Long-term Cannabis-based oil therapy and pain medications prescribing patterns: an Italian observational study.

OBJECTIVE: Chronic pain is one of the most common medical conditions in developed countries. The 2020 Italian National Report on Medicines shows how, in the last years, there was a light but constant increase in the prescription of pain medications. The purpose of our study was to assess the effects of long-term cannabis-based oil consumption on the distribution of patients with analgesics prescriptions for chronic pain in a Pain Medicine Unit in Northern Italy. PATIENTS AND METHODS: This is a retrospective, observational study in which patients treated with long-term medical cannabis-based oils, followed between June 2016 and July 2019, were enrolled. The effects of cannabis-based oil consumption on the distribution of patients with pain medications, before and after its long-term use, were evaluated with a Related Samples McNemar Test. Subgroups analyses were performed based on sex, age, comorbidity, duration of cannabis treatment, and condition driving cannabis prescription. RESULTS: A significant difference in opioid non-users after a long-term cannabis-based oil therapy was identified (from 32.1% to 55.4%, p = 0.0023), while no significant differences were found in the distribution of anticonvulsant, antidepressant, and benzodiazepine users. A high benzodiazepine use prevalence was revealed, while subgroup analyses showed increased antidepressant use in people over 65 years old (from 93.7% to 56.2%; p = 0.0313). CONCLUSIONS: Pain medication patterns of prescribing show how necessary it is to improve prescription practices among chronic pain patients. Opioid-sparing medications represent a crucial aspect of the pain treatment process, along with deprescribing protocols. Clinicians and clinical pharmacologists must cooperate to meet the need of a guide that can represent the most possible appropriate therapy for these patients.

Vitamin D deficiency in HIV infection: an underestimated and undertreated epidemic.

Hypovitaminosis D is a very common disorder, regarding both Western and developing countries. A growing amount of data over the last years have shown vitamin D deficiency to be high prevalent among HIV-positive subjects. In addition to "classic" risk factors, such as female sex, low dietary intake, dark skin pigmentation and low sun exposure, HIV-related factors, including immune activation and antiretroviral adverse effects, may affect vitamin D status. Even if both protease inhibitors and non-nucleoside reverse transcriptase inhibitors have been associated with low vitamin D levels, available evidences have failed to univocally associate hypovitaminosis D with specific antiretroviral class effects. Low vitamin D is known to have a negative impact not only on bone health, but also on neurocognitive, metabolic, cardiovascular and immune functions. Similarly to the general population, several studies conducted on HIV-infected subjects have associated hypovitaminosis D with a greater risk of developing osteopenia/osteoporosis and fragility fractures. Analogously, vitamin D deficiency has been described as an independent risk factor for cardiovascular disease and metabolic disorders, such as insulin resistance and type 2 diabetes mellitus. Last EACS guidelines suggest to screen for hypovitaminosis D every HIV-positive subject having a history of bone disease, chronic kidney disease or other known risk factors for vitamin D deficiency. Vitamin D repletion is recommended when 25-hydroxyvitamin D levels are below 10 ng/ml. Furthermore, it may be indicated in presence of 25OHD values between 10 and 30 ng/ml, if associated with osteoporosis, osteomalacia or increased parathyroid hormone levels. The optimal repletion and maintenance dosing regimens remain to be established, as well as the impact of vitamin D supplementation in preventing comorbidities.

[Archeology in medicine: digging up into the tophi of Popes, Dukes and Kings]. / Archeologia medica: scavando nei tofi di Papi, di Duchi e di Re.

According to an Anglo-Saxon pun, "gout is the king of diseases and the disease of Kings". In fact, it is well-known that in past times a quantity of famous persons, including Kings and Popes, were affected with this rheumatic disorder. In this paper biographical anecdotes on several Popes (Pius III, Julius II, Julius III, Clement VIII, Innocent XI, Clement XII and Pius VIII), King George IV and Queen Anne of England, as well as on some members of the Lorraine lineage, all suffering from gout, are sketched out. These historical data are briefly discussed in relation to the celebrated Hippocrates's aphorisms on gout.

Flupirtine: the first Italian experience.

This paper reports the results of five single-dose short-term, controlled clinical trials conducted in Italy with the structurally new analgesic flupirtine. A total of 200 patients were enrolled in the trials. One hundred and two patients received flupirtine, 61 were treated with reference drugs (suprofen and paracetamol) and 37 were on placebo. Analgesic efficacy was evaluated in post-episiotomy pain (2 studies and 70 patients), post-traumatic pain (2 studies and 100 patients) and in 30 post-operative patients. Flupirtine was given as a single dose of 100 mg (one capsule) or as a single day's treatment (100 mg t.i.d.). For suprofen and paracetamol, oral doses of 200 mg and 500 mg respectively were used. A semi-quantitative four- or five-point scale or a linear analogue scale was used to determine the degree of pain. In post-episiotomy pain, the time required to achieve a reduction of 50% of the initial pain was also used. In post-operative pain, flupirtine induced a 69% reduction in the pain score 6 hours after administration, compared with 26% in the placebo group. In post-episiotomy pain and pain due to sport injury, flupirtine showed greater efficacy as judged by the number of patients reporting good and acceptable pain relief, and a faster onset of pain relief than suprofen (episiotomy) or paracetamol plus massage (sport injury). The adverse reaction, nausea, was complained of once only during treatment with flupirtine.