Inhaled Cannabis for Chronic Neuropathic Pain: A Meta-analysis of Individual Patient Data

Andreae, Michael H.; Carter, George M.; Shaparin, Naum; Sandberg, Kathryn; Ellis, Ronald J.; Ware, Mark A.; Abrams, Donald I.; Prasad, Hannah; Wilsey, Barth; Indyk, Debbie; Johnson, Matthew S.; Sacks, Henry S.

doi:10.1016/j.jpain.2015.07.009

Cited by 200 publications

(176 citation statements)

References 87 publications

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“…29 Patients showing an insufficient response or a major side effect to these agents may benefit from the opioids tramadol, fentanyl, or buprenorphine and even from inhaled medical cannabis. 36 Poorly validated treatments are lidocaine patches or creams, transcutaneous electrical nerve stimulation, and acupuncture (see Table 3). [27][28][29] In the absence of convincing clinical evidence and with a potential risk for drug interference, we do not recommend the routine use of high-dose vitamins or other neuroprotective strategies.…”

Section: Comments About Patient 1 Peripheral Neuropathymentioning

confidence: 99%

How I manage the toxicities of myeloma drugs

Delforge

Ludwig

2017

Blood

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The treatment of multiple myeloma is considered a continuously evolving paradigm as a result of the growing availability of new and highly effective drugs, including first- and second-generation proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies. Clinical trials advocate long-term rather than short-term treatment schedules with combinations of these new anti–myeloma drug classes. Although the overall toxicity profile of the recommended regimens can be considered favorable, their increasing complexity and prolonged use warrant a heightened vigilance for early and late side effects, a priori because real-life patients can be more frail or present with 1 or more comorbidities. The treatment decision process, at diagnosis and at relapse, therefore requires myeloma physicians to carefully balance efficacy and toxicity profiles for each individual patient. Early and/or unnecessary tapering or treatment discontinuation for drug-related adverse events may not only reduce patients’ quality of life, but also negatively impact their outcome. Accurate knowledge in recognizing and managing the potential side effects of present-day treatment regimens is therefore a cornerstone in myeloma care. Using 5 case vignettes, we discuss how to prevent and manage the most common nonhematological adverse events of anti–myeloma treatment regimens containing proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies.

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Section: Comments About Patient 1 Peripheral Neuropathymentioning

confidence: 99%

How I manage the toxicities of myeloma drugs

Delforge

Ludwig

2017

Blood

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“…Double blind randomized clinical trials have shown that inhaled THC, a key constituent of C. sativa, significantly decreased allodynia, and was suggested that this effect is due to THC specific suppression of central and peripheral sensitization. 80,96 The third most potent herb was F. hermonis. Interestingly, there has been no detailed clinical studies investigating F. hermonis in the amelioration of NP reported in the English language.…”

Section: Discussionmentioning

confidence: 99%

“…This study showed a 30% reduction in chronic pain improvement at the individual patient level. 80 Therefore, cannabinoids open doors for a future treatment for NP. Elder has shown significant effects towards amelioration of mechanical allodynia and hyperalgesia 24 Elder were fractioned by RP-column chromatography and RP-HPLC, and showed that the most effective compound was kaempferol.…”

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confidence: 99%

Neuropathic Pain: Literature Review and Recommendations of Potential Phytotherapies

Raafat¹,

El-Haj²,

Shoumar³

et al. 2017

Phcog J

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Introduction:One of the common syndromes that affect humanity is neuropathic pain (NP), yet poorly understood with no efficient treatment till now. Consequently, it is extremely crucial to seek further evidence for accurate diagnosis and optimum treatment. The aim of this work is to summarize the findings related to neuropathic pain in terms of etiology, types, diagnosis, current and future management prospective, and identify the gaps in neuropathic pain therapy. Methods: A literature investigation was carried out by analyzing classical peer reviewed papers and textbooks, taking into consideration worldwide well established scientific databases mainly PUBMED and SCOPUS to retrieve accessible published literature. The selection of phytotherapies was based upon their potentials in relieving NP in pre-clinical or clinical models. Results: One of the most critical points in this research is that recommendations of the future plans should be focused on the engagement of phytotherapy in the treatment regimen aiming at improving patients' quality of life and reaching optimum efficacy and minimum toxicity. Phytotherapies offer relatively low-risk options to NP patients and have an increasing evidence to be the future of neuropathic pain management. Patients suffering from neuropathy are depending increasingly on phytotherapies; however, they need more clinical trials in order to fully understand their mechanism of actions. Conclusion: Health-care specialists should be regularly informed about neuropathic pain current therapies and promising future phytotherapies, bearing in mind the risk/benefit profile of the utilization of these therapies in the amelioration of NP. Consistent with this criteria NP can be classified into "defined" (all criteria present), "probable" (I and II, in addition either III or IV) or "possible" (I and II, with no confirmatory tests). 3 Moreover, risk factors and epidemiology are cornerstones in understanding NP. Risk factors and EpidemiologyThe literature survey has shown fewer studies on the NP epidemiology. A study on patients evidenced neuropathic pain in 8.2% of adult patients having significantly higher pain intensity than others in a British study. 1,4 Moreover, in a randomly selected adult population using the Douleur Neuropathique four Questions, neuropathic pain were identified in 6.9% of the examined persons in a French study. 5 NP risk factors includes: females, elderly age, minor level of education, living in a rural area worse health (compromised physical, mental and social wellbeing). [5][6][7][8][9] Pathomechanisms Pathomechanisms causing the development of NP are divided into 3 groups: first, electrophysiological properties of the cellular membrane of the first Post-amputation Pain Phantom pain was incident in amputated patients with extremity and stump pain located surrounding the post-surgical stump scar. 31 Due to the fact that strong opiods, tramadol, gabapentin, lidocaine infusions, calcitonin pregabalin or amitriptyline are recommended, evidence of effectiveness ...

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“…Inhaled or vaporized cannabis has also been studied, but, again, few randomized trials have been conducted. A recently published meta-analysis demonstrated that 1 in 5-6 patients would benefit from the use of inhaled cannabis treatments for neuropathic pain 43 .…”

Section: Painmentioning

confidence: 99%

A User’s Guide to Cannabinoid Therapies in Oncology

Maida

Daeninck

2016

Current Oncology

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ABSTRACT"Cannabinoid" is the collective term for a group of chemical compounds that either are derived from the Cannabis plant, are synthetic analogues, or occur endogenously. Although cannabinoids interact mostly at the level of the currently recognized cannabinoid receptors, they might have cross reactivity, such as at opioid receptors.Patients with malignant disease represent a cohort within health care that have some of the greatest unmet needs despite the availability of a plethora of guideline-driven disease-modulating treatments and pain and symptom management options. Cannabinoid therapies are varied and versatile, and can be offered as pharmaceuticals (nabilone, dronabinol, and nabiximols), dried botanical material, and edible organic oils infused with cannabis extracts. Cannabinoid therapy regimens can be creative, involving combinations of all of the aforementioned modalities. Patients with malignant disease, at all points of their disease trajectory, could be candidates for cannabinoid therapies whether as monotherapies or as adjuvants.The most studied and established roles for cannabinoid therapies include pain, chemotherapy-induced nausea and vomiting, and anorexia. Moreover, given their breadth of activity, cannabinoids could be used to concurrently optimize the management of multiple symptoms, thereby reducing overall polypharmacy. The use of cannabinoid therapies could be effective in improving quality of life and possibly modifying malignancy by virtue of direct effects and in improving compliance or adherence with disease-modulating treatments such as chemotherapy and radiation therapy.

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Inhaled Cannabis for Chronic Neuropathic Pain: A Meta-analysis of Individual Patient Data

Cited by 200 publications

References 87 publications

How I manage the toxicities of myeloma drugs

How I manage the toxicities of myeloma drugs

Neuropathic Pain: Literature Review and Recommendations of Potential Phytotherapies

A User’s Guide to Cannabinoid Therapies in Oncology

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