Cannabinoid–Opioid Interaction in Chronic Pain

Abrams, Donald I.; Couey, Paul; Shade, Starley B.; Kelly, Mary Ellen; Benowitz, Neal L.

doi:10.1038/clpt.2011.188

Cited by 286 publications

(248 citation statements)

References 33 publications

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“…This is an important area for future research as the interaction effects between cannabis and opioids have not been fully investigated. 30,31 Interestingly, some studies have found that jurisdictions where cannabis is available for therapeutic purposes tend to see a decrease in prescription opioid/pain medication use, 32,33 suggesting that some people with chronic pain may be using therapeutic cannabis as a substitute for prescription opioids. 34,35 This study also indicated that among those who reported CUTP, 15.2% reported that they had medical approval to use cannabis therapeutically.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic use of cannabis: Prevalence and characteristics among adults in Ontario, Canada

Hamilton

Brands

Ialomiteanu

et al. 2017

Can J Public Health

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OBJECTIVE: To investigate the prevalence of therapeutic cannabis use within a general population sample of adults and to describe various characteristics associated with use.METHODS: Data were derived from the 2013 and 2014 CAMH Monitor Survey of adults in Ontario, Canada. This repeated cross-sectional survey employed a regionally stratified design and utilized computer-assisted telephone interviewing. Analyses were based on 401 respondents who reported using cannabis. RESULTS:The data indicated that 28.8% of those who used cannabis in the past year self-reported using cannabis for therapeutic purposes. Of therapeutic users, 15.2% reported having medical approval to use cannabis for therapeutic purposes. Cannabis use for therapeutic purposes was associated with more frequent use of cannabis, a moderate to high risk of problematic cannabis use, and a greater likelihood of using prescription opioids for medical purposes. There was little difference in cannabis use for therapeutic purposes according to sex, age, and marital status after adjusting for opioid use and problematic cannabis use. CONCLUSION:Findings suggest some potential negative consequences of cannabis use for therapeutic purposes; however, further research is needed to better understand the range and patterns of use and their corresponding vulnerabilities.KEY WORDS: Medical cannabis use; medical marijuana use; prescription opioids; problematic cannabis use La traduction du résumé se trouve à la fin de l'article.

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Section: Discussionmentioning

confidence: 99%

Therapeutic use of cannabis: Prevalence and characteristics among adults in Ontario, Canada

Hamilton

Brands

Ialomiteanu

et al. 2017

Can J Public Health

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“…66 Iversen stated that the brain is the organ mostly affected by administration of (THC) because its main effects are mediated through the cannabinoid receptors CB1 that densely concentrated e brain regions. 67 Similarly, Yassa studied the effect of subchronic toxicity of cannabis leaves (bango) on brain of experimental rats and they found noticeable brain tissue affection in the form of irregular shrunken cells with dense nuclei and vacuolated cytoplasm in all layers. 22 Accordingly, in the current study, tramadol, cannabis and their simultaneous abuse induced-brain oxidative stress is a Caspase triggering based on biochemical data.…”

Section: Discussionmentioning

confidence: 99%

A study of the neurotoxic effects of tramadol and cannabis in adolescent male albino rats

et al. 2016

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Background: Adolescence is a critical period for cerebral development. Exposure to addictive substances during this phase leads to various alterations in brain functions that persist into adulthood. The present study was designed to study the neurotoxic effects of tramadol and cannabis, alone and in combination, in adolescent male albino rats by studying their behavioral, biochemical, and histopathological neurotoxic effects and their long–term consequences after withdrawal.Methods: For this purpose, 132 adolescent male albino rats were divided into 5 groups (22 rats/ group). Group I (negative control), received only regular diet and tap water to measure the basic parameters, Group II (positive control; IIA&IIB); IIA, gavaged with normal saline. IIB, gavaged with olive oil. Group III (tramadol), gavaged with tramadol (42, 84 and 168 mg/kg/day) in the first, second and third ten days of the study respectively. Group IV (cannabis), gavaged with hashish extract (92, 184 and 368 mg/kg/day) in the first, second and third ten days of the study respectively. Group V (tramadol+cannabis), gavaged with tramadol and hashish extract in the same doses as Group III&IV. By the end of the first month, the half number of rats was subjected to performing behavior tests. Specimens from the brain were taken for performing biochemical and histopathological studies. All remaining rats were held for another 4 weeks non–dosing spontaneous recovery period after withdrawal of the treatment and were evaluated again by the same previous parameters.Results: Abuse of tramadol or cannabis, alone and in combination, caused antidepressant effect (sucrose preference test), impaired spatial memory (Morris water maze), elevated serotonin levels in the cerebral cortex and hippocampus, induced oxidative stress (significantly elevated malondialdehyde level and reduced catalase activity) as well as deleteriously altered brain histopathology and marked increase in brain Caspase–3 expression. However, abuse of both tramadol and cannabis conferred more antidepressant effect but more neurotoxic effect. After withdrawal, the antidepressant effect was reversed, no improvement of the spatial memory, marked depletion of 5–HT, more improvement in antioxidants and apoptotic markers and incomplete regression of brain histopathological alteration resulted.Conclusions: Abuse of tramadol and cannabis, alone and in combination, induced neurotoxicity which proved behaviorally, biochemically and histopathologically.

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“…Eicacy of Sativex for treating cancer pain is currently being tested [72], and use of cannabinoids also potentiates and improves the analgesic action of opioids in chronic pain conditions [73]. "dditionally, cannabinoids atenuate ischemia/reperfusion injury [74], which is a hallmark feature of VOC in SCD.…”

Section: Cannabinoid Receptors Cbrsmentioning

confidence: 99%

Mechanisms of Pain in Sickle Cell Disease

Aich¹,

Beitz²,

Gupta³

2016

Sickle Cell Disease - Pain and Common Chronic Complications

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Pain is one of the most common features of sickle cell disease SCD lacking efective therapy. Pain in SCD is relatively more complicated than other conditions associated with pain requiring understanding of the pathobiology of pain speciic to SCD. The characterization of pain to deine the diverse modalities of nociception in SCD is currently under progress via human studies accompanied by transgenic mouse models of SCD. Sickle pathobiology characterized by oxidative stress, inlammation and vascular dysfunction contributes to both peripheral and central nociceptive sensitization via mast cell activation in the periphery, and reactive oxygen species and glial activation and endoplasmic reticulum stress in the spinal cord among other efectors. These efects are mediated via several cellular receptors, which can be targeted to produce positive therapeutic outcomes. In this chapter, we will discuss the present understanding of molecular mechanisms of SCD pain and outline the mechanism-based translational potential of novel actionable targets to treat SCD pain.Keywords: pain, sickle cell disease, neurogenic inlammation, substance P, mast cell . IntroductionPain is a hallmark feature of sickle cell disease SCD , which can start in infancy, leading to hospitalization, reduced survival and poor quality of life. Pain in SCD is unique because of unpredictable and recurrent episodes of acute pain due to vaso-occlusive crises VOC , in addition to chronic pain experienced by a majority of adult patients on a daily basis [1]. Treatment choices remain limited to opioids, which impose liabilities of their own including constipation, mast cell activation, fear of addiction and respiratory depression [2]. Moreover, signiicantly larger doses of opioids are required to treat pain in SCD as compared to other acute and chronic pain conditions [1]. Pain can be lifelong in SCD and may therefore inluence © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.cognitive function and lead to depression and anxiety, which can in turn promote the perception of pain [1].Treatment of chronic pain remains unsatisfactory overall, perhaps due to the diverse pathobiology in diferent diseases. Therefore, it is critical to understand the mechanisms speciic to the genesis of sickle pain to develop targeted therapies. Vascular dysfunction, inlammation, ischemia/reperfusion injury and oxidative stress in the wake of VOC can each evoke activation of the nociceptive nerve ibers leading to acute pain. On the other hand, con...

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Cannabinoid–Opioid Interaction in Chronic Pain

Cited by 286 publications

References 33 publications

Therapeutic use of cannabis: Prevalence and characteristics among adults in Ontario, Canada

Therapeutic use of cannabis: Prevalence and characteristics among adults in Ontario, Canada

A study of the neurotoxic effects of tramadol and cannabis in adolescent male albino rats

Mechanisms of Pain in Sickle Cell Disease

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