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CBD guides: Can CBD help with cancer pain or nausea?

To mark World Cancer Day, we examine the science to see if CBD or medical cannabis could help.

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CBD for cancer pain and nausea

To mark World Cancer Day, we examine if cannabidiol (CBD) could play a role in the alleviation of symptoms from cancer or its treatment.

It is estimated that there are around 375,000 new cases in the UK every year, that’s around 1,000 cases of cancer every day. Some of the most common cancers include breast, lung, bowel and prostate.

There is growing interest in CBD and medical cannabis in the treatment of cancer pain or nausea.

We asked the experts if either could help with keeping symptoms under control.

How can CBD help with cancer pain or nausea?

Speaking with Cannabis Health, Dr Simon Erridge, head of research and access at Sapphire Medical Clinics explained how CBD may help.

“With respect to cannabis-based medicinal products, there is limited evidence of the role of cannabidiol (CBD) in managing nausea related to cancer. However, tetrahydrocannabinol (THC) has a clear role in the treatment of nausea, specifically chemotherapy-induced nausea and vomiting,” he said.

Dronabinol, which is THC created synthetically rather than derived directly from plants, is licensed for this indication. There are randomised controlled trials ongoing in the United States and Austria seeking to assess if Dronabinol has an effect in nausea or vomiting directly related to cancer itself rather than any treatment side effects.

There is no evidence of the effectiveness of cannabis-based medicinal in the treatment of cancer itself. When seeking treatment for cancer-related symptoms in the UK, patients must have tried and failed to receive sufficient benefit from first-line licensed therapies.”

Effects on pain

There is growing evidence of the effects of CBD in regulating the impact of pain by modulating the activity of peripheral pain receptors and regulation of pain response within the central nervous system.

A recent cell-based study from Imperial College London demonstrated that CBD directly inhibits the response of receptors that are involved in neuropathic pain processes.

Dr Simon Erridge continued: “The randomised trials of cannabis-based medicinal products to date in cancer-related have only studied the effects of combined THC and CBD products, such as Sativex. Therefore, the exact effects of CBD in isolation without THC for cancer-related pain are therefore unknown. However, a recent recommendation published in the British Medical Journal suggested for people living with chronic cancer or non-cancer pain that if standard care is not sufficient at controlling symptoms they can consider ‘offering a trial of non-inhaled medical cannabis or cannabinoids.”

Inflammation

There is evidence that CBD may inhibit pro-inflammation signals. In particular, CBD’s effect on inflammation appears to come from inhibiting proteins involved in cell signalling that are responsible for acute inflammation, such as interleukin-6 and tumour necrosis factor-alpha. It is not clear yet what role this plays in affecting cancer pain.

CBD may help cancer pain by treating inflammation. One study revealed that it may work by preventing the release of compounds responsible for inflammation in the body.

Cancer pain: could CBD gummies work?

Can CBD help with anxiety caused by a cancer diagnosis?

A diagnosis of cancer may cause a lot of anxiety for a patient or their family. CBD may help those with a diagnosis of an anxiety disorder following a cancer diagnosis.

Dr Simon Erridge explains: “CBD has demonstrated in pre-clinical studies that it increases endocannabinoids as well as activating serotonin receptors. Both mechanisms are purported to produced anxiolytic effects. There have been limited randomised controlled trials in anxiety disorders, pilot clinical trials and real-world evidence however suggest promise in improving anxiety in healthy volunteers and those with diagnosed anxiety disorders.”

What is the best type of CBD to take for cancer pain or nausea?

For the treatment of specific symptoms, it is important to seek the advice of a trained medical professional before starting any new treatments. CBD wellness products have not undergone clinical evaluation and are not recommended to be taken for the treatment of cancer or its symptoms.

Cannabis-based medicinal products, manufactured to pharmaceutical standards, containing CBD can be prescribed by doctors on the specialist register for the condition in which you are seeking treatment.

If they deem it appropriate for you to receive a prescription containing CBD for your condition this should be tailored towards your specific symptoms. For example, oils and capsules produced sustained effects, whereas dried flower that is vaped has a quicker onset of action.

Future Research on CBD and Cancer

There have been promising pre-clinical studies of the effects of CBD in brain cancers such as glioblastoma. A major UK trial, led by the University of Leeds, of cannabis-based drug Sativex in treating brain tumours, is now in development. It will be launched at 15 different NHS hospitals following positive results from 27 patients in the first phase of the study. Phase one found that more glioblastoma patients were alive after one year in the Sativex group compared to those on the placebo.

Other cancers where that have demonstrated promising future developments for research include pancreatic, colorectal and breast cancers

How do I know if THC or CBD will work better for me?

It is always best to discuss taking any new supplement or medication with your doctor or specialists. They can help you decide what may work best for you and they may be able to offer support in the case of any problems.

It can also help to speak to private doctors at medical cannabis clinics about the options available and if it could be prescribed to you.

CBD for cancer in dogs or cats?

Sadly, it’s not just humans who can experience cancer as our beloved pets can also develop it. While CBD is not legal for use with pets in the UK, it is in other parts of the world.

A small study published in the journal Animals reported that CBD-rich hemp nutraceuticals were found to be safe in a group of dogs. However, it also discovered cats had slower absorption rates and faster elimination. The researchers did note that there needed to be further research conducted.

The products do need to be zero-THC as it can be toxic for animals. The effect of THC in different animals can be down to breed, size or diet. Animals may have a reaction that includes symptoms such as becoming wobbly and uncoordinated. Pets may be become hyperactive, disoriented, or vocal. Their pupils may dilate, giving them a wild-eyed appearance, and they may drool excessively or vomit.

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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.

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Pain measures improved significantly with medical cannabis and other cancer-related symptoms also decreased.

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.

Keto: A banner advert for Medical Cannabis Clinics

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.”

Improved symptoms

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.”

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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.

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CreakyJoints review article

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.

Osteoarthritis: A banner advert for the medical cannabis clinics

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”.

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Study shows safety of using cannabis with opioids 

Findings suggest that CBD and THC are safe for use with opioid pain medication.

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There were over 100,000 opioid-related deaths in America in the last 12 months. 

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. 

According to data from the Center for Disease Control, there were over 100,000 opioid-related deaths in America in the last 12 months. 

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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