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There is hope: Don’t let your back pain ruin 2022

Dr Anthony Ordman explains how cannabis medicines could offer relief for back pain and the best dosage techniques

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Back pain: A person holding their lower back in pain

Leading pain expert Dr Anthony Ordman, explains how cannabis medicine can offer an effective chronic pain solution

Anthony Ordman has spent over twenty years working in the Pain Management Clinic of London’s Royal Free Hospital, having set the clinic up in 1997. He now works in private pain medicine practice and is the past president of the pain medicine section of the Royal Society of Medicine.

He was awarded the Fellowship of the Royal College of Physicians in 2005 in recognition for his work in Pain Medicine, Anthony is now Senior Medical Adviser and Lead Clinician of Integro, Medical Cannabis Clinics Ltd. He is also a medical advisor to charities helping musicians, and those in the performing arts, and the Clinical Advisor on the board of BackCare, the National Back Pain Charity.

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Anthony Ordman on back pain

Anthony writes:  I became a Consultant in Pain Medicine some 24 years ago and have always had a special interest in the back and spinal pain which trouble so many patients attending the pain clinic, and so much of the general population.

Perhaps back pain is so common because our spines are designed by evolution for walking on all four limbs and supported at both ends. But we, as humans, insist on walking only on our hind limbs, and sitting upright, putting much more mechanical strain on every structure in our backs than they were ‘designed’ for.

Many of us also mobilise our backs through exercise rather less than we perhaps should. We only have to look at our pet cats to see how regular bending and stretching of our spines should be done several times a day to keep our spines healthy. We also tend to be much more sedentary than we should, and so the postural ‘core stability’ muscles surrounding our spines, can become rather less effective as ’guy ropes’ than they should be.”

As intervertebral discs become worn, and facet joints at the back of the spine become enlarged and stiff, nerve roots leaving the spine to go down the arm or leg become pinched, and spinal muscles can become painfully tight and stiff.

Often, with the right balance of rest, exercise, and simple pain medicines, such as paracetamol and ibuprofen, an episode of back pain can settle down relatively quickly. Sometimes people are not so fortunate and pain in the spine and limbs can go on to become long-term or chronic. There are many other people who suffer spinal pain brought on by their long-term medical conditions, such as multiple sclerosis, inflammatory arthritis, fibromyalgia, or hypermobility and Ehlers-Danlos syndrome, who have a very difficult time, despite receiving the best medical treatment of the underlying medical condition itself.

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Modern physiotherapy and medicine can often be of great help in such circumstances. But sometimes, even in the best of pain clinics with x-ray guided spinal injections, the best pain medicines and expert physiotherapists and clinical psychologists, accompanied by acupuncture and homoeopathy, are simply not enough. We struggle to help people rid themselves of back pain, enough to be able to enjoy life again. Often, this is because the pain has been ‘centralised’ by changes in the nerve cells of the central nervous system.

Thinking in particular of the specialist pain medicines we have to offer, choices can be surprisingly limited, and we have to be careful not to do more harm than good. Opioids such as codeine, tramadol and morphine don’t often help after a few weeks but continue to cause sedation, brain fog and constipation, with a high risk of dependency. Medicines such as amitriptyline used for nerve pain, low mood and poor sleep, often take more away more from patients in terms of memory and alertness, than they give through pain reduction. The same is so often true for gabapentin and pregabalin, and many of the other medicines licensed for treating pain. And while we are hopeful that the new classes of pain medicines will come along soon, we can’t expect any miracles just yet.

Dr Anthony Ordman from Integro Medical Clinics

Throughout my years in pain medicine, I’ve always attended national and international scientific medical meetings and, interestingly, almost every scientific conference seemed to have at least one lecture on the mysterious ‘endo-cannabinoid system’. This is a system of natural biological pathways present in all of our bodies, where nerve cells, and immune and other cells use natural ‘cannabinoid’ substances to signal to each other, regulating bodily processes such as pain transmission, inflammation, and so on. The function of the endocannabinoid system seems to have to do with normalising body activity after illness or injury. The hope had always been that, very soon, the big mainstream pharmaceutical companies would find us the medicines we needed to modulate the endocannabinoid system to reduce pain and improve lives.

Back pain and cannabis

But, unfortunately for us all, this hasn’t happened, partly because the legal and regulatory frameworks of many countries have made the development of cannabinoid drugs difficult or impossible. One or two cannabinoid medicines did become available in this country, Sativex being one, but this rarely seemed to help my pain patients who tried it. By contrast, some patients, and the doctors treating them, told me that when desperation drove people to try illicitly-sourced cannabis for their pain, this often did more good than many of our new and expensive licensed medicines.

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The main risk to patients seemed to be the illegality of the purchase of an illegal substance. Meanwhile, in other countries, such as Canada and Israel, the legal situation was eased, as it was seen that the pharmaceutical extracts of cannabis could be extremely helpful for those suffering long-term pain, and other conditions. Then, in November 2018, regulations were slightly eased here in the UK, to allow specialist doctors to prescribe cannabis-based medicines legally, for long-term conditions where conventional medical approaches had been tried or seriously considered, without benefit to the patient.

I was keen to find out for myself what cannabis medicines might have to offer patients who I could not help in other ways. And I was extremely fortunate to be approached by the chief executive of Integro Medical Clinics to see if I would take up the medical leadership role in a service that would specialise in using the new cannabis-based medicines. With the partnership and expert support of IPS, the country’s, leading expert pharmacy in dispensing pharmaceutical cannabis medicines, and several months of study on cannabis medicine, I found myself prescribing cannabis medicines for people whose lives were on hold because of pain.

Many had already tried CBD oil and found this just wasn’t enough to help, something we’re seeing more and more now. But in the clinic, we find that by blending just the right amount of THC and terpenes in each individual patient’s cannabis oil or flower, we are improving patients’ nerve and inflammatory joint pain and the painful muscle spasm of spinal pain, as well as improving sleep at night, without the daytime sedation or dependency of conventional pain medicines. People can begin to get back to their work, childcare and leisure activities with a clear head and sharper memory. And then, within two or three months, we can begin to relieve people of the burden of their conventional pain medicines. The very same cannabis medicines can also restore healthy sleep to patients and lift mood, which had been depressed by pain for so long. People also felt brighter and less anxious than before.

One patient I’m seeing, a fellow hospital clinician, was asked by her colleagues why she was walking normally now. She didn’t mention her new low-dose cannabis medicines to them, but importantly, I have no doubt she is safer in clinical practice than when she still had a lot of pain, and her conventional painkillers and muscle relaxants were making her sleepy.

So, thirty years of scientific awareness of the endo-cannabinoid system is finally beginning to benefit patients with long-term pain, including ‘centralised’ pain, and I’m delighted to be at the cutting edge of medical practice again, helping people to reduce their pain and improve their lives.

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Dosing techniques

Cannabis oils are taken by mouth, perhaps half a ml. placed under the tongue, or swallowed. The oil’s effect comes on gradually and, taken two or three times a day, give sustained benefit over many hours.

Pharmaceutical grade cannabis flower, with known levels of CBD, THC and terpene content, is inhaled using a specialist medical vaporizer, which heats the flower to exactly the right temperature to activate the cannabinoids. ‘Vaping’ is much safer than smoking cannabis, as it preserves the medicinal cannabinoids, which are damaged by the excess heat of smoking. We never recommend vaping with tobacco.

I’m sometimes asked why NICE, the National Institute for Health and Care Excellence do not recommend cannabis medicines for treating chronic pain in the NHS.

I answer by explaining that NICE relies on evidence from large ‘double-blinded random allocation clinical trials’, which are usually so expensive and time-consuming to carry out, that they have to be sponsored by the large, international pharmaceutical companies. Unsurprisingly, for various reasons including the adverse regulatory environment that still exist around the world, these studies have not yet taken place. On the other hand, there are plenty of ‘retrospective’ medical scientific papers that do show the safety and effectiveness of cannabis medicines for many long-term pain conditions.

In this, and other ways, The NHS is not ready for cannabis medicines yet, except in a few very limited cases. Fortunately, specialist cannabis medicine clinics have been quick to respond to the new opportunities to use cannabis carefully and safely for those with long-term pain when conventional medical approaches have not been enough.

Appointments

If you would like to book an appointment to see Dr Ordman and discuss your, or a family member’s, back pain please contact Integro Clinics and speak to our nurse who can take all your details. Consultations are remote so you can have an appointment from the comfort of your own home.

If you would like to watch BackCare, the National Back Pain Charities webinar on Back Pain and Cannabis Medicine with Dr Ordman speaking, please click on the link: https://youtu.be/2r5X6_Nhlq4

Dr Anthony Ordman, senior clinical adviser and hon. clinical director Integro Medical Clinics Limited said: Integro Clinics Ltd always recommends 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 Integro Clinics:

Website: www.integroclinics.com
Email: Contact@integroclinics.com
Twitter: @clinicsintegro

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New studies examine effects of THC and CBD on stroke

New data suggests both positive and negative effects of cannabis in stroke patients

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A new study has shown that pre-treatment CBD may have a neuroprotective effect in stroke patients.

The study aimed to investigate the effect of CBD on oxidative stress and cell death which occurs in ischemic stroke patients.

It revealed that the cannabinoid may reduce the destructive effects of cell damage associated with stroke.

Ischemic strokes are the most common type of stroke. They occur when a blood clot blocks a flow of oxygen or blood to the brain. This takes place in arteries that have been narrowed or blocked over time by fatty deposits (plaques). The most common symptoms of a stroke include facial drooping on one side, not being able to lift your arms and slurred speech.

If this occurs, it is vital that a person be taken to the emergency room immediately.

The National Institute of Health Care and Excellence (NICE) estimate that there are around 100,000 strokes every year in the UK. It is also thought that 1.3 million people live with the effects of a stroke.

Stroke recovery and CBD results

The Study showed that CBD reduced the amount of infarction in those samples which had been given the cannabinoid. Infarction refers to the death of tissue as a result of a lack of blood supply and is commonly due to a blood vessel being obstructed or narrowed.

There were also differences in malondialdehyde level (MDA) – a common marker of oxidative stress – between the brains of the CBD group and the vehicle group.

It also revealed that CBD may help to protect tissue by preventing further damage.

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THC and stroke risk

Another recent study examined the effect that tetrahydrocannabinol (THC) could have on strokes. It found that it may increase the risk of a certain type of stroke among cannabis consumers.

According to findings, cannabis consumers who experience a stroke known as an aneurysmal subarachnoid haemorrhage (aSAH), are twice as likely to develop further complications.

An aSAH occurs when a weakened blood vessel bursts on the surface of the brain leading to bleeding between the brain and tissue that covers it. It can result in neurological disabilities, long-term slurred speech or even death. It is estimated that aSAH affects around eight people per 100,000 of the population each year, accounting for six per cent of first strokes.

The study by the American Stroke Association suggested there is twice the risk of developing delayed cerebral ischemia for cannabis consumers. The researchers analysed data from 1,000 patients who had received treatment for bleeding over a 12 year period. In the group of participants, 36 per cent developed cerebral ischemia and 50 per cent had moderate to severe disabilities.

When comparing the results of patients who tested positive for THC with those who did not, they found cannabis consumers were 2.7 times more likely to develop cerebral ischemia. They were also 2.8 times more likely to develop long-term moderate to severe physical disabilities.

However, compared to those who tested negative for THC, the cannabis group did not have larger aneurysms, higher blood pressures or worse stroke symptoms when admitted to the hospital. They did not have any higher cardiovascular risk factors than the negative group.

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Researchers are now conducting further studies in which they hope to better understand if THC can impact aneurysm formation and rupture.

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New study shows CBD may prevent Covid-19 infection

Researchers are calling for more trials to determine if CBD could be a preventative or early treatment for the virus.

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Covid: A covid infection

Researchers are recommending clinical trials to examine if CBD could help to prevent Covid infection after more positive findings have been published.

Researchers from the University of Chicago have reported that CBD may stop the infection of Covid-19 by blocking its ability to replicate in the lungs.

A number of cannabinoids including CBD and THC were tested along with 7-Hydroxycannabidiol (7-OH-CBD) which is thought to be produced when cannabidiol is processed by the body.

The study found that CBD showed a significant negative association with SARS-CoV-2 positive tests in a national sample of patients who were taking  high doses of CBD, prescribed for epilepsy.

As a result of their findings, researchers are calling for more clinical trials to determine whether CBD could eventually be used as a preventative or early treatment for the virus.

Covid- Covid infection

Covid and CBD study

Researchers treated human lung cells with a non-toxic dose of CBD for two hours before exposing the cells to SARS-CoV-2 and monitoring them for the virus and the viral spike protein.

They found that, above a certain threshold concentration, CBD inhibited the virus’ ability to replicate.

Further investigation found that CBD had the same effect in two other types of cells and for three variants of SARS-CoV-2 in addition to the original strain.

CBD did not affect the ability of SARS-CoV-2 to enter the cell. Instead, CBD was effective at blocking replication early in the infection cycle and six hours after the virus had already infected the cell.

Like all viruses, SARS-CoV-2 affects the host cell by hijacking its gene expression machinery to produce more copies of itself and its viral proteins. This effect can be observed by tracking virus-induced changes in cellular RNAs. High concentrations of CBD almost completely eradicated the expression of viral RNAs.

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When it came to the other cannabinoids, CBD was found to be the only potentially potent agent. There was no or limited antiviral activity noted by the similar cannabinoids including THC, CBDA, CBDV, CBC or even CBG.

Marsha Rosner, PhD, professor and senior author of the study said it was a completely unexpected result, she commented: “CBD has anti-inflammatory effects, so we thought that maybe it would stop the second phase of COVID infection involving the immune system, the so-called ‘cytokine storm.’ Surprisingly, it directly inhibited viral replication in lung cells.

She added: “We just wanted to know if CBD would affect the immune system. No one in their right mind would have ever thought that it blocked viral replication, but that’s what it did.”

The researchers do caution that this is not possible with commercially available CBD. The CBD tested was high-purity and also medical grade.

However, Rosner cautioned:  “Going to your corner bakery and buying some CBD muffins or gummy bears probably won’t do anything. The commercially available CBD powder we looked at, which was off the shelf and something you could order online, was sometimes surprisingly of high purity but also of inconsistent quality. It is also hard to get into an oral solution that can be absorbed without the special, FDA-approved formulation.”

CBD and Covid studies

This is the second study to be released showing the potential for cannabinoids in Covid management and prevention.

A study by Oregon State University has revealed that the compounds cannabigerolic acid (CBGA) and cannabidiolic acid (CBDA), may have the ability to prevent the virus that causes Covid-19 from entering human cells.

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Researchers and scientists, led by Richard van Breedan, found that a pair of cannabinoid acids bind to the SARS-CoV-2 spike protein, blocking a step in the process the virus takes for infection.

Targeting compounds that block the virus-receptor interaction has been helpful for patients with other viral infections such as HIV-1 and hepatitis.

The researchers and scientists identified the two cannabinoid acids through a screening technique, developed previously in van Breeman’s laboratory. The team also screened different botanicals such as red clover, hops, wild yam and three types of liquorice.

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Partner of Irish politician “six years seizure free” faces charges over medical cannabis use

John Montaine uses medical cannabis to manage his epilepsy – and is said to be six years seizure free.

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Irish government medical cannabis
John Montaine, is the partner of Clare Sinn Fein TD Violet Ann Wynne.

The partner of a sitting Irish TD is contesting charges of cannabis possession, saying he uses it medicinally to manage his epilepsy.

John Montaine, who is the partner of Clare Sinn Fein TD Violet Ann Wynne, was charged with the alleged illegal possession of cannabis on February 11, 2021, at his family home, the Irish Independent reported.

Mr Montaine contests the charges and his partner Deputy Wynne has previously spoken publicly about how he uses cannabis medicinally to manage his epilepsy.

Speaking after the initial court hearing in November, Deputy Wynne said in March her partner would be “six years seizure free”.

She went on to say that it has improved his quality of life “100 per cent, without a doubt”.

“There was always some kind of issue – say John having a number of fits within the one month or losing teeth or suffering with severe migraine, but since John has been using the medicinal cannabis, he has had a better quality of life,” Deputy Wynne told the Independent.

She added: “It has also freed myself up. John would have been on disability allowance and I would have had to have been his carer but since using the medicinal cannabis, he doesn’t suffer from any of those issues any longer.”

Medical cannabis is legal in Ireland, but access to a prescription is limited.

Last year Ryan Gorman, a 26-year-old man, from Dublin, who also suffers from epilepsy, became the first patient to receive a cannabis-based medicine through the Medical Cannabis Access Programme.

Despite legislation being signed off in 2019, Ireland’s Health minister Stephen Donnelly only announced funding for it in January 2021, with the programme only becoming fully operational in November.

Four cannabis-based medicines are expected to be available through the MCAP, to people living with one of three qualifying conditions. These include intractable nausea and vomiting associated with chemotherapy, severe treatment-resistant epilepsy and spasticity associated with multiple sclerosis (MS). 

Mr Montaine’s solicitor appeared in Kilrush District Court on behalf of his client this week, where his case was adjourned until 15 March.

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