From The Journal of Pain, 14 February 2014. E-published 11 December 2012.
Low-dose vaporized cannabis significantly improves neuropathic pain.
Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H.
VA Northern California Health Care System, and Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Sacramento, California
Correspondence: Barth Wilsey, MD, Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, 4860 Y St, Suite 3850, Sacramento, CA 95817.
Abstract
We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment.
Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling medium-dose (3.53%), low-dose (1.29%), or placebo cannabis with the primary outcome being visual analog scale pain intensity. Psychoactive side effects and neuropsychological performance were also evaluated.
Mixed-effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the 2 active dose groups' results (P > .7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo versus low-dose, 2.9 for placebo versus medium-dose, and 25 for medium- versus low-dose.
As these NNTs are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being as effective a pain reliever as the medium dose.
Psychoactive effects were minimal and well tolerated, and neuropsychological effects were of limited duration and readily reversible within 1 to 2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain.
PERSPECTIVE
The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (1.29%) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome. In general, the effect sizes on cognitive testing were consistent with this minimal dose. As a result, one might not anticipate a significant impact on daily functioning.
From Psychology, Health & Medicine, 2 September 2014 (e-published before print).
Pain in people with chronic fatigue syndrome/myalgic encephalomyelitis: The role of traumatic stress and coping strategies
Anna Krzeczkowska(a), Thanos Karatzias(b,c,*), Adele Dickson(a)
a) School of Life, Sport and Social Sciences, Edinburgh Napier University, Edinburgh, UK
b) Faculty of Health, Life & Social Sciences, Edinburgh Napier
University, Edinburgh, UK
c) NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
* Corresponding autho
Abstract
Pain is a significant problem for many people with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). This exploratory study investigated the extent to which severity of pain was related to coping strategies and post-traumatic symptomatology in people with
CFS/ME.
Participants comprised 27 individuals with CFS/ME and 27 healthy controls. All participants completed the CFS/ME Symptom Questionnaire, the brief pain inventory, the impact of event scale-revised and the brief-COPE.
It was found that CFS/ME participants present with significantly more post-traumatic stress symptoms and report significantly less emotion focused strategies and problem focused coping strategies compared with healthy controls.
Severity of pain in the CFS/ME subgroup was not associated with traumatic symptomatology, although those with severe pain reported less use of self-distraction, positive re-framing and acceptance than those with mild pain.
Our results suggest that the enhancement of certain coping strategies (facilitated by psychological interventions such as acceptance and commitment therapy) may be beneficial in alleviating pain in people with CFS/ME.