Arthritis

Cannabis for Rheumatic Pain is Under-researched

Cannabis for rheumatic pain- hope or hype?

In Summary

Despite the large number of patients utilizing cannabis for rheumatic pain there is a lack of clinical evidence for such use. A recent review has come out discussing the inconsistent results found amongst previous clinical trials that examine the effects of cannabis on patients with rheumatoid arthritis, fibromyalgia, and spinal pain. Previous studies have found a myriad of results, all uncertain when compared to each other or statistically analyzed despite the many online articles boasting about the benefits of cannabis for rheumatoid arthritis. Physicians of those suffering from chronic pain are advised to caution their patients and make them fully aware of the lack of clinical evidence, but also to push for clinical studies so that evidence can be provided as many continue to suffer. 

It is important to note the “known side effects” of cannabis are different depending on the person and consumption method. The author of the featured piece highlights the dangerous side effects including psychosis and short-term dizziness or sleepiness. Various cannabinoids have different effects and act on different receptors, meaning that blanketing the entire plant with a warning label is often misleading. Patients should discuss cannabis use with their physicians and should be careful to mind which cannabinoids they aim to use and the method of consumption as that can greatly affect the potency and perceived effects. Consume cannabis responsibly and continue reading blogs like this one or other well-researched articles to remain fully aware of current findings.  

The study is available for review or download here

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Benjamin Caplan, MDCannabis for Rheumatic Pain is Under-researched
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A Flavonol from Sweetscented Marigold Alleviates Pain

Tagetes Lucida as a potential analgesic

In Summary:

Researchers have recently provided evidence that a flavonol extract derived from a common flower has antinociceptive (pain-relieving) properties. Sweet-scented Marigold has been used is frequently used in cooking techniques in South America and has now been found to alleviate pain through serotonin and opioid mechanisms of action. The antinociceptive properties of this flavonol, like those of many other plant-derived compounds, are ripe for testing in a clinical setting to determine their effectiveness in human patients. In this small animal study, it clearly demonstrates promise as a safe alternative to commonly used pain medications. 

Dr. Caplan and the #MDTake:

Modern medicine seems to have largely forgotten its roots. Long before pharmaceutical companies were the source of all medication, the earth served as a resource for medications, and apothecaries, pharmacists, and druggists, as they were known, supported the medical industry with formulations and a deep understanding of natural resources. As the greater scientific arena and dominant culture have lost touch with the earth’s natural medicinal resources, our culture has lost a deeply valuable reservoir of opportunity. As the fast-paced life of modernity demands faster results on an ever-greater, mass-production scale, the construction of sprawling cities, which often demands deforestation and destruction of natural resources, may turn out to be a greater threat to human health than most of us have yet to even understand.

View this review (yellow link) or download:

 

This paper is also stored here:   http://bit.ly/2Sn1qY9      inside the CED Foundation Archive

Benjamin Caplan, MDA Flavonol from Sweetscented Marigold Alleviates Pain
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Medical Cannabis for Adults Over 50

In Summary:

As with all elements of the aging process, the human endocannabinoid system loses tone over time. Whether it is a reduction in the numbers of cannabinoid receptors or a slow waning of the machinery used to create the signaling molecules that bind to the receptors or the natural senescence of the system that supports all of these normal signaling processes, the fact remains that adults over 50 are best-suited for external support for the endocannabinoid system.

Indeed, the average age at dispensaries is surprising to most who are not familiar with the modern medical cannabis arena. Baby Boomers, perhaps more than any other age group, tend to dominate the medical cannabis dispensaries. This is no new phenomenon, however. Through the ages, across cultures and around the globe, cannabis has been consumed primarily by older adults. Whether by tribe elders, wise councilmen, spiritual leaders, or the educated elite, cannabis has been an integral part of human aging for as long as we have recorded history.

Here, a review out of Israel followed at 184 patients over 65 (average age was 81.2) beginning cannabis treatment. 63.6% were female. “After six months of treatment, 58.1% were still using cannabis. Of these patients, 33.6% reported adverse events, the most common of which were dizziness (12.1%) and sleepiness and fatigue (11.2%). Of the respondents, 84.8% reported some degree of improvement in their general condition.”

Appropriately, the authors advise caution for older adults related to those adults who may be consuming multiple pharmaceuticals, for potential medication interaction effects, as well as nervous system impairment, and increased cardiovascular risk for those who may quire the concern. Wisely, they recommend that “Medical cannabis should still be considered carefully and individually for each patient after a risk-benefit analysis and followed by frequent monitoring for efficacy and adverse events.”

Dr. Caplan and the #MDTake:

At CED Clinic, we have long seen that the average age of medical patients is over 50. Whether for concerns related to sleep, pain, mental or physical health, it seems as though Baby Boomers have either weathered enough politics to have developed a healthy cynicism for the misinformation campaigns of the 1930s and 1970s, or they have direct or indirect experience with cannabis to have learned of its safety and efficacy. Either way, it is quickly reclaiming its historical place in the care of older adults, although oddly… it seems to be a demographic skipped over by the marketing systems of most establishments in the cannabis arena, at least for now.


suggested dose for elderly and cannabis
direction of action for cannabis treatments
bar of significant improvement with cannabis

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This paper is also stored here:    http://bit.ly/2QbJ6yE     inside the CED Foundation Archive

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Benjamin Caplan, MDMedical Cannabis for Adults Over 50
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Extensive Cannabis Studies Underway Globally

Current Status and Prospects for Cannabidiol Preparations as New Therapeutic Agents

In Summary:

As of 2016, upwards of 60 clinical trials relating to the use of medical cannabis were in progress. The scope of clinical trials included conditions such as anxiety, cocaine dependence, infantile spasms, schizophrenia, solid tumor, and many more. The status of cannabis as a Schedule I drug, under the Controlled Substance Act, limits researchers’ ability to freely collect data if they require support from NIH funding. While there are opportunities for researchers to study cannabis and its derivatives with the support of private funds, this typically risks an appearance of sacrificed scientific integrity and independence. Very few private entities would condone research which might shed an unfavorable light on their products. On the other hand, current NIH-funded research requires the use of the national supply of cannabis, a crop well-known to be very limited in quality. Increasingly, more states have been legalizing the medical and recreational use of cannabis in recent years, allowing scientists with more opportunities for private funding in which to shed more light on the vast medicinal benefits of cannabis. Animal models and human trials have pointed toward clinical applications of medical cannabis including anxiety, nausea, seizures, and inflammation, although the array of competing and synergistic compounds within the plant seem to continually open new doors to relief from a large array of illnesses.

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This paper is also stored here:     http://bit.ly/32HVVpc    inside the CED Foundation Archive

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Benjamin Caplan, MDExtensive Cannabis Studies Underway Globally
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Pre-clinical Evidence for Analgesic Effects of Cannabis Doesn’t Match Human Trial Results

Current evidence of cannabinoid-based analgesia obtained in preclinical and human experimental settings

In Summary:

Pre-clinical animal models of pain provide a wealth of data supporting the pain-relief capabilities of cannabis; however, reproducing this data in human clinical trials has proved difficult. Data from the animal pre-clinical trials point to cannabinoids reducing stress responses and pain-evoked stress, desensitizing pain receptors, and increased pain sensitivity in animals that lack cannabinoid receptors. However, human trials present conflicting results: several studies have shown dose-dependent relationships, and in the current review this was experienced by many participants, wherein lower and medium doses provided pain relief, but higher doses triggered increased sensitivity to pain. Controlled studies may show a lack of impressive pain relief effects, personal reports of pain relief associated with cannabis use are nearly universal in retrospective reports. This suggests that there may be an important effect on well-being or mood, rather merely sensory pain. Furthermore, the relieving effects of cannabis appear to impact men and women differently.

Dr. Caplan and the #MDTake:

Additionally, much of pain relief is subjective, in both sensation, description, and inside the study environment. The description of pain varies from person to person, and researchers may be asking the wrong questions to the right people or the right questions to the wrong people. In fact, a growing perspective is that this mismatch may be more common and more pronounced than previously recognized. The makeup of pain is also quite complicated. For instance, a limb might hurt, but if there is swelling or tenderness nearby, those may amplify the discomfort. How can we take the full picture into account in the form of helpful data points? What of the emotional or psychological impacts of pain? Is it even possible that such things can be fully understood, let alone measured reliably? Assuming that emotional phenomenon or stress/suffering can be conveyed to research scientists, how can we ever hope to compare one person’s experience to another’s? For example, one would imagine that frustration associated with the pain experienced by a venerable world war veteran, who has previously endured tremendous and complex pains and associated psychological trauma may be quite different from someone who has never experienced a particular pain before.

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This paper is also stored here:    http://bit.ly/2P1v7MI     inside the CED Foundation Archive

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Benjamin Caplan, MDPre-clinical Evidence for Analgesic Effects of Cannabis Doesn’t Match Human Trial Results
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Informing Doctors and Patients on Cannabis Use for Pain

Paper Title: Cannabis and Pain: A Clinical Review

Although results from many bench-scientific and preclinical animal trials support the use of medical cannabis for pain management, there is not yet an equal body of evidence in human clinical trials. However, this is, in part, due to the fact that, despite millennia of accounts supporting the use of cannabis to treat a large number of medical concerns, in the shorter history of cannabis research, the number of controlled, double-blind, placebo studies are limited, and to some points of view, may not even be possible. Additionally, in an era where increasingly more patients request cannabis therapy from their clinicians, health professionals are catastrophically undereducated on the topic. Furthermore, given the status of the modern opioid crisis, there is a growing need for alternative pain management strategies: states with medical marijuana laws experience significantly fewer opioid-related deaths than states lacking them. Additional research could reduce these deaths further and provide viable alternatives for patients seeking pain management when other therapies have failed. 

Below are interesting clippings from this article, points that are either described eloquently or bring a welcome addition to the ongoing discussion:

Benjamin Caplan, MDInforming Doctors and Patients on Cannabis Use for Pain
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Psychiatric Disorders Reduce Survival Among Immune-Mediated Inflammatory Disease Patients

Psychiatric comorbidity increases mortality in immune-mediated inflammatory diseases

Summary Information:

A new study finds that a diagnosis of depression, anxiety, and/or bipolar disorder increases mortality rates for patients of one of three immune-mediated inflammatory diseases (IMID):

1) multiple sclerosis (MS), or

2) inflammatory bowel disease (IBD), or

3) rheumatoid arthritis (RA).

Depression and bipolar disorder can cause poor health behaviors in patients, as depression, bipolar disorder, and anxiety disorders are “associated with increased inflammation and immune dysregulation.” Suicide risk and attempts are increased among IMID patients with mental illness, compared with IMID patients who are not also suffering from one of these additional battles. Given that cannabis has shown promise in treating both inflammation and a range of psychiatric disorders, there is reason to be optimistic for further cannabis research to uncover multifunctional treatment options.  

Dr Caplan and the #MDTake:

Clinically, it’s rare to see medical patients who have only one concern. Sure, there are some who are hoping that cannabis will help them to treat seizures, headaches, anxiety, sleep troubles, or terrible back pain, but more often, it is a combination of several troubles that each add to a cumulative tipping point.

Naturally, very few individual systems act alone. When a body part is injured, sleeping (or not sleeping) effects the course of illness. Similarly, feeling less anxious, or improving sleep, may make symptoms of a struggle with consistent headaches seem more tolerable. Even when there aren’t direct connections between symptoms, a treatment which implements a systemic treatment can have multiplied benefits.

Many patients have found that cannabis offers them a way to attack more than one problem, with a single actor. Some with Diabetes are finding that some formulations are not only helping them reduce blood sugar levels, but also reducing appetite. Similarly, some patients with ADD are turning to cannabis options which may help them focus, without their ability to get to sleep at night.

To a related note, many elderly patients are treated with too many medications. Modern Western medical treatment often compels patients into silos of treatments by isolated specialists, who are not always monitoring the patient as a being beyond individual organ systems. Medications, such as cannabis, which have the opportunity to treat more than one system, without multiplying the risk of potential drug-drug interactions presents a much safer approach to care

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This paper is also stored here:  http://bit.ly/2MRDfiP       inside the CED Foundation Archive

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Benjamin Caplan, MDPsychiatric Disorders Reduce Survival Among Immune-Mediated Inflammatory Disease Patients
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California veterinarians & Cannabis

Vets in CA can now discuss the use of cannabis for patients and their pets legally and soon, prescribe cannabis medication. Although there is still more much research to be done, adults can already legally buy products, so involving professional vets can help keep pets safe http://bit.ly/33dmbIK

Benjamin Caplan, MDCalifornia veterinarians & Cannabis
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Medical Marijuana Offers Benefits Comparable to Prescription Medication, Without the Side Effects

Title: Preferences for Medical Marijuana over Prescription Medications Among Persons Living with Chronic Conditions: Alternative, Complementary, and Tapering Uses

In a survey of 30 patients using medical cannabis for a range of diseases including rheumatoid arthritis, cancer, hepatitis C, PTSD, among others, patients reported an array of benefits they have reaped from cannabis use. Patients successfully used cannabis in several ways: as an alternative to prescription medication, complementarily with prescription medicine, and to gradually replace use of prescription medication.

Benefits described by participants included the effects of cannabis lasting longer than that of opioids, lower risk of addiction, fewer side-effects. Patients also saw their sleep, anxiety, appetite, and adverse reactions improve with the use of medical cannabis. Larger, more controlled studies may suggest cannabis more affirmatively as an alternative or complementary therapy with prescription medications.

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This paper is also stored here:    http://bit.ly/2wqDDdQ     inside the CED Foundation Archive

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Benjamin Caplan, MDMedical Marijuana Offers Benefits Comparable to Prescription Medication, Without the Side Effects
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Video: Do-It-Yourself Cannabis Tinctures

One of the terrific realities of modern Cannabis is that it is possible, and often quite simple, to make effective products at home. With suitable education and access to testing facilities, the soil, nutrients, and plant growth can be supported at home, lab-tested for make-up and potency, as well as safety-checked for potential microscopic contaminants, and ultimately, individualized medicine can be created right at home!

Here is a sample instructional for just one way that cannabis tincture can be made at home. There are countless others and hopefully, many that are yet to be discovered!

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Benjamin Caplan, MDVideo: Do-It-Yourself Cannabis Tinctures
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