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.
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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