Cannabis in Cancer Survivors Who Report High Impact Chronic Pain: Findings from a 1500+ Patient Survey.

BACKGROUND: Chronic pain in cancer survivors negatively impacts quality of life. This study sought to investigate the relationship between high-impact chronic pain (HICP) -- defined as chronic pain that limits life or work activities on most days or every day in the past 3 months -- and cannabis in cancer survivors. METHODS: An electronic survey was developed in conjunction with the National Cancer Institute Comprehensive Cancer Centers in the United States. This survey was distributed to cancer survivors within a multi-site, single institution setting. RESULTS: The survey response rate was 23.0% (2304/10,000); 72.7% of these patients (1676/2304) did in fact have a confirmed cancer diagnosis. Among these cancer survivors, 16.5% (unweighted 278/1676) had HICP, and 12.4% (208/1676) reported cannabis use since their cancer diagnosis. The prevalence of past 30-day cannabis use was 12.3% (206/1676). Compared to cancer survivors without pain, those with HICP were more likely to believe in the benefits of cannabis (unweighted 92.1% vs. 74.7%; age-adjusted odds ratio [OR] = 3.1; 95% CI: 1.9-5.1) and less likely to believe in its risks (unweighted 48.2% vs. 58.4%; age-adjusted OR = 0.6; 95% CI: 0.4-0.7). CONCLUSIONS: Cancer survivors with HICP have a higher prevalence of cannabis use compared to those patients without pain. More research is needed to advance pain and symptom management among cancer survivors and to identify clinical scenarios in which benefit is greater than potential harm.

Low-level laser therapy for weight reduction: a randomized pilot study.

Obesity and overweight is a global health crisis and novel methods of treatment are needed to address it. Low-level laser therapy (LLLT) is a currently available non-invasive procedure for lysing excess fat, but there is a lack of consensus exists on LLLT frequency and limited research from studies of LLLT. The purpose of this pilot study is to compare the effect of three of the most common LLLT frequencies on weight, waist circumference, body fat percentage, and quality of life. Sixty overweight (body mass index (BMI) 25-29.9 kg/m2) adult participants were randomized to 12 LLLT treatments: (1) three times weekly for 4 weeks, (2) twice weekly for 6 weeks, or (3) once weekly for 12 weeks. All participants attended an in-person visit at baseline and at weeks 4, 6, 12, and 26. Participants were recruited September 30, 2016 through to August 27, 2017. The majority of the 60 participants were female (90%) with an average age of 43.7 years (± 9.2 years). Most participants (98%) completed 10 or more of the 12 LLLT treatments. When comparing across treatment groups, the greatest reductions from baseline were observed in those assigned to twice weekly for 6 weeks in weight (1 ± 1.7 (±SD) kg by week 6), waist circumference (- 2.0 ± 3.2 in. by week 6 and - 1.5 ± 3.2 in. by week 26), body mass index (- 0.4 ± 0.6 kg/m2), and body fat mass (- 1.1 ± 1.6 kg). This group also had the most significant improvement from baseline in quality of life (+ 0.5 ± 0.8 by week 6), body satisfaction (+ 0.2 ± 0.4 by week 6 and week 26), and body appreciation (+ 0.2 ± 0.3 by week 6 and + 0.3 ± 0.3 by week 26). LLLT twice weekly for 6 weeks could be proposed as the optimal frequency and duration for the management of body weight. Trial registration: https://clinicaltrials.gov/ct2/show/NCT02877004. Registered August 24, 2016.

Medical Cannabis.

Medicolegal realities surrounding "medical marijuana" or "medical cannabis" are rapidly evolving in the United States. Clinicians are increasingly being asked by patients to share information about or certify them for medical cannabis. In order to engage in informed discussions with patients or be comfortable certifying them in states with medical cannabis laws, clinicians may benefit from an understanding of the current state of medical knowledge about medical cannabis. Intended for the generalist and subspecialist, this review provides an overview of the legal status, pharmacology, benefits, risks, and abuse liability of medical cannabis along with a general framework for counseling patients.

Utilizing Administrative Data to Focus Quality Improvement Efforts for Opioid Prescribing in an Integrated Health System.

This case study describes the use of multiple administrative data sources within a large, integrated health care delivery system to understand opioid prescribing patterns across practice settings. We describe the information needed to understand prescribing patterns and target interventions, the process for identifying relevant institutional data sources that could be linked to provide information on the settings for prescriptions, and the lessons learned in developing, testing, and implementing an algorithm to link the data sources in a useful manner.

Improved Self-Acceptance, Quality of Life, and Stress Level from Participation in a Worksite Yoga Foundations Program: A Pilot Study.

Yoga is increasing in popularity in the United States and across the globe. However, most yoga programs are provided outside the worksite; although many companies offer worksite wellness programs, at present there is limited documentation regarding the potential benefits of participating in a worksite yoga program. Therefore, the purpose of this project was to examine the potential effect of a worksite yoga program on self-acceptance, quality of life, and perceived stress. A prospective cohort pilot study that examined a structured worksite yoga program was designed and tailored to individuals new to yoga. The 8-week Yoga Foundations program was conducted at an academic medical center's worksite wellness center with 86 subjects. Outcome measures were the 36-item Self-Acceptance Scale; a six-item quality-of-life measure that assesses overall, social, mental, physical, emotional, and spiritual well-being; and the ten-item Perceived Stress Scale. Participants demonstrated significant improvement in their overall self-acceptance ( p < 0.001), quality of life ( p < 0.001), and perceived stress ( p < 0.001) levels. They also highly rated the yoga instructors and the weekly format of the program. Participation in a Yoga Foundations program was associated with improvements in self-acceptance, quality of life and stress levels in worksite wellness center members. Future studies should use randomized designs and examine other wellness domains to learn more about the potential benefits of worksite yoga programs.

Trial of intensive acupuncture for smoking cessation: a pilot study.

BACKGROUND: Despite the significant decline in smoking rates in the USA over the last 50 years, 42 million Americans continue to smoke. Although the combination of behavioural counselling with FDA-approved medications offers the best evidence-based treatment approach, 12-month relapse rates remain at >60%. Both healthcare providers and patients are searching for alternative treatment options. Most acupuncture trials have yielded poor results for smoking cessation; however, most trials have not used an intense treatment protocol and maintained treatment for at least 12 weeks. METHODS: We designed a pilot study to address these methodological problems. Twenty-eight smokers were recruited to attend two 1 h acupuncture sessions weekly for 12 weeks. Primary endpoints included completion rate, acceptability of the protocol and side effects. Secondary endpoints included carbon monoxide (CO)-confirmed, 7-day point prevalence quit rates at 12 weeks and 26 weeks. RESULTS: Sixteen of the 28 patients enrolled (57%) completed 12 weeks of treatment. Of the 17 patients who completed the end-of-study questionnaire, 94% (16/17) rated the programme as helpful, and 82% noted they would recommend it to friends for smoking cessation. Three of the 28 who initially enrolled in the study were confirmed abstinent at 12 weeks (10.7%); one of the 28 (3.6%) was abstinent at 26 weeks. CONCLUSIONS: A larger study with a slightly less rigorous and more acceptable treatment protocol is feasible and should be considered.

S-adenosyl-L-methionine (SAMe) for smoking abstinence: a randomized clinical trial.

OBJECTIVES: S-Adenosyl-L-methionine (SAMe) is a dietary supplement commonly used to treat depression. SAMe facilitates dopamine and norepinephrine synthesis in the central nervous system. This study investigated the efficacy of SAMe for increasing tobacco abstinence among cigarette smokers. DESIGN: A randomized, blinded, placebo-controlled, three-arm, dose-ranging clinical trial was conducted. Subjects were randomly allocated to receive SAMe 1600 mg or 800 mg by mouth every day or a matching placebo for 8 weeks. All subjects received a behavioral smoking cessation intervention. Self-reported smoking abstinence was biochemically confirmed with exhaled-air carbon monoxide. SUBJECTS: Subjects in the study comprised 120 adults. RESULTS: One hundred and twenty (120) subjects with a mean age of 40.0±14.0 (SD) years were enrolled. Participants smoked an average of 19.6±8.6 cigarettes per day for 21±13.2 years. The study dropout rate was high (42.5%). By intention-to-treat analysis, no significant differences were observed in abstinence rates at 8 and 24 weeks between SAMe dose groups and placebo. SAMe did not attenuate withdrawal symptoms among abstinent subjects. Rates of gastrointestinal side-effects were higher with SAMe 1600 mg/d compared to placebo. CONCLUSIONS: SAMe did not increase smoking abstinence rates. Abstinence and tobacco withdrawal data from this clinical trial suggest that SAMe holds little promise for the treatment of tobacco dependence.

A randomized clinical trial of St. John's wort for smoking cessation.

INTRODUCTION: St. John's wort (SJW) is a widely used herbal supplement. The predominant mechanism(s) accounting for the activity of SJW in vivo are, however, unclear. The purpose of this study was to investigate the efficacy of SJW for smoking cessation. METHODS: We conducted a randomized, blinded, placebo-controlled, three-arm, dose-ranging clinical trial. A total of 118 subjects were randomly allocated to receive SJW 300 mg, 600 mg, or a matching placebo tablet 3 times a day combined with a behavioral intervention for 12 weeks. Self-reported smoking abstinence was biochemically confirmed with expired air carbon monoxide. RESULTS: Mean age of the study participants was 37.6 +/- 12.4 years; they smoked an average of 20.0 +/- 6.6 cigarettes per day for 20 +/- 12.1 years. The study dropout rate was high (43%). By intention-to-treat analysis, no significant differences were observed in abstinence rates at 12 and 24 weeks between SJW dose groups and placebo. SJW did not attenuate withdrawal symptoms among abstinent subjects. Abstinence rates did not differ by study group among subjects who took at least 75% of their study medication. No significant side-effects were noted with SJW. CONCLUSIONS: In this randomized trial, SJW did not increase smoking abstinence rates. Our data, in combination with data from other studies, suggest that SJW has little role in the treatment of tobacco dependence.

Gender differences in self-reported use, perceived efficacy, and interest in future use of nicotine-dependence treatments: A cross-sectional survey in adults at a tertiary care center for nicotine dependence.

BACKGROUND: Clinical trials have assessed the effectiveness of nicotine-dependence treatments (NDTs), alone or in combination, and reported that men and women have variable responses to these treatments. The variations in therapeutic responses highlight the need to explore gender-specific preferences for NDTs, including complementary and alternative medicine (CAM), which has become increasingly popular in the US population for the cessation of tobacco use. OBJECTIVE: The aim of this study was to assess gender differences in the self-reported use, perceived efficacy, and interest in future use of NDTs, including CAM, in an outpatient setting. METHODS: This cross-sectional survey was conducted in men and women at a tertiary care NDT clinic. The primary inclusion criterion was the willingness and ability of the patients to participate in the survey. RESULTS: Data from 1171 patients were included (599 men, 572 women; mean age: men, 46.2 years; women, 46.5 years). Of these, 68% of women and 65% of men reported use of nicotine-replacement therapy (NRT), other prescription medication, or counseling/group support. In men and women, NRT was the most commonly used type of pharmacologic treatment, of which the patch was the most popular (77% and 75%). A significantly greater proportion of women than men perceived the nicotine inhaler to be efficacious (67% vs 50%; P = 0.027). No other significant gender differences were found among NRTs. Among non-NRT methods, bupropion sustained release (SR) and counseling/group support were used by significantly more women than men (53% vs 43% [P = 0.007] and 16% vs 11% [P = 0.026], respectively). Compared with men, significantly greater proportions of women reported current or previous use of CAM for nicotine abstinence and expressed an interest in future use of CAM (34% vs 22% [P < 0.001] and 71% vs 64% [P = 0.006]). CONCLUSIONS: In this sample of patients at an NDT clinic, significantly more women than men reported previous use of bupropion SR, counseling, and CAM. More women than men expressed an interest in the future use of CAM. Based on these findings, an improved understanding of gender-based differences in the use of conventional and nonconventional NDTs might improve the rates of success of nicotine-cessation efforts among women.

Clinicians' guide to new tools and features of PubMed.

Practicing clinicians need to have the skills required to obtain up- to-date medical information to address both the expansion of scientific knowledge and patients' increasing use of the Internet. PubMed (www.pubmed.gov) allows clinicians free access to the largest biomedical resource available. This article is the third in a Mayo Clinic Proceedings series designed specifically to help clinicians unlock the tools and information available through this valuable resource.

Complementary treatments for tobacco cessation: a survey.

Little information is available regarding the prevalence of use and interest in future use of complementary and alternative medicine (CAM) for tobacco cessation among tobacco users. We conducted a self-administered anonymous survey among 1,175 patients seen at a midwestern outpatient tobacco treatment specialty clinic between November 2003 and July 2005. Patient use of CAM for tobacco cessation, perceived efficacy of these treatments, and interest in future use of CAM were ascertained. Data were summarized using descriptive statistics, and logistic regression models were used to determine the characteristics associated with past CAM use or interest in future use of CAM for tobacco cessation. All of the patients who received the survey completed it. A total of 27% of patients reported previous use of CAM for tobacco cessation. The interventions most commonly used were hypnosis, relaxation, acupuncture, and meditation. CAM treatments most commonly perceived to be efficacious were yoga, relaxation, meditation, and massage therapy. A total of 67% of the patients reported interest in future use of CAM for tobacco cessation. The treatments of greatest interest for use in the future were hypnosis, herbal products, acupuncture, relaxation, and massage therapy. Female gender, previous use of conventional tobacco cessation products, previous use of CAM treatments, and a higher level of education were significantly associated with interest in future CAM use. The high level of interest in CAM among tobacco users underscores the need to conduct further research in this field.

Cochrane systematic reviews in acupuncture: methodological diversity in database searching.

BACKGROUND: Since the early 1970s, the efficacy of acupuncture for treating clinical conditions has been evaluated in several hundred randomized trials. Results from these trials have been synthesized in systematic reviews. A well-designed systematic review provides the highest level of evidence for establishing the efficacy of a clinical intervention. OBJECTIVES: The present study assesses the source of original literature contributing to Cochrane reviews on acupuncture. Databases searched to retrieve original studies are evaluated. The distribution of controlled trials in acupuncture across different topic areas and journals, the ability of the reviews to provide conclusive results, and the proportion of original studies indexed with MEDLINE are evaluated. METHODS: Systematic reviews on acupuncture were extracted from the Cochrane Database of Systematic Reviews. The key search term used was "acupuncture." When more than one systematic review was retrieved on the same topic, the most recent review was included. Indexing of individual clinical trials with MEDLINE was searched using the Single Citation Matcher in PubMed. RESULTS: A total of 94 papers were retrieved from the Cochrane database, of which 10 were included in the analysis. The most common subject areas were related to chronic pain. Considerable heterogeneity was observed in the number of databases searched (median 5, range 3-12). A total of 69% (74/108) papers were indexed with PubMed. Only 13% (14/108) of the papers were published in the primary acupuncture journals. Conclusive statements about the efficacy of acupuncture were made in only 2 of the 10 systematic reviews. CONCLUSIONS: Considerable methodological diversity exists in the comprehensiveness of database searches for Cochrane systematic reviews on acupuncture. This diversity makes the reviews prone to bias and adds another layer of complexity in interpreting the acupuncture literature.

Efficacy of acupuncture for cocaine dependence: a systematic review & meta-analysis.

: BACKGROUND: Acupuncture is a commonly used treatment option for the treatment of addictions such as alcohol, nicotine and drug dependence. We systematically reviewed and meta-analyzed the randomized controlled trials of acupuncture for the treatment of cocaine addiction. METHODS: Two reviewers independently searched 10 databases. Unpublished studies were sought using Clinicaltrials.gov, the UK National Research Register and contacting content experts. Eligible studies enrolled patients with the diagnosis of cocaine dependence of any duration or severity randomly allocated to either acupuncture or sham or other control. We excluded studies of acupuncture methods and trials enrolling patients with polysubstance use or dependence. We abstracted data on study methodology and outcomes. We pooled the studies providing biochemical confirmation of cocaine abstinence. RESULTS: Nine studies enrolling 1747 participants met inclusion criteria; 7 provided details for biochemical confirmation of cocaine abstinence. On average, trials lost 50% of enrolled participants (range 0-63%). The pooled odds ratio estimating the effect of acupuncture on cocaine abstinence at the last reported time-point was 0.76 (95% CI, 0.45 to 1.27, P = 0.30, I2 = 30%, Heterogeneity P = 0.19). CONCLUSION: This systematic review and meta-analysis does not support the use of acupuncture for the treatment of cocaine dependence. However, most trials were hampered by large loss to follow up and the strength of the inference is consequently weakened.