Prescribiendo cannabis para reducir daños
Prescribing cannabis for harm reduction.
Collen M.
PainExhibit,com, 9008 El Cajon Way, #4, Sacramento, CA, 95826, USA.Mark@PainExhibit.com.
Harm Reduct J. 2012 Jan 1;9(1):1. doi: 10.1186/1477-7517-9-1.
Abstract
Neuropathic pain affects between 5% and 10% of the US population and can be refractory to treatment. Opioids may be recommended as a second-line pharmacotherapy but have risks including overdose and death. Cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning. The author suggests that physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. This harm reduction strategy may reduce the morbidity and mortality rates associated with
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295721/pdf/1477-7517-9-1.pdf
El consumo de cannabis en pacientes con fibromialgia: efecto sobre los síntomas de alivio de la salud y la calidad de vida
Cannabis use in patients with fibromyalgia: effect on symptoms relief and health-related quality of life.
Fiz J, Durán M, Capellà D, Carbonell J, Farré M.
Human Pharmacology and Neurosciences Unit, Institut de Recerca Hospital del Mar-IMIM, Parc de Salut Mar, Barcelona, Spain.
PLoS One. 2011 Apr 21;6(4):e18440. doi: 10.1371/journal.pone.0018440.
Abstract
BACKGROUND: The aim of this study was to describe the patterns of cannabis use and the associated benefits reported by patients with fibromyalgia (FM) who were consumers of this drug. In addition, the quality of life of FM patients who consumed cannabis was compared with FM subjects who were not cannabis users. METHODS: Information on medicinal cannabis use was recorded on a specific questionnaire as well as perceived benefits of cannabis on a range of symptoms using standard 100-mm visual analogue scales (VAS). Cannabis users and non-users completed the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI) and the Short Form 36 Health Survey (SF-36). RESULTS: Twenty-eight FM patients who were cannabis users and 28 non-users were included in the study. Demographics and clinical variables were similar in both groups. Cannabis users referred different duration of drug consumption; the route of administration was smoking (54%), oral (46%) and combined (43%). The amount and frequency of cannabis use were also different among patients. After 2 hours of cannabis use, VAS scores showed a statistically significant (p<0.001) reduction of pain and stiffness, enhancement of relaxation, and an increase in somnolence and feeling of well being. The mental health component summary score of the SF-36 was significantly higher (p<0.05) in cannabis users than in non-users. No significant differences were found in the other SF-36 domains, in the FIQ and the PSQI. CONCLUSIONS: The use of cannabis was associated with beneficial effects on some FM symptoms. Further studies on the usefulness of cannabinoids in FM patients as well as cannabinoid system involvement in the pathophysiology of this condition are warranted
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080871/pdf/pone.0018440.pdf
La actividad de la amígdala contribuye al efecto disociativo de cannabis sobre la percepción del dolor
Amygdala activity contributes to the dissociative effect of cannabis on pain perception.
Lee MC, Ploner M, Wiech K, Bingel U, Wanigasekera V, Brooks J, Menon DK, Tracey I.
Centre for Functional MRI ofBrain (FMRIB), Department of Clinical Neurology, University of Oxford, Oxford, UK. mlee@fmrib.ox.ac.uk
Pain. 2013 Jan;154(1):124-34. doi: 10.1016/j.pain.2012.09.017.
Abstract
Cannabis is reported to be remarkably effective for the relief of otherwise intractable pain. However, the bases for pain relief afforded by this psychotropic agent are debatable. Nonetheless, the frontal-limbic distribution of cannabinoid receptors in the brain suggests that cannabis may target preferentially the affective qualities of pain. This central mechanism of action may be relevant to cannabinoid analgesia in humans, but has yet to be demonstrated. Here, we employed functional magnetic resonance imaging to investigate the effects of delta-9-tetrahydrocannabinol (THC), a naturally occurring cannabinoid, on brain activity related to cutaneous ongoing pain and hyperalgesia that were temporarily induced by capsaicin in healthy volunteers. On average, THC reduced the reported unpleasantness, but not the intensity of ongoing pain and hyperalgesia: the specific analgesic effect on hyperalgesia was substantiated by diminished activity in the anterior mid cingulate cortex. In individuals, the drug-induced reduction in the unpleasantness of hyperalgesia was positively correlated with right amygdala activity. THC also reduced functional connectivity between the amygdala and primary sensorimotor areas during the ongoing-pain state. Critically, the reduction in sensory-limbic functional connectivity was positively correlated with the difference in drug effects on the unpleasantness and the intensity of ongoing pain. Peripheral mechanisms alone cannot account for the dissociative effects of THC on the pain that was observed. Instead, the data reveal that amygdala activity contributes to interindividual response to cannabinoid analgesia, and suggest that dissociative effects of THC in the brain are relevant to pain relief in humans.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549497/
Marihuana médica: Necesidad médica vs agenda política
Medical marijuana: medical necessity versus political agenda.
Clark PA, Capuzzi K, Fick C.
Jesuit Community, St Joseph's University, Philadelphia, PA 19131, USA.pclark@sju.edu
Med Sci Monit. 2011 Dec;17(12):RA249-61.
Abstract
Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government's stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628147/pdf/medscimonit-17-12-ra249.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Prescribing cannabis for harm reduction.
Collen M.
PainExhibit,com, 9008 El Cajon Way, #4, Sacramento, CA, 95826, USA.Mark@PainExhibit.com.
Harm Reduct J. 2012 Jan 1;9(1):1. doi: 10.1186/1477-7517-9-1.
Abstract
Neuropathic pain affects between 5% and 10% of the US population and can be refractory to treatment. Opioids may be recommended as a second-line pharmacotherapy but have risks including overdose and death. Cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning. The author suggests that physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. This harm reduction strategy may reduce the morbidity and mortality rates associated with
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295721/pdf/1477-7517-9-1.pdf
El consumo de cannabis en pacientes con fibromialgia: efecto sobre los síntomas de alivio de la salud y la calidad de vida
Cannabis use in patients with fibromyalgia: effect on symptoms relief and health-related quality of life.
Fiz J, Durán M, Capellà D, Carbonell J, Farré M.
Human Pharmacology and Neurosciences Unit, Institut de Recerca Hospital del Mar-IMIM, Parc de Salut Mar, Barcelona, Spain.
PLoS One. 2011 Apr 21;6(4):e18440. doi: 10.1371/journal.pone.0018440.
Abstract
BACKGROUND: The aim of this study was to describe the patterns of cannabis use and the associated benefits reported by patients with fibromyalgia (FM) who were consumers of this drug. In addition, the quality of life of FM patients who consumed cannabis was compared with FM subjects who were not cannabis users. METHODS: Information on medicinal cannabis use was recorded on a specific questionnaire as well as perceived benefits of cannabis on a range of symptoms using standard 100-mm visual analogue scales (VAS). Cannabis users and non-users completed the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI) and the Short Form 36 Health Survey (SF-36). RESULTS: Twenty-eight FM patients who were cannabis users and 28 non-users were included in the study. Demographics and clinical variables were similar in both groups. Cannabis users referred different duration of drug consumption; the route of administration was smoking (54%), oral (46%) and combined (43%). The amount and frequency of cannabis use were also different among patients. After 2 hours of cannabis use, VAS scores showed a statistically significant (p<0.001) reduction of pain and stiffness, enhancement of relaxation, and an increase in somnolence and feeling of well being. The mental health component summary score of the SF-36 was significantly higher (p<0.05) in cannabis users than in non-users. No significant differences were found in the other SF-36 domains, in the FIQ and the PSQI. CONCLUSIONS: The use of cannabis was associated with beneficial effects on some FM symptoms. Further studies on the usefulness of cannabinoids in FM patients as well as cannabinoid system involvement in the pathophysiology of this condition are warranted
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080871/pdf/pone.0018440.pdf
La actividad de la amígdala contribuye al efecto disociativo de cannabis sobre la percepción del dolor
Amygdala activity contributes to the dissociative effect of cannabis on pain perception.
Lee MC, Ploner M, Wiech K, Bingel U, Wanigasekera V, Brooks J, Menon DK, Tracey I.
Centre for Functional MRI ofBrain (FMRIB), Department of Clinical Neurology, University of Oxford, Oxford, UK. mlee@fmrib.ox.ac.uk
Pain. 2013 Jan;154(1):124-34. doi: 10.1016/j.pain.2012.09.017.
Abstract
Cannabis is reported to be remarkably effective for the relief of otherwise intractable pain. However, the bases for pain relief afforded by this psychotropic agent are debatable. Nonetheless, the frontal-limbic distribution of cannabinoid receptors in the brain suggests that cannabis may target preferentially the affective qualities of pain. This central mechanism of action may be relevant to cannabinoid analgesia in humans, but has yet to be demonstrated. Here, we employed functional magnetic resonance imaging to investigate the effects of delta-9-tetrahydrocannabinol (THC), a naturally occurring cannabinoid, on brain activity related to cutaneous ongoing pain and hyperalgesia that were temporarily induced by capsaicin in healthy volunteers. On average, THC reduced the reported unpleasantness, but not the intensity of ongoing pain and hyperalgesia: the specific analgesic effect on hyperalgesia was substantiated by diminished activity in the anterior mid cingulate cortex. In individuals, the drug-induced reduction in the unpleasantness of hyperalgesia was positively correlated with right amygdala activity. THC also reduced functional connectivity between the amygdala and primary sensorimotor areas during the ongoing-pain state. Critically, the reduction in sensory-limbic functional connectivity was positively correlated with the difference in drug effects on the unpleasantness and the intensity of ongoing pain. Peripheral mechanisms alone cannot account for the dissociative effects of THC on the pain that was observed. Instead, the data reveal that amygdala activity contributes to interindividual response to cannabinoid analgesia, and suggest that dissociative effects of THC in the brain are relevant to pain relief in humans.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549497/
Marihuana médica: Necesidad médica vs agenda política
Medical marijuana: medical necessity versus political agenda.
Clark PA, Capuzzi K, Fick C.
Jesuit Community, St Joseph's University, Philadelphia, PA 19131, USA.pclark@sju.edu
Med Sci Monit. 2011 Dec;17(12):RA249-61.
Abstract
Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government's stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628147/pdf/medscimonit-17-12-ra249.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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