scholarly journals Cannabis, concussion, and chronic pain: An ongoing retrospective analysis at Dent Neurologic Institute in Buffalo, NY

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S18.3-S19 ◽  
Author(s):  
Jennifer McVige ◽  
Vincent Harry Bargnes ◽  
Said Shukri ◽  
Laszlo Mechtler
Keyword(s):  
Quality Of Life ◽  
New York ◽  
Chronic Pain ◽  
Side Effects ◽  
New York State ◽  
Activity Level ◽  
Average Dose ◽  
Medical Cannabis ◽  
Preliminary Results

ObjectiveTo examine medical cannabis (MC) as treatment for concussion-related chronic pain.Design/methodsIndividuals with concussion often experience chronic discomfort from headaches. MC treatment was approved for use in chronic pain by New York State in March 2017. DENT has treated 4,123 patients with MC, including 2,792 for chronic pain and 142 with concussion symptoms. Sixty-six charts were reviewed, with a total of 100 expected by presentation.Preliminary results(1) The Patient Global Impression of Improvement (PGI-I) scale revealed 80% of patients experienced significant improvement in activity level and symptoms. (2) Five common concussion symptoms (headache, mood, sleep, attention, and dizziness) were evaluated via modified-Likert scale (0 rated as “Much Worse” and 10 as “Much Better”). Moderate improvement (MI) was defined as 7–8 and significant improvement (SI) 9–10. Improvement was greatest in mood (63% MI, 20% SI), sleep (53% MI, 23% SI), and headache (60% MI, 14% SI). (3) Quality of Life after Brain Injury Score (QOLIBRI) scores were obtained on patients who had started MC (46) and those who had not yet (19). Comparison of the groups showed a significant improvement (p = 0.0035) in quality of life in individuals on MC. (4) The routes of administration that produced optimal benefit were 1:1 (THC:CBD) oral tincture at an average dose of 1.5 mL TID for prophylaxis and 20:1 vapor pen for acute pain. Together these products cost an average of $242 per month. (5) 15% of patients reported side effects, all minimal, with 63% related to administration route (poor taste, cough). No patients discontinued MC due to side effects.ConclusionsThese results support MC as an option for treatment of concussion-related chronic pain. While prospective studies are required, these preliminary results lay the foundation for investigating MC as a valid treatment for concussion and chronic pain.

scholarly journals Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis

2018 ◽  
Vol 8 (3) ◽  
pp. 110-115 ◽  
Author(s):  
Terrance Bellnier ◽  
Geoffrey W. Brown ◽  
Tulio R. Ortega
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Randomized Clinical Trials ◽  
New York State ◽  
The United States ◽  
Preliminary Evaluation ◽  
Medical Cannabis ◽  
Image Study ◽  
Post Therapy

Abstract Introduction: Medical cannabis (MC) is commonly claimed to be an effective treatment for chronic or refractory pain. With interest in MC in the United States growing, as evidenced by the 29 states and 3 US districts that now have public MC programs, the need for clinical evidence supporting this claim has never been greater. Methods: This was a retrospective, mirror-image study that investigated MC's effectiveness in patients suffering from chronic pain associated with qualifying conditions for MC in New York State. The primary outcome was to compare European Quality of Life 5 Dimension Questionnaire (EQ-5D) and Pain Quality Assessment Scale (PQAS) scores at baseline and 3 months post-therapy. The secondary outcomes included comparisons of monthly analgesic prescription costs and opioid consumption pre- and post-therapy. Tolerability was assessed by side effect incidence. Results: This investigation included 29 subjects. Quality of life and pain improved, measured by change in EQ-5D (Pre 36 – Post 64, P < .0001) and change in PQAS paroxysmal (Pre 6.76 – Post 2.04, P < .0001), surface (Pre 4.20 – Post 1.30, P < .0001), deep (Pre 5.87 – Post 2.03, P < .0001), unpleasant (Pre “miserable” – Post “annoying”, P < .0001). Adverse effects were reported in 10% of subjects. Discussion: After 3 months treatment, MC improved quality of life, reduced pain and opioid use, and lead to cost savings. Large randomized clinical trials are warranted to further evaluate the role of MC in the treatment of chronic pain.

scholarly journals Buprenorphine: Far Beyond the “Ceiling”

Biomolecules ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 816
Author(s):  
Rosmara Infantino ◽  
Consalvo Mattia ◽  
Pamela Locarini ◽  
Antonio Luigi Pastore ◽  
Sabatino Maione ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Drug Abuse ◽  
Side Effects ◽  
National Health System ◽  
Analgesic Drugs ◽  
Third Line ◽  
Dynamic Profile

Chronic pain, including neuropathic pain, represents an untreated disease with important repercussions on the quality of life and huge costs on the national health system. It is well known that opioids are the most powerful analgesic drugs, but they represent the second or third line in neuropathic pain, that remain difficult to manage. Moreover, these drugs show several side effects that limit their use. In addition, opioids possess addictive properties that are associated with misuse and drug abuse. Among available opioids compounds, buprenorphine has been suggested advantageous for a series of clinical reasons, including the effectiveness in neuropathic pain. Some properties are partly explained by its unique pharmacological characteristics. However, questions on the dynamic profile remain to be answered. Pharmacokinetics optimization strategies, and additional potentialities, are still to be explored. In this paper, we attempt to conceptualize the potential undiscovered dynamic profile of buprenorphine.

scholarly journals Opioid Analgesia: Perspectives on Right Use and Utility

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 479-491 ◽  
Author(s):  
Jane C. Ballantyne
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Side Effects ◽  
Clinical Decision Making ◽  
Analgesic Efficacy ◽  
Clinical Decision ◽  
Opioid Analgesia ◽  
Opioid Treatment

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the “principle of balance” may justify that “…efforts to address abuse should not interfere with legitimate medical practice and patient care.” Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients’ function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients’ rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of “producing good for the patient and protecting from harm,” so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. Key Words: Opioids, chronic pain, addiction, side effects, utility, ethics

Use of medical cannabis to reduce pain and improve quality of life in cancer patients.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 198-198
Author(s):  
Jessica Cudmore ◽  
Paul Joseph Daeninck
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Retrospective Chart Review ◽  
Clinic Visit ◽  
Average Dose ◽  
Improve Quality ◽  
Medical Cannabis ◽  
Opioid Dose

198 Background: Early attention to pain and symptoms in those with cancer improves both quality of life and survival. Opioid medications are the mainstay treatment of cancer-related pain. Cannabinoids are increasingly used as adjunctive treatments for cancer pain, but clinical evidence supporting their use as an “opioid sparing agent” or to improve quality of life is as yet unknown. Our study sought to determine if the addition of cannabinoids (medical cannabis) resulted in the reduction of the average opioid dose required for pain control, and improve self-reported quality of life indices. Methods: A retrospective chart review of cancer patients followed in our CCMB Pain and Symptom Clinic was conducted. Inclusion criteria: age over 18 years and formal enrollment in Health Canada’s Marihuana for Medical Purposes (MMPR) program (n = 24). Average dose of opioids were calculated in milligrams of morphine equivalent (ME) per day at the last documented visit prior to enrolment in the MMPR and then at the subsequent clinic visit. Averages of self-reported ESAS scores (pain, tiredness, drowsiness, nausea, appetite, depression, anxiety, sense of wellbeing) were calculated for the same visits. Statistical analysis using the paired student’s t-test compared means and determined the significance of any changes. Results: Following enrolment in the MMPR, the average opioid dose decreased by 70.375mg of MEs (p = 0.29). Self-reported ratings (10-point Likert scale) in pain (0.75, p = 0.23), tiredness (0.58, p = 0.21), drowsiness (1.125, p = 0.04), nausea (1.125, p = 0.04), appetite (1.42, p = 0.04), depression (1.29, p = 0.02) and anxiety (1.58, p = 0.004) improved after enrolment. Sense of wellbeing ratings did not change. Conclusions: Patients with cancer pain benefited from the addition of cannabinoids. The average opioid dose decreased following access to medical cannabis. Self-reported ratings of several quality of life indicators showed statistically significant improvement. Our study shows a signal that cannabinoids may reduce cancer patients’ reliance on opioids to control pain. Further prospective controlled studies are needed to further elucidate the role of cannabinoids in the treatment of cancer pain.

scholarly journals PPN17 QUANTIFYING HEALTH RELATED QUALITY OF LIFE IN A CHRONIC PAIN POPULATION: PRELIMINARY RESULTS

2007 ◽  
Vol 10 (3) ◽  
pp. A176
Author(s):  
A Chuck ◽  
A Ohinmaa ◽  
P Jacobs ◽  
W Adamowicz ◽  
S Rashiq ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Health Related Quality ◽  
Preliminary Results ◽  
Related Quality ◽  
Health Related

Hopes and fears before opioid tapering: a quantitative and qualitative study of patients with chronic pain and long-term opioids

2020 ◽  
pp. 204946372097405
Author(s):  
Jane Quinlan ◽  
Heather Willson ◽  
Katheryn Grange
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Side Effects ◽  
Phenomenological Approach ◽  
Free Text ◽  
Significant Depression ◽  
Opioid Tapering ◽  
The Uk

Background: It is clear that the risks of opioids in chronic pain outweigh the benefits, creating a drive for clinicians to support patients taper and stop long-term opioids. However, it is not known how patients who have been taking these medicines for months or years feel about reducing them. Using quantitative and qualitative data, this study describes the psychological complexity of these patients and examines their hopes and fears before opioid reduction. Methods: Sixty patients attending the opioid clinic completed psychological and pain questionnaires, providing quantitative data, just before they commenced opioid tapering. They scored the severity of opioid side effects and completed a free text framework to express their beliefs about stopping or continuing opioids. A phenomenological approach was used to identify common qualitative themes. Results: Most patients were taking opioid doses above the UK recommended maximum dose and reported severe pain with high pain interference. Over 80% of patients described significant depression and 60% significant anxiety. Negative themes around stopping opioids were more common than positive ones, with 63% patients fearing increased pain. A quarter of patients referred to addiction and 16% feared withdrawal. Five patients hoped for a better quality of life; seven feared a worse one. Opioid side effects were common and severe. Conclusion: Patients with chronic pain taking long-term opioids demonstrate high psychological distress and low self-efficacy. Their concerns around opioid tapering relate to pain, quality of life and withdrawal. Identifying and addressing patients’ individual concerns should increase the likelihood of successful opioid tapering.

scholarly journals Health outcomes among adults initiating medical marijuana for chronic pain: A 3-month prospective study incorporating ecological momentary assessment (EMA)

Cannabis ◽  
2021 ◽  
Vol 4 (2) ◽  
pp. 69-83
Author(s):  
Yan Wang ◽  
Jennifer Jacques ◽  
Zhigang Li ◽  
Kimberly Sibille ◽  
Robert Cook
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Sleep Quality ◽  
Prospective Study ◽  
Ecological Momentary Assessment ◽  
Medical Cannabis ◽  
Ecological Momentary ◽  
Anxiety Depression ◽  
Momentary Assessment

In response to the need of more rigorous data on medical cannabis and chronic pain, we conducted a 3-month prospective study incorporating ecological momentary assessment (EMA) to examine the effects of medical cannabis on pain, anxiety/depression, sleep, and quality of life. Data were collected from 46 adults (Mean age=55.7±11.9, 52.2% male) newly initiating medical cannabis treatment for chronic pain. Participants completed a baseline survey, EMA for approximately 1 week pre- and up to 3 weeks post- medical cannabis treatment, and a 3-month follow-up survey. The self-reported EMA data (2535 random and 705 daily assessments) indicated significant reductions in momentary pain intensity (b = -16.5, p < .001, 16.5 points reduction on 0-100 visual analog) and anxiety (b = -0.89, p < .05), and significant increase in daily sleep duration (b = 0.34, p < .01) and sleep quality (b = 0.32, p <.001) after participants initiated medical cannabis for a few weeks. At 3 months, self-reported survey data showed significantly lower levels of worst pain (t = -2.38, p < .05), pain interference (t = -3.82, p < .05), and depression (t = -3.43, p < .01), as well as increased sleep duration (t = 3.95, p < .001), sleep quality (t = -3.04, p < .01), and quality of life (t = 4.48, p < .001) compared to baseline. In our sample of primarily middle-aged and older adults with chronic pain, medical cannabis was associated with reduced pain intensity/inference, lower anxiety/depression, and improved sleep and quality of life.

Growing Nightlife Scenes

2014 ◽  
Author(s):  
Richard E. Ocejo
Keyword(s):  
Quality Of Life ◽  
New York ◽  
Sense Of Community ◽  
New York State ◽  
Government Agency ◽  
York State ◽  
Life Issues ◽  
The Government

This chapter examines the role of the local government in influencing economic development and diminishing civic power in city neighborhoods. It begins with an episode from a public forum on quality-of-life issues held for downtown residents. The vignette shows the open hostility that residents direct at the CEO of the New York State Liquor Authority (SLA), the government agency that they blame for the development of nightlife in the neighborhood in spite of their protests. The chapter proceeds by discussing the policies behind the growth of downtown Manhattan's nightlife scenes, especially the SLA's liquor licensing that facilitated the proliferation of bars. It shows how this policy, which represents “urban entrepreneurialism,” sparked local unrest and led neighborhood residents to organize and protest bars. Residents consider the SLA and bar owners as complicit perpetrators in the destruction of their neighborhood and sense of community, and view themselves as victims of these policies.

Medical Cannabis for the Management of Pain and Quality of Life in Chronic Pain Patients: A Prospective Observational Study

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 3073-3086 ◽  
Author(s):  
Ramin Safakish ◽  
Gordon Ko ◽  
Vahid Salimpour ◽  
Bryan Hendin ◽  
Imrat Sohanpal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Observational Study ◽  
Medication Use ◽  
Medical Cannabis ◽  
Opioid Medication ◽  
Chronic Pain Patients ◽  
Pain Patients ◽  
Observation Period

Abstract Objective To evaluate the short-term and long-term effects of plant-based medical cannabis in a chronic pain population over the course of one year. Design A longitudinal, prospective, 12-month observational study. Setting Patients were recruited and treated at a clinic specializing in medical cannabis care from October 2015 to March 2019. Subjects A total of 751 chronic pain patients initiating medical cannabis treatment. Methods Study participants completed the Brief Pain Inventory and the 12-item Short Form Survey (SF-12), as well as surveys on opioid medication use and adverse events, at baseline and once a month for 12 months. Results Medical cannabis treatment was associated with improvements in pain severity and interference (P &lt; 0.001) observed at one month and maintained over the 12-month observation period. Significant improvements were also observed in the SF-12 physical and mental health domains (P &lt; 0.002) starting at three months. Significant decreases in headaches, fatigue, anxiety, and nausea were observed after initiation of treatment (P ≤ 0.002). In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (P &lt; 0.0001), while correlates of pain were significantly improved by the end of the study observation period. Conclusions Taken together, the findings of this study add to the cumulative evidence in support of plant-based medical cannabis as a safe and effective treatment option and potential opioid medication substitute or augmentation therapy for the management of symptoms and quality of life in chronic pain patients.

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