Cannabis for the Treatment of Chronic Pain in the Era of an Opioid Epidemic: A Symposium-Based Review of Sociomedical Science

Abstract Objective This manuscript reviews medical literature published pertaining to the management of chronic pain with medical marijuana therapy (MMJ), with an emphasis on the social, medical, and legal aspects of therapy. Design Narrative review of peer-reviewed literature. Methods The 3rd Symposium on Controlled Substances and Their Alternatives for the Treatment of Pain was held in Boston on February 27, 2016, with a focus on MMJ for the treatment of chronic pain. Invited speakers had diverse backgrounds, including pain management, addiction psychiatry, neurology, and legal authorities. The purpose of this conference and this subsequent narrative review is to provide a medical, legal, and logistical framework for physicians and other health care providers to refer to when considering the initiation of medical marijuana therapy. Results The invited speakers each covered a unique aspect of MMJ therapy for the treatment of chronic pain. These presentations highlighted the current data for and against the use of MMJ as a pain therapy. Optimal patient selection and screening, in addition to policy developments, were discussed. Conclusions Increasing interest in MMJ for chronic pain underscores a need for primary care and pain physicians to better understand the indications and evidence for its use free from cultural bias. Given a lack of full conclusive clinical utility, continued research is needed to better understand how to best utilize MMJ therapy for the treatment of chronic pain. Policy initiatives, such as enumerated indications, should follow medical science in order to prevent another abused substance epidemic.

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Health providers’ perspectives on medical marijuana use.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.235 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 235-235 ◽

Cited By ~ 1

Author(s):

Diana Martins-Welch ◽

Christian Nouryan ◽

Myriam Kline ◽

Sony Modayil

Keyword(s):

Health Care ◽

Chronic Pain ◽

Side Effects ◽

Health Care Providers ◽

Prescription Drugs ◽

Medical Marijuana ◽

The United States ◽

Care Providers ◽

Opioid Use ◽

Cord Injury

235 Background: According to the CDC, 117 million Americans have one or more chronic health conditions and 31% have used two or more prescription drugs in the past month. Approximately 40% of adults in the United States are using some form of Complementary and Alternative Medicine. Medical marijuana is one such medicine, and to date 29 states have legalized medical marijuana. Methods: A multicenter, anonymous, on-line survey of health care providers was distributed via e-mail within a large health system in the NY Metropolitan area. The survey was distributed in April and May of 2017. The specific aim was to collect information about health care providers’ perspectives on the use of MM in general and for specific medical conditions. Results: The sample (n = 137) consisted of 4% RNs, 10% NPs, 10% fellows, 21% resident physicians, and 52% attending physicians. Average experience was 13 years (range: 0-43), half (53%) were under 40 years old and just over half (56%) were female. Most practitioners recognized a benefit of MM for the treatment of cancer-associated symptoms, few were concerned with side effects and 5% of responders answered that MM was not appropriate at any stage of illness. Responders were “most likely to recommend or refer MM if other therapies were not effective” for cancer (83%), chronic pain (68%), spinal cord injury with spasticity (50%), MS (46%), epilepsy (42%), neuropathy (42%) and Parkinson’s disease (41%). Most providers (77%) believed that MM has the potential to reduce overall opioid use, this was found to be statistically more common in younger providers. The most common conditions that providers reported their patients were requesting MM for were cancer (37%), chronic pain (26%) and neuropathy (10%). The most common concerns about MM use were side effects (16%), addiction (13%), legal consequences (11%), cost (7%) and that other providers would judge MM use (7%). Conclusions: Our survey shows that providers are overwhelmingly in support of MM use in patients with chronic illness, particularly in cancer patients. However providers describe significant and practical concerns about MM utilization. Given the rate at which MM is being legalized throughout the country, it is imperative that there be increased focus on education and clinical studies on MM.

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Talking to Children and Families about Chronic Pain: The Importance of Pain Education—An Introduction for Pediatricians and Other Health Care Providers

Children ◽

10.3390/children7100179 ◽

2020 ◽

Vol 7 (10) ◽

pp. 179

Author(s):

Helen Koechlin ◽

Cosima Locher ◽

Alice Prchal

Keyword(s):

Health Care ◽

Chronic Pain ◽

Children And Adolescents ◽

Health Care Providers ◽

Treatment Options ◽

Narrative Review ◽

Care Providers ◽

Pain Education ◽

Pediatric Chronic Pain ◽

Patient Health

Chronic pain in children and adolescents is a common and debilitating health problem. This narrative review will give a brief overview on what pediatric chronic pain is and what treatment options there are for children and adolescents. The specific emphasis will be on pediatric chronic pain education and communication: this narrative review aims to show how important a good patient–health care provider relationship is—it builds the foundation for successful communication—and how this relationship can be established. In addition, we will present five steps that health care providers can perform to explain pediatric chronic pain to patients and their parents and what to keep in mind in their clinical routine. Our review is intended for pediatricians and other health care providers who treat pediatric patients with chronic pain but might feel uncertain on how to best communicate with them.

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Concerns of Patients With Cancer on Accessing Cannabis Products in a State With Restrictive Medical Marijuana Laws: A Survey Study

Journal of Oncology Practice ◽

10.1200/jop.19.00184 ◽

2019 ◽

Vol 15 (10) ◽

pp. 531-538 ◽

Cited By ~ 2

Author(s):

Vinita Singh ◽

Ali J. Zarrabi ◽

Kimberly A. Curseen ◽

Roman Sniecinski ◽

Justine W. Welsh ◽

...

Keyword(s):

Health Care ◽

Palliative Care ◽

Health Care Providers ◽

Medical Marijuana ◽

Survey Study ◽

Care Practice ◽

Care Providers ◽

Patients With Cancer ◽

Medical Marijuana Laws ◽

Source Of Information

PURPOSE: Several states, particularly in the Southeast, have restrictive medical marijuana laws that permit qualified patients to use specific cannabis products. The majority of these states, however, do not provide avenues for accessing cannabis products such as in-state dispensaries. METHODS: We conducted a survey of patients registered for medical marijuana (low tetrahydrocannabinol [THC] oil cards) in an ambulatory palliative care practice in Georgia (one of the states with restrictive medical marijuana laws). RESULTS: We had a total of 101 responses. Among our sample of patients who use cannabis as part of a state-approved low THC oil program, 56% were male and 64% were older than age 50 years. Advanced cancer was the most common reason (76%) for granting the patients access to a low THC oil card. Although patients reported cannabis products as being extremely helpful for reducing pain, they expressed considerable concerns about the legality issues (64%) and ability to obtain THC (68%). Several respondents were using unapproved formulations of cannabis products. For 48% of the patients, their physician was the source of information regarding marijuana-related products. Furthermore, they believed that their health care providers and family members were supportive of their use of cannabis (62% and 79%, respectively). CONCLUSION: Patients on Georgia’s medical marijuana program are most concerned about the legality of the product and their ability to obtain marijuana-related products. Therefore, we recommend that states with medical marijuana laws should provide safe and reliable access to cannabis products for qualifying patients.

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Cultural Considerations in the Management of Chronic Pain

CAND Journal ◽

10.54434/candj.93 ◽

2021 ◽

Vol 28 (4) ◽

pp. 11-13

Author(s):

Shakila Mohmand ◽

Sumar Chams

Keyword(s):

Health Care ◽

Chronic Pain ◽

Cultural Competency ◽

Patient Outcomes ◽

Health Care Providers ◽

Cultural Beliefs ◽

Coping Mechanisms ◽

Care Providers ◽

Pain Experience ◽

Cultural Considerations

Cultural competency within health care helps eliminate racial and ethnic health disparities. When assessing and treating patients with chronic pain, practitioners should feel confident in using information regarding a patient’s individual cultural beliefs due to their significant impact on the pain experience. Culture impacts perception, outlook, and communication of pain, as well as coping mechanisms. These are aspects of subjective history that influence important decisions regarding the management of chronic pain. Becoming more aware of what to look for and which questions to ask can allow naturopathic doctors and other health-care providers to continue improving therapeutic relationships and patient outcomes.

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Patients’ Views on Self-Management of Chronic Musculoskeletal Pain

Izzivi prihodnosti ◽

10.37886/ip.2020.015 ◽

2020 ◽

Vol 5 (4) ◽

pp. 254-266

Author(s):

Barbka Huzjan ◽

Ivana Hrvatin

Keyword(s):

Health Care ◽

Chronic Pain ◽

Musculoskeletal Pain ◽

Health Care Providers ◽

Multidisciplinary Approach ◽

Research Question ◽

Chronic Musculoskeletal Pain ◽

Self Management ◽

Care Providers ◽

The Individual

Research Question (RQ): Chronic musculoskeletal pain is a complex condition and one of the most important causes of suffering of modern times. Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition. The research question is; what is the view on the selfmanagement of chronic musculoskeletal pain from the patient's perspective? Purpose: The purpose of this literature review was to review original articles that reported how selfmanagement educational programmes are viewed from the patient’s perspective. Method: We used an integrative review of the literature. The search was conducted from November 2019 to March 2020 on the PubMed, PEDro and OTseeker databases. We included original studies, written in English that examined the patients’ point of view on self-management. The included studies, needed to be conducted on adult patients of both sexes, that were suffering from chronic pain and were educated on self-management of their pain. Two authors independently searched for original studies. Results: Nine article were included in the review. Most of the studies included a multidisciplinary approach. Patients reported they more frequently used passive strategies to manage their pain. They want to be included in the management and be able to communicate with the provider of selfmanagement. There are several positive aspects of a multidisciplinary and groups approach. Organization: Health care providers can encourage an individual to proactively behave through ongoing processes of communication, partnerships and the creation of appropriate self-management plans over time. Society: We assume that the analysis will help to identify the social responsibility of the individual and society in the common concern for the health of the population and the individual within it. Originality: The research provides an up-to-date, new overview of the patients' perspective on self management on chronic pain. The review can be helpful to health care providers s they can compare their expectations with patients's. Limitations / further research: Further research would focus on high quality studies, and specific forms of multidisciplinary approach, and finding what patients use at a home setting and how to help them continue in the self management of their pain. Limitations of this review include the lack of risk of bias assessment and the fact that this is not a systematic review.

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Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises

Pain Medicine ◽

10.1093/pm/pnaa127 ◽

2020 ◽

Vol 21 (7) ◽

pp. 1331-1346 ◽

Cited By ~ 37

Author(s):

Steven P Cohen ◽

Zafeer B Baber ◽

Asokumar Buvanendran ◽

Brian C McLean ◽

Yian Chen ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Chronic Pain ◽

Pain Management ◽

Health Care Providers ◽

Risk Mitigation ◽

Health Administration ◽

Care Providers ◽

Health Crisis ◽

Management Services

Abstract Background It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for. Methods To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week period. Results In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization. Conclusions The COVID-19 public health crisis has strained health care systems, creating a conundrum for patients, pain medicine practitioners, hospital leaders, and regulatory officials. Although this document provides a framework for pain management services, systems-wide and individual decisions must take into account clinical considerations, regional health conditions, government and hospital directives, resource availability, and the welfare of health care providers.

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Ambulatory Surgical Centers: Improving Quality of Operative Spine Care?

Global Spine Journal ◽

10.1177/2192568219849391 ◽

2020 ◽

Vol 10 (1_suppl) ◽

pp. 29S-35S ◽

Cited By ~ 1

Author(s):

Christopher D. Witiw ◽

Jefferson R. Wilson ◽

Michael G. Fehlings ◽

Vincent C. Traynelis

Keyword(s):

Health Care Providers ◽

Spine Surgery ◽

Cost Optimization ◽

Safety Data ◽

Case Series ◽

Surgical Care ◽

Narrative Review ◽

Care Providers ◽

Ambulatory Surgical Centers

Study Design: Narrative review with commentary. Objective: Present healthcare reform focuses on cost-optimization and quality improvement. Spine surgery has garnered particular attention; owing to its costly nature. Ambulatory Surgical Centers (ASC) present a potential avenue for expenditure reduction. While the economic advantage of ASCs is being defined, cost saving should not come at the expense of quality or safety. Methods: This narrative review focuses on current definitions, regulations, and recent medical literature pertinent to spinal surgery in the ASC setting. Results: The past decade witnessed a substantial rise in the proportion of certain spinal surgeries performed at ASCs. This setting is attractive from the payer perspective as remuneration rates are generally less than for equivalent hospital-based procedures. Opportunity for physician ownership and increased surgeon productivity afforded by more specialized centers make ASCs attractive from the provider perspective as well. These factors serve as extrinsic motivators which may optimize and improve quality of surgical care. Much data supports the safety of spine surgery in the ASC setting. However, health care providers and policy makers must recognize that current regulations regarding safety and quality are less than comprehensive and the data is predominately from selected case-series or comparative cohorts with inherent biases, along with ambiguities in the definition of “outpatient.” Conclusions: ASCs hold promise for providing safe and efficient surgical management of spinal conditions; however, as more procedures shift from the hospital to the ASC rigorous quality and safety data collection is needed to define patient appropriateness and track variability in quality-related outcomes.

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Medical Professional and Usage of Social Media

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v16i4.33622 ◽

2017 ◽

Vol 16 (4) ◽

pp. 606-609 ◽

Cited By ~ 3

Author(s):

Rabeya Yousuf ◽

Sheikh Muhammad Abu Bakar ◽

Mainul Haque ◽

Md Nurul Islam ◽

Abdus Salam

Keyword(s):

Health Care ◽

Social Media ◽

Health Care Providers ◽

Medical Profession ◽

Medical Science ◽

Code Of Conduct ◽

Medical Professional ◽

Care Providers ◽

Future Health ◽

Future Health Care

Social media connect people by sharing text, photos, audio and videos among themselves. Medical professional and patients also communicate through social media; however, issues of privacy and confidentiality of medical professions in regards to medical and health care decisions contradict with the openness of the usage of social media. Member of the medical profession can use social media but need to abide by the code of conduct of medical ethics in order to render the best possible services. This paper emphasizes on the needs of inclusion of social media usage in future health care providers curriculum by the higher educational institutions in order to aware of the ethical and professional aspect.Bangladesh Journal of Medical Science Vol.16(4) 2017 p.606-609

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Color, Caption and Emoji – Using Instagram as a Screening Tool for Depression in Teenagers and Adults

INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH AND ANALYSIS ◽

10.47191/ijmra/v4-i8-15 ◽

2021 ◽

Vol 04 (08) ◽

Author(s):

Alexandra Enciu, MD ◽

Keyword(s):

Health Care Providers ◽

Health Sector ◽

Narrative Review ◽

Care Providers ◽

Major Depressive ◽

Comparison Theory ◽

The Public ◽

Demographic Group ◽

The Social ◽

Insight Into

Instagram, the largest growing social network site today, has grown exponentially since its launch in 2010. Mental health challenges, particularly anxiety and major depressive disorder in those aged 16 to 30 have been associated with Instagram’s popularity. Depression is of particular interest to health care providers within the public health sector: it affects 264 million people globally; suicide is the second most common cause of death in 18 to 29-year-olds. This age group also constitutes the main demographic group of Instagram users. A narrative review was conducted on peer-reviewed articles between January 2019-July 2020 to analyze Instagram use and its association with depression, and using it as a tool to diagnose depression. PubMed, EBSCO, NCBI, NIH, and Google Scholar were used to source articles published between 2015-2020. The narrative review focused on four primary papers. The first study looked at the social comparison theory, while the second and third studies used screening questionnaires in conjunction with analyzing an individual’s Instagram content into text-based scores. The fourth study analyzed the content of photos which were posted to give insight into an individual’s status regarding depressive states. Accounting for 18 to 30 year olds’ Instagram usage into how they engaged with content can accurately screen for, and diagnose depression.

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Gamification and Game-Based Strategies for Dermatology Education: Narrative Review

JMIR Dermatology ◽

10.2196/30325 ◽

2021 ◽

Vol 4 (2) ◽

pp. e30325

Author(s):

Mindy D Szeto ◽

Daniel Strock ◽

Jarett Anderson ◽

Torunn E Sivesind ◽

Victoria M Vorwald ◽

...

Keyword(s):

Medical Education ◽

Health Care Providers ◽

Literature Search ◽

Medical Training ◽

Educational Games ◽

Narrative Review ◽

Care Providers ◽

Large Variability ◽

Promising Alternative ◽

Games And Simulations

Background Game-based approaches, or gamification, are popular learning strategies in medical education for health care providers and patients alike. Gamification has taken the form of serious educational games and simulations to enable learners to rehearse skills and knowledge in a safe environment. Dermatology learners in particular may benefit from gamification methods, given the visual and procedural nature of the field. Objective This narrative review surveys current applications of gamification within general medical training, in the education of dermatology students, and in dermatology patient outreach. Methods A literature search was performed using PubMed, Google Scholar, and ResearchGate to access and review relevant medical education- and dermatology-related gamification studies published in peer-reviewed journals. Two independent researchers with education and experience in dermatology screened publications to select studies featuring a diversity of gamification approaches and study subjects for in-depth examination. Results A total of 6 general medical education–related and 7 dermatology-specific gamification studies were selected. Gamification generally increased motivation and engagement, improved reinforcement of learning objectives, and contributed to more enjoyable and positive educational experiences compared to traditional modes of instruction. Enhancing examination scores, building confidence, and developing stronger team dynamics were additional benefits for medical trainees. Despite the abundance of gamification studies in general medical education, comparatively few instances were specific to dermatology learning, although large organizations such as the American Academy of Dermatology have begun to implement these strategies nationally. Gamification may also a provide promising alternative means of diversifying patient education and outreach methods, especially for self-identification of malignant melanoma. Conclusions Serious games and simulations in general medical education have successfully increased learner motivation, enjoyment, and performance. In limited preliminary studies, gamified approaches to dermatology-specific medical education enhanced diagnostic accuracy and interest in the field. Game-based interventions in patient-focused educational pilot studies surrounding melanoma detection demonstrated similar efficacy and knowledge benefits. However, small study participant numbers and large variability in outcome measures may indicate decreased generalizability of findings regarding the current impact of gamification approaches, and further investigation in this area is warranted. Additionally, some relevant studies may have been omitted by the simplified literature search strategy of this narrative review. This could be expanded upon in a secondary systematic review of gamified educational platforms.

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