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Quarta-feira, 29.07.15

Cannabis May Reduce Pain in Diabetic Peripheral Neuropathy

 

Inhaling Cannabis May Reduce Pain in Diabetic Peripheral Neuropathy

 

Patients diagnosed with diabetic peripheral neuropathy may have an alternative treatment to managing pain if dosages are examined more closely -- medical cannabis. 

About 50% of patients with diabetes are suffering from diabetic peripheral neuropathy, which can be present in a multiple forms.1 Some common symptoms include: hyperalgesia, numbness, paresthesia, sensitivity to touch, unsteadiness and weakness.

Published in the Journal of Pain, a new study revealed that inhaling cannabis relieves pain resulting from neuropathy — but there's a catch.2

Researchers found that there's a dose-dependant reduction in pain. Higher doses caused more sedation and euphoria in patients suffering from diabetic peripheral neuropathy pain.2

"There is some uncertainty regarding the dosing range that results in analgesia after administration of cannabis," the authors wrote in the study.

Study author Mark Steven Wallace, MD, told Clinical Pain Advisor that “there have been very few studies looking at different doses.”

"Most studies used single doses with inconsistencies between results," said Wallace, chair of the Division of Pain Medicine in the Department of Anesthesiology at UCSanDiego Health, an academic health system. "One study using experimental pain in healthy volunteers showed that medium doses of cannabis were effective in relieving pain whereas high doses actually increased pain."

In Wallace's randomized, double-blinded, placebo-controlled crossover study, researchers sampled 16 patients with  diabetic peripheral neuropathy to analyze both the tolerability and short-term efficacy of inhaled cannabis.

Each participant was exposed to placebo or cannabis in four sessions, separated by two weeks. Dosage amounts varied for those who were administered aerosolized cannabis. Researchers gave participants a low (1% THC), medium (4% THC), or high (7% THC) dose of cannabis. Pain intensity and subject "highness" scores were measured at various intervals. Researchers measured highness by asking participants to rank how "high" they felt on a 10-point scale (0 being "not high at all").

"It is unclear on the balance between the positive (pain relieving effects) and the negative," Wallace noted. "However, there was actually minimal effects on psychomotor testing."

His team measured psychomotor speed, attention and cognitive sequencing using what's known as the Trail Making Test, a neuropsychological test consisting of visual attention and task switching. Researchers, using the Paced Auditory Serial Attention Test (PASAT), also measured participant attention, working memory and information processing speed.

"Cannabis does not treat the underlying disease process of diabetic neuropathy,” he said. “It will not prevent the progression of the disease nor will it reverse the process. It only relieves the pain that results from the neuropathy.

As for pain specialists using medical marijuana for chronic pain, many questions still remain. What can this treatment be used for? Up until May of this year, about 15 trials of medical cannibinoids have been conducted worldwide. These findings indicated effectiveness in reducing pain in patients with cancer, diabetes, fibromyalgia and neuropathy.

One lingering question that hasn't been answered: Should physicians be allowed to prescribe medical cannabis to children? While nearly 65% of Americans approve of medical marijuana use for adults, only 36% agree that medical marijuana should be available for children, according to one report.3 The majority of survey respondents also noted that medical cannabis should not be used in front of children who are under the age of 18. When children do use the drug, however, it's typically not inhaled -- it's normally available in liquid, non-psychoactive form, such as the cannabinoid cannabidiol (CBD).

More recently, a recent study in JAMA concluded that there was moderate-quality evidence suggesting that cannabinoids could benefit those with chronic neuropathic or cancer pain. The study also revealed, however, that there was low-quality evidence for no effect on psychosis. There was very low-level evidence that cannabinoids affected depression.

"More studies are needed on chronic delivery," Wallace said. "And more studies are needed on cannabidiol (the non psychoactive component of marijuana). Our study used cannabis that had very low levels of cannabidiol."

References

  1. Tesfaye S, et al. Painful Diabetic Polyneuropathy. 2015; doi: 10.1007/978-1-4614-6299-6_13.
  2. Wallace M, et al. J. Pain. 2015; doi: 10.1016/j.jpain.2015.03.008.
  3. Uofmhealth.org. Most Americans say medical marijuana shouldn't be used by kids or in front of kids – legal or not | University of Michigan Health System. 2015. Accessed July 22, 2015.
 

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