Cannabinoids as a Potential Alternative to Opioids in the Management of Various Pain Subtypes: Benefits, Limitations, and Risks

Ang, Samuel P; Sidharthan, Shawn; Lai, Wilson C; Hussain, Nasir; Patel, Kiran V; Gulati, Amitabh; Henry, Onyeaka; Kaye, Alan D.; Orhurhu, Vwaire

doi:10.1007/s40122-022-00465-y

Cited by 11 publications

(6 citation statements)

References 88 publications

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“…These findings suggest that cannabinoids may be a useful adjunct to traditional opioid-based pain management after cardiac surgery. Our results build upon previous research suggesting that combining opioids and cannabinoids may have synergistic effects on pain relief, potentially allowing reduced opioid dosages [22][23][24][25]. The mechanisms underlying this opioid-sparing effect likely stem from interactions between the endocannabinoid and opioid systems.…”

Section: Discussionsupporting

confidence: 80%

Perioperative Cannabinoids Significantly Reduce Postoperative Opioid Requirements in Patients Undergoing Coronary Artery Bypass Graft Surgery

Kumar,

Macko,

Kang

et al. 2024

Cureus

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Background Opioids, commonly used to control pain associated with surgery, are known to prolong the duration of mechanical ventilation and length of hospital stay. A wide range of adjunctive strategies are currently utilized to reduce postoperative pain, such as local and regional nerve blocks, nerve cryoablation, and adjunctive medications. We hypothesized that dronabinol (a synthetic cannabinoid) in conjunction with standard opioid pain management will reduce opioid requirements to manage postoperative pain. Methods Sixty-eight patients who underwent isolated first-time coronary artery bypass graft surgery were randomized to either the control group, who received only standard opioid-based analgesia, or the dronabinol group, who received dronabinol (a synthetic cannabinoid) in addition to standard opioid-based analgesia. Dronabinol was given in the preoperative unit, before extubation in the ICU, and after extubation on the first postoperative day. Preoperative, intraoperative, and postoperative parameters were compared under an IRB-approved protocol. The primary endpoints were the postoperative opioid requirement, duration of mechanical ventilation, and ICU length of stay, and the secondary endpoints were the duration of inotropic support needed, left ventricular ejection fraction (LVEF), and the change in LVEF. This study was undertaken at Northwest Medical Center, Tucson, AZ, USA. Results Sixty-eight patients were randomized to either the control group (n = 37) or the dronabinol group (n = 31). Groups were similar in terms of demographic features and comorbidities. The total postoperative opioid requirement was significantly lower in the dronabinol group [39.62 vs 23.68 morphine milligram equivalents (MMEs), p = 0.0037], representing a 40% reduction. Duration of mechanical ventilation (7.03 vs 6.03h, p = 0.5004), ICU length of stay (71.43 vs 63.77h, p = 0.4227), and inotropic support requirement (0.6757 vs 0.6129 days, p = 0.7333) were similar in the control and the dronabinol groups. However, there was a trend towards lower durations in each endpoint in the dronabinol group. Interestingly, a significantly better preoperative to postoperative LVEF change was observed in the dronabinol group (3.51% vs 6.45%, p = 0.0451). Conclusions Our study found a 40% reduction in opioid use and a significantly greater improvement in LVEF in patients treated with adjunctive dronabinol. Mechanical ventilation duration, ICU length of stay, and inotropic support requirement tended to be lower in the dronabinol group, though did not reach statistical significance. The results of this study, although limited by sample size, are very encouraging and validate our ongoing investigation.

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Section: Discussionsupporting

confidence: 80%

Perioperative Cannabinoids Significantly Reduce Postoperative Opioid Requirements in Patients Undergoing Coronary Artery Bypass Graft Surgery

Kumar,

Macko,

Kang

et al. 2024

Cureus

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“…Of the questionnaire participants who reported current medicinal cannabinoid use, only half sourced it through a prescription, suggesting a potentially unsafe absence of physician oversight to monitor efficacy and adverse effects. Although cannabinoids have been highlighted as a potential alternative to opioids in treating fibromyalgia pain, 31 most (87.5%) questionnaire participants on medicinal cannabinoids reported concurrent opioid use. This combination heightens the risk of other complications and has been associated with increased anxiety and depression, two common fibromyalgia comorbidities 32 …”

Section: Discussionmentioning

confidence: 99%

Significant use of non‐evidence‐based therapeutics in a cohort of Australian fibromyalgia patients

Warren,

Guymer,

Mezhov

et al. 2023

Internal Medicine Journal

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BackgroundFibromyalgia is a common condition characterised by chronic widespread musculoskeletal pain and central sensitivity features. Appropriate management requires a multidisciplinary approach prioritising non‐pharmacological strategies. Evidence‐based fibromyalgia medications are not always easily available, effective or tolerated.AimTo characterise actual medication usage in Australian fibromyalgia patients.MethodsDemographic and clinical data, including medication use information, were gathered by chart review from patients attending the Monash Fibromyalgia Clinic between January 2019 and June 2022. Eligible patients were invited to complete an anonymous questionnaire between June and August 2022 to assess current therapeutic use. The questionnaire assessed fibromyalgia clinical features by using the Revised Fibromyalgia Impact Questionnaire and the 2016 modified American College of Rheumatology Fibromyalgia criteria.ResultsThe chart review included 474 patients, and 108 participants completed the questionnaire. Most chart review (78.7%) and questionnaire participants (85.2%) reported using at least one medication for their fibromyalgia. 48.5% of chart review patients and 58.3% of questionnaire participants reported using at least one evidence‐based medication, usually amitriptyline, duloxetine or pregabalin. However, the most common individual medications for questionnaire participants were non‐steroidal anti‐inflammatory drugs (48.2%), paracetamol (59.3%) and opioids (34.3%), with most opioids being typical opioids. Among questionnaire participants, 14.8% reported using cannabinoids, and 70.4% reported using at least one supplement, vitamin or herbal/naturopathic preparation. Not all medication or substance use was recorded during clinic appointments.ConclusionFibromyalgia patients engage in various pharmacotherapeutic strategies that are not always evidence‐based or disclosed to their treating clinicians.

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“…Additionally, the impact on the nervous system, issues pertaining to product quality and regulation, as well as ethical and legal aspects, including those concerning legality, require comprehensive consideration. Therefore, despite the promising therapeutic prospects, the utilization of cannabinoids, especially the minor cannabinoids, necessitates further research, regulations, and a balanced approach to ensure benefits while minimizing potential health and societal risks [ 69 , 70 ].…”

Section: Limitationsmentioning

confidence: 99%

Therapeutic Potential of Minor Cannabinoids in Dermatological Diseases—A Synthetic Review

Kwiecień,

Kowalczuk

2023

Molecules

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Dermatological diseases pose a significant burden on the quality of life of individuals and can be challenging to treat effectively. In this aspect, cannabinoids are gaining increasing importance due to their therapeutic potential in various disease entities including skin diseases. In this synthetic review, we comprehensively analyzed the existing literature in the field of potential dermatological applications of a lesser-known subgroup of cannabinoids, the so-called minor cannabinoids, such as cannabidivarin (CBDV), cannabidiforol (CBDP), cannabichromene (CBC), tetrahydrocannabivarin (THCV), cannabigerolic acid (CBGA), cannabigerol (CBG), cannabielsoin (CBE), cannabimovone (CBM) or cannabinol (CBN), while drawing attention to their unique pharmacological properties. We systematically searched the available databases for relevant studies and analyzed the data to provide an overview of current thematic knowledge. We looked through the full-text, bibliographic and factographic databases, especially Scopus, Web of Science, PubMed, Polish Scientific Journals Database, and selected the most relevant papers. Our review highlights that minor cannabinoids exhibit diverse pharmacological activities, including anti-inflammatory, analgesic, antimicrobial, and anti-itch properties. Several studies have reported their efficacy in mitigating symptoms associated with dermatological diseases such as psoriasis, eczema, acne, and pruritus. Furthermore, minor cannabinoids have shown potential in regulating sebum production, a crucial factor in acne pathogenesis. The findings of this review suggest that minor cannabinoids hold therapeutic promise in the management of dermatological diseases. Further preclinical and clinical investigations are warranted to elucidate their mechanisms of action, determine optimal dosage regimens, and assess long-term safety profiles. Incorporating minor cannabinoids into dermatological therapies could potentially offer novel treatment options of patients and improve their overall well-being.

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Cannabinoids as a Potential Alternative to Opioids in the Management of Various Pain Subtypes: Benefits, Limitations, and Risks

Cited by 11 publications

References 88 publications

Perioperative Cannabinoids Significantly Reduce Postoperative Opioid Requirements in Patients Undergoing Coronary Artery Bypass Graft Surgery

Perioperative Cannabinoids Significantly Reduce Postoperative Opioid Requirements in Patients Undergoing Coronary Artery Bypass Graft Surgery

Significant use of non‐evidence‐based therapeutics in a cohort of Australian fibromyalgia patients

Therapeutic Potential of Minor Cannabinoids in Dermatological Diseases—A Synthetic Review

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