CBD, short for cannabidiol, is the second most common cannabinoid in the cannabis plant, and has been marketed for everything from mood stabilization to pain relief, without the intoxicating effects produced by the most common cannabinoid, THC. THC, which stands for delta-9-tetrahydrocannabinol, is the ingredient in marijuana that causes people to feel high.
Yet the finding that products containing only CBD also provided pain relief and were substituted for pain medications is promising and merits future study, noted Boehnke.
The cannabis-derived substance provides fewer side effects, with less potential for abuse.
The daily dosages of milled MC used for treatment were as follows:
The demographic and clinical parameters (Table 2), comorbidities (Table 3), and associated pain syndromes (Table 4) of the 38 patients included in the study were evaluated. The most frequent comorbidities were hypovitaminosis D, with or without osteoporosis/osteopenia (44.7%), hypertension (39.5%), and depression (31.6%). The most frequently associated pain syndromes were lower back pain (23.7%), cervical pain (21.1%), and headache (21.1%).
Herein, disability was evaluated using ODI, and a statistically significant improvement was observed in MC responsive patients at all time points. The Revised Fibromyalgia Impact Questionnaire is a validated questionnaire that is commonly used to assess health-related quality-of-life in patients with FMS (Bennet et al. 2009). However, this questionnaire was not used here, instead, ODI, which is commonly applied to assess disability in patients with lower back pain, was employed. Since lower back pain is the most common pain syndrome treated in our pain clinic, daily clinical practice ensures every patient accessing the pain clinic completes an ODI questionnaire. Notably, many patients included in the study had lower back pain (23.7%), and all MC-treated patients had to complete this questionnaire at each monthly follow-up. Although ODI is not generally used to assess FMS patients, in a recent study evaluating the prevalence of the FMS phenotype in patients with spinal pain (Brummett et al. 2013), ODI was used to evaluate disability in a particular FMS population affected by lower back pain. However, considering that ODI has not been validated for FMS, the results should be interpreted carefully with regard to patient disability.
Effect on mood disorders
Numerical Rating Scale at 1, 3, and 12 months. NRS boxplots before and after MC therapy at 1, 3, and 12 months. Statistically significant improvements were registered for comparisons at 1, 3, and 12 months (P < 0.01). The boxes contain the middle 50% of the values; the thick white lines indicate the median; the whiskers connected by dashed lines to the boxes mark the minimum and maximum values except when there are outliners, which are specifically indicated by circles. NRS Numerical Rating Scale, MC medical cannabis
Pregabalin at least 75 mg twice a day to 150 mg twice a day (EULAR recommendation: weak for, 94% agreement)
Table 14 shows the number of patients taking different drugs at 3 and 12 months. Prior to MC therapy, all patients responsive to MC were taking one or more drugs. After 3 and 12 months of MC therapy, 33.3% and 66.7% of patients were taking MC alone, respectively. After 12 months of MC therapy, one patient, who experienced no analgesic effect, but had an increase in sleep hours, was taking four drugs. Two patients continued taking duloxetine for depression, and one patient continued to take low-dose steroids for associated psoriatic arthritis.
At the beginning of the study, the type of cannabis prescribed by the physician depended on the availability of the MC cultivar at the hospital pharmacy. When both types of cannabis, i.e., THC-dominant cultivar and hybrid MC cultivar (with a similar THC/CBD ratio), were available, the first choice was the hybrid MC cultivar to reduce the risk of side effects due to THC. The patients consumed only one cultivar at a time (during the 1-month period), however, could take both types of MC cultivars using different routes of administration over the course of the treatment.
Tables 11 and 12 show the dosages of MC administered to the 18 patients who continued therapy for a minimum of 3 months.