More and more patients with chronic pain are using the non-psychotropic cannabinoid cannabidiol (CBD) to relieve their pain. A survey of patients in America showed that cannabis-based medications and CBD reduced chronic pain in a large proportion of them. In addition, these medicines help to reduce the use of opiate-based painkillers.

Survey in seven pain clinics in America

A total of 253 patients from seven pain centres in Southern California were interviewed. The average age of the patients was 45.4 years. They were invited to participate in the survey through posters and flyers.

62 % of the respondents (152 people) already had experience with CBD products. Back pain was the most common type of pain with a share of 67.3 %. This was followed by nerve pain (46.7 %) and neck pain (44.7 %). In about half of the cases (56.3 %), the psychotropic and pain-relieving tetrahydrocannabinol (THC) was also contained in the cannabis product.

Chronic pain conditions treated included:

• Back pain
• Neuropathic pain
• Neck pain
• Migraine
• Limb pain
• Fibromyalgia

The CBD products were taken in different ways. The most common was by inhalation (62.9 %), followed by edible cannabis products (54.3 %) and oral cannabis tinctures (52.3 %). Some of the respondents had experience with several forms of administration.

The delivery forms used included:

• Inhalation or smoking
• Edibles
• Oral tinctures
• Topical cannabis preparations (cream, ointment, oil)
• Capsules
• Spray

Less pain for most people affected

For 59% of the respondents, CBD products help to alleviate their chronic pain. In addition, around 68 % of the patients were able to reduce the dosage of other painkillers. 53.7 % of the respondents were even able to reduce the intake of opiate painkillers.

In the survey, those affected were also asked about experiences in their surroundings, i.e. from friends, family members and acquaintances, regarding the use of CBD products. The result was positive, as 78.1 % of the respondents stated that they knew people who had successfully treated complaints with CBD. The results regarding tolerability were also quite positive. Only about 7 % of the respondents reported undesirable side effects.

A huge 91.9% of respondents said they wanted to learn more about the medicinal uses of CBD.

The state of research on CBD for chronic pain

There is still much research to be done on the treatment of chronic pain with CBD. However, it is already known that CBD has a low abuse potential. CBD even has rather the opposite effect. An American study in 2019 showed that Epidiolex®, a CBD-containing drug, can reduce addiction pressure and anxiety in patients with heroin addiction.

For chronic pain, especially neuropathic pain, recent data suggests that the cannabinoid THC has a greater analgesic effect than CBD. In 2020, another American study showed that chronic pain patients were able to reduce the dosage of their opiate painkillers after being treated with CBD for 8 weeks. THC and CBD-containing medications can therefore support pain relief.

More studies are needed in the future to find out whether CBD is an effective treatment alternative for the different kinds of pain disorders. In addition, the differences between CBD isolates and full-spectrum extracts need to be further investigated.

Source:

Schilling JM, Hughes CG, Wallace MS, Sexton M, Backonja M, Moeller-Bertram T. Cannabidiol as a Treatment for Chronic Pain: A Survey of Patients’ Perspectives and Attitudes. J Pain Res. 2021;14:1241-1250

https://doi.org/10.2147/JPR.S278718

According to estimates, up to nine million people in Germany suffer from migraines. Women are affected more often than men. Although migraine is one of the most common neurological diseases, its causes are not yet fully understood.

By definition, migraine is a type of headache in which there is a temporary functional disorder in the brain. This results in increased nerve excitability. In addition, more pain-triggering neurotransmitters are released in the brain, so that the vessels in the brain temporarily become inflamed.

The symptoms of migraine are expressed by an attack-like, pulsating and often hemiplegic headache. Often, sufferers also experience vegetative symptoms such as nausea/vomiting and sensitivity to noise or light.

About 15 per cent of sufferers also suffer from an aura phase, which occurs before the actual headache. In a few cases, there is no headache after the aura phase. Symptoms in the aura phase include flashes of light, double vision, blinding sensations, visual field defects, speech disorders and/or motor disorders. Perceptual disturbances are also possible, such as disturbances of the sense of colour or a magnification/reduction of objects.

Migraine: treatment and therapy options

According to the German Neurological Society (DGN) and the German Migraine and Headache Society (DMKG), painkillers such as ibuprofen, ASA, naproxen and diclofenac are effective for mild and moderate migraine attacks.

Triptans are used for severe migraine attacks, but their use is often accompanied by unpleasant side effects.

In the search for new treatment options, cannabinoid-containing medicines have increasingly become the focus of scientific attention in recent years. Various studies suggest that cannabinoids, especially cannabidiol (CBD) could be helpful in acute migraine attacks. This assumption is also supported by various experience reports and surveys.

New survey among migraine patients

Researchers at the University of Colorado in Boulder (USA) conducted an online survey with 161 migraine patients who have legal access to cannabis. The aim of the survey was to investigate the pattern of cannabis use and the associated improvement in migraine.

Seventy-six per cent of participants endorsed the use of cannabis to treat their migraines and 70 per cent of participants used over-the-counter painkillers as well as triptans in addition to cannabis.

The results state that migraine patients who used cannabis reported more severe attacks compared to patients who did not use cannabis. Compared to painkillers, cannabis was significantly more effective, according to the participants.

In the end, the researchers state that migraine patients experience a high degree of symptom relief through the use of cannabis. Future studies are needed to determine the cannabis forms, potencies and dosages that are most effective in treating migraines, they say.

Source:

Gibson LP, Hitchcock LN, Bryan AD, Bidwell LC. Experience of migraine, its severity, and perceived efficacy of treatments among cannabis users. Complement Ther Med. 2020 Nov 20;56:102619. doi: 10.1016/j.ctim.2020.102619. Epub ahead of print. PMID: 33227352.
https://pubmed.ncbi.nlm.nih.gov/33227352/

Two important judgments within a very short time create movement in the cannabis industry. Firstly, at the end of November, the ruling of the European Court of Justice (ECJ) provided clarity with regard to the sale of CBD products. This states that, according to the current state of scientific knowledge, cannabidiol (CBD), other than tetrahydrocannabinol (THC), does not appear to have psychotropic effects or harmful effects on human health.

Last week, the United Nations Commission on Narcotic Drugs (CND) officially recognised cannabis as a substance with “medical benefits”. Before that, cannabis was considered to be a substance with no or very little benefit. The Commission on Narcotic Drugs thus follows the recommendation of the World Health Organisation (WHO).

The Commission on Narcotic Drugs then voted by 27 votes in favour, 25 against and one abstention to classify cannabis as a substance with medical properties.

According to a media report, Yann Bisiou (assistant professor at the University of Montpellier-III and expert in drug law) made a statement on this historic reassessment:

“This is the first time since 1916 that cannabis has been recognised at international level as being of therapeutic interest. For a century, international conventions on drugs have consistently emphasised that this substance is dangerous and has no medical benefit whatsoever. In 2020, the UN declares that the opposite is true”.

Jürgen Neumeyer from the industry association Cannabiswirtschaft commented on the reclassification as follows:

“Following this international impulse, we expect to see worldwide facilitation in the handling of medical cannabis. We very much welcome this, as importers, growers and distributors can expect less bureaucratic hurdles in the future”.

Way to legalisation?

The decision of the Commission on Narcotic Drugs does not yet pave the way for legalisation of cannabis in the EU member states. Cannabis is still listed as a substance that must be strictly controlled, no longer in the highest category IV with heavy drugs like heroin, but still in subgroup I together with drugs like cocaine and methadone.

However, experts believe that the re-evaluation of cannabis could be a small step towards relaxation. Further developments remain to be seen, however.

In Deutschland bleibt der Besitz von Cannabis strafbar. In vielen Bundesländern werden die Ermittlungsverfahren jedoch häufig wegen Geringfügigkeit eingestellt.

In Germany the possession of cannabis remains a criminal offence. But, in many federal states, investigations are often dropped on the grounds of insignificance.

Sources:
https://www.gentside.de/gesundheit/uno-erkennt-medizinischen-nutzen-von-cannabis-an_art20477.html
https://www.dw.com/de/vereinte-nationen-bewerten-cannabis-neu/a-55807237

Professor Thomas M. Clark of the University of Indiana, while conducting the meta-analysis, found that cannabis use correlated with a decrease in various cancers, including head, neck and lung cancer and cancers associated with obesity. However, Clark also found that cannabis use was associated with a slight increase in testicular cancer.

Despite the interesting results, Clark says that these are not necessarily conclusive. This is due to the fact that the data sets were very heterogeneous. There were also not enough data sets for many types of cancer.

Risk factors for cancer types

Clark also noted that cannabis users tended to show a low rate of obesity. Obesity is a known risk factor for many cancers. He also noted that most cannabis users have a low rate of inflammation. This is also a risk factor for cancer. This finding is supported by previous research that has already shown links between cannabis use and a reduced risk of inflammation.

The results also showed that cannabis users tended to have improved insulin resistance and thus a lower risk of diabetes than non-users. This association could also contribute to a reduced risk of cancer. This is because poor insulin resistance and diabetes are associated with a higher risk of cancer, as well as faster cancer growth.

As a conclusion, Professor Clark summarised:

“The current analysis does not support the average recreational use of cannabis as an effective stand-alone cure for cancer. However, the results suggest that cannabis therapy added to established cancer treatment regimens not only significantly improves the quality of life of cancer patients, but could also improve the effectiveness of treatment without stimulating tumour growth”.

Clark added that cannabis use could potentially reduce the cancer-related death rate in the USA (around 600,000 people die of cancer every year). However, the available data would give little confidence in this conclusion. This is because there seem to be different responses among cancers. There would also be little or no data available for many cancers.

In addition, Clark notes that although a relationship between cannabis use and cancer can be proven, a causality cannot. Therefore, caution should be exercised in interpreting the data.

Source:
https://www.liebertpub.com/doi/10.1089/can.2019.0095

The legal situation for the sale of products containing the cannabinoid cannabidiol (CBD) is still unclear in Germany. Cannabis with all its plant parts is subject to the German Narcotics Law (BtMG). Since CBD is not listed as an active substance in the BtMG, it could be assumed that it is therefore not considered a narcotic in the legal sense. However, there are different judgements on this.

However, a recent ruling by the European Court of Justice (ECJ) now provides clarity. In France, the entrepreneurs Sebastien Beguerie and Antonin Cohen-Adad were sentenced by the court in Marseille to 18 and 15 months imprisonment and a fine of €10,000 each for importing CBD-containing liquids for e-cigarettes from the Czech Republic and offering them for sale in France. Only hemp fibres and seeds may be used commercially here.

After the entrepreneurs appealed against the judgement, the proceedings finally reached the ECJ. This was to clarify the question whether the marketing of a CBD product manufactured in an EU Member State from the entire cannabis plant and not only from hemp fibres/seeds is compatible with EU law.

According to a report, the judges of the ECJ decided that the French law discriminates against competitors from other EU Member States. The reasoning stated that it could not refer to the free movement of goods when dealing with narcotics. This is because the marketing of narcotics is prohibited in all member states. An exception is the supervised trade in narcotics for scientific and medical use.

“On the other hand, the Court observes that the provisions on the free movement of goods within the European Union (Articles 34 and 36 TFEU) are applicable, since the CBD at issue in the main proceedings cannot be regarded as a ‘narcotic drug’”, the ECJ stated.

CBD has no harmful effects on health

The judges also stated that the terms “narcotic drugs” and “narcotic substances” are defined in the Convention on Psychotropic Substances and the Single Convention on Narcotic Drugs. While the cannabis plant is not mentioned in the first-mentioned Convention, the second Convention refers to the plant Cannabis Sativa L., which led the European Commission to conclude that the CBD, produced from the flowers and fruit of the plant, should be classified as a narcotic.

According to the ECJ, this interpretation by the EU Commission contradicted “the general spirit of that convention and to its objective of protecting ‘the health and welfare of mankind’”.

„According to the current state of scientific knowledge, which it is necessary to take into account, unlike tetrahydrocannabinol (commonly called THC), another hemp cannabinoid, the CBD at issue does not appear to have any psychotropic effect or any harmful effect on human health “.

For the CBD industry, the ECJ’s ruling is ground-breaking, as both European and national courts will be guided by it in the future.

Source:
https://www.apotheke-adhoc.de/nachrichten/detail/apothekenpraxis/eugh-cbd-ist-kein-betaeubungsmittel/?fbclid=IwAR3t-oEnXrFnJLWrGOZCqCKIE6iuQd_DSzR5BPiXndIHn4OYnpkFkdN2GAM

Fibromyalgia syndrome (soft tissue rheumatism) is a chronic pain disorder. About one to two percent of the German population is affected, with women six to seven times more often than men.

It is a very complex pain syndrome in which the symptoms can occur in both the muscles and the connective tissue of the entire body. Patients frequently complain of pain in the arms, legs and back. Typical for fibromyalgia is a painful pressure over various pain points (tender points). Patients also often suffer from sleep disorders, exhaustion, headaches, abdominal pain and digestive problems.

The causes have not yet been fully clarified. It is assumed that the patients’ perception of pain has changed so that they perceive stimuli more quickly and give them greater significance. Studies also suggest that the nerve fibres in the muscle tissue might also be altered. In many cases, however, no cause or trigger of the disease can be found.

The use of medical cannabis in fibromyalgia has been the subject of many trials. Because the endocannabinoid system is involved in the perception of pain, among other things, this might explain the positive results of the trials. Although the link between medical cannabis and fibromyalgia is not yet clear, the results so far are positive.

Cannabis extract shows effect in fibromyalgia patients

The Public Health School of the Municipal Ministry of Health in Florianopolis (Brazil) and the Federal University of Santa Catarina have now published the results of their eight-week clinical placebo-controlled trial. The study involved 17 women with fibromyalgia. They were given a daily dose of THC-rich cannabis extract (24.44 mg/mL THC and 0.51 mg/mL CBD).

During the eight-week period, the patients were interviewed regularly and, compared to the placebo group, the cannabis group showed a marked improvement in the values for pain, well-being, fatigue and depression. No serious side effects were reported.

The researchers say that more trials with different cannabinoids need to be done to assess the long-term benefits. This is the only way to improve our knowledge about the effects of medical cannabis in fibromyalgia.

Source:
Chaves C, Bittencourt PCT, Pelegrini A. Ingestion of a THC-Rich Cannabis Oil in People with Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Pain Med. 2020 Oct 1;21(10):2212-2218. doi: 10.1093/pm/pnaa303. PMID: 33118602; PMCID: PMC7593796.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593796/

According to estimates, over 320,000 people in Germany suffer from chronic inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis. Several studies have already shown that cannabinoids can have anti-inflammatory and pain-relieving effects in IBD.

In May this year, the Lambert Initiative for Cannabinoid Therapies at the University of Sydney published the results of its survey on chronic inflammatory bowel disease and the use of cannabis. About one quarter of Australians suffering from Crohn’s disease or ulcerative colitis are using illegal cannabis. Only 1.4 per cent of the 838 participants interviewed received legal medical cannabis.

The researchers said that these results indicate that patients cannot adequately treat their disease with drugs and are therefore looking for alternative treatment options. In particular, the use of cannabis helped patients to relieve cramps and pain. In addition, sleep quality and anxiety symptoms improved. In contrast, stool frequency, consistency and urgency improved only slightly.

Latest survey on IBD and cannabis use

The online magazine Medical Tribune reports on a current survey conducted by the Clinic for Integrative Medicine and Naturopathy in Bamberg. A total of 417 IBD patients were asked about their experiences with cannabis.

About 8 percent of the participants stated that they had already used cannabis to relieve their symptoms. 16.7 percent stated that medical cannabis was recommended to them by their doctor and 5.7 percent asked their health insurance companies to cover the costs. 82.4 percent obtained cannabis on the black market.

It is particularly interesting that 40 percent of those interviewed, according to their subjective assessment, stated that they were able to reduce their dose of biologicals by using cannabis. 6.7 percent stopped taking their medication altogether.

It is further stated that the most common reason for stopping cannabis use for symptom relief was the lack of access to legal medical cannabis. For this reason, 62.9 percent were in favour of legalising cannabis.

The researchers concluded that the high level of supply via the black market was a cause for concern. Furthermore, controlled clinical trials of medical cannabis for IBD were necessary.

Sources:
https://www.canpharma.eu/de/studie-medizinalcannabis-bei-chronischen-darmerkrankungen/
https://www.medical-tribune.de/medizin-und-forschung/artikel/cannabis-eigentherapie-bei-chronisch-entzndlichen-darmerkrankungen-weit-verbreitet/

In Germany, chronic back pain in the lumbar spine area (lumbalgia) is one of the most common diseases. The causes can be manifold. Patients suffer particularly frequently from arthrosis of the vertebral joints, osteochondrosis (wear-related changes in the vertebral bodies and intervertebral discs) and disc protrusion.

In many cases, non-drug therapies and the administration of painkillers are not sufficient to effectively relieve the symptoms. If the pain is very severe, opioids are used, which have considerable side effects and a high risk of dependence.

Various studies have already shown in the past that patients taking opioids and additionally medical cannabis have been able to reduce their opioid dose. This is possible because cannabinoids can enhance the effect of opioids. In this respect, opioids and cannabinoids can complement each other in pain management.

New study delivers positive results

The Society of Cannabis Clinicians in Sebastopol (USA) has now published the results of its retrospective cohort study with 61 patients suffering from chronic lumbar spinal pain and taking opioids.

After the patients received medical cannabis, 50.8 percent were able to stop taking opioids. This lasted a median of 6.4 years (IQR01.75-11 years). Of the 29 patients who could not stop taking opioids, nine patients were able to reduce their opioid dose. Another three patients maintained the dose and 17 patients had to increase the dose.

The authors of the study stated that no variables could be identified to measure which patients stopped taking opioids. However, the authors assume that those who used higher doses of cannabis were also more likely to stop using opioids for pain relief.

In their concluding statement, the authors of the study stated that in this long-term observational study, cannabis use was effective in about half of the clients as an alternative to opioids and as a supplement to reducing use in chronic opioid users.

Takakuwa KM, Hergenrather JY, Shofer FS, Schears RM. The Impact of Medical Cannabis on Intermittent and Chronic Opioid Users with Back Pain: How Cannabis Diminished Prescription Opioid Usage. Cannabis Cannabinoid Res. 2020 Sep 2;5(3):263-270. doi: 10.1089/can.2019.0039. PMID: 32923663; PMCID: PMC7480723
https://pubmed.ncbi.nlm.nih.gov/32923663/

Every woman over 40 will somewhen go through the menopause (menopause). During this time, the interplay of hormones in the body changes, so that symptoms like hot flashes, sweating, severe pain during menstruation, mood swings and sleep disturbances can occur.

For some women, the symptoms are so severe that their quality of life suffers considerably. There are several treatment options available to relieve the symptoms. These include hormone replacement therapy (oestrogens, gestagens), herbal preparations and local hormone preparations. However, many of these drugs are associated with adverse effects, so research is constantly looking at new treatment options.

One such alternative could be medical cannabinoids. It is thought that the endocannabinoid system (ECS) plays an important role in menopause. Among other things, ECS is responsible for regulating pain, mood, memory, appetite and the reproductive organs. Because cannabinoid receptors are found in the female reproductive system, medical cannabinoids might reduce symptoms.

However, there has been little research on the effects of cannabinoids on menopausal symptoms.

Women have been able to relieve complaints of cannabis

During the virtual annual meeting of the North American Menopause Society (NAMS) interesting study results were presented. In a sample of 232 menopausal women, more than half reported symptoms like hot flashes and night sweats, insomnia and urogenital problems.

About 27 percent of the women used cannabis to relieve these typical menopausal symptoms. Another 10 percent of women showed interest in using cannabis. Only 19 percent declared that they were taking traditional treatment (e.g. hormone therapy).

“These findings suggest that cannabis use to manage menopause symptoms may be relatively common. However, we do not know whether cannabis use is safe or effective for menopause symptom management or whether women are discussing these decisions with their healthcare providers […] his information is important for healthcare providers, and more research in this area is needed,” said Carolyn Gibson, PhD, MPH, psychologist and public health researcher at the San Francisco VA Health Care System and lead author of the study.

Dr. Stephanie Faubion, NAMS Medical Director, further explained that the study shows an alarming trend and the need for more research into the benefits and potential risks of cannabis use in the treatment of menopausal symptoms.

Source:
https://www.androidkosmos.de/wachsende-zahl-von-frauen-die-cannabis-zur-behandlung-von-wechseljahrsbeschwerden-konsumieren-studie/

Researchers at the Medical University of Innsbruck have now tested in a randomised controlled trial to what extent the synthetic THC drug nabilone can relieve non-motor symptoms (NMS). The results were published in the renowned journal of the American Neurological Assosiation “Annals of Neurology”.

Approximately two percent of the world’s population over the age of 60 suffers from the neurodegenerative disease Parkinson’s disease. Those affected suffer from a variety of motor disorders such as muscle tremor at rest, lack of movement, slowed movements and stiff muscles. In addition, the upright posture becomes increasingly unstable. Various non-motor symptoms (NMS) can also occur, such as mood swings, perception and sleep disorders, daytime tiredness, reduced performance, depression and anxiety.

The researchers explain that the burden on the NMS often increases during the course of the disease. There is little data from controlled clinical trials on treatment and the available treatment options are limited.

“The potential therapeutic effect of cannabinoids on motor function and NMS in Parkinson’s disease is an important issue and is often raised by patients in the treatment room,” said Marina Peball, the study’s lead author.

The neurologist and corresponding author of the study, Klaus Seppi, further explained that the study had examined the effect of nabilone “on the controlled treatment of NMS in Parkinson’s disease in a randomised, double-blind and placebo-controlled manner in a large number of patients”.

Nabilone is a synthetic analogue of tetrahydrocannabinol (THC), the psychoactive component of cannabis. Nabilone has similar pharmacological properties to THC.

Results of the study

In the study, a withdrawal design was used after all patients were adjusted to nabilone. The results said that the NMS load decreased under treatment with nabilone. In particular, anxiety decreased and the quality of sleep improved. In addition, the patients tolerated the therapy well.

“Given the data and possible mechanisms of action, we can say that nabilone seems to improve non-motor symptoms in patients with Parkinson’s disease,” the researchers said.

Thus, the results of the study may contribute to a better understanding of the value of cannabinoids in the treatment of NMS. The results may also serve as a basis for larger controlled trials that might lead to approval.

Source:
https://www.i-med.ac.at/mypoint/news/748324.html