Cannabis-Based Products for Chronic Pain

McDonagh, Marian; Morasco, Benjamin J.; Wagner, Jesse; Ahmed, Azrah Y.; Fu, Rongwei; Kansagara, Devan; Chou, Roger

doi:10.7326/m21-4520

Cited by 63 publications

(47 citation statements)

References 45 publications

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“…Although, in male mice there is a significantly greater reduction in mechanical sensitivity by pure THC when CBD was excluded. These data are consistent with a recent meta-analysis that found that high THC:CBD ratios were better at reducing pain severity across a wide range of conditions, including diabetic neuropathy, in patients [ 22 ]. These data are also consistent with reports that CBD is an antagonist at cannabinoid receptors 1 and 2, and can blunt the effects of THC [ 23 , 24 , 25 ].…”

Section: Discussionsupporting

confidence: 91%

Combinations of Cannabidiol and Δ9-Tetrahydrocannabinol in Reducing Chemotherapeutic Induced Neuropathic Pain

et al. 2022

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Neuropathic pain is a condition that impacts a substantial portion of the population and is expected to affect a larger percentage in the future. This type of pain is poorly managed by current therapies, including opioids and NSAIDS, and novel approaches are needed. We used a cisplatin-induced model of neuropathic pain in mice to assess the effects of the cannabinoids THC and CBD alone or in varying ratios as anti-nociceptive agents. In addition to testing pure compounds, we also tested extracts containing high THC or CBD at the same ratios. We found that pure CBD had little impact on mechanical hypersensitivity, whereas THC reduced mechanical hypersensitivity in both male and female mice (as has been reported in the literature). Interestingly, we found that high CBD cannabis extract, at the same CBD dose as pure CBD, was able to reduce mechanical hypersensitivity, although not to the same level as high THC extract. These data suggest that, at least for CBD-dominant cannabis extracts, there is an increase in the anti-nociceptive activity that may be attributed to other constitutes of the plant. We also found that high THC extract or pure THC is the most efficacious treatment for reducing neuropathic pain in this model.

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Section: Discussionsupporting

confidence: 91%

Combinations of Cannabidiol and Δ9-Tetrahydrocannabinol in Reducing Chemotherapeutic Induced Neuropathic Pain

et al. 2022

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“…However, research is still attempting to parse out whether tetrahydrocannabinol (THC) or CBD imparts greater pain-reducing properties since both active components of marijuana bind to CBD receptors. Current evidence suggests a high THC to CBD ratio imparts greater pain-reducing properties, but this comes with the risk of more side effects including sedation and dizziness since THC is highly psychoactive 24. In fact, patients given prescriptions with high THC-CBD ratios have side effects severe enough to result in clinical study withdrawal 24.…”

Section: Discussionmentioning

confidence: 99%

Marijuana Use and its Effect on Clinical Outcomes and Revision Rates in Patients Undergoing Anterior Cervical Discectomy and Fusion

Lambrechts

D’Antonio

Toci

et al. 2022

Spine

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Study Design. A retrospective cohort study. Objective. To determine if (1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), (2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and (3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period. Summary of Background Data. A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use. The effects of marijuana on clinical outcomes and PROMs in the postoperative period are unknown. Methods. All patients 18 years of age and older who underwent primary one-to four-level ACDF with preoperative marijuana use at our academic institution were retrospectively identified. A 3.1 propensity match was conducted to compare patients who used marijuana versus those who did not. Patient demographics, surgical characteristics, clinical outcomes, and PROMs were compared between groups. Multivariate regression models measured the effect of marijuana use on the likelihood of requiring a reoperation and whether marijuana use predicted inferior PROM improvements at the one-year postoperative period. Results. Of the 240 patients included, 60 (25.0%) used marijuana preoperatively. Multivariate logistic regression analysis identified marijuana use (odds ratio = 5.62, P < 0.001) as a predictor of a cervical spine reoperation after ACDF. Patients who used marijuana preoperatively had worse one-year postoperative Physical Component Scores of the Short-Form 12 (PCS-12) (P = 0.001), Neck Disability Index (P = 0.003), Visual Analogue Scale (VAS) Arm (P = 0.044) and VAS Neck (P = 0.012). Multivariate linear regression found preoperative marijuana use did not independently predict improvement in PCS-12 (β = −4.62, P = 0.096), Neck Disability Index (β = 9.51, P = 0.062), Mental Component Scores of the Short-Form 12 (MCS-12) (β = −1.16, P = 0.694), VAS Arm (β = 0.06, P = 0.944), or VAS Neck (β = −0.44, P = 0.617). Conclusion.Preoperative marijuana use increased the risk of a cervical spine reoperation after ACDF, but it did not significantly change the amount of postoperative opioids used or the magnitude of improvement in PROMs.

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“…Still the concentration of THC in a cannabis extract cannot be compared to THC alone, but should be considered in relation to other cannabinoids present. For example, a systematic review of cannabinoid treatment of chronic pain found products with high-THC-to-CBD ratios the most useful for shortterm relief of neuropathic chronic pain (McDonagh et al, 2022).…”

Section: A B Cmentioning

confidence: 99%

Alterations of auditory sensory gating in mice with noise-induced tinnitus treated with nicotine and cannabis extract

Ciralli

Malfatti

Lima

et al. 2022

Preprint

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Aims/Hypothesis: Tinnitus is a phantom sound perception affecting both auditory and limbic structures. The mechanisms of tinnitus remain unclear and it is debatable whether tinnitus alters attention to sound and the ability to inhibit repetitive sounds, a phenomenon also known as auditory gating. Methods: 22 male C57BL/6J mice were used in this study. Anesthetized mice were exposed to a 9-11 kHz narrow band noise (90 dBSPL for 1 hr) and sham exposed mice were used as controls. Hearing thresholds were measured using auditory brainstem responses (ABRs) and tinnitus was assessed using Gap prepulse inhibition of acoustic startle (GPIAS). After the induction of tinnitus, mice were implanted multi-electrodes to assess auditory event-related potentials (aERPs) in the dorsal hippocampus in response to paired clicks. Alterations of aERPs under nicotine (1.0 mg/kg, intraperitoneal (i.p.) or cannabis extract (100 mg/Kg, i.p.) were evaluated (in isolation or in combination), the latter containing 47.25 mg/kg of tetrahydrocannabinol (THC); 0.43 mg/kg of cannabidiol (CBD) and 1.17 mg/kg of cannabinol (CBN), as analyzed by high-performance liquid chromatography (HPLC). Saline-treated animals were used as controls. Results: Our results show that mice with behavioral evidence of tinnitus display auditory gating of repetitive click, but with larger amplitudes and longer latencies of the N40 component. In contrast, no difference was observed in the P80 amplitude and latency between groups or treatments. The combination of cannabis extract and nicotine also improved auditory gating ratio in mice with noise-induced tinnitus without permanent hearing threshold shifts by strongly increasing the first N40 click amplitude but without altering the second click response amplitude. Furthermore, the increased latency of the N40 component suggests altered temporal processing of triggered attention in mice with tinnitus due to an increased sensitivity to the exposure to cannabis extract. Conclusion/Interpretation: In summary, we show that nicotine and cannabis extract alter sensory gating in mice with behavioral evidence of tinnitus and propose that the altered central plasticity in tinnitus is more sensitive to the combined actions on the cholinergic and the endocannabinoid systems. We conclude that the limbic system may play a role in the altered sensory gating responses on tinnitus since the hippocampus responses to auditory inputs are altered. These findings could enable a new understanding of which neuronal pathways could be involved in sensory gating in tinnitus.

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Cannabis-Based Products for Chronic Pain

Cited by 63 publications

References 45 publications

Combinations of Cannabidiol and Δ9-Tetrahydrocannabinol in Reducing Chemotherapeutic Induced Neuropathic Pain

Combinations of Cannabidiol and Δ9-Tetrahydrocannabinol in Reducing Chemotherapeutic Induced Neuropathic Pain

Marijuana Use and its Effect on Clinical Outcomes and Revision Rates in Patients Undergoing Anterior Cervical Discectomy and Fusion

Alterations of auditory sensory gating in mice with noise-induced tinnitus treated with nicotine and cannabis extract

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