Today's post from the ever-reliable sciencedaily.com (see link below) provides yet more evidence that inhaled cannabis can be one of the few genuinely effective means of quietening neuropathic symptoms. Of course, smoking a joint is also inhaling cannabis (or at least the THC component) but many people quite understandably, can't take the smoking aspect of it and inhaling via vaporizers is for them, a better solution. The argument drags on but the more studies like this one, the more the relevant authorities will be convinced that it doesn't lead to a path of depravity and ruin. Meanwhile, savvy neuropathy patients have known this for years and regularly control their pain by means of inhaled cannabis, with no ill effects. When the moral and law-giving forces catch up we may get sensible legislation rolled out across the world.
Inhaled cannabis shown effective for diabetic neuropathy pain Date: July 20, 2015 Source: American Pain Society Summary:
Inhaled cannabis reduces diabetic neuropathy and the analgesic effect is dose-dependent, new research suggests. Researchers conducted a randomized, double-blind study evaluating 16 subjects to assess the efficacy and tolerability of inhaled cannabis for treating pain caused by diabetic peripheral neuropathy (DPN).
FULL STORY
New research reported in The Journal of Pain, published by the American Pain Society, shows that inhaled cannabis reduces diabetic neuropathy and the analgesic effect is dose-dependent.
Researchers at the University of California San Diego conducted a randomized, double-blind study evaluating 16 subjects to assess the efficacy and tolerability of inhaled cannabis for treating pain caused by diabetic peripheral neuropathy (DPN). They studied the effects of low, medium and high doses of inhaled cannabis on DPN pain and hyperalgesia. Subjects participated in four outpatient treatment sessions, separated by two weeks, in which they were exposed to placebo or three different doses of aerosol 1% THC, the most abundant and psychoactive compound in cannabis. As a drug delivery method for marijuana research, inhalation is preferred because the pharmacokinetics of inhalation are superior to smoking, as peak effects occur quickly and are more easily titrated.
DPN occurs in half of diabetes patients and 15 percent have pain, especially in the feet. Many patients do not achieve satisfactory relief from two FDA-approved treatments. Animal research in models of neuropathic pain suggest that cannabinoids may be effective in reducing pain, but no studies have focused specifically on painful DPN.
"We hypothesized that inhaled cannabis would result in a dose-dependent reduction in spontaneous and evoked pain with a concomitant effect on cognitive function," said lead author Mark S. Wallace, M.D., professor of anesthesiology, University of California San Diego School of Medicine.
Results showed there was a dose-dependent reduction in pain intensity from inhaled cannabis, which the authors noted is consistent with results of other trials of the drug for diverse neuropathic pain syndromes.
"The dose dependent analgesic effect was evident for both spontaneous and evoked pain in the trial subjects, but it was more consistent on spontaneous pain," said Wallace.
The also authors reported that all subjects experienced either euphoria or somnolence, which may limit the acceptability of cannabis as an analgesic. However, in measuring the impact of inhaled cannabis impact on cognition (attention and memory), they found modest effects with no dramatic declines or impairments.
"These findings along with previous studies suggest that cannabis might have analgesic benefit in neuropathic pain syndromes, including treatment-refractory DPN," said Wallace.
Story Source:
The above post is reprinted from materials provided by American Pain Society. Note: Materials may be edited for content and length.
Journal Reference:
Mark S. Wallace, Thomas D. Marcotte, Anya Umlauf, Ben Gouaux, Joseph H. Atkinson. Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. The Journal of Pain, 2015; 16 (7): 616 DOI: 10.1016/j.jpain.2015.03.008
http://www.sciencedaily.com/releases/2015/07/150720115147.htm
Today's post from nursing.onclive.com (see link below) again promotes exercise as a way of reducing neuropathy symptoms but in this case, the evidence seems a little thin. By testing a group of cancer patients with neuropathy as a side effect, they found that walking and other general exercise prevented the symptoms from worsening, especially in older patients. I would suggest that moderate exercise will help older patients feel generally better anyway than sitting or lying for long periods of time but they'll need to provide much more specific evidence to prove that neuropathic symptoms can be reduced by a graduated walking course. In this case, I would suggest that with this sort of patient, there are far too many variables to come to the conclusion that exercise is more effective in reducing or limiting nerve damage symptoms in older people. That said, there is a general consensus among doctors that regular exercise will improve neuropathy, or at least stop it getting worse but in this case, I feel too much is being assumed from too little data.
LAUREN M. GREEN @OncNurseEditor Wednesday, July 20, 2016
Patients undergoing chemotherapy prescribed a formal exercise program experienced less chemotherapy-induced peripheral neuropathy (CIPN), and the finding held true across all chemotherapy regimens tested. The effect was strongest in older patients, according to findings from a nationwide randomized controlled trial reported at the 2016 ASCO Annual Meeting.
CIPN is a highly prevalent and severe side effect of certain chemotherapy types, such as platinums, taxanes, and vinca alkaloids, affecting more than 50% of patients receiving these therapies. Nevertheless, “there are currently no established treatments for CIPN—despite 50 randomized clinical trials—testing the efficacy of drugs to prevent or treat it,” explained lead study author Ian Kleckner, PhD.
Kleckner, a research assistant professor at the University of Rochester Medical Center, and colleagues performed a secondary analysis of a subset of 314 sedentary patients receiving taxane-, vinca alkaloid-, or platinum-based chemotherapy derived from a larger, phase III, national, randomized controlled trial (N = 619).
The majority of patients were women (92%), and 78% had breast cancer. They were randomized to chemotherapy alone or chemotherapy plus exercise. Patients randomized to the EXCAP arm (Exercise for Cancer Patients) which is a personalized, 6-week, home-based, moderate-intensity progressive program, were prescribed a daily walking regimen (eg, steps per day), supplied with pedometers, and also given a set of resistance bands to perform specific exercises.
Walking and resistance exercises were recommended for the control group. They did not receive any formalized support; however, control participants were given the exercise kit at the end of the study.
The investigators used patient self-report of tingling and numbness at baseline and after the intervention, rated on a 0-10 scale with 10 being the worst level of CIPN. In the EXCAP arm, CIPN was reduced compared with controls, with an effect size of 0.26 (P = .06), and the finding was independent of other variables, such as gender, BMI, and cancer stage. However, age was a moderating variable.
“We found that exercise was more effective for older patients,” said Kleckner. “Older patients in the control arm experienced a large increase in CIPN after 6 weeks of chemotherapy, whereas older patients in the experimental exercise arm had a very small, if any, increase in CIPN.”
Kleckner said that based on these findings, he and colleagues hope to expand their research. “What we’d like to do now is design a randomized clinical trial testing exercise against chemotherapy alone, where CIPN is the primary outcome. Only one trial to date has looked at this, and it was very small—60 patients.”
He hopes researchers can identify biomarkers in the brain circuitry or signals of the role inflammation may play to help better identify who is most at risk for CIPN.
Over the next few years, Kleckner would like to see this research continue to “scale up, so we can better learn about the effectiveness of exercise, understand what dose/intensity of exercise is important, what type of exercise, and who responds best to exercise … we’re hoping for an exercise prescription, instead of the generic ‘please exercise.’”
Kleckner I, Kamen CS, Peppone LJ, et al. A URCC NCORP nationwide randomized controlled trial investigating the effect of exercise on chemotherapy-induced peripheral neuropathy in 314 cancer patients. J Clin Oncol. 2016; 34 (suppl; abstr 10000).
http://nursing.onclive.com/web-exclusives/walking-and-resistance-training-eases-cipn-especially-among-older-patients
Today's post from the reliable drugs.com (see link below) takes a look at a new initiative by a European pharmaceutical company (the makers of Tapentadol (Palexia) amongst others) to help chronic pain patients better assess the extent of their own pain. By means of an online questionnaire and many patient own testimonies, the idea is to help patients put their pain in context and provide information that will be both useful to themselves and their doctors. This blog never advertises on behalf of commercial companies but this does seem to be of genuine benefit to people living with neuropathy.
Pharma Website Addressing Pain Perception Debuts "My Pain Feels Like…" - Pain Perception is as Individual as Pain Patients
AACHEN, Germany, October 8, 2013
- A new website helps pain patients to better express and explain how their pain feels like
Pain can appear in many forms and affects people in different ways. One kind of long-lasting or chronic pain results from a damaged nerve that sends incorrect pain messages to the brain. This pain is called neuropathic pain or nerve pain.
Over 26 million people worldwide suffer from neuropathic pain[ 1 ] but only 40-60% of patients achieve adequate pain relief.[ 2 ]
The majority, approximately 60%, of neuropathic pain is localised[ 3 ] (localised neuropathic pain, LNP) and is often described as a burning, shooting, lancinating, electric shock like.[ 4 ] But more frequently patients are trying to describe their pain in their own words by using their individual, often very pictographic language.
A correct and early diagnose is crucial to find the right treatment. Therefore patients need to describe their symptoms in as much detail as possible to their doctor.
At the new website http://www.mypainfeelslike.com patients find a questionnaire that helps them to describe in detail how their pain feels like, how it affects their life and where the pain is allocated.
"My pain feels like…" has been developed by Grünenthal GmbH in collaboration with the Montescano Pain School, Italy. For more information please visit http://www.grunenthal.com
About Grünenthal
The Grünenthal Group is an independent, family-owned, international research-based pharmaceutical company headquartered in Aachen, Germany. Building on its unique position in pain treatment, its objective is to become the most patient-centric company and thus to be a leader in therapy innovation. Grünenthal is one of the last remaining five research-oriented pharmaceutical companies with headquarters in Germany which sustainably invests in research and development. The research and development costs amounted to a preliminary of about 26 percent of revenues in 2012. Grünenthal's research and development strategy concentrates on selected fields of therapy and state-of-the-art technologies. We are intensely focused on discovering new ways to treat pain better and more effectively, with fewer side-effects than current therapies. Altogether, the Grünenthal Group has affiliates in 26 countries worldwide. Grünenthal products are sold in more than 155 countries and today approx. 4,400 employees are working for the Grünenthal Group worldwide. In 2012, Grünenthal achieved preliminary revenues of € 973 mn. More information: http://www.grunenthal.com.
References:
1 Pal M et al (2009). Vanilloid receptor antagonists: emerging class of novel anti-inflammatory agents for pain management. Curr Pharm Des 15:1008-26
2 Dworkin RH, O'Connor AB, Backonja M, et al (2007). Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain;132:237-51
3 Mick G et al (2012). What is localised neuropathic pain? A first proposal to characterise and define a widely used term. Pain manage 2(1), 71-77
4 Woolf C et al (1999). Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet; 353:1959-64
Contact: Jeanette Hübsch, Grünenthal Europe & Australia
Phone: +49-241-569-1487, email: jeanette.huebsch@grunenthal.com
Posted: October 2013
http://www.drugs.com/news/pharma-website-addressing-pain-perception-debuts-47995.html
