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Cannabis and chronic pain: What conditions could it help?

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A range of chronic pain conditions do not have a cure, but symptoms can be eased with cannabis

One of the most frequently asked questions linked to the use of CBD and medical cannabis is, ‘will it ease my pain?’

While there’s no definitive answer yet, research into the subject so far is indicating a positive response, much to the relief of chronic pain sufferers across the world.

Here, Cannabis Health explores the most common chronic pain conditions cannabis may help with.

 

Fibromyalgia 

Thought to affect around one in 20 people, fibromyalgia is a long-term condition that causes pain all over the body, as well as other symptoms including headaches and muscle stiffening. There is currently no cure for the condition and those affected continue to look for new and alternative ways to manage their pain – with a recent US study finding that one third of fibromyalgia patients use medicinal cannabis for symptom relief.

A 2019 study of 367 patients supported this usage, finding that the remedy can reduce pain intensity. The team leading the research stated that “cannabis therapy should be considered to ease the symptom burden among those fibromyalgia patients who are not responding to standard care”.

 

Endometriosis

Despite affecting at least one in ten women in the UK, endometriosis is a regularly misunderstood and misdiagnosed condition. Again, there is no cure for the condition, which is caused by tissue similar to the lining of the womb growing in other places and reacting to the menstrual cycle. Treatment is limited to painkillers and hormonal contraception, however in severe cases this can provide little relief – which is why more and more women are turning to CBD.

Results from women using the remedy are encouraging, with research supporting this and finding that cannabinoids such as CBD can stop endometrial cells from multiplying, reduce inflammation and desensitise nerves that transmit pain.

 

Multiple Sclerosis (MS)

A 2017 review from the MS Society found that 66% of people with MS surveyed had used cannabis to help with their symptoms, which can include muscle spasms, stiffness and chronic pain. As much-needed research and evidence to support these claims continues to grow, the number of MS patients turning to CBD is likely to have grown even further.

While still ongoing, research certainly seems to back up usage, with Rudroff and Sosnoff stating in a 2018 study: “It is our opinion that CBD supplementation may be advisable for PwMS (patients with MS) to reduce fatigue, pain, spasticity, and ultimately improve mobility.”

Arthritis

Arthritis is the most common cause of disability in the UK, with around 10 million people of all ages thought to be affected. However, despite a growing number of cases, most sufferers are left to self-manage pain and find their own methods of relief – such as CBD.

While no rigorous clinical studies in humans have been conducted to confirm the science behind the impact of CBD on arthritic pain so far, extensive positive reviews by users and results from animal studies are encouraging. For example, a 2017 study found that CBD might be a safe and useful treatment option for joint pain associated with osteoarthritis, while a 2016 review found that topical application of CBD had the potential to relieve pain and inflammation associated with the condition.

For sufferers of these conditions – as well as other illnesses causing chronic pain – CBD has been a welcome natural alternative for easing symptoms and reducing intensity, with ever-growing research only set to increase its popularity.

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Project Twenty21 finds medical cannabis dramatically improves quality of life

The first findings from the UK’s largest medical cannabis patient study show quality of life improved by more than 50 percent. 

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Results show a 51 percent increase in patients ability to lead a more normal life

The first findings from the UK’s largest medical cannabis patient study show quality of life improved by more than 50 percent. 

Preliminary results from Drug Science’s Project Twenty21 study, have found medical cannabis significantly improves quality of life for people with life-limiting conditions such as chronic pain, multiple sclerosis (MS) Tourette’s syndrome and post-traumatic stress disorder (PTSD).

Published on Tuesday 11 May, the report is the first real-world data to be collected on medical cannabis in the UK.

Launched in 2019, Project Twenty 21 has now licensed prescriptions of medical cannabis to over 900 patients, who have been unable to manage their conditions with commonly prescribed medicines. 

Their progress has been assessed using the established methodology that is used to study the wellbeing of patients with cancer, cardiovascular disease, dementia and numerous other conditions.

Results show a 51 percent increase in patients’ self-reported health and ability to lead a more normal life, as well as significant improvements in managing debilitating secondary conditions such as anxiety, insomnia and depression.

Every patient enrolled had at least two ‘failed treatments’ on their medical records –  where commonly prescribed medications, such as opioids, had little to no effect on their ability to manage their conditions. 

Sixty four percent of patients involved in the study were male, 35 percent female and one individual identified as non binary, with an average age of 39.9 years.

The vast majority of patients (56 percent) reported chronic pain as their primary condition.

By 13 March 2021, a total of 75 individuals had completed both an initial and three-month follow up appointment, indicating the life-improving effect of prescribed medical cannabis on improved health. 

Dr Anne Katrin Schlag

Dr Anne Katrin Schlag, head of research at Drug Science

Dr Anne Schlag, head of research at Drug Science, the organisation behind the project and an honorary fellow at Imperial College London, said: Our patient population comprises a huge age range, who often have multiple health problems. The low quality of life that they experience demonstrates just how unwell many of them are.

“Stereotypes of medicinal cannabis users as being young, healthy recreational users looking for a legal source could not be further from the truth.”

Speaking to Cannabis Health she said that the treatment of patient’s secondary conditions was “essential” when considering their overall quality of life.

“The majority of patients have secondary conditions, some even as many as up to 10,” said Dr Schlag.

“Most common secondary conditions diagnosed were depression, back and neck problems, insomnia, stress and anxiety, which all can be severely detrimental to patients’ quality of life.

“With this high number of multi-morbidity, many of these patients would have been excluded from formal, randomised controlled trials, highlighting the importance of a real-world evidence database, such as Twenty21.” 

Almost two thirds (63 percent) of patients in the study had previously turned to illegal cannabis use in an attempt to treat their conditions, but have been able to avoid criminality thanks to a legal prescription. 

According to researchers, prescriptions also provide an opportunity to reduce and stop reliance on widely available medicines which can come with serious side effects, including dependency.

The report follows guidance from the National Institute for Clinical Excellence (NICE) published in April 2021, which stated, ‘there is little or no evidence that [commonly prescribed drugs, such as benzodiazepines or opioids] make any difference to people’s quality of life, pain or psychological distress, but they can cause harm, including possible addiction’.

Drug Science experts have previously called for NICE and other regulatory bodies to reconsider their guidance on medical cannabis and give patients another viable option. 

Dr Schlag told Cannabis Health that the impact of medical cannabis on opioid use would be analysed in a future report.

“In the current paper, we can see that the majority of patients are using medical cannabis to treat pain but not – yet – whether this led to opioid sparing,” she added.

Through project Project Twenty21, Drug Science is aiming to build the UK’s largest body of evidence for the effectiveness of medical cannabis, in the hope that the findings will lead to NHS funding where the benefits of treatment outweigh the potential risks.

Founder of Drug Science, Professor David Nutt, commented: “A lack of clinical evidence has made it difficult for doctors to confidently prescribe legal medical cannabis in the UK. These new findings provide a major step forward, and help to clarify the benefit these medicines can have for thousands of seriously ill patients.”

The scheme subsidises prescriptions for eligible patients to access affordable treatment through a number of UK clinics.

Eric Bystrom, CEO of Cellen, one Project Twenty21’s prescribing clinics said the findings were “significant” in furthering the understanding of medical cannabis, he added: “To date, much of the narrative in the UK has been centred around the perceived lack of data and evidence. For the first time, we now have meaningful data and research from the UK.

“This is significant because it starts to equip clinicians with data and furthers the education and understanding of medical cannabis in the UK”

What’s it like to be a patient on Project Twenty21?

My experience as a medical cannabis prescriber on Project Twenty21

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Experts to explore the role of medical cannabis in women’s health

A line-up of leading experts will discuss how cannabis medicines can play a vital role in women’s health.

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Many women are still unaware of female-specific health conditions such as pelvic inflammatory syndrome (PIS) or vulvodynia

Leading pain specialist, Dr Sally Ghazaleh will join a line-up of experts to discuss how cannabis medicines can play a vital role in women’s health.

The first of a four-part webinar series, taking place on Wednesday 12 May, will focus on the experience’s of women who have not felt supported by the current healthcare system – and how cannabis has helped them find relief from their conditions.

Dr Sally Ghazaleh, a pain specialist at Integro Medical Clinics, will join Sarah Higgins, clinical nurse specialist and women’s health lead at Cannabis Patient Advocacy Support Services (CPASS), alongside endometriosis patients Abby Hughes, outreach chair of PLEA (Patient-Led Engagement for Access) and Laura, author of The Endomonologues blog.

Dr Sally Ghazaleh

Dr Sally Ghazaleh is a pain management specialist

Aimed at patients, clinicians and the general public the webinar series, hosted by Cannabis Health, Integro Clinics and CPASS, aims to discuss the application of cannabis medicines in the management of complex female health conditions.

It will also highlight some of the wider issues and gender inequalities played out in the modern medical model.

Studies have shown that women’s pain is not acted on as quickly and is more likely to be dismissed than men’s, while many conditions can present differently in women than in men and therefore take longer to diagnose.

Many women are still unaware of female-specific health conditions such as pelvic inflammatory syndrome (PIS) or vulvodynia and can live with the symptoms for many years before they are correctly diagnosed and treated.

Some patients are now reporting that they have found cannabis medicines to be helpful in the management of their health conditions.

Dr Ghazaleh, a consultant at Whittington Hospital and the National Hospital of Neurology and Neurosurgery in London, joined Integro Clinics as a prescriber of medical cannabis in January. 

She specialises in managing patients with a wide range of pain conditions and has a particular interest in bladder and abdominal pain in women, and women’s health in general.

The free webinar will take place on Wednesday 12 May at 7pm.

The event is hosted by Cannabis Health, Integro Medical Clinics and CPASS, sign up for free here

If you would like further information, or to make an appointment for a medical consultation with Dr Sally Ghazaleh please contact Integro Clinics:  

Email: Contact@integroclinics.com

Twitter: @clinicsintegro

www.integroclinics.com

 

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Study: Novel CBD strain shows promising effects on pain

A novel strain of CBD has been shown to have positive pain-relieving effects in studies on mice.

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Pain sensitivity was greatly reduced in animals that were treated with KLS-13019 or CBD. 

A novel strain of CBD has been shown to have positive pain-relieving effects in mice.

A US study has generated promising results around the pain-relieving capabilities of a novel CBD analog in animals with chemotherapy-induced peripheral neuropathy (CIPN). 

CIPN is a common side effect of certain cancer treatments that damage peripheral nerves, which carry sensory information to the arms, legs, and brain. 

The severe pain manifests in different ways in human patients but involves tingling or burning sensations and numbness, weakness, or discomfort in the limbs.

Studies have shown that while CBD reduces pain sensation in animals, its ability to do so in humans is limited by low bioavailability.

New work by scientists at the Lewis Katz School of Medicine at Temple University, suggests this obstacle may be overcome by a novel CBD analog known as KLS-13019, developed by the Pennsylvania-based biopharmaceutical company Neuropathix.

In previous work in cell models, it was found to be more potent than CBD, and studies in animals suggested it had improved bioavailability.

In a series of experiments designed to gauge animals’ pain responses, researchers found that pain sensitivity was greatly reduced in animals with CIPN that were treated with KLS-13019 or CBD. 

KLS-13019 further reversed sensitivity to painful stimuli in animals in which peripheral neuropathy was already established, an effect that was not observed in CBD-treated animals.

Dr Sarah Ward

Dr Sara Ward. Photo: Temple University Health System

Dr Sara Jane Ward, PhD, Assistant Professor of Pharmacology at the Katz School of Medicine and senior investigator on the new study, commented: “In a mouse model of chemotherapy-induced peripheral neuropathy (CIPN), we’ve been able to show for the first time that KLS-13019 works as well as, if not better than, CBD in preventing the development of neuropathy and reversing pain sensitivity after pain has been established.” 

Earlier studies have also hinted at the possibility that CBD is able to reduce opioid craving in patients with opioid use disorder.

While Dr Ward and colleagues did not find evidence supporting a role for CBD in reducing opioid craving, they did observe significantly reduced opioid-seeking behaviour in KLS-13019-treated animals.

“This tells us that KLS-13019 has benefits beyond its ability to alleviate pain,” Dr Ward added.

Researchers suspect that while sharing a mechanism with CBD for pain relief, KLS-13019 may have an additional mechanism of action, one that breaks up the pathways reinforcing opioid use.

Dr Ward and her team also plan to test the ability of KLS-13019 to alleviate other types of pain, beyond CIPN.

The findings were published online in the British Journal of Pharmacology.

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