Specific phytocannabinoid compositions are associated with analgesic response and adverse effects in chronic pain patients treated with medical cannabis.

Medical cannabis (MC) treatment for chronic pain is increasing, but evidence regarding short- and long-term efficacy and associated adverse effects (AEs) of the different cannabis plant components is limited. Most reports focus on two phytocannabinoids, (-)-Δ9-trans-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD). This study, aimed to identify patterns of phytocannabinoid compositions associated with MC treatment response and with related AEs. Participants in this multicenter prospective cohort were patients with chronic non-cancer pain that were prescribed MC by physicians. Data was collected before MC treatment, at one month (short-term) and at 12 months (long-term). Simultaneously, liquid chromatography mass spectrometry identification and quantification of phytocannabinoids from the cultivars were performed. The monthly dose of each phytocannabinoid for each patient was z-scaled and clustered into ten groups to assess the difference in analgesic treatment response (≥30%/50% pain intensity reduction) and AEs rates. We identified ten clusters that had similar analgesic treatment response rates. However, there were significant differences in AEs rates both at short- and long-term. We identified specific phytocannabinoid compositions that were associated with overall AEs rates (5% compared to 53% at short-term and 44% at long-term) and with specific AEs rates such as MC related central nervous system, gastrointestinal and psychological AEs. To conclude, Evaluating only Δ9-THC or CBD is insufficient to find associations with MC related AEs. Therefore, comprehensive profiling of phytocannabinoids is needed to discover associations to related AEs and help physicians prescribe safer cannabis with less AEs while still relieving pain.

Medical cannabis treatment for chronic pain: Outcomes and prediction of response.

BACKGROUND: Although studied in a few randomized controlled trials, the efficacy of medical cannabis (MC) for chronic pain remains controversial. Using an alternative approach, this multicentre, questionnaire-based prospective cohort was aimed to assess the long-term effects of MC on chronic pain of various aetiologies and to identify predictors for MC treatment success. METHODS: Patients with chronic pain, licensed to use MC in Israel, reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 months following MC treatment initiation. A general linear model was used to assess outcomes and identify predictors for treatment success (≥30% reduction in pain intensity). RESULTS: A total of 1,045 patients completed the baseline questionnaires and initiated MC treatment, and 551 completed the 12-month follow-up. At 1 year, average pain intensity declined from baseline by 20% [-1.97 points (95%CI = -2.13 to -1.81; p < 0.001)]. All other parameters improved by 10%-30% (p < 0.001). A significant decrease of 42% [reduction of 27 mg; (95%CI = -34.89 to 18.56, p < 0.001)] from baseline in morphine equivalent daily dosage of opioids was also observed. Reported adverse effects were common but mostly non-serious. Presence of normal to long sleep duration, lower body mass index and lower depression score predicted relatively higher treatment success, whereas presence of neuropathic pain predicted the opposite. CONCLUSIONS: This prospective study provides further evidence for the effects of MC on chronic pain and related symptoms, demonstrating an overall mild-to-modest long-term improvement of the tested measures and identifying possible predictors for treatment success.

Does experimental pain affect auditory processing of speech-relevant signals? A study in healthy young adults.

AIM: To assess the effect of tonic pain stimulation on auditory processing of speech-relevant acoustic signals in healthy pain-free volunteers. METHODS: Sixty university students, randomly assigned to either a thermal pain stimulation (46 degrees C/6 min) group (PS) or no pain stimulation group (NPS), performed a rate change detection task (RCDT) involving sinusoidally frequency-modulated vowel-like signals. Task difficulty was manipulated by changing the rate of the modulated signals (henceforth rate). Perceived pain intensity was evaluated using a visual analog scale (VAS) (0-100). RESULTS: Mean pain rating was approximately 33 in the PS group and approximately 3 in the NPS group. Pain stimulation was associated with poorer performance on the RCDT, but this trend was not statistically significant. Performance worsened with increasing rate of signal modulation in both groups (p < 0.0001), with no pain by rate interaction. CONCLUSIONS: The present findings indicate a trend whereby mild or moderate pain appears to affect auditory processing of speech-relevant acoustic signals. This trend, however, was not statistically significant. It is possible that more intense pain would yield more pronounced (deleterious) effects on auditory processing, but this needs to be verified empirically.

Quantitative sensory testing for spinal cord stimulation in patients with chronic neuropathic pain.

OBJECTIVE: A prospective pilot study was conducted, attempting to identify objective tests that would help clinicians to assess the efficacy of spinal cord stimulation (SCS) trial preceding permanent device implantation. SETTING: Four university hospitals in the United States and Israel. PARTICIPANTS: Thirteen patients with radicular leg pain due to failed back surgery syndrome (FBSS) or leg pain due to complex regional pain syndrome (CRPS) who were candidates for SCS. METHODS: PARTICIPANTS underwent a series of quantitative sensory tests prior to, and seven days after the initiation of SCS trial. These tests included: vibration threshold (conducted using the VSA 3000; Medoc Inc., Ramat Ishay, Israel), cold threshold, warm threshold, heat pain threshold, phasic heat pain threshold, tonic heat pain threshold (conducted using the TSA 2001; Medoc Inc.), and electrical pain tolerance at 5, 250 and 2000 Hz (administered using the NerveScan 2000; Neurotron, Inc., Baltimore, MD, USA). RESULTS: Useful data were obtained from 12 patients. The results of the vibration threshold and the tolerance to electrical stimulation at 5 and 250 Hz changed with an SCS trial. These results also correlated with the decision regarding the permanent implantation, which was made independently of them. In contrast, the results of thermal thresholds and tolerance to electrical stimulation at 2000 Hz tests did not change with the SCS trial. CONCLUSIONS: Our findings, which agree with those of a few other studies, suggest that the vibration threshold and the tolerance to electrical stimulation at 5 and 250 Hz tests can assist the clinician to select the right patients for permanent stimulation.

Complementary and alternative medicine use in lung cancer patients in eight European countries.

This paper presents findings from a cross-sectional survey about the use of complementary and alternative medicine (CAM) in patients with lung cancer, forming part of a larger study. Data from 111 lung cancer patients in 8 countries in Europe were collected through a descriptive 27-item questionnaire. The data suggest that 23.6% of the lung cancer patients used CAM after the diagnosis with cancer. The most popular CAM modalities were herbal medicine (48.1%), medicinal teas (11.5%), homeopathy (11.5%), use of animal extracts (11.5%) and spiritual therapies (11.5%). Herbal use increased by three times after the diagnosis of cancer. Patients seemed quite satisfied with the CAM used. They were also spending on average about 142 Euros monthly on CAM therapies or remedies. The most common motivation to use CAM was to increase the body's ability to fight the cancer. Main sources of information about CAM were friends and family. As CAM is increasingly used by patients with lung cancer, it is important to be able to assist patients make an appropriate decision by discussing the issue of CAM openly, providing reassurance and communicating safe and appropriate information to patients.

Complementary and alternative medicine use in breast cancer patients in Europe.

Complementary and alternative medicine (CAM) has gained popularity among cancer patients in the past years. For this study, CAM includes any group of health care systems, practices or products that are not considered to be part of conventional medicine at present (National Center for Complementary and Alternative Medicine). The present study assessed patterns of CAM use in breast cancer patients in Europe. The study used a descriptive cross-sectional design, and data were collected through a 27-item questionnaire. The sample, which was part of a larger study, consisted of 282 breast cancer patients from 11 countries in Europe. Among participants, 44.7% used CAM since their diagnosis of cancer. The most common therapies used included herbal medicine (46.4%) and medicinal teas, relaxation techniques, spiritual therapies, homeopathy and vitamins/minerals. Younger patients with higher education and who had received combination treatments for their cancer in the past were more likely to use CAM. High levels of satisfaction were reported, with only 6.5% of the women reporting no benefits from the CAM used. Main sources of information about CAM were mostly friends/family and the media. Findings suggested that a high proportion of breast cancer patients used CAM, which may have implications for the clinical management of these patients.

The effects of noxious heat, auditory stimulation, a cognitive task, and time on task on pain perception and performance accuracy in healthy volunteers: a new experimental model.

The effects of cognitive and competing sensory processing tasks on pain perception and as a function of time are only partially understood. To study these effects, we compared the simultaneous effects of noxious heat stimulation (HS), auditory stimulation (AS) (sinusoidally modulated speech-like signal, SMSLS), and a cognitive task (CT) (rate change detection of the SMSLS) on pain perception and task performance over repeated experimental runs. Sixty healthy paid volunteers were randomly assigned to four groups, one exposed to AS while performing the CT, one to HS (46 degrees C/6 min), one to AS and HS, and one to AS and HS while performing the CT. Each group performed the experimental run four times, each run for 6 min. Immediately after each run, the subjects rated pain intensity using a VAS (0-100). Two-way RM-ANOVA for analyzing pain intensities among the three heat pain groups demonstrated significant differences of VAS ratings (F(2,179) = 4.57, P = 0.019), being highest in the HS group (55 +/- 0.7SEM), followed by the AS+HS (39 +/- 6.8) and AS + HS + CT (33 +/- 0.7) groups. Post-hoc analyses revealed that group HS differed significantly from group AS + HS + CT and from group AS + HS (P < 0.05, SNK), whereas group AS+HS did not differ significantly from group AS + HS + CT. Neither pain rating, nor rate of errors on the CT varied significantly across runs. These findings point to a significant influence of competing passive sensory processing on pain perception, with the cognitive task not necessarily adding to the perception of pain. Advantages and shortcomings of the present experimental model for future pain studies are discussed.

Complementary and alternative medicine use in colorectal cancer patients in seven European countries.

PURPOSE: The aim of the present study was to examine the use of complementary and alternative medicine (CAM) in a sample of colorectal cancer patients in Europe. METHODS: The study was a descriptive cross-sectional survey and data were collected through a 27-item self-reported questionnaire from seven European countries. RESULTS: As part of a larger study, 126 colorectal cancer patients participated in this survey. Among the participants, 32% used CAM after the diagnosis of cancer. Almost half the CAM therapies used were new therapies, never tried before the diagnosis. The most common CAM therapies used included herbal medicine (48.7%), homeopathy (20.5%), use of vitamins/minerals (17.9%), spiritual therapies (15.4%), medicinal teas (15.4%) and relaxation techniques (12.8%). A dramatic increase was observed in the use of CAM from usage levels before the cancer diagnosis. High levels of satisfaction with CAM were also reported. Patients used CAM more often to increase the body's ability to fight the cancer or to improve physical well-being. However, expectations did not always match with the benefits reported. CONCLUSIONS: As one-third of colorectal cancer patients use CAM, health professionals should be more aware of this approach to the patient's management. They should discuss the role of CAM therapies with their patients in a non-judgemental and open manner, and endeavour to provide accurate information in order to allow patients to make their own decision about CAM.

Complementary and alternative medicine use in patients with haematological malignancies in Europe.

This study reports upon a descriptive cross-sectional survey assessing the use of complementary and alternative medicine (CAM) in patients with haematological cancers. Twelve European countries contributed data from patients with haematological cancers, as part of a larger study. Sixty-eight patients with haematological cancer participated. Among the participants, 26.5% used some form of CAM after the cancer diagnosis. The most common therapies used were homeopathy (38.9%), herbal medicine (22.2%) various psychic therapies, such as use of mediums, healers, rebirthing or past life regression therapy (22.2%). A particular profile of a CAM user was not evident in the sample. Moderate levels of satisfaction with CAM were reported. Patients commonly used CAM to increase the ability of their body to fight cancer and to improve physical and emotional well-being. Information about CAM was received mainly from friends or family. As CAM use in patients with haematological malignancies is common, clinicians should assist patients who want to use CAM to make an appropriate decision, and improve communication with them about CAM use in an open and non-judgemental dialogue.