The Food and Drug Administration (FDA), Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institute for Drug Abuse (NIDA) report that no sound scientific studies support the medicinal use of cannabis. Despite this lack of scientific validation, many patients routinely use "medical marijuana," and in many cases this use is for pain related to nerve injury. We conducted a double-blinded, placebo-controlled, crossover study evaluating the analgesic efficacy of smoking cannabis for neuropathic pain. Thirty-eight patients with central and peripheral neuropathic pain underwent a standardized procedure for smoking either high-dose (7%), low-dose (3.5%), or placebo cannabis. In addition to the primary outcome of pain intensity, secondary outcome measures included evoked pain using heat-pain threshold, sensitivity to light touch, psychoactive side effects, and neuropsychological performance. A mixed linear model demonstrated an analgesic response to smoking cannabis. No effect on evoked pain was seen. Psychoactive effects were minimal and well-tolerated, with some acute cognitive effects, particularly with memory, at higher doses. KeywordsNeuropathic pain; analgesia; cannabis; clinical trial; neuropsychological testingThe case for the clinical utility of cannabis as an analgesic derives from experimental studies as well as anecdotal reports. Activation of the endocannabinoid system suppresses HHS Public AccessAuthor manuscript J Pain. Author manuscript; available in PMC 2016 August 01. Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript behavioral responses to acute and persistent noxious stimulation through both central 71 and peripheral 45 mechanisms. Cannabinoid receptors are localized in neuroanatomic regions intimately involved with transmission and modulation of pain signals: The periaqueductal gray (PAG), the rostral ventromedial medulla (RVM), 40,66 and the dorsal horn of the spinal cord. 66 Animal experimentation has clearly demonstrated that synthetic and endogenous cannabinoids not only produce analgesia but also interact in some manner to potentiate opioids, 18,70 particularly in neuropathic pain. 41 Surveys involving the use of medicinal marijuana reveal that pain, sleep, and mood improve with only modest side effects. 72,73 In one human pain experiment, subjects had a significant dose-dependent antinociception (increased finger withdrawal latency) effect that was not reversed by opioid antagonism. 31 In a somewhat contradictory manner, hyperalgesic activity and enhancement of the perception of pain on acute exposure in chronic users of marijuana was reported. 20 Experience with cancer pain revealed that 120 mg codeine and 20 mg delta-9-tetrahydrocannabinol (9-THC) were similar to each other and significantly superior to placebo for the sum of the pain intensity differences and total pain relief. 55,56 However, there was a clear dose-response relationship for sedation, mental clouding, and other central nervous system (CNS) related side effects f...

ObjectiveThe objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported.MethodsAn interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached.ResultsThe consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain.ConclusionsThese competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain.

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Causes of opioid-related deaths are multifactorial, so solutions must address prescriber behaviors, patient contributory factors, nonmedical use patterns, and systemic failures. Clinical strategies to reduce opioid-related mortality should be empirically tested, should not reduce access to needed therapies, should address risk from methadone as well as other opioids, and should be incorporated into any risk evaluation and mitigation strategies enacted by regulators.