UK Study Shows Chronic Pain Patients Benefit from Cannabis

By Pat Anson, PNN Editor

Chronic pain patients who used a variety of cannabis products experienced less pain, better sleep and improved quality of life, according to a new UK study that found the most improvement in patients who used oil-based cannabis products.

Researchers at Imperial College London assessed the safety and efficacy of cannabis in over 700 pain patients enrolled in the UK Medical Cannabis Registry. Participants were divided into three groups that used either oil-based cannabis, smoked or vaporized dried flowers, or a combination of both (CBMP) for six months. The oil-based products included extracts, lozenges and capsules.

The study findings, published in the journal Expert Review of Neurotherapeutics, show symptom improvement in all three groups, with patients using cannabis oil either alone or in combination with dried flower reporting the most improvement.

Researchers think the CBMP group derived the most benefit because the cannabis was ingested through two different administrative routes, one absorbed straight into the blood stream through inhaling (dried flowers) and the other slowly absorbed through the digestive system (oil-based cannabis).

“The findings in this study demonstrate treatment with oil-based, dried flowers, or a combination of both CBMPs are associated with statistically significant improvements in pain relief and sleep quality after 6 months in chronic pain patients,” researchers reported.

“Additionally, patients prescribed oils or both types of CBMPs experienced reduced anxiety and an improvement in their ability to perform daily activities. Patients prescribed a combination of both CBMPs recorded improvements in their self-care and mobility abilities. Collectively, this evidence signals that initiation of CBMP treatment is associated with improved HRQoL (health related quality of life).

In addition to symptom improvement, participants in the CBMP group reported a small reduction (3.28%) in their use of opioid analgesics.

About one in every four patients had an adverse side effect, such as fatigue, somnolence and dry mouth. Adverse events were more common in females, former cannabis users and cannabis naïve (new) users.  

A previous study of patients enrolled in the UK Medical Cannabis Registry found significant improvement in their pain, discomfort and sleep quality after using cannabis oil.

A recent survey of U.S. adults with chronic pain found that nearly a third have used cannabis for pain relief. Over half of those who used cannabis said it also enabled them to decrease their use of opioids and other pain medications.

Medical Cannabis Improves Symptoms in Cancer Patients

By Pat Anson, PNN Editor

Medical cannabis improved pain and other symptoms in patients undergoing cancer treatment, while significantly reducing their use of opioids and other analgesics, according to a new study by Israeli researchers.

Over 300 cancer patients participated in the 6-month study, including many who were seriously ill. Breast, colon, lung and ovarian cancers were the most common diagnoses, with about half the patients receiving chemotherapy (55%) or diagnosed with advanced stage IV cancer (48%).

“Traditionally, cancer-related pain is mainly treated by opioid analgesics, but most oncologists perceive opioid treatment as hazardous, so alternative therapies are required,” said lead author David Meiri, PhD, an assistant professor at the Technion-Israel Institute of Technology in Haifa.

“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.”

Patients ingested cannabis that was rich in tetrahydrocannabinol (THC) through oil extracts, smoking or a combination of the two. For many, it was their first time using cannabis.

Most patients (60%) reported a positive effect from cannabis treatment, with significant improvement in their anxiety, depression, sleep, quality of life and pain catastrophizing. Most reported a small improvement in pain intensity and 20% said there was no improvement in their pain levels.

There was, however, a significant change in the use of analgesics. About 40 percent of patients who were taking pain medication of some kind (opioids, NSAIDs, anticonvulsants or antidepressants) stopped taking the drugs while using cannabis.

“We encountered numerous cancer patients who asked us whether medical cannabis treatment can benefit their health,” said co-author Gil Bar-Sela, MD, an 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.”

Notably, about one in every five participants died during the course of the study, which researchers attributed to their poor health and advanced cancer. Many of the patients also lost weight.

“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,” said Meiri. “Interestingly, we found that sexual function improved for most men but worsened for most women.”

Overall, researchers say cannabis treatment provided “mild to modest” improvement in cancer patients, with only minor side effects. Their findings were published in the journal Frontiers in Pain Research.

Study Finds Marijuana Reduces Pain, but Worsens Self-Care

By Pat Anson, PNN Editor

The 1998 comedy “The Big Lebowski” has a cult-like status as a stoner film, largely because of the way Jeff Bridges portrays a weed-smoking slacker who has no job, can’t pay the rent and spends half the movie in a bathroom robe. The Dude abides life at his own pace.

A new study may have inadvertently reinforced some of that stoner stigma, finding that marijuana use reduces pain but significantly worsens patient “self-care” – a broad category that includes behavior such as motivation, physical activity and appearance.

The study involved 181 pain patients enrolled in Pennsylvania’s medical marijuana program, who used marijuana for eight weeks and regularly completed surveys on its effects.

The study findings, recently published in the journal Medical Cannabis and Cannabinoids, showed that participants reported significant improvement in their pain and anxiety, and a small improvement in quality of life. But there was a caveat.

“One sees that the improvements to the pain and anxiety dimensions are tempered by a decline in the area of self-care. This is important because the side effect profile of cannabis may be diminishing the improvement in (quality of life),” wrote lead author Andrew Peterson, PharmD, University of the Sciences in Philadelphia. “A review of the literature found no other study connecting the use of marijuana with declines in self-care in pain patients using MM (medical marijuana).”

The study did not look at the doses used by participants, but since all products in Pennsylvania’s medical marijuana program contain some level of tetrahydrocannabinol (THC) – the psychoactive substance in marijuana – researchers believe there might be a connection. They said further studies were needed to see if there’s a relationship between THC, self-care and quality of life.

“There are many sources describing the negative consequences of marijuana,” Peterson wrote. “Given that our study found a decline in self-care among pain patients using MM (medical marijuana), it would be of interest to learn what aspects of self-care change when using MM for pain.”

According to the National Institute on Drug Abuse, some of the negative consequences of marijuana use include changes in mood, difficulty with thinking and problem-solving, impaired memory and an altered sense of time.  

Study Finds ‘Evidence Lacking’ for Most Fibromyalgia Treatments

By Pat Anson, PNN Editor

A new analysis has found little evidence to support the long-term use of any medication or therapy to treat fibromyalgia, a poorly understood disorder characterized by widespread body pain, fatigue, poor sleep and depression.

An international team of researchers from Brazil and Australia reviewed 224 clinical trials of fibromyalgia treatments and found many of them small and of poor quality. High quality evidence was found for cognitive behavioral therapy (CBT), anti-depressants, and central nervous system (CNS) depressants as short and medium-term treatments for fibromyalgia. No treatment was found to be effective long term.

“In this systematic review, the effectiveness of most therapies for fibromyalgia was not supported. Strong evidence supported only cognitive behavioral therapy for pain, as well as antidepressants and central nervous system depressants for pain and quality of life, but these associations were small,” wrote lead author Vinícius Cunha Oliveira, PhD, an adjunct professor at Federal University of the Valleys of Jequitinhonha and Mucuri in Brazil.

“Some therapies may be associated with small reductions in pain and improvements in quality of life in people with fibromyalgia; however, current evidence is lacking for most therapies.”

The study findings, published in JAMA Internal Medicine, reflect what many fibromyalgia sufferers already know; many treatments are ineffective in improving their symptoms.

The Food and Drug Administration has approved only three drugs for fibromyalgia; the antidepressants duloxetine (Cymbalta) and milnacipran (Savella), and the anti-seizure medication pregabalin (Lyrica). All three drugs were originally developed for other medical conditions and are being repurposed as treatments for fibromyalgia.

A large 2014 survey of fibromyalgia patients by the National Pain Foundation found that most people who tried the three FDA-approved drugs did not feel they were effective.

Exercise, acupuncture, massage, electrotherapy, myofascial release, and several other non-pharmaceutical treatments are also commonly recommended for fibromyalgia pain. Researchers found only “moderate” evidence to support their short-term use. High quality evidence was only found for CBT, a form of meditation in which a therapist works with a patient to reduce unhelpful thinking and behavior.

“Clinicians should be aware that current evidence for most of the available therapies for the management of fibromyalgia is limited to small trials of low methodological quality,” researchers concluded. “Clinicians and patients should choose therapies by considering other important outcomes in addition to those presented in this review, such as adverse effects, out-of-pocket costs, and patient preferences.”

The National Institutes of Health estimates about 5 million Americans have fibromyalgia. Most people diagnosed with fibromyalgia are women, although men and children also can be affected.

Relieving Pain Should Be a Pro-Life Issue

By Anne Fuqua, Guest Columnist

There’s an article in the Boston Globe this week about doctors who stopped prescribing opioid pain medication, even when they knew it might be harmful to patients.

As a registered nurse, I never expected to be on the other side of this issue.  But primary generalized dystonia and surgical complications inducted me into the “chronic pain club” 17 years ago.

As a patient in Alabama, I can attest to the fact that there is an overwhelming atmosphere of fear among physicians about prescribing opioids.

In 2012, seven Alabama doctors were investigated for over-prescribing.  Two years later that number sky-rocketed to 44 investigations.  The very few doctors that still prescribe are now distrustful of their most reliable, long-term patients. 

When my own well-respected doctor of nine years left pain management out of fear for his license, I had my medical records sent to almost 60 different physicians in the state. 

None of them were willing to treat me.

This was the most difficult and physically painful time of my life.  In just a few weeks’ time, I went from driving and being thrilled to start a part-time job as an “Obamacare Navigator” to being barely able care for myself independently.  I had no quality of life whatsoever.  Over a year later, I still have lasting physical effects from the wear and tear of severe spasms on my body. 

Beyond simple pain relief, opioid medication has always exerted a direct effect on my dystonia and makes a huge difference.  It’s far more than the benefit I received from any of the medications typically prescribed for dystonia (and without their side effects).  I’m so grateful to have the life I have today, even if I don’t live in the same body I did before I was forced to taper my medications.

Of the nearly 60 doctors I contacted 18 months ago, not a single one is still treating chronic pain patients. Those that didn’t stop out of fear for their licenses have been investigated by the state medical board or raided by law enforcement. 

We have entered an era where politicians, bureaucrats and licensing board members are now practicing unlicensed medicine by dictating the care that healthcare professionals should provide. 

Forcing patients with chronic pain to suffer because some people abuse opioids is no different than jailing someone just because you think they might commit a crime someday. This type of government over-reach directly contradicts the principles on which our nation was founded

We need more emphasis on determining who is at risk of developing addiction and the ability to provide a necessary structure for their safe use of medication.  Treatment should be available without stigma for those who need it. 

The same grace of withholding stigma that we provide to addicts should also be given to chronic pain patients.  Responsible patients have done nothing to deserve the horrible stigma they often face because they require opioids for a decent quality of life. 

Life without quality isn’t living at all.  There is no more of a “pro-life” issue than controlling pain and providing quality of life.  If you are pro-life and don’t support physician-assisted death, then you need to support physician-assisted quality of life. And that means pain management that utilizes opioids when necessary. 

This isn’t a special interest issue.  It’s everyone’s business. If you haven’t been affected or known someone who has, you will.  As a society, it’s our moral imperative to care for the least among us.  Relieving pain is the least we can do – and when life expectancy is limited, it’s the most we can do.

Anne Fuqua has primary generalized dystonia.  She is a former registered nurse and does volunteer work with at-risk youth and in animal rescue.  Anne is very involved with patient advocacy efforts, pushing for access to all forms of therapy, including opioids.

Pain News Network invites other readers to share their stories with us.  Send them to:  editor@PainNewsNetwork.org. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.