Medical cannabis relieves cancer pain

In a recent article published in BMJ Supportive & Palliative Care In the Journal, researchers published findings from the Quebec Cannabis Registry (QCR), a multicenter trial evaluating the efficacy of medical cannabis (MC) in managing cancer-induced pain.

study: Medical cannabis is effective for cancer-related pain: results of Quebec cannabis registryImage credit: 420MediaCo / Shutterstock

Background

More than 65% of terminal cancer patients experience moderate to severe pain, and up to 61.5% of physicians urge cancer patients to consider MC to manage pain and other cancer symptoms. I ask for it often. About one-third of patients have side effects despite treatment with opioid analgesics, such as nabilone, nabiximol, and other agents such as anticonvulsants and anti-inflammatory drugs. Adverse effects of opioid treatment for cancer-related pain include nausea, vomiting, constipation and, in more severe cases, respiratory depression.

About research

The Medical College of Quebec, Canada, established the QCR to prospectively and systematically collect safety data. Effectiveness, and overall use of MC products in real-world settings. QCR he collected data from May 2015 to October 2018, or over three and a half years. A general practitioner, specialist, and physician referred cancer patients throughout Quebec who agreed to obtain her MC within the research framework specified by He QCR in order to enroll in this registry.

The study population consisted of adults 18 years of age or older at enrollment, who were able to provide consent and complete a QCR questionnaire. Both met the criteria for her first MC certification candidate. In this study, researchers monitored patient socio-demographics, pre-existing health conditions, cancer diagnoses, other medications, including recreational medications, smoking status, and baseline, i.e., alcohol use at the beginning of the study. Did.

They also reviewed the major MC products approved for use, their method of administration (oral/inhaled, or both), and chemover profiles, i.e., tetrahydrocannabinol (THC) predominance, cannabidiol (CBD) predominance. Documented MC indications and MC treatment regimens., or THC balance: CBD.

Findings on the use of MC included the revised Edmonton Symptom Rating System (ESAS-r), Quantitative Medication Scale (MQS), Brief Pain Inventory (BPI), and Morphine Equivalent Daily Dose (MEDD). rice field.

From the BPI, the team considered worst and average pain, pain relief, and overall pain severity and disability 24 hours prior to MC use. The ESAS-r measured pain intensity on a 0 to 10 rating scale. 0 and 10 indicate no pain and extreme pain respectively. A minimum 30% reduction in the BPI measure and a reduction of approximately 1.2 units in the ESAS-r pain scale helped investigators determine the minimal clinically important difference (MCID).

Researchers used MQS to quantify MC load and monitor changes in drug use over time. To distinguish between opioid sparing effects and MC use, it was calculated at baseline and then at follow-up.

The team used a repeated-measures ANCOVA to assess age, sex, cancer diagnosis, occupation, smoking, alcohol use, drug use, chemover profile, and route of MC administration. Study follow-up visits continued from every 3 months until he was over a year.

Investigation result

The study dataset consisted of 358 patients, 47.8% of whom were male (mean age 57.6±14.7 years) with a confirmed cancer diagnosis, selected from 2991 QCR enrollees. The top three cancer diagnoses were breast, colorectal, and genitourinary. Most patients (72.4%) in this study reported pain as the primary indication for MC use. Clinicians most frequently allowed oral administration of MC in 58.9% of cases. THC-dominant, CBD-dominant, and THC approval: CBD-balanced products occurred at frequencies of 24.5%, 16.4%, and 37.9%, respectively.

All patients reported pain as a symptom, regardless of baseline pain score. All these patients participated in this study to minimize selection bias. This explains why the mean ± SD of worst pain and overall pain severity at baseline equaled 5.5 ± 0.7 and 3.7 ± 0.5, respectively. All pain intensity indices assessed via BPI and ESAS-r decreased in statistical and clinical relevance between baseline and final follow-up visits.

Bar-Lev Schleider et al. documented that a cancer patient whose pain intensity was 8 to 10, he decreased from 53% to 4.6% between baseline and his 6-month follow-up. Similarly, Portenoy et al. Nabiximols, a THC:CBD balanced spray, was shown to be more effective (compared to placebo) in managing pain in cancer patients. We found that patients who tested positive for THC in their urine had higher ESAS-r pain scores in cancer patients than those who tested negative.

However, in this study, patients using THC-dominant MC products reported decreased mean pain and pain intensity on the BPI and ESAS-r, respectively. However, using his THC:CBD balanced MC product significantly improved the pain profile over both types of products alone. Among all chemover profiles, only the THC:CBD balanced product significantly reduced worst and average pain, pain relief, and overall pain severity and interference at 3-month follow-up. decreased. Additionally, the authors noted that MQS and MEDD scores decreased from baseline to subsequent follow-up visits.

The authors also observed that patients with a high symptom burden sought more cannabinoids than those with a relatively low symptom burden. It is worth noting that use may lead to more severe AEs that interfere with symptom burden. The authors also observed MCID at 3, 6, 9 and 12 months follow-up.

Only 5 patients discontinued MC use due to AEs, while 11 patients suffered from 15 moderate to severe AEs. The top two of the 13 non-serious AEs were fatigue and somnolence, followed by dizziness. On the contrary, studies have found that opioids are associated with more difficult AEs such as constipation and delirium. His two other serious AEs, pneumonia and cardiovascular events, appeared unrelated to MC.

Conclusion

Several previous studies have yielded inconsistent and conflicting results regarding variability in dose ranges, MC product types, and methods of quantifying opioid use. For example, O’Connell et al. We highlighted a significant reduction in mean morphine equivalents in 79 non-cancer patients at 3- and 6-month follow-up compared to baseline.

On the contrary, Johnson et al. reported no significant change in mean opioid use among cancer patients who were also using MC products. Future studies should address and elucidate these discrepancies.

Nonetheless, the current study found MC to be a safe and effective alternative therapy for cancer patients seeking pain relief and reduced drug dependence. The balanced MC product performed better than the THC- and CBD-dominant products alone. Therefore, MC products may be a complementary therapy for cancer patients for whom conventional analgesics such as opioids do not provide adequate pain relief.