OBJECTIVE:Pain is one of the most common nonmotor symptoms of Parkinson disease (PD) and other Parkinson plus syndromes, with a major effect on quality of life. The aims of the study were to examine ...the prevalence and characteristics of pain in PD and other Parkinson plus syndromes and patient use and response to pain medications.
METHODS:The cohort consisted of 371 patients300 (81%) with PD and 71 (19%) with Parkinson plus syndromes. Data on clinical parameters and pain were collected by questionnaire. Disease severity was measured with the Unified PD Rating Scale for patients with PD.
RESULTS:Pain was reported by 277 patients (74%)241 with PD and 36 with Parkinson plus syndromes. The prevalence of pain was significantly higher in the patients with PD than in the patients with Parkinson plus syndromes (80% vs. 50%, P<0.001) and higher in patients with synucleinopathies than in patients with tauopathies (70% vs. 40%, P<0.001). In the synucleinopathies, the most common pain was central pain (32%), whereas in the tauopathies only 4% of patients had central pain. Anti-Parkinson treatment relieved the pain in 21% of the patients with PD. Only 114 patients (48%) who experienced pain were treated with pain medications. The most beneficial analgesics were nonsteroidal anti-inflammatory drugs and medical cannabis.
CONCLUSION:Pain is prevalent among patients with PD and Parkinsonian plus syndromes. Pain relief can be achieved by more intensive anti-Parkinson medications or pain medications.
Cannabinoids are a group of chemicals that bind to receptors in the human body and, in turn, modulate the endocannabinoid system (ECS). They can be endogenously produced, synthetic, or derived from ...the plant
. Research over the past several decades has shown that the ECS is a cellular communication network essential to maintain multiple biological functions and the homeostasis of the body. Indeed, cannabinoids have been shown to influence a wide variety of biological effects, including memory, pain, reproduction, bone remodeling or immunity, to name a few. Unsurprisingly, given these broad physiological effects, alterations of the ECS have been found in different diseases, including cancer. In recent years, the medical use of cannabis has been approved in different countries for a variety of human conditions. However, the use of these compounds, specifically as anticancer agents, remains controversial. Studies have shown that cannabinoids do have anticancer activity in different tumor types such as breast cancer, melanoma, lymphoma and adult brain cancer. Specifically, phytocannabinoids Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) has been shown to induce apoptosis and inhibit proliferation of adult cancer cells, as well as modulate angiogenesis and metastasis. Despite increasing evidence that cannabinoids elicit antitumor effects in adult cancers, there is minimal data available on their effects in children or in pediatric cancers despite public and clinical demand for information. Here we describe a comprehensive and critical review of what is known about the effects of cannabinoids on pediatric cancers, highlight current gaps in knowledge and identify the critical issues that need addressing before considering these promising but controversial drugs for use in pediatric oncology.
Objective. To assess pharmacy student confidence in their knowledge of qualifying conditions for medical cannabis use in the US and their attitudes toward curricular coverage of medical cannabis.
...Methods. Students were asked to complete an electronic survey to measure knowledge and confidence in various domains of medical cannabis treatment, including qualifying conditions, adverse effects, and other patient care skills.
Results. There were 238 students who completed the survey. Responses to all domains and their corresponding confidence levels displayed a lack in confidence. The only domain wherein students had confidence in was their ability to retrieve related drug information. Nearly 80% of students felt that the topic of medical cannabis should be added to existing curricula within the next five years.
Conclusion. With the prevalence of cannabis programs and knowledge gap, pharmacy schools should consider coverage of medical cannabis in the curricula.
Introduction
: There are limited therapeutic options for individuals with fibromyalgia. The aim of this study is to analyze changes in health‐related quality of life and incidence of adverse events ...of those prescribed cannabis‐based medicinal products (CBMPs) for fibromyalgia.
Methods
: Patients treated with CBMPs for a minimum of 1 month were identified from the UK Medical Cannabis Registry. Primary outcomes were changes in validated patient‐reported outcome measures (PROMs). A p‐value of <.050 was deemed statistically significant.
Results
: In total, 306 patients with fibromyalgia were included for analysis. There were improvements in global health‐related quality of life at 1, 3, 6, and 12 months (p < .0001). The most frequent adverse events were fatigue (n = 75; 24.51%), dry mouth (n = 69; 22.55%), concentration impairment (n = 66; 21.57%), and lethargy (n = 65; 21.24%).
Conclusion
: CBMP treatment was associated with improvements in fibromyalgia‐specific symptoms, in addition to sleep, anxiety, and health‐related quality of life. Those who reported prior cannabis use appeared to have a greater response. CBMPs were generally well‐tolerated. These results must be interpreted within the limitations of study design.
A case series was analysed of 306 patients with fibromyalgia enrolled in the
UK Medical Cannabis Registry. Cannabis‐based medicinal product treatment was
associated with improvements in fibromyalgia‐specific symptoms, in addition to
sleep, anxiety and health related quality of life. CBMPs were generally well‐
tolerated, however those with fibromyalgia may be more sensitive to their
adverse effects compared to those with other conditions where they are
prescribed.
Background:
A minority of palliative care patients benefit from prescribed cannabinoid-based medicines (CBMs).
Objective:
The objective of this study was to explore the perceptions, expectations, and ...experiences of CBM usage among palliative care patients and to evaluate whether and how they may constitute an obstacle to prescription.
Design:
This is a qualitative study involving semistructured in-depth interviews with 10 patients hospitalized in a palliative care unit in Geneva, Switzerland. The data were analyzed using the interpretative phenomenological analysis method.
Results:
Semistructured interviews were conducted on 10 patients (average age of 73.3 years), mainly with advanced cancer. Most patients favored CBM use in palliative care and distinguished it from recreational use. Seven themes were identified from patients' perceptions, experiences, and expectations during the interviews: right time to begin CBMs, off-label use, information about side effects, lack of a safe medical framework, costs, relatives, and social acceptance of CBMs.
Conclusion:
The obstacles described by the patients seem to be surmountable with specific measures at the clinical level. We suggest training health professionals in a palliative care setting, especially in explaining the effects and side effects. CBMs will undoubtedly play a more significant role in palliative care medicine in the years to come.
Cannabis is widely used as a therapeutic drug, especially by patients suffering from psychiatric and neurodegenerative diseases. However, the complex interplay between phytocannabinoids and their ...targets in the human receptome remains largely a mystery, and there have been few investigations into the relationship between the chemical composition of medical cannabis and the corresponding biological activity. In this study, we investigated 59 cannabis samples used by patients for medical reasons. The samples were subjected to extraction (microwave and supercritical carbon dioxide) and chemical analyses, and the resulting extracts were assayed in vitro using the CB
and CB
receptors. Using a partial least squares regression analysis, the chemical compositions of the extracts were then correlated to their corresponding cannabinoid receptor activities, thus generating predictive models that describe the receptor potency as a function of major phytocannabinoid content. Using the current dataset, meaningful models for CB
and CB
receptor agonism were obtained, and these reveal the insignificant relationships between the major phytocannabinoid content and receptor affinity for CB
but good correlations between the two at CB
receptors. These results also explain the anomalies between the receptor activities of pure phytocannabinoids and cannabis extracts. Furthermore, the models for CB
and CB
agonism in cannabis extracts predict the cannabinoid receptor activities of individual phytocannabinoids with reasonable accuracy. Here for the first time, we disclose a method to predict the relationship between the chemical composition, including phytocannabinoids, of cannabis extracts and cannabinoid receptor responses.
The gradual liberalization of international and Ukrainian legislation regarding the circulation of cannabis-based medical products requires a more detailed study of the degree of awareness and ...attitude of various stakeholders, in particular, health professionals (pharmacists), to this issue. For this purpose, a survey was conducted, in which 563 Ukrainian pharmacy workers took part. It was revealed that the respondents largely share the "myths" about the dangerous narcotic properties of medical cannabis; two-thirds of them believe that all cannabinoids have psychotropic properties. Pharmacists are poorly aware of medicinal products containing herbal and synthetic cannabinoids, as well as medical indications for their use. Only 14.4% of surveyed pharmacists fully support the manufacture of cannabis preparations on the basis of pharmacies, following the example of the European Union countries. At the same time, almost half of the respondents approve of the legalization of medical cannabis in Ukraine, although they fear the risks of illegal turnover. The great majority of pharmacists consider it important to conduct scientific research, educational and awareness-raising activities on medical cannabis to improve the health and quality of life of Ukrainian patients.
Cannabis is one of the important food and textile resources that has been used since 4000 BC. The fact that it was used as a medicine by the Chinese caused it to be included in the oldest ...pharmacopoeia in the world. However, in the 20th century, marijuana production from cannabis was a turning point in cannabis history, and then led to the limitation of cultivation areas and use. Today, cannabis is the most popular illicit drug worldwide. Regular use of cannabis is associated with impaired functioning, decreased academic performance, amotivation, addiction and, psychiatric disorders like psychosis, schizophrenia and mood disorders. On the other hand, recent research proposed promising therapeutic potential of cannabis-based drugs for a wide range of medical conditions including neurological and psychiatric disorders. These findings have led to the legalization of medical use of cannabis in certain states of the United States and in certain European countries. In this review, cannabis use, the historical process of cannabis use, medical use of cannabis, possible consequences of medical use of cannabis and the reflections of cannabis-related policy changes on society will be discussed.
Abstract Background There is increased interest in the therapeutic potential of cannabis in recent decades. Canada, the Netherlands, Israel and some states in the United States have developed ...programs to allow access to cannabis for therapeutic purposes (CTP). In Canada, enrollment in the federal CTP program represents fewer than 5% of the estimated users of CTP. The discrepancy between the number of Canadians who report using CTP and the rate of utilization of the federal CTP program suggests the existence of barriers to access to this program. Methods In the present study we employ a health services analytical framework to examine barriers to access to CTP among 628 current CTP users. We define barriers to access as areas of poor fit between clients and services. We use five dimensions of accommodation , accessibility , availability , affordability , and acceptability to examine access to CTP. Results Our findings reveal that it is difficult for Canadians to find a physician to support their application to access CTP. Accessing CTP from unauthorized sources was common; only 7% of respondents accessed CTP exclusively from authorized sources. Access to CTP was positively associated with the presence of medical cannabis dispensaries, which were not included in the regulatory regime. Access to CTP varied by medical condition and general quality of health. Affordability of CTP was a substantial barrier to access. Conclusions Strategies need to be developed to encourage scientific inquiry into CTP and address the barriers to access to CTP and the stigma and controversy that surround CTP and strain patient–physician relationships.
We determined the prevalence and correlates of cannabis use in Massachusetts after recreational use was passed, but before recreational cannabis stores opened. A cross-sectional, population-based ...survey of Massachusetts adults, age 18 years or older, (n = 3,022) was conducted in November-December, 2017. We estimated population-level prevalence and correlates of past 30-day cannabis use. 21.1% 95% CI: 18.6, 23.6 of Massachusetts adults reported past 30-day cannabis use. Among cannabis users, 56.0% CI 49.1, 62.9 reported non-medical cannabis use, 15.5% 12.1, 18.9 reported medical cannabis use, and 28.5% CI 22.3, 34.8 reported both types of use. Men were more likely than women to use cannabis (Risk Ratio: 1.3 CI 1.1, 1.6), as were young adults (18-25 years old), those with lower socioeconomic status, non-parenting individuals, those who used alcohol (1.9 CI 1.4, 2.6) or other substances (1.7 CI 1.3, 2.4), and residents of Western Massachusetts (2.0 1.3, 3.0; ref: Boston area), the Northeast (1.8 CI 1.2, 2.7), and the Southeast (1.8 CI 1.1, 2.7). Cannabis is widely used in Massachusetts, with varying prevalence rates by gender, age, socioeconomic status, poly-substance use, and region. Findings may inform public health efforts and serve as a baseline for measuring health and social impacts of opening retail cannabis stores.
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