their medical marijuana for recreational purposes, which is similar to rates observed in a previous study.  

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Benefits and Harms of Plant-Based Cannabis for PTSD Reviewed

The Annals of Internal Medicine the benefits and harms of plant-based cannabis preparations in treating PTSD in adults.

O’Neil ME, Nugent SM, Morasco BJ, Freeman M, Low A, Kondo K, et al. Benefits and Harms of Plant-Based Cannabis for Posttraumatic Stress DisorderA Systematic Review. Ann Intern Med. [Epub ahead of print 15 August 2017] doi: 10.7326/M17-0477

http://annals.org/aim/article/2648596/benefits-harms-plant-based-cannabis-posttraumatic-stress-disorder-systematic-review