Experts at Integro Clinics explain how cannabis medicines can help alleviate and manage the excruciating pain of migraine.
Migraine can be a devastating and utterly miserable condition that can have a profound effect upon the patient’s quality of life, but medical cannabis can offer an effective, side-effect free treatment option.
A migraine is categorised as a moderate or severe headache felt as a throbbing pain on one side of the head. It is generally accompanied with symptoms such as feeling sick, vomiting and increased sensitivity to light or sound.
It’s a common health condition, affecting around one in every five women and around one in every 15 men and they usually begin in early adulthood.
No-one knows exactly what causes migraines, although they’re thought to be the result of temporary changes in the chemicals, nerves and blood vessels in the brain.
Many patients find they have a specific trigger such as certain food or drink, stress, tiredness or hormonal changes such as starting your period. Around half of all people who experience migraines also have a close relative with the condition.
There are several types of migraine, including:
- migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights
- migraine without aura – the most common type, where the migraine happens without the specific warning signs
- migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop
The frequency of the occurrence of migraines really depends upon the individual. It can be several times a week to every few years.
There’s no one specific cure for migraines. Patients try pain medicines such as paracetamol and ibuprofen and triptans to help with the pain but these medicines are often ineffective
If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines. It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.
Cannabis medicines have been found by certain patients to be incredibly helpful in the management of pain.
Dr Anthony Ordman, senior clinical adviser and hon. clinical director of Integro Clinics explains: “Recent medical scientific research is showing that cannabis medicines can have several useful roles in the prevention of migraine, and also reducing pain if a migraine attack does occur.
“It is likely that substances in cannabis medicines (plant-derived CBD, THC and terpenes) all have roles to play, and that they supplement the activity of the brain’s naturally occurring endocannabinoid system. This system may be under-active in people prone to migraine.
“There are three likely mechanisms by which cannabis medicines may be effective. Firstly, the natural stabilising or anticonvulsant effect of the cannabinoids suppresses the spreading abnormal wave of voltage depression in the brain’s cortical neurones. This wave precedes all migraine attacks and causes the aura familiar to migraine sufferers. Secondly, cannabis substances are thought to stabilise the mast cells of the immune system.
“In migraine, mast cells are involved in dilatation, or opening up of the blood vessels of the brain’s lining (dura), causing that familiar pulsating headache. Cannabis medicines may prevent this process from occurring.
“And finally, as in other painful conditions, if a migraine does occur, cannabis medicines are likely to block the transmission of pain messages in nerves running from the brain stem to the pain centres of the brain, to reduce pain itself. A recent study showed that cannabinoids may reduce migraine severity by 49.6 percent, without causing the ‘overuse headache,’ that other pain medicines such as paracetamol may cause.”
The patient’s story
Mike is a physically fit 37-year-old South African who first experienced migraines as a teenager. The pain he suffered was agonising and totally debilitating. It disturbed his vision, caused nausea and deep pain. Prior to the onset he experienced the aura of lights and would go blind in one eye.
An attack could wipe out days of his life whilst he recovered. For several days after the attack, he would feel befuddled and that his brain was not working properly.
Initially he looked into what could be causing the migraines worrying that he might have a brain tumour, but MRI scans thankfully showed that this was not the case. It was through luck and circumstance he stumbled upon cannabis as a medicine for his condition.
Mike was out playing golf in the hot sun and he became dehydrated. He felt the first symptoms of the headache begin so he paused for a rest under a tree and consumed some cannabis.
Instantly, he felt the pain begin to recede and he knew he had found a solution to his condition. He also wanted to point out that he was able to finish his round of golf and win. He came to the realisation that dehydration and hot sun were his major triggers.
Using cannabis would also mean that when a migraine did come it would last for a much shorter period of time and there was none of the post attack brain fog.
“I cannot recommend medical cannabis highly enough as treatment for migraine,” Mike adds.
“It addresses all of the symptoms of the loss of vision, nausea and deep pain by addressing the inflammation in the blood vessels of the brain.”
Integro Medical Clinics Ltd always recommend remaining under the care and treatment of your GP and specialist for your condition, while using cannabis-based medicines, and the Integro clinical team would always prefer to work in collaboration with them.
If you would like further information, or to make an appointment for a medical consultation, please contact us Integro Clinics: www.integroclinics.com
Email: [email protected]
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Medical cannabis reduces pain and opioid use in cancer patients – study
Findings suggest that medicinal cannabis can be carefully considered as an alternative to the pain relief medicines.
Medical cannabis reduces cancer-related pain and the need for opiate-based painkillers, reveals a new study in oncology patients.
A comprehensive assessment of the benefits of medical cannabis for cancer-related pain, has found that for most oncology patients, pain measures improved significantly, other cancer-related symptoms also decreased, the consumption of painkillers was reduced, and the side effects were minimal.
Published in Frontiers in Pain Research, these findings suggest that medicinal cannabis can be carefully considered as an alternative to the pain relief medicines that are usually prescribed to cancer patients.
Pain, along with depression, anxiety, and insomnia, are some of the most fundamental causes of oncology patient’s disability and suffering while undergoing treatment therapies, and may even lead to worsened prognosis.
Author, David Meiri, assistant professor at the Technion Israel Institute of Technology, explained: “Traditionally, cancer-related pain is mainly treated by opioid analgesics, but most oncologists perceive opioid treatment as hazardous, so alternative therapies are required.
“Our study is the first to assess the possible benefits of medical cannabis for cancer-related pain in oncology patients; gathering information from the start of treatment, and with repeated follow-ups for an extended period of time, to get a thorough analysis of its effectiveness.”
Need for alternative treatment
After talking to several cancer patients, who were looking for alternative options for pain and symptom relief, the researchers were keen to thoroughly test the potential benefits of medicinal cannabis.
“We encountered numerous cancer patients who asked us whether medical cannabis treatment can benefit their health,” said co-author Gil Bar-Sela, associate professor at the Ha’Emek Medical Center Afula.
“Our initial review of existing research revealed that actually not much was known regarding its effectiveness, particularly for the treatment of cancer-related pain, and of what was known, most findings were inconclusive.”
The researchers recruited certified oncologists who were able to issue a medical cannabis license to their cancer patients. These oncologists referred interested patients to the study and reported on their disease characteristics.
Bar-Sela said: “Patients completed anonymous questionnaires before starting treatment, and again at several time points during the following six months. We gathered data on a number of factors, including pain measures, analgesics consumption, cancer symptom burden, sexual problems, and side effects.”
An analysis of the data revealed that many of the outcome measures improved, with less pain and cancer symptoms. Importantly, the use of opioid and other pain analgesics decreased.
In fact, almost half of the patients studied stopped all analgesic medications following six months of medicinal cannabis treatment.
“Medical cannabis has been suggested as a possible remedy for appetite loss, however, most patients in this study still lost weight. As a substantial portion were diagnosed with progressive cancer, a weight decline is expected with disease progression,” reported Meiri.
He continued: “Interestingly, we found that sexual function improved for most men but worsened for most women.”
Meiri would like future studies to dig deeper and look at the effectiveness of medicinal cannabis in different groups of cancer patients.
“Although our study was very comprehensive and presented additional perspectives on medical cannabis, the sex, age, and ethnicity, as well as cancer types and the stage of the cancer meant the variety of patients in our study was wide-ranging. Therefore, future studies should investigate the level of effectiveness of medicinal cannabis in specific subgroups of cancer patients with more shared characteristics.”
Lack of research preventing wider prescribing of cannabis for arthritis
The review found limited progress in understanding the potential of cannabis for the treatment of pain.
A lack of research is preventing wider uptake of medical cannabis prescribing for arthritis pain, according to a new review published in the US.
A new review article has found that there has been limited progress in understanding the potential of cannabis-based therapies for the treatment of pain associated with rheumatic conditions in the past five years.
The article concluded that this is primarily due to a lack of standardisation of clinical research and barriers to conducting research due to existing federal and state regulations in the US.
The review, which was published by CreakyJoints, an international digital community for arthritis patients and caregivers, found that the legalisation and decriminalisation of cannabis at a state level in the US reflects changing attitudes about cannabis as use of the drug increases across a broad range of conditions, including rheumatic diseases.
Unfortunately, while there is strong preclinical evidence showing that cannabis-based products play a role in alleviating pain and reducing inflammation, the highly variable state and federal statutes have limited patient-centred prospective research, education of clinicians and comfort of patients in disclosing their cannabis use to clinicians.
W. Benjamin Nowell, PhD, director of patient-Centered research at CreakyJoints said: “In 2019, CreakyJoints presented data from our ArthritisPower Research Registry study showing more than half of arthritis patients reported wanting information on or actually had tried cannabis and/or cannabidiol products for a purpose they perceived as medical – often for pain relief and help sleeping.
“Yet, three years later, there’s been virtually no advancement in the research necessary to provide clinical evidence that rheumatologists and patients need to make decisions about cannabis use for symptom relief in combination with approved treatments.”
He added: “Without this research, it is impossible to develop clinical guidelines for medicinal cannabis in the US, which is vital for patients seeking the full range of treatment options to explore in partnership with their physicians. The best way to treat rheumatic conditions is through the use of US Food and Drug Administration approved medications, which are backed by evidence demonstrating their effectiveness and safety profile.”
Only three cannabis-based medications are approved by the US Food and Drug Administration, none of which are for the treatment of pain or other symptoms related to rheumatic conditions.
Lack of research stymying uptake of medical cannabis
Researchers draw attention to an array of studies that have shown that cannabinoids are effective in the laboratory at decreasing inflammation in cells and reducing inflammation and pain in mice and rats.
In addition, studies in humans that support efficacy are primarily surveys of people using medicinal marijuana who report relief of pain. However, in rheumatic diseases, there are very few studies of cannabis-based therapies in humans and the clinical trials conducted to date have small sample sizes and inconsistent methods.
“Although the clinical evidence about cannabis for rheumatic disease pain is lacking, it is nevertheless important to educate patients about the known benefits and risks of alternative treatments, including medical cannabis,” said Dr Stuart Silverman, rheumatologist, clinical professor of medicine, Cedars-Sinai Medical Center and UCLA School of Medicine and medical director, OMC Clinical Research Center.
“As a rheumatologist who treats patients with pain, I am aware that some of my patients have found cannabis to be an effective option when traditional medications fail to reduce their pain.
“I am open to discussing medical cannabis when patients express an interest in its use. Then, if they choose to use it, I follow them closely to monitor efficacy and any side effects and to ensure that they do not consider it as a replacement for FDA-approved disease-modifying drugs.”
CreakyJoints recommends that rheumatologists and healthcare providers be prepared to “discuss medicinal cannabis with their patients in an empathetic, non-biased manner”.
Study shows safety of using cannabis with opioids
Findings suggest that CBD and THC are safe for use with opioid pain medication.
Researchers in the US have found that using cannabis with opioids does not increase the risk of addiction.
Findings from a new study suggest that CBD and THC might be safe for use with opioid pain medication, without increasing the risk of addiction.
Although more studies are needed, the results suggest that these compounds, found in cannabis, might be a low-risk way to reduce the dose of opioids needed to relieve pain.
The results show that CBD and THC do not enhance the rewarding effects of opioids, meaning that these compounds may not increase the risk for addiction when used in conjunction with opioid medications.
In the new study, the researchers gave rhesus monkeys the opportunity to choose a food reward or an injection of the opioid fentanyl.
They then tested whether CBD, THC or mixtures containing both compounds affected the number of times monkeys selected fentanyl over food.
They found that a wide range of doses of CBD or THC both alone or in a mixture did not increase or decrease the number of times they selected fentanyl.
Medical cannabis is often cited as an alternative pain reliever to opioid medication, with many patients finding they are able to reduce the number of opioids they are taking after being prescribed cannabis.
Lawrence Carey, PhD, a postdoctoral fellow at the University of Texas Health Science Center, San Antonio, said: “There is intense interest in using medical marijuana in patients with chronic pain because compounds in marijuana like CBD and THC may produce pain relief themselves or enhance the pain-relieving effects of opioids.
“This means people could potentially use lower doses of opioids and still get relief from pain. Taking less pain medication could also lead to a lowered risk of addiction or physical dependence to opioids.”
He continued: “Giving the animals the opportunity to choose between a drug injection and a food reward helped us to somewhat replicate choices a human drug user may face, such as whether to spend money on drugs or food.
“Having the option of responding for food is also useful for studying drugs like THC that produce sedative effects. It helps demonstrate the animal is reallocating behaviour from drug to food choice instead of simply shutting down response for a drug due to sedation.”
The researchers are now conducting other studies to assess whether CBD and THC can decrease signs of opioid withdrawal and relapse.
“A big reason why people continue to take opioids after they become addicted is the appearance of withdrawal symptoms,” said Carey.
“We are using what we learned from this study to determine whether these doses — which didn’t alter choice for food or drug rewards — may help relieve opioid withdrawal or decrease relapse and drug seeking behavior following periods of abstinence.”
The researchers caution that opioid use disorder is a complex disease and there are many factors to consider when developing a drug to treat it.
Although this study indicates that THC and CBD do not increase the rewarding effects of opioids, they say that before applying these findings to people, it will be necessary to determine whether these treatments alter other pathological processes involved with opioid use and to better understand any risks that may be associated with their use.
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