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mr peabody

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Why opioids cannot fix chronic pain

University of Washington | Neuroscience News | 30 Dec 2020

A broken heart is often harder to heal than a broken leg. Now researchers say that a broken heart can contribute to lasting chronic pain.

In a reflections column published Dec. 21 in the Annals of Family Medicine, pain experts Mark Sullivan and Jane Ballantyne at the University of Washington School of Medicine, say emotional pain and chronic physical pain are bidirectional. Painkillers, they said, ultimately make things worse.

Their argument is based on new epidemiological and neuroscientific evidence, which suggests emotional pain activates many of the same limbic brain centers as physical pain. This is especially true, they said, for the most common chronic pain syndromes – back pain, headaches, and fibromyalgia.

Opioids may make patients feel better early on, but over the long term these drugs cause all kinds of havoc on their well-being, the researchers said.
“Their social and emotional functioning is messed up under a wet blanket of opioids,” Sullivan said.

The researchers said new evidence suggests that the body’s reward system may be more important than tissue damage in the transition from acute to chronic pain.

By reward system, they are referring, in part, to the endogenous opioid system, a complicated system connected to several areas of the brain, The system includes the natural release of endorphins from pleasurable activities.

When this reward system is damaged by manufactured opioids, it perpetuates isolation and chronic illness and is a strong risk factor for depression, they said.

“Rather than helping the pain for which the opioid was originally sought, persistent opioid use may be chasing the pain in a circular manner, diminishing natural rewards from normal sources of pleasure, and increasing social isolation,” they wrote.

Both Sullivan and Ballantyne prescribe opioids for their patients and say they have a role in short-term use.

“Long-term opioid therapy that lasts months and perhaps years should be a rare occurrence because it does not treat chronic pain well, it impairs human social and emotional function, and can lead to opioid dependence or addiction,” they wrote.

What Sullivan recommends is if patients are on high-dose long-term opioids and they are not having clear improvement in pain and function, they need to taper down or switch to buprenorphine. If available, a multidisciplinary pain program using a case manager to monitor their care and well-being, similar to those for diabetes and depression care, may be of benefit.

 
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Treating Fibromyalgia with Prednisone

Drugs.com

Prednisone has an average rating of 8.1 out of 10 from a total of 49 ratings for treating Fibromyalgia. 73% of those users who reviewed Prednisone reported a positive effect.

Here are some user reviews :

Ann808 - August 18, 2020
“I have Sjogrens Syndrome, Fibromylagia and Raynauds. I have taken Prednisone Oral Solution (Roxane Westward) for over 22 years. It's worked very well."

Aniwren - May 25, 2020
“In 1996 I saw a rheumatologist who diagnosed me with fibromyalgia. My Doctors prescribe Prednisone. Within 24 hours I feel pretty good. The pain dissipates, and finally I get some relief. So many medications I can't take.”

Anonymous · Taken for less than 1 month - April 30, 2020
“I have had fibromyalgia type pain, stinging, burning and aches in muscles and hips for years. Recently I started getting severe aches and stiffness in my hands hips and feet. I could barely walk in AM. My rings would not come off. I went on prednisone and after two days 10 mgs for 1, 40mgs for day two, my hands are back to normal, hip pain is gone, and muscle aches too. I can remove my rings again. I can bend easily, walk down stairs in AM easily. Sleep without waking from hip pain. It is working for me.”

Daisy - January 24, 2020
“I have been on prednisone for many years. I was bedridden and friends had to do everything for me. After trying a low dose , the improvement was very quick. However over the years I have gradually had to increase the dose to be able to function after being diagnosed with fibromyalgia and Hashimotos. I am presently on 10 mg per day and sometimes (when I've got a virus or have overdone things) I increase to 12 or 15, but try and return to 10mg ASAP.

Debbie - December 7, 2019
“Prednisone literally gave me my quality of life back!!! The days I don't take it, I hurt so bad, all I want to do is lay in bed, the days I do take it, I am very productive! I'm in a good mood, I have minimal pain, the only downside is your super hungry, but after a while that tapers off to.... Prednisone is not the typical treatment for Fibromyalgia, but I highly recommend it!

Trixi jade - November 23, 2019
“I've had fibromyalgia for 26 years it started when a chiropractor damaged my spine. I begged my doctor to let me try steroid she said no, then a year later she said she would give me a trial. She offered me 10 mg per day I said no 5 mg prednisone will do! I now have 9 pain free hours per day, a lot less pain in the rest of the hours its miraculous. I'm relaxed less bothered about stuff I take it early morning no problem sleeping. I have got my life back."

HappyNow - July 22, 2019
“Long story short, tapered down from 7 to O mg of prednisone for PMR. Pain has slowly become unbearable. I don’t walk, I shuffle. Can’t bend down for pain, my place is a mess. I’m 61. Last night on a lark I tried 10 mg of leftover pred. This morning I am newborn! Pain has gone from 6-7 to 2! I’ve had fibro diagnoses for 4 yrs now. All Dr’s try to get me off pred. Huh?!! What an eye-opener reading this has been!”

Glo - July 8, 2019
“Works so well for me. I have osteoarthritis, too. After 2 days of prednisone, 80 mg, 60 mg, no pain, no spasms, no fatigue, don't have to sleep 9 hours. Have energy . Swelling in hip, shoulder reduced 85 %. Wish I could stay on this miracle drug, but I gain weight, and have other side effects that are not healthy. I can only use short term, 4 days, but sure LOVE those days!!”

JJ - June 17, 2019
“I have been diagnosed with Fibromyalgia for over 6 years. It has gotten bad. I struggle with daily life tasks. I fall and or lose my balance a lot. Pain excruciating. Body locks up. Recently after a fall I had a lot of numbness because of inflammation pressing on nerves. Doctor prescribed me Prednisone. I have used it many times. It helps a tremendous amount with Fibromyalgia in general."

Greg H - November 26, 2018
“I was diagnosed with fibro about 10 years ago. The symptoms have gradually gotten worse in that time, mental fog, joint pain, muscle pain, lack of energy. I am on a good diet of more natural foods and find that the energy side isn't too bad normally. I was prescribed Prednisone for gout, and low and behold ALL my symptoms improved. Pain, energy, clarity all were markedly improved."

Connie - February 27, 2018
“I was diagnosed with fibromyalgia about 15 years ago. Since that time, I have been in constant pain. I have pain in knees, hips, wrists, legs, low back, neck, jaw, hands and fingers. I also suffer from chronic sinusitis, which can usually be controlled by a nasal steroid, antibiotic nasal rinse, allergy medication. During this time, I have been prescribed prednisone to help with the sinus infection. These are the only two times I have had no pain in 15 years.

Rainna - August 29, 2016
“I have stiffness in lower back, pain in neck area, hips for many years. I also get periodic muscle stabs of pain followed by a twitch like when you fall asleep. From time to time the pain would get bad and I would need to take pain medications. I went to the ER they gave me prednisone. Within two days of taking the Prednisone I had SO MUCH energy and was pain FREE. I felt like I was 20 years old again."


I find that 5mg of Prednisone per day is the ideal maintenance dose, with no side effects. -pb
 
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Study: Nearly half of medical cannabis users cease using opioids for pain after twelve months

by NORML | 21 Jan 2021

Patients authorized to use medical cannabis significantly reduce or eliminate their use of opioids over time, according to longitudinal data published in the Canadian Journal of Anaesthesia.

A team of Canadian investigators assessed self-reported opioid consumption patterns over time in a cohort of authorized medical cannabis patients who suffered from pain-related issues. Consistent with numerous other studies, researchers reported that many subjects tapered their use of opioids following medical cannabis initiation.

“The proportion of individuals who reported using opioids decreased by half over a period of twelve months," they determined.

In addition, subjects’ “pain intensity and pain-related interference scores were reduced and [their] quality of life and general health symptom scores were improved compared with baseline.” Authors also noted that many subjects switched from consuming herbal cannabis to ingesting oil extracts over the course of the trial.

Authors concluded: “Over time, individuals who continued consuming cannabis within this longitudinal study reported lower pain severity and pain interference scores, as well as improved quality of life and general health symptoms scores. … Beneficial effects of cannabis appear to persist long-term and tolerance may not become a significant issue for patients on a stable regimen. … The proportion of patients using opioids at each follow-up was decreased, … suggesting an opioid-sparing effect with cannabis use. … Our data speaks to the need for robust clinical trials, given the overall increase in opioid cessation for those that remained on cannabis.”

The study comes only weeks after separate longitudinal data, also from Canada, reported that patients prescribed opioids reduce their mean opioid dosage by over 70 percent following the use of medical cannabis.

Commenting on the findings, NORML’s Deputy Director Paul Armentano said: “The data to date is consistent and persuasive: For many pain patients, cannabis offers a viable alternative to opioids, potentially improving their quality of life while possessing a superior safety profile.”

Full text of the study, “Patient-reported outcomes in those consuming medical cannabis: A prospective longitudinal observational study in chronic pain patients,” appears in the Canadian Journal of Anaesthesia. Additional information is available in the NORML fact-sheet, “Relationship Between Marijuana and Opioids.”

 
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Study finds arthritis patients benefit from medical cannabis and CBD*

by Steven Bridge | CBD Testers

Medical cannabis and CBD have proven over the years that they can help people suffering from arthritis. A new study claims that 90 percent of patients who tried cannabis felt relief from their symptoms.

The survey was carried out by CreakyJoints, a nonprofit under the Global Healthy Living Foundation. CreakyJoints offers support to people living with arthritis and wanted to look at the efficacy of medical cannabis and CBD for treating the disorder. It’s been suggested for years that cannabis and CBD contain analgesic and anti-inflammatory properties. Many chronic pain sufferers around the world also choose cannabis over prescription medication in many cases.

The FDA is scrambling to get a hold on cannabis and CBD, as it becomes legal across many states in the US. Due to various reasons, cannabis is unregulated on the whole, and the CBD industry is even more problematic. At the same time, the Transportation Security Administration recently announced a new policy that allows medical cannabis patients to fly domestically and internationally with their medication.

One thing is abundantly clear; more research and clinical trials are needed to understand the profound effects medical cannabis and CBD can have for a range of conditions. These include things like chronic pain, but also conditions like anxiety and insomnia. That’s the main reason for the CreakyJoints study, as they wanted to understand how members of their community use cannabis for their symptoms.

The findings were presented at the 2019 Annual European Congress of Rheumatology conference in Madrid. A total of 1,059 arthritis patients filled out a questionnaire containing 77 questions, to better understand medical cannabis and CBD usage for arthritis. At least 57 percent of the participants said they’ve tried medical cannabis or CBD (or both) to help with their pain. The majority of patients surveyed either had rheumatoid arthritis or osteoarthritis, while a smaller percentage suffered from psoriatic arthritis, fibromyalgia, and ankylosing spondylitis.

Participants also commented that they didn’t only use medical cannabis and CBD for pain but also a range of other issues related to their condition. These included things like insomnia, depression from pain, nausea, physical function, and fatigue. The amazing statistic to come out of the study was that 97 percent of people living with arthritis said that cannabis had helped to ease their symptoms. At the same time, 93 percent reported that CBD was the compound they preferred that was effective for them.

Another interesting thing to come from the survey was the issue of doctor-patient conversations when it comes to cannabis and CBD. Around 45 percent of participants said they started taking either cannabis or CBD or both to treat their arthritis symptoms despite being on prescription medication already.

W. Benjamin Nowell, Ph.D., Director of Patient-Centered Research at CreakyJoints said, “Anecdotally, and via this survey data, we know that there are many people with arthritis who benefit from marijuana and CBD products. However, we have to temper our potential excitement about adding these products to an arthritis management strategy because there is so much yet to learn about how these supplements interact with people’s prescribed and over-the-counter medicines and if, in fact, they can be proven to positively impact a person’s experience of disease and symptoms.”

Nowell also noted that “It’s vital that marijuana and CBD products are tested for their safety, dosing, and effectiveness in randomized controlled trials, which are the gold standard for understanding the risks and benefits of treating disease.” That’s why many people across different industries are pushing for more studies on cannabis and CBD to see if they could be a solid, long-term solution for arthritis patients.

*From the article here :
 

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Can psychedelics treat chronic pain?*

by Suzannah Weiss | DoubleBlind | 14 Sep 2020

From ayahuasca to iboga, and even synthetic compounds, people are turning to psychedelics to treat pain, in addition to mental health.

During the first year I spent suffering from chronic Lyme disease, I tried all kinds of treatments, including antibiotics and other Western medications, along with alternative methods like acupuncture, herbal supplements, ozone, and hyperbaric oxygen therapy—but they only took me so far. Still experiencing insomnia, heart palpitations, headaches, fatigue, bladder irritation, and muscle twitches, I took several friends’ recommendation to undergo a ceremony with iboga, a powerful psychedelic made of the African tabernanthe iboga plant.

After my first iboga ceremony with a shaman in Mexico, I was shocked that not only did my Lyme symptoms completely lift, but the pain that I’d been feeling in my knees after falling on them a month prior was also gone. The Lyme-related issues returned after a few weeks, but the more I did iboga—six times total over the course of that year—the more and more lasting the effects were, and the better my knees got as well.

I’m not the only one to experience a physical transformation like this through psychedelics. Michael Mationschek, a healer in Mallorca, Spain who works with psychedelics, says iboga completely repaired neurological damage he’d incurred after an accident.

“It was so bad that I couldn’t feel half my face, memory didn’t work, couldn’t walk straight, life force was cutting out,” he says. “And iboga saved my life. The first journey I did with iboga, my motor neocortex rebuilt itself. The next morning, I was eating breakfast and I could see my hand recalibrating itself as if I was using it for the first time. And I could feel my face again and started to get some memory functions back.”

It’s not just iboga that can heal physical ailments. Maria Johanna, who used to run ayahuasca retreats in the Netherlands, has worked with multiple people who saw relief from physical complaints. One woman who could not move her feet walked for the first time in ages after participating in one of her ceremonies.
“The first journey I did with iboga, my motor neocortex rebuilt itself. The next morning, I was eating breakfast and I could see my hand recalibrating itself as if I was using it for the first time.”

Nor is it only natural psychedelics within the “plant medicine” category that can work wonders on physical ailments. Jen, a 47-year-old in the Chicago area, noticed improvement in her chronic migraines after an acid trip. “It seemed to help both mood and migraines for about three weeks,” she says. The nausea associated with her migraines was completely gone for those three weeks, and she also had more energy. Caitlin Thompson, founder of the mental wellness supplement company EntheoZen, says LSD helped her manage chronic nerve and joint pain, while also alleviating her pain for weeks after each trip.

Psychedelics have been investigated over the past few years for their ability to help with various mental health conditions, including anxiety, depression, and PTSD. What’s less well-established—but equally promising—is their potential to help people heal from physical health conditions.

Johanna believes such transformations are possible because ayahuasca and other psychedelics heal the emotions, which are connected to the body. Some fields such as somatic therapy contend that emotions from past experiences can get trapped in the body, causing pain and other symptoms, and research has correlated traumatic childhood events with physical illnesses. “I believe in the holistic principle—everything is connected, so if you have illnesses or if your body is giving signs, it means something,” says Johanna. “Changing the inner world is changing the outer world.”

James Giordano, professor of neurology and biochemistry at Georgetown University Medical Center, agrees that psychedelics can influence the body through the mind. “It’s important to consider the role that neurological systems—including the brain—play in integrating and regulating our physiology, as well as our thoughts, feelings, and behaviors,” he says. “These functions are not mutually exclusive, but instead can be—and often are—dynamically interactive.”

"Sometimes, psychedelics improve people’s health by inspiring them to change their behaviors,"
says Johanna. “One thing that happens so many times after ayahuasca is that people don’t want to drink alcohol or eat meat anymore because it shows you how important your health is, and you’re more connected with your body,” she says.

Psychedelics can also increase awareness of what’s happening inside someone’s body. Raven Marie, assistant facilitator at the iboga retreat center Awaken Your Soul, was actually able to diagnose a physical health problem because of iboga. During the ceremony, she took a journey into her body and noticed a tumor in her abdomen. This led her to get an ultrasound, and the doctor found that she had uterine fibroid tumors.

Despite the doctor recommending surgery, Marie chose to continue using plant medicine, including iboga and 5-MeO-DMT, along with other natural healing methods. During the DMT ceremony, she says she remembers feeling as if she shed the sexual trauma of her ancestors. After three months, she went back to the doctor and found out the fibroids had shrunk to the point that surgery was unnecessary.
During the ceremony, she took a journey into her body and noticed a tumor in her abdomen. This led her to get an ultrasound, and the doctor found that she had uterine fibroid tumors.

"There also may be direct physical changes that psychedelics can cause in the body. This is easiest to explain for issues like migraines or Lyme disease that involve the nervous system," says Giordano. "Psychedelics like LSD, iboga, and 5-MeO-DMT act on the serotonin system, which could allow them to alleviate a number of neurological issues. The serotonin system also plays a role in the immune system, so stimulating it could stimulate self-healing," Giordano adds. London life science company Eleusis is even working on a drug that could combat inflammation, Alzheimer’s, and retinal disease by binding to serotonin in a similar way to mescaline. In addition, the feeling of connection one might gain from psychedelics can put the nervous system in a parasympathetic state, decreasing inflammation and facilitating healing.

Iboga in particular also acts on the opioid system, which can help with pain relief, even after the drug wears off. “Injury-induced pain — like that from falling on your knees — involves a cyclic mechanism of inflammation, which triggers pain that triggers more inflammation,” says Giordano. “By blocking the pain component through activation of the opioid system, you interrupt the inflammatory-pain cycle,and ‘break the chain’ of pain perpetuation. Not only that, but substances like iboga and 5 MEO DMT might affect hormones like progesterone and estrogen, which could help with issues like fibroids."

There has not been a ton of research on psychedelics’ effects on the body, but the data that does exist is promising. One study in the International Review of Psychiatry found that activating serotonin receptors in animals in a way that mimicked psychedelics produced anti-inflammatory effects. Another in Frontiers in Pharmacology showed that iboga modifies expression of genes affecting brain regions involved in neurodegenerative disorders like Parkinson’s Disease. And ayahuasca acts on the brain’s sigma-1 receptor, which could allow it to fight inflammation and oxidative stress.

Since most potential health benefits of psychedelics haven’t been formally studied, it’s difficult to say they definitely help with certain ailments, rather than simply promoting a feeling of well-being. "However, if it’s just the latter, that’s still something," Giordano points out. “Even if the individuals reporting these results simply felt better—and felt better for a protracted, durable time after their psychedelic experience,” he says, “that in and of itself would warrant further research.”

*From the article here :
 
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Cannabis mitigates symptoms in patients with Fibromyalgia*

by NORML | 19 Feb 2021

The adjunctive use of cannabis is associated with improvements in pain and other symptoms in patients with refractory fibromyalgia, according to data published in the Journal of Cannabis Research.

An Italian researcher assessed the long-term use of various types of cannabis preparations (e.g., herbal cannabis, oil extracts, etc.) in a cohort of 38 patients with treatment-resistant fibromyalgia. Participants in the study consumed cannabis for up to twelve months in combination with their prescribed medications.

The author reported that “significant improvements were observed” following the initiation of cannabis therapy in most patients. Participants were most likely to report reductions in pain, as well as declines in their disability index and overall symptom severity scores. Most subjects who were responsive to medical cannabis reported experiencing “no or mild side effects.” Subjects also did not appear to develop long-term tolerance to the substance, as patients had no need to increase their dosages of medical cannabis over the duration of the study period. No improvements in patients’ anxiety or depression scores were reported.

Similar to the findings of other studies, the majority of trial subjects who responded favorably to cannabis therapy either discontinued or significantly reduced their consumption of prescription medicines.

The study’s author concluded: “The current study revealed the positive effects of MC [medical cannabis] therapy in some patients with FMS [fibromyalgia syndrome] and resistance to conventional treatment. Thus, cannabinoids may be considered for FMS treatment, although several side effects may still occur. Further studies are warranted to confirm these findings.”

Numerous studies of fibromyalgia patients – such as those here, here, here, and here – have also concluded that cannabis is effective and well-tolerated in patients with FMS.

NORML’s Deputy Director Paul Armentano said: “A growing number of patients with fibromyalgia are experimenting with cannabis products. This study’s findings add to the growing body of literature indicating that cannabis is a promising alternative therapeutic option for many of these patients.”

Full text of the study, “Medical cannabis for the treatment of fibromyalgia syndrome: A retrospective, open-label case series,” appears in the Journal of Cannabis Research. Additional information on cannabis and fibromyalgia is available from NORML here.

*From the article here :
 

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Naltrexone promising for treatment-resistant chronic pain*

by Fran Lowry | Medscape | 30 Apr 2021

Low-dose naltrexone (LDN) may be effective in the treatment of refractory chronic pain, early research suggests.

Preliminary data from a retrospective chart review of patients with chronic pain showed those who received LDN experienced significant improvement in both pain and disability.

"Naltrexone has been studied especially in the setting of opioid and alcohol abuse, but we're seeing that at low doses, it has a paradoxical effect where it exhibits anti-inflammatory properties and it may be beneficial for patients with fibromyalgia or low-back pain," study investigator Kaivalya Deshpande, MD, a resident at the University of Pittsburgh Medical Center (UPMC), told Medscape Medical News.

"The results showed that with appropriate patient selection, LDN could be an additional treatment option within the pain physician's tool kit,"
Deshpande said.

In addition, because the dose of naltrexone used to treat pain is so low at just one tenth of the actual dose used in addiction, the potential for addiction is low, he noted.

"With high-dose naltrexone, you definitely have some of those risks of addiction, but thus far, there hasn't been any documented abuse potential with low-dose naltrexone," he added.

The findings were presented at the virtual American Academy of Pain Medicine (AAPM) 2021 Annual Meeting.

Refractory patients

The investigators wanted to understand the effects of low-dose naltrexone as an adjunctive treatment in their chronic pain patients, many of whom are resistant to first-line treatments.

The study included 65 patients attending the UPMC pain clinic. All had experienced pain for more than 3 months from either low-back pain with radiculopathy or fibromyalgia. They also had failed traditional treatment strategies including physical therapy, anti-inflammatory and neuropathic pain medications, and epidural steroid injections.

All patients filled out standardized pain inventories to measure pain, disability, and the impact of naltrexone on their ability to carry out daily activities. Deshpande noted these surveys are helpful in tracking patient progress.

"Pain is such a subjective modality so it's really important to evaluate outcomes, especially function, to be able to say a particular intervention has been effective," he said.

"While there are many variables unable to be controlled for within a retrospective study, we were able to follow longitudinal outcomes of patients on low-dose naltrexone to assess if the medication was contributing to some of the benefit that we were seeing," he added.

Patients received low-dose naltrexone for a minimum period of 1 month and were followed longitudinally.

Outcome measures included pain scores, percent improvement in disability, the Oswestry Disability Index (ODI), the Pain Catastrophizing Scale, and Patient-Reported Outcomes Measurement Information System (PROMIS) metrics.

Viable treatment option?

Preliminary data analysis showed a statistically significant improvement in pain scores, percent improvement in disability, and ODI scores for patients who received low-dose naltrexone. These improvements were found at 3 and 6 months after treatment initiation.

Patients also reported improved sleep and decreased pain interference using the PROMIS metric. Numerical Pain Scale scores improved from an average of 8 to 5 at 3 months following the start of low-dose naltrexone.

In addition, investigators found a 40% improvement in disability at 3 months, and this improvement increased to 50% at 12 months. ODI scores improved from 50 to 44 at 3 months after treatment initiation.

"Adverse events included dry mouth, headache, dizziness, gastrointestinal upset, and vivid dreams. However, these were transient and generally mild," Deshpande said.

"Overall, we definitely saw positive results in our clinic with low-dose naltrexone with the pain and disability scores," he noted.

Deshpande reported that the investigators' next step is to review other metrics to examine potential improvement in psychosocial or fitness outcomes.

"Ultimately, it will be important to do a randomized control trial to eliminate potential confounding variables and increase the study's generalizability, in order to be able to say that LDN is helpful. But we can use this study as a foundation for such a trial," he said.

"I definitely think this is promising data that can be used to guide further studies," Deshpande said. "For now, we can say that low-dose naltrexone has potential. It has a fascinating mechanism of action, safe side-effect profile, and for the right patient it can be a viable treatment option."

Critical preliminary data

Commenting on the findings for Medscape Medical News, W. Michael Hooten, MD, professor of anesthesiology at Mayo Clinic, Rochester, Minnesota, noted that "naltrexone is generally considered not to have any abuse potential."

Hooten, who is also president-elect of the AAPM, was not involved with the current research. He added that the results may help expand the potential number of patients who could be candidates for low-dose naltrexone therapy.

"It provides the critical preliminary data necessary to conduct a prospective randomized placebo-controlled trial," Hooten said.

*From the article here :
 

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Lower dose ketamine just as effective as standard dose for treating pain in adults

Loyola University Health System | News Medical Life Sciences | 10 Mar 2021

A recent Loyola Medicine study found that reducing the standard dose of IV-administered ketamine in half is as effective as the larger, standard dose in reducing pain in adults.

Ketamine is known to provide pain relief comparable to opioid medications, which are highly addictive. In the recent study, appearing in the journal Academic Emergency Medicine, researchers studied 98 patients, ages 18 to 59, who presented to the emergency department with acute, moderate to severe pain.

The patients were randomized prospectively to receive either 0.15 mg/kg of ketamine (low dose) or 0.30 mg/kg (high dose). Patients and providers were blinded to dose, with the primary outcome of pain measured on the 11-point numerical rating scale (NRS) at 30 minutes. At 15 minutes, the high dose group had a greater decrease in pain on the NRS but more adverse events. At 30 minutes, adverse events and pain were similar.

Overall, patients generally reported that they would take ketamine again for pain - 76% in the low-dose group and 62% in the high-dose group.

The study did not find a significant reduction in side effects from the lower dose.

"As we continue with our research, we hope to find data that supports diminished side effects with the lower dose of ketamine with equal efficacy in treating pain," said senior study author Megan A. Rech, emergency medicine clinical pharmacist at LUMC and an adjunct assistant professor and research coordinator at Stritch.

*From the article here :
 

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Cannabis mitigates symptoms in patients with Fibromyalgia*

by NORML | 19 Feb 2021

The adjunctive use of cannabis is associated with improvements in pain and other symptoms in patients with refractory fibromyalgia, according to data published in the Journal of Cannabis Research.

An Italian researcher assessed the long-term use of various types of cannabis preparations (e.g., herbal cannabis, oil extracts, etc.) in a cohort of 38 patients with treatment-resistant fibromyalgia. Participants in the study consumed cannabis for up to twelve months in combination with their prescribed medications.

The author reported that “significant improvements were observed” following the initiation of cannabis therapy in most patients. Participants were most likely to report reductions in pain, as well as declines in their disability index and overall symptom severity scores. Most subjects who were responsive to medical cannabis reported experiencing “no or mild side effects.” Subjects also did not appear to develop long-term tolerance to the substance, as patients had no need to increase their dosages of medical cannabis over the duration of the study period. No improvements in patients’ anxiety or depression scores were reported.

Similar to the findings of other studies, the majority of trial subjects who responded favorably to cannabis therapy either discontinued or significantly reduced their consumption of prescription medicines.

The study’s author concluded: “The current study revealed the positive effects of MC [medical cannabis] therapy in some patients with FMS [fibromyalgia syndrome] and resistance to conventional treatment. Thus, cannabinoids may be considered for FMS treatment, although several side effects may still occur. Further studies are warranted to confirm these findings.”

Numerous studies of fibromyalgia patients – such as those here, here, here, and here – have also concluded that cannabis is effective and well-tolerated in patients with FMS.

NORML’s Deputy Director Paul Armentano said: “A growing number of patients with fibromyalgia are experimenting with cannabis products. This study’s findings add to the growing body of literature indicating that cannabis is a promising alternative therapeutic option for many of these patients.”

Full text of the study, “Medical cannabis for the treatment of fibromyalgia syndrome: A retrospective, open-label case series,” appears in the Journal of Cannabis Research. Additional information on cannabis and fibromyalgia is available from NORML here.

*From the article here :
 

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Psychedelic medicines for pain go mainstream*

by Frieda Wiley, PharmD | Drug Topics | 16 Jul 2020

An estimated 32 million individuals 12 years and older used psychedelic medicine in the United States in 2010, according to a US population survey. As the opioid epidemic has eclipsed concerns about illegal drugs in recent years, the medical community and the federal government alike have begun reexamining certain illicit drugs as potential alternatives to opiates in pain management.​

Cannabis

Cannabis has been studied extensively for its potential benefits in neuropathic pain, chronic pain, and inflammation. A 2014 study found that most patients cited relief from chronic pain as the most common reason for their medicinal use of cannabis. Yet the plant's psychoactive properties continue to draw concerns regarding abuse potential, owing to the effects of 1 phytochemical, Delta-9-tetrahydrocannabinol, known for its psychoactive properties.

However, these are not the only challenges pharmacists face when it comes to assisting patients. "The biggest pitfall in advising patients on cannabis is that dosing is so difficult to standardize," said Victoria Starr, RPh, a cannabis pharmacist at SageLife, LLC, in Portland, Oregon.

Cannabis for medicinal purposes is highly complex, largely because of its high number of phytochemicals, called constituents. To date, the plant has been found to contain more than 560 constituents. When individuals consume these as the whole plant, the chemicals offer synergistic and therapeutic benefits while mitigating potential toxicities, what's known as the entourage effect. Synthetic cannabis typically contains only 1 active ingredient and lacks additional chemicals that can help regulate undesirable effects. However, customizing cannabis dosing to even the individual patient is no small feat.

"Besides attaching medical benefits to each of these components, the combination of synergistic benefits needs to be determined, along with the proper ratio and dose," Starr explained. "So unlike Western medicine, in cannabis, there exists a multitude of different medications—with a wide range of potencies, targeting a vast array of medical conditions—made up of varied combinations of cannabinoids, terpenes, and flavonoids."​

Psilocybin

Psilocybin, the primary ingredient found in mushrooms that produce psychoactive effects, in enjoying an increased share of popularity and renewed exploratory use.

"It’s exciting that patients are starting to ask their pharmacist about psilocybin,” said Emily Kulpa, PharmD, an integrative health pharmacist and psychedelic medicine consultant based in Milwaukee, Wisconsin.

Although psychedelic mushrooms have been used for millennia, they gained popularity in the United States for recreational use during the 1960s and had spawned some academic interests as well. From 1960 to 1962, psilocybin, along with psychedelic relatives lysergic acid diethylamide (LSD) and mescaline, became the focus of a series of trials known as the Harvard Psilocybin Project. At the time, these drugs were legal. Criminalization of these drugs would later erupt in the following decade as safety concerns grew.

Fast-forward to the new millennium. Psilocybin sparked some interest in its potential analgesic effects in cluster headaches and migraines. Psilocybin agonizes the 5-hydroxytryptamine receptor and may interact with nociceptive and antinociceptive processing. The results from one 2016 retrospective study Googling the keywords “cluster headache discussion forums” and “migraine discussion forums” found that patients who self-treated themselves with psychedelic tryptamines such as psilocybin and LSD reportedly experienced a reduction in cluster frequency and severity.

Although these claims may warrant clinical study in pain management, research has focused on the role of psilocybin in mood disorders. Kulpa credits events in popular culturwith helping bring psilocybin into the mainstream. In the fall of 2019, Johns Hopkins announced the opening of the Center for Psychedelic & Consciousness Research, the first institution in the United States devoted exclusively to psychedelic research.​

Kratom

Indigenous to Thailand, Malaysia, Myanmar, and other regions of Southeast Asia, kratom (Mitragyna speciosa) belongs to the coffee family and also exhibits dose-dependent sedative and stimulatory effects. The plant is typically consumed in pill, capsular, or extract form, although some individuals brew dried or powdered leaves as a tea. Others may chew, smoke, or consume the leaves in food. However, because of kratom’s harmful adverse effects and abuse potential, the FDA warns individuals against using the substance.

Kratom contains mitragynine, an alkaloid bearing a tryptamine-like structure that exhibits µ- and ∂-opioid receptor agonist activity that results in dose-dependent stimulatory and analgesic effects. In lower doses, mitragynine produces stimulatory effects, whereas higher doses result in opioid-like activity. However, its metabolite, 7-α-hydroxymitragynine, exhibits significantly stronger µ-opioid receptor agonist behavior.

Although kratom is not an opioid, the CDC found an association between kratom use and overdose deaths, also involving opioid and nonopioid use, in the State Unintentional Drug Overdose Reporting System. Moreover, based on toxicology results, medical examiners or coroners determined kratom as the culprit in deaths in 11 states from July 2016 to June 2017 and 27 states during the last 6 months of 2017.

“There is no legitimate medical use for kratom in the US,” the Drug Enforcement Administration (DEA) wrote in a report on its website. On August 16, 2016, the DEA announced its intent to classify kratom as a Schedule I controlled substance, noting that "kratom has been abused for its ability to produce opioidlike effects, and is often marketed as a legal alternative to controlled substances.”

Pharmacists should be aware of the substance so they can educate patients about the potential harms.​

Psychedelic medicine in the near future

Varanasi believes the importance of cannabis in pain management will only continue to grow. “Preliminary evidence demonstrates cannabis’ ability to provide significant pain relief as well as to help individuals taper off opioids particularly in the setting of addiction,” she said. “Though the research is inconclusive, patient anecdotes support the continued use of cannabis in pain management.”

In Oregon, the Oregon Psilocybin Program Initiative will appear on ballots in November 2020. “If passed, it would [be] the first state-sanctioned program for the administration of psilocybin services between a certified practitioner and a patient,” Varanasi said. “This would not only set the standard for other states but also support published studies reporting that a strong patient-practitioner relationship improves overall health outcomes.”

In the meantime, patients and practitioners alike will have wait to see how these and other psychedelics will alter integrative medicine and the world of health care.

*From the article here :
 

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Hemp oil for pain relief*

by Debra Rose Wilson, Ph.D. | MedicalNewsToday | 14 Feb 2019

Many people use hemp or CBD oil as a form of natural pain relief, especially if the pain is a result of inflammation.

Those who do not want to take over-the-counter or prescription pain medications may turn to a high-quality hemp oil for relief.

A 2018 review notes that CBD, one of the main compounds in full-spectrum hemp oil, and other cannabinoids show promise for the treatment of many types of pain.

There is very little risk of intoxication from hemp oil as all forms of hemp oil come from food-grain strains of hemp. The authors of a study in the journal Cannabis and Cannabinoid Research note that food-grain strains of hemp must contain less than 0.3 percent tetrahydrocannabinol (THC). THC is the compound that causes the so-called “high” of marijuana.

Hemp oil is not the same as cannabidiol (CBD) oil. The production of CBD oil uses the stalks, leaves, and flowers of the hemp plant, which contain a higher concentration of CBD, another potentially beneficial compound in the plant.

Hemp seed oil comes from the small seeds of the Cannabis sativa plant. The seeds do not contain the same levels of compounds as the plant itself, but they still have a rich profile of nutrients, fatty acids, and useful bioactive compounds.

Full-spectrum hemp oil that also contains plant matter may add other effective compounds, which may help with certain health issues, such as inflammation.

Takeaway and future research

The research on hemp oil is still relatively new, particularly in the United States and other places where restrictive laws have prevented researchers from fully exploring the potential of cannabis plants until recently.

As CBD comes into more common use in an increasing number of areas, research into the potential benefits of full-spectrum hemp oil may expand. As a result, scientists may find more evidence to support the potential benefits of the plant or even reveal new benefits. In any case, the future of research on hemp oil looks promising.

There is also still a small risk of THC getting into the system, even from hemp seeds, which normally contain no THC. The THC could be present as a result of contamination with other plant matter. The results of a 2017 study show that some commercial brands of food-grade hemp seeds can have a THC concentration that is as much as 1,250 percent higher than the legal limit.

It is essential to ensure that hemp seed oil comes from a reliable manufacturer. The seeds and oil should be free of plant matter that may add additional compounds, such as THC.

*From the article here :
 

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Pinwheel flower

A Natural Treatment for Chronic Pain

LIH | Neuroscience News | 3 Jun 2021

Summary: Conolidine, a natural painkiller derived from the pinwheel flower and frequently used in Chinese medicine, interacts with a newly identified opioid receptor that regulates natural opioid peptides produced in the brain.

Building on their previous findings, scientists from the Immuno-Pharmacology and Interactomics group at the Department of Infection and Immunity of the Luxembourg Institute of Health (LIH), in collaboration with the Center for Drug Discovery at RTI International (RTI), a nonprofit research institute, have demonstrated that conolidine, a natural painkiller derived from the pinwheel flower and traditionally used in Chinese medicine, interacts with the newly identified opioid receptor ACKR3/CXCR7 that regulates opioid peptides naturally produced in the brain.

The researchers also developed a synthetic analogue of conolidine, RTI-5152-12, which displays an even greater activity on the receptor.

These findings, which were published on June 3rd in the prestigious international journal Signal Transduction and Targeted Therapy, further advance the understanding of pain regulation and open alternative therapeutic avenues for the treatment of chronic pain.

Opioid peptides are small proteins that mediate pain relief and emotions, including euphoria, anxiety, stress and depression, by interacting with four classical receptors (“molecular switches”) in the brain. Dr Andy Chevigné, Head of Immuno-Pharmacology and Interactomics, and his team had previously identified the chemokine receptor ACKR3 as a novel fifth atypical opioid receptor, with high affinity for various natural opioids.

ACKR3 functions as a ‘scavenger’ that ‘traps’ the secreted opioids and prevents them from binding to the classical receptors, thereby dampening their analgesic activity and acting as a regulator of the opioid system.

In the current study, the researchers identified ACKR3 as the most responsive target for conolidine, an alkaloid with analgesic properties, by screening over 240 receptors for their ability to be activated or inhibited by this molecule.

“We confirmed that conolidine binds to the newly identified opioid receptor ACKR3, while showing no affinity for the other four classical opioid receptors. By doing so, conolidine blocks ACKR3 and prevents it from trapping the naturally secreted opioids, which in turn increases their availability for interacting with classical receptors. We believe that this molecular mechanism is at the basis of the beneficial effects of this traditionally used medicine on pain relief,” said Dr Martyna Szpakowska, first author of the publication and scientist within the LIH Immuno-Pharmacology and Interactomics group.

In parallel to characterising the interaction between conolidine and ACKR3, the two teams went a step further. The scientists developed a modified variant of conolidine — which they called “RTI-5152-12” — which exclusively binds to ACKR3 with an even higher affinity.

Like LIH383, a patented compound previously developed by Dr. Andy Chevigné and his team, RTI-5152-12 is postulated to increase the levels of opioid peptides that bind to classical opioid receptors in the brain, resulting in heightened painkilling activity.

The LIH-RTI research teams established a collaboration agreement and filed a joint patent application in December 2020.

“The discovery of ACKR3 as a target of conolidine further emphasises the role of this newly discovered receptor in modulating the opioid system and, consequently, in regulating our perception of pain,” said Dr. Chevigné, corresponding author of the publication and leader of the LIH Immuno-Pharmacology and Interactomics group.

“Our findings could also mean that conolidine, and potentially also its synthetic analogues, could carry new hope for the treatment of chronic pain and depression, particularly given the fact that conolidine was reported to trigger fewer of the detrimental side-effects — namely addiction, tolerance and respiratory problems — associated with commonly used opioid drugs like morphine and fentanyl.”

“Our work could therefore set the basis for the development of a new class of drugs with alternative mechanism of action, thereby contributing to tackling the public health crisis linked to the increasing misuse of and addiction to opioid drugs,”
says Dr. Ojas Namjoshi, co-corresponding author of the publication and lead scientist on the study at RTI.

“Once again, we have built on the findings of our excellent fundamental research and translated them into applications with the potential of tangibly improving clinical outcomes for patients,” said Prof Markus Ollert, Director of the LIH Department of Infection and Immunity.

 

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More than half of people using cannabis for pain experience multiple withdrawal symptoms

University of Michigan | Neuroscience News | 8 Jan 2021

More than half of people who use medical marijuana products to ease pain experience clusters of multiple withdrawal symptoms, a new study finds.

And about 10% of the patients taking part in the study experienced worsening changes to their sleep, mood, mental state, energy and appetite over the next two years as they continued to use cannabis.

Many of them may not recognize that these symptoms come not from their underlying condition, but from their brain and body’s reaction to the absence of substances in the cannabis products they’re smoking, vaping, eating or applying to their skin, says the University of Michigan Addiction Center psychologist who led the study.

When someone experiences more than a few such symptoms, it’s called cannabis withdrawal syndrome – and it can mean a higher risk of developing even more serious issues such as a cannabis use disorder.

In the new research published in the journal Addiction, a team from the U-M Medical School and the VA Ann Arbor Healthcare System reports findings from detailed surveys across two years of 527 Michigan residents. All were participating in the state’s system to certify people with certain conditions for use of medical cannabis, and had non-cancer-related pain.

“Some people report experiencing significant benefits from medical cannabis, but our findings suggest a real need to increase awareness about the signs of withdrawal symptoms developing to decrease the potential downsides of cannabis use, especially among those who experience severe or worsening symptoms over time,” says Lara Coughlin, Ph.D., the addiction psychologist who led the analysis.

Long-term study in medical cannabis use

The researchers asked the patients whether they had experienced any of 15 different symptoms – ranging from trouble sleeping and nausea to irritability and aggression – when they had gone a significant time without using cannabis.

The researchers used an analytic method to empirically group the patients into those who had no symptoms or mild symptoms at the start of the study, those who had moderate symptoms (meaning they experienced multiple withdrawal symptoms) and those who had severe withdrawal issues that included most or all of the symptoms.

They then looked at how things changed over time, surveying the patients one year and two years after their first survey.

At baseline, 41% of the study participants fell into the mild symptoms group, 34% were in the moderate group and 25% were classed as severe.

Misconceptions about medical cannabis

Many people who turn to medical cannabis for pain do so because other pain relievers haven’t worked, says Coughlin, an assistant professor in the Department of Psychiatry who sees patients as part of U-M Addiction Treatment Services. They may also want to avoid long-term use of opioid pain medications because they pose a risk of misuse and other adverse health consequences.

She notes that people who experience issues related to their cannabis use for pain should talk with their health care providers about receiving other pain treatments including psychosocial treatments such as cognitive behavioral therapy.

The perception of cannabis as “harmless” is not correct, she says. It contains substances called cannabinoids that act on the brain – and that over time can lead the brain to react when those substances are absent.

In addition to a general craving to use cannabis, withdrawal symptoms can include anxiety, sleep difficulties, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger and shakiness.

Previous research has shown that the more symptoms and greater severity of symptoms a person has, the less likely they are to be able to reduce their use of cannabis, quit using it or stay away from it once they quit.

They may mistakenly think that the symptoms happen because of their underlying medical conditions, and may even increase the amount or frequency of their cannabis use to try to counteract the effect – leading to a cycle of increasing use and increasing withdrawal.

Coughlin says people who decide to use a cannabis product for a medical purpose should discuss the amount, route of administration, frequency and type of cannabis product with their regular health provider. They should also familiarize themselves with the symptoms of cannabis withdrawal and tell their provider if they’re experiencing them.

Feeling the urge to use cannabis after a period without use, such as soon after waking up, can be a sign of a withdrawal syndrome, she notes. So can the inability to cut back on use without experiencing craving or other symptoms of withdrawal.

Because there is no medically accepted standard for medical cannabis dosing for different conditions, patients are often faced with a wide array of cannabis products that vary in strength and route of administration. Some products could pose more risk for development of withdrawal symptoms than others, Coughlin says.

For example, people who smoked cannabis tended to have more severe withdrawal symptoms than others, while people who vaped cannabis reported symptoms that tended to stay the same or get worse, but generally did not improve, over time.

As more states legalize cannabis for medical or general use, including several states that will legalize its use based on the results of last November’s election, use is expected to grow.

More about the study

The researchers asked the patients about how they used cannabis products, how often, and how long they’d been using them, as well as about their mental and physical health, their education and employment status.

Over time, those who had started off in the mild withdrawal symptom group were likely to stay there, but some did progress to moderate withdrawal symptoms.

People in the moderate withdrawal group were more likely to go down in symptoms than up, and by the end of the study the number of the people in the severe category had dropped to 17%. In all, 13% of the patients had gone up to the next level of symptoms by the end of the first year, and 8% had transitioned upward by the end of two years.

Sleep problems were the most common symptom across all three groups, and many in the mild group also reported cravings for cannabis. In the moderate group, the most common withdrawal symptoms were sleep problems, depressed mood, decreased appetite, craving, restlessness, anxiety and irritability.

The severe withdrawal symptom group was much more likely to report all the symptoms except sweatiness. Nearly all the participants in this group reported irritability, anxiety, and sleep problems. They were also more likely to be longtime and frequent users of cannabis.

Those in the severe group were more likely to be younger and to have worse mental health. Older adults were less likely to go up in withdrawal symptom severity, while those who vaped cannabis were less likely to transition to a lower withdrawal-severity group.

The study didn’t assess nicotine use, or try to distinguish between symptoms that could also be related to breakthrough pain or diagnosed/undiagnosed mental health conditions during abstinence.

Future directions

Coughlin and her colleagues hope future research can explore cannabis withdrawal symptoms among medical cannabis patients further, including the impact of different attempts to abstain, different types of use and administration routes, and interaction with other physical and mental health factors. Most research on cannabis withdrawal has been in recreational users, or “snapshot” looks at medical cannabis patients at a single point in time.

Further research could help identify those most at risk of developing problems, and reduce the risk of progression to cannabis use disorder, which is when someone uses cannabis repeatedly despite major impacts on their lives and ability to function.

 

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How to use CBD for pain

LA Weekly

The pain-relieving properties of CBD are well recognized in different parts of the world. A large number of people are now using this compound for dealing with pain. CBD is now replacing the prescription medicines that are commonly used for pain. This hemp-derived compound can be useful for avoiding the side effects associated with opioids and other medicines which are prescribed for controlling chronic pain. We are listing some of the important pain-relieving properties of CBD that can help you to find out whether you can also use CBD for pain.​

Can you use CBD for chronic pain?

CBD can be used for reducing chronic pain that is associated with many diseases. Our body has a system called the endocannabinoid system (ECS), which manages different functions in the body. It can regulate pain, immune responses, appetite, mood changes, etc.

Researchers suggest that CBD interacts with the endocannabinoid receptors that are distributed all across your body. Receptors are tiny proteins that are attached to the cells in your body. These receptors have the ability to receive signals from different stimuli and will help your cells to respond.

These responses can create pain-relieving and anti-inflammatory effects that are useful for pain management. Hence, using CBD oil or other CBD products can help people to deal with chronic pain. Studies suggest that CBD can be useful in dealing with neuropathic pain, cancer pain and pain associated with fibromyalgia. Therefore, CBD can be effective for overall pain management without causing much side effects.​

How can CBD help with arthritis pain?

Arthritis, which is a common autoimmune disease, can result in severe pain and inflammation in your joints. Arthritis cannot be cured, but controlling its symptoms can be helpful in preventing this disease from getting worse.

A study conducted in 2019 for finding out the effectiveness of CBD for arthritis showed promising results. This study used rats with arthritis as subjects and administered different doses of CBD for each rat. The researchers noted that there was a considerable reduction in pain and inflammation in the joints of affected rats. Hence, it was concluded that CBD can be useful for reducing pain, inflammation, and swelling associated with arthritis in humans too.​

Can you use CBD for cancer pain?

Cancer and its treatments can often result in severe pain in patients. Patients who have undergone cancer treatments like chemotherapy and radiation suffer from different side effects including pain, inflammation, nausea, etc. Even though there are a lot of prescribed medicines available for controlling them, they all come with a large number of side effects. But now CBD can be a great relief for cancer patients for reducing the pain associated with cancer and its treatments.

Most of the studies used THC along with CBD for controlling pain associated with cancer. THC is the psychoactive compound in cannabis that is known across the world for its intoxicating effects. Hence, more studies are needed to find out the effectiveness of CBD alone for controlling the pain associated with cancer.​

Can CBD help with migraine?

A lot of people are using CBD for controlling migraines. This is a neurological condition that can result in a large number of symptoms including headache, vomiting, nausea, sensitivity to light, etc. This is a condition that affects a large number of people across the world.

Migraine can cause powerful headaches which can be unbearable at times. As CBD is found to be useful for controlling this pain, many people are choosing this natural compound over other prescribed medications.

Studies conducted for finding out the effectiveness of CBD for migraine used a combination of CBD and THC. It is found that this combination was helpful in reducing the pain associated with migraine by a considerable amount. However, more studies are needed in this field for finding out the effect of CBD for pain caused by migraine.​

How to use CBD for pain

You can choose a variety of methods for consuming CBD for pain. If you want immediate results it is better to choose smoking/vaping, where you will get the results in a few minutes itself. The sublingual method can also give you fast relief, but not as fast as vaping/smoking.

If you are not comfortable with these methods, you can choose a product that can be taken orally. There are a lot of CBD pills, capsules and edibles available in the market that can help you to consume CBD easily.

In addition to this, you may also choose CBD topicals that you can apply directly to the infected areas for reducing the pain and inflammation. Different topicals including CBD lotions, creams, salves, ointments, balms, etc. are available in the market that you can use based on your convenience.

The large number of CBD products available in the market helped users to choose a method that is comfortable for them. This compound might also be useful for you, if you are searching for a natural product that does not cause much side effects and can effectively control pain.

 

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Pain and psychedelics – Drug interactions with analgesics

SPIRIT PHARMACIST | 10 Dec 2019

This is the second of two installments on pain and psychedelics. In the first installment or Part I (above), I cover mechanisms of psychedelic action in the context of pain, suffering and philosophy. In this installment I cover drug interactions with different classes of analgesics.

Pain and analgesics: Psychedelic healing, set, and setting

There are many different types of analgesics and pain medications available, each of which has different mechanisms, effects, risks, and interactions with psychedelics. Therefore, we’ll take a class by class approach in this guide. Generally speaking, psychedelic healing works via the heightening of senses, expression or feeling of emotion, and (hopefully) resolution of repressed emotions. Pain relievers or analgesics are drugs that act to suppress pain signals or modulate emotions in a way that suffering is decreased. From this perspective, there is a possibility for counterproductive effects between analgesics and psychedelic-assisted psychotherapy. Counterproductive effects may be further increased by agents that have strong effects in the Central Nervous System (CNS) such as opioids. On the flip side, analgesic agents may increase physical comfort and reduce sympathetic nervous system (fight or flight) arousal due to painful conditions. This could confer beneficial effects on user ‘set’ and the depth of their experience.

When pain conditions are present, the psychedelic user should inquire into and reflect upon any drug or non-drug based modifications that would preserve user ‘set’ or improve user ‘setting’. Adjustments can be made to the physical setting, such as allowing an individual with orthopedic hip and knee injuries to use a comfortable chair to sit in opposed to having them sit on the ground. Many pain medications have the tendency to cause physical or psychological dependence. Discontinuing pain medication may be so damaging to user ‘set’ that they aren’t able to actively participate in their experience. For example, if the user has advanced illness or severe chronic pain (e.g. cancer) it may not be reasonable (due to physical and psychological dependence as well as medical necessity) to discontinue opioid or other pain medication. For others, use of pain medication may be problematic or unwanted. They may be approaching psychedelics in hopes of using less or stopping the use of pain medications. In these cases substance use treatment mind sets may improve outcomes and stopping use of pain medication may be intentional. In most cases (with the exception of ibogaine and ayahuasca which harbor severe physical risks in combination with analgesics), use of pain medication is primarily a risk vs. benefit decision the user can assess based upon their pain condition and goals of analgesic use. A comprehensive assessment of pain conditions as well as their treatments is an essential part of preparing for a therapeutic psychedelic experience.

Over the counter (OTC) analgesics

There are a few different classes of pain relievers that are sold over the counter (OTC) in the United States including acetaminophen/paracetamol (Tylenol), ibuprofen (Motrin, Advil), naproxen (Aleve), and Aspirin. Generally, these medications do not pose any risk of physiological danger in combination with psychedelics, including psychedelics that contain MAOIs such as ayahuasca.

Acetaminophen (Tylenol, paracetamol)

Interestingly, there is an emerging body of research, particularly with acetaminophen (Tylenol) demonstrating that OTC pain relievers can have effects on emotional processing and behavior. It was demonstrated that acetaminophen (Tylenol) has the ability to blunt emotional processing to both positive and negative stimuli. It can also reduce effects of pain secondary to things like social rejection. It appears that it can interfere with our judgement of errors and make us more apathetic to mistakes. The site of interference in error evaluation appears to be in the cortex, which is a site in the brain targeted by psychedelics via their stimulation of 5HT2A receptors. Evidence for an effect on emotional processing is less well established with other OTC analgesics, although ibuprofen has also been shown to have a sex specific effect on emotional processing. How strong these effects on the interference of emotional processing are and whether they could influence psychedelic healing processes in a clinically significant manner is unknown. OTC analgesics have been permitted to be used in protocols of clinical trials utilizing psychedelics to date.

Non-steroidal anti-inflammatory drugs (NSAIDS)

Another more theoretical area of drug interaction involves effect on the immune system and inflammatory responses. Non-steroidal Anti-Inflammatory Drugs (NSAIDS) such as ibuprofen, naproxen (and several other prescription agents such as meloxicam, diclofenac etc.) work by blocking the production of pro-inflammatory mediators termed prostaglandins. Psychedelics are known to have immunomodulatory and anti-inflammatory effects, thus there could be an immune system mediated interaction. The significance of this interaction, if any, is unknown.

Aspirin

Aspirin has a similar mechanism of action to NSAIDS, although low daily doses are often used for advanced cardiovascular conditions. Therefore, when use of low-dose or daily aspirin is reported, a contraindicated condition to psychedelic use may be present.

Due to the benign nature of OTC analgesics from a physical perspective when used with psychedelics and lack of perceptual psychoactive effects, their benefits still likely outweigh risks of interference with emotional processing for minor aches and pains before or after psychedelic experiences. For example, OTC analgesic use prior to psychedelics to relieve menstrual cramps may improve ‘set’ of the user enough to be worth the risk of blunted emotional processing. Similarly, a mild-moderate tension headache is a common side effect the day after psilocybin use and if adequately relieved by an OTC analgesic, it may allow for a less distracted period of reflection in the immediate post-use period, creating a compelling benefit. Conversely, for a new pain or a pain that becomes exacerbated by psychedelic use without an explanatory provocation, it may be preferable to attempt working through pain using psychosomatic processing or other non-drug related methods rather than taking analgesics.

Neuropathic analgesics

Nerve pains are often described as stabbing, shooting, tingling, or burning types of pains and are treated with a variety of analgesics. These analgesics are almost universally active in the CNS and many share therapeutic overlap with other psychiatric or neurologic illnesses including depression, anxiety, and seizure disorders. The only neuropathic agents that are not CNS active involve topical remedies.

Antidepressants

I discuss interactions with antidepressants used for nerve pain such as duloxetine (Cymbalta) and amitriptyline (Elavil) elsewhere. Psychedelics, either in macro or micro doses, may be effective agents in pain conditions. It’s a logical hypothesis to test: if antidepressants work for depression, anxiety nerve pain, or fibromyalgaia and psychedelics also work for depression, anxiety, and have anti-inflammatory effects, that they may have potential to impact nerve pain too.

Gabapentinoids

The gabapentinoids include the agents gabapentin (Neurontin) and pregabalin (Lyrica). They are used for neuropathic pain and anxiety disorders primarily, although gabapentin is also an antiepileptic agent. There is likely some mild interaction potential between gabapentin, pregabalin and psychedelics that may blunt the experience, although user anecdotes don’t support a strong interaction and in a clinical study of MDMA for PTSD, they allowed users to remain on gabapentin when used for pain. There is no rationale to believe that gabapentin or pregabalin would have a high risk of serotonin syndrome or other severe adverse reactions if combined with ayahuasca. Speculatively, they may diminish effects of ibogaine or ketamine due to GABAergic activity.

Both gabapentin and pregabalin have dependence when taken for extended periods of time and can cause withdrawal syndromes if not tapered appropriately. Therefore, in persons with neuropathic pain that are getting a beneficial effect from these agents, it is reasonable to simply continue them. For persons using lower doses for anxiety disorders, tapering the medication over a period of a few weeks may be considered instead.

Opioids

Opioids is an umbrella term that encompasses drugs that produce an analgesic effect by binding with μ-opioid receptors. It includes both naturally derived drugs such as codeine, morphine, and heroin (opiates) as well as synthetics such as oxycodone, methadone, buprenorphine, tramadol, and others. Opioids are notorious for leading to dependence, tolerance, and substance use disorders (addiction) and harms associated with opioids are currently epidemic in the US. They are regulated as controlled substances and produce sedative effects on the CNS, which can lead to fatal respiratory depression in overdose. Drugs that depress CNS activity, tend to generally have blunting effects on psychedelics, although how significant this effect is may depend on individual factors such as tolerance, dose, or the agent(s) used. If an underlying opioid use disorder is present, then the psychedelic ibogaine would likely be of most benefit, although is limited by potential for fatal arrhythmia.

Opioids are oftentimes used for the short-term management of severe pains associated with post-surgical pain, acute physical trauma, or pain flares associated with various medical conditions. For these indications they may be offered ‘as needed’ and taken for such a short period of time or so sparingly that physical dependence does not occur. For the opioid user that doesn’t have a physical dependence on opioids, it is likely best and relatively easy to avoid them for at least 72 hours prior to psychedelic use, which is the timeframe that it could be expected that most opioids used on an as needed basis are eliminated from the body. If persons are experiencing an acute pain flare requiring as needed opioids, it may be best for user set and setting to simply postpone the psychedelic session until the individual is no longer in high amounts of pain and using opioids.

In users of opioids for the treatment of chronic pain in which a substance use disorder is not present, then the choice of psychedelic and management approach is important. Some opioids are contraindicated with ayahuasca or ibogaine. For life-threatening illness or illness in which opioids are medically necessary, continuation of long-acting opioids may be necessary for comfort in user ‘set’.

Which opioids can you combine with Ayahuasca?

While opioids all share their activity at μ-opioid receptors, some of them have additional pharmacology at serotonin and norepinephrine reuptake pumps that could introduce serious drug interaction potential with MAOI containing psychedelics such as ayahuasca. The opioids methadone (Dolophine), meperidine (Pethidine), tapentadol (Nucynta), and tramadol (Ultram) and dextromethorphan all have some weak affinity for the serotonin reuptake pump and have been implicated in cases of serotonin syndrome when combined with MAOIs. Therefore, these agents should be either avoided or discontinued at least 5 half-lives ahead of ayahuasca use. The opioids hydrocodone, oxycodone, buprenorphine, morphine, hydromorphone, oxymorphone, heroin and codeine do not have activity at the serotonin reuptake pump and have not been implicated in cases of serotonin syndrome.

Have opioids and psychedelics ever been combined in clinical trials with other psychedelics?

It is relatively common for opioids to be prescribed for pain associated with illnesses such as late stage cancers. In clinical trials of psilocybin assisted psychotherapy for life-threatening illness in which many participants had late stage cancer, the use of long-acting opioid medications (e.g. sustained release morphine or oxycodone) administered every 12 hours were permitted to be used concurrently per the clinical trial protocol. The protocol stipulated that psilocybin administration would be timed 6 hours after the ingestion of their opioid and 6 hours prior to their next dose of opioid. Therefore, it appears their strategy was to time the dose of psychedelic the farthest possible from the previous opioid dose, while still allowing time for the psilocybin experience to unfold prior to the next opioid dose. For serotonergic psychedelics that do not contain an MAOI, such as MDMA, psilocybin, or short-acting inhaled tryptamines (5-MeO-DMT), this strategy would seem to be adaptable. For other serotonergic psychedelics such as LSD or mescaline, the length of the psychedelic effect may present challenges for use of this strategy. Notably, while the trial protocol permitted long-acting opioids, it’s unclear how many trial participants were actually taking them or if their results differed from others in the trial.

How are opioids used with ibogaine?

When ibogaine is used in a person that uses opioids, it is typically with the intention of managing opioid use disorder (OUD) rather than helping mood or having an analgesic effect in a person with chronic pain. Ibogaine is contraindicated to be used in conjunction with long-acting or extended-release formulations as well as the Medication Assisted Treatment (MAT) drugs methadone and buprenorphine. This is because ibogaine is known to sensitize the user to opioids back to pre-opioid use levels, thus opioid use while on ibogaine can be dangerous and increase risks for overdose. Another risk is arrhythmias and cardiotoxicity, which is worsened considerably by methadone. Therefore, ibogaine use should be attempted only in the opioid user that wants to stop using opioids completely and is on a short-acting opioid prior to ibogaine use.

Ketamine

Ketamine is more accurately classified as a dissociative anesthetic rather than a psychedelic. Given anesthetics have sedative properties, there could be additive risks of sedation or respiratory depression when ketamine or opioids are combined. This can become excessively dangerous with high doses, unmonitored environments, or use of other sedatives like GHB, alcohol, or benzodiazepines. Serotonergic psychedelics are likely lower risk psychedelics to use in combination with opioids when it comes to ketamine. Other pain medications such as OTC analgesics possess minimal risk in combination. There may be some theoretical interactions between drugs that interfere with GABA such as the gabapentinoids (gabapentin, pregabalin), although these interactions are not well documented if they are real.

Conclusions

OTC analgesics are low risk with many psychedelics and can be used to help with minor aches and pains that come up around the time of psychedelic use. Prescription agents to manage pain taken on a chronic basis are more complex and should be assessed in the context of user ‘set & setting’ to optimize potential for healing psychedelic experiences. Ketamine has some additional risk with sedative analgesics like opioids, although is combined in clinical practice for opioid-sparing effects. Ayahuasca and ibogaine are special cases in which scrutiny for drug interaction that has physical risks should be assessed, particularly with opioids.

 

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Researchers report 20 micrograms of LSD delivers similar analgesic results
to opioids such as oxycodone and morphine in an acute pain test.

LSD microdosing trial for acute pain relief reports remarkable results*

by Rich Haridy | NEW ATLAS | 26 Aug 2020

An incredible, first-of-its-kind trial testing the pain-killing properties of LSD microdoses has delivered the compelling suggestion that tiny, non-psychedelic doses of this infamous drug could serve as an effective analgesic.

Back in the 1960s, during the original heyday of psychedelic science, one of the more fascinating research areas for LSD was its unexpected efficacy as an analgesic. Researcher Eric Kast was one of the pioneer investigators on the topic, publishing over a dozen key papers exploring the ways pain perception is influenced by LSD.

Kast’s work was primarily with active psychedelic doses of LSD, and he consistently found the drug produced effective, and protracted, analgesic effects. Unfortunately, Kast’s work with LSD ended, as most psychedelic research did, when access to the drug was restricted in the late 1960s.

Decades later, as the freeze on psychedelic research begins to thaw, the idea of LSD as a pain-reliever still sits on the fringes of psychedelic science. No modern clinical researcher has returned to Kast’s ideas, however, anecdotal cases have begun to emerge highlighting some people self-medicating with LSD microdoses to treat chronic pain.

This new study, led by researchers from Maastricht University with assistance from the Beckley Foundation, is the first clinical trial to revisit this topic in more than 50 years. Unlike Kast’s prior work, this new research focused on microdoses of LSD rather than larger, actively psychedelic doses.

“From a medical point of view, controlled research on the efficacy of LSD in pain management should focus on non-hallucinogenic, low doses of LSD, which are more manageable and thus preferable over treatment with high doses of LSD that produce full-blown psychedelic effects,” the researchers explain in their paper.

The double-blind, placebo-controlled trial recruited 24 healthy subjects, each of whom took part in four separate experimental sessions, separated by at least five days. Three different LSD microdoses were tested (five, 10, and 20 micrograms) alongside a placebo.

During each experimental session, the subjects completed a Cold Pressor Test (CBT) at two time points following dosing: 90 minutes after and five hours after. The test basically involves plunging one’s hand into a tank of water at 3 °C (37.4 °F). Pain tolerance is measured by combining the amount of time one can hold their hand in the cold water, with a series of subjective ratings regarding painfulness.

The researchers described the results of the study as “remarkable”, with the 20-µg-dose group revealing prolonged improvements to pain tolerance compared to both lower doses and placebo. The results were sustained across both time points suggesting the analgesic effect is just as prominent five hours later as it is within the first 90 minutes.

“The current data consistently indicated that LSD 20 µg significantly reduced pain perception as compared with placebo, whereas lower doses of LSD did not,” the researchers write. “LSD 20 µg significantly increased pain tolerance (i.e. immersion time) by about 20%, while decreasing the subjective levels of experienced painfulness and unpleasantness.”

So what exactly is going on here? Is LSD just distracting people from the acute pain, or is it actually inhibiting pain signaling through a more direct pharmacological mechanism?

Kast hypothesized 50 year ago these analgesic effects were the result of LSD reorienting attention away from pain sensations to a more encompassing psychedelic experience. While that hypothesis certainly is reasonable when high LSD doses are administered, it doesn’t really explain the results seen in this new microdose trial.

The researchers do note a small correlation between increasing levels of psychedelic disassociation and greater pain relief in their results, but the association was weak. They estimate it accounting for no more than six percent of the variance in analgesic results.

A variety of possible alternate hypotheses are presented in the new study, from pharmacologically influencing specific brain receptors known to mediate pain sensation, to triggering a condition called hypertension-associated hypoalgesia whereby blood pressure rises can lead to a diminished perception of pain.

“… an extended dose-finding study is needed to determine the dose at which analgesic effects of LSD are optimal, i.e. when efficacy is maximal and mental interference is minimal,” propose the researchers. “Such a study could potentially explore the trade-off between increments in treatment efficacy and psychedelic symptoms in a low to medium dose range (i.e. 20–50 µg LSD).”

Perhaps the most intriguing finding in the study is the observation that the analgesic effect seen in the 20-µg LSD group is comparable to what prior studies have seen with in the same cold water pain test for opioids such as oxycodone and morphine.

Needless to say, a great deal more research is needed before these results can be extrapolated into any real-world clinical treatment. Will these LSD microdose results translate into pain relief for chronic pain sufferers? Or is this kind of analgesic best for certain types of acute pain? What are the safety issues surrounding long-term use?
Does a tolerance eventually build to low-dose LSD?

At the very least these promising results suggest further clinical trials are necessary as modern researchers slowly catch up with where the science was half a century ago.

The new study was published in the Journal of Psychopharmacology.

*From the article here :
 
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I can live again!

by Tim Riley | LDN Science | 1 Mar 2017

Low Dose Naltrexone dramatically reduced my severe chronic back pain, making opiates obsolete.

Please tell us a little about your health condition.

In 1998 I had 2 back operations that failed and left me in a lot more pain than ever. We're talking constant pain. Every 3-6 months, I'd see yet another doctor and do another procedure (epidurals, burning of the nerves, steroid injections). They did over 30 procedures on my lower back, but nothing seemed to work. I was in an incredible amount of pain.

What was your pain like before LDN?

It was constant and crippling. I'd wake up in the morning and think, Where is my medication? I'd have to pop a pill and wait 20 minutes for it to take effect in order just to get up out of bed. I had to hang onto things, like the countertop, in order to walk. It took me an hour to get going in the morning. I'm only 63 now but I felt like a very old man.

How did your doctors treat your pain?

The doctors put me on high doses of long-acting morphine, and short-acting and extended-release oxycodone. At one point, I would take 60 mg of long-acting morphine in the morning, another 60 mg again at night, and every 4 hours during the day I would take an oxycodone. Here I was taking all those heavy duty drugs, and my body was depending on them. 3 to 4 four hours after taking oxycodone, the pain would flare up again and Id feel like I needed to take it again.

Why did you want to get off opiate-based medications?

I was on those medications for 12 years. I was able to get off of them, but then eventually had to go back on them for another 5 years. A couple times the pain got so bad, I took more than my usual amount. But if you run out of your medication early and you need more (because you cant do without it), you are looked at like a criminal. It was so depressing. If you do one thing wrong, doctors will throw you out of their practice. First they tell you that you need morphine, and then, a year later, they are locking doors behind you. They are treating you like a criminal, requiring urine tests, and scrutinizing your every move. At one point, I couldn't stand it any longer. I was going to commit suicide. I wanted off those other medications.

How did you come to take LDN?

About 16 months ago, after telling my doctor I wanted to get off all opiates, he told me to go to a detoxification center that deals specifically with people with chronic pain. By giving me various other medications for different periods of time, they were able to help me get off all the opiates. As part of their treatment, they gave me shots of Vivitrol, and I started to feel much better. After a year, though, insurance no longer covered those treatments. So, I needed to find something else. I had been reading about low dose naltrexone and decided to pursue it. I found a doctor willing to prescribe 50 mg naltrexone pills to me that I dissolved in water, and I dosed myself with 4.5 mg of LDN each morning. I've been on LDN for about 3 months. I haven't felt this kind of pain relief in over 20 years.

How successful has LDN been in reducing your pain?

I have 75-80% less pain than when I was taking opiates. LDN is affordable and has virtually no side effects. Even with all that, its infuriating that most doctors aren't interested in it. I asked my doctors about LDN every now and then over the years, and they dismissed it, saying that it didn't work. But it does. Yesterday I forgot to take my LDN, and I started to feel the pain return. I took it this morning, and now the pain is gone.

Has LDN affected you in any other way?

I also have COPD, which is a lung disorder. I usually have 2-3 bouts with it during the wintertime, but this winter (since Ive been on LDN) I haven't had any exacerbations. Also, my mood is better. When I was on all those opiates, although I never allowed myself to get really depressed, I had to really fight becoming depressed. Now, because I'm in so much less pain, I don't have to struggle to stay positive.

You mentioned that you take LDN in the morning. Why?

I tried taking it at night, but I couldn't sleep well. So, I started taking it in the morning instead, and it worked just as well without any side effects at all. I could probably try taking it at night again and see if my body has adjusted to it already.

What's been the biggest change for you since starting LDN?

I can walk freely. I just step out of the bed, and I'm walking right away. Like normal. It's incredible. I could walk right across the street. My spine is like a disaster area, so that's really saying something. I'm not 100% pain free, but I can do a lot more than before. LDN has been amazing for me. I am now doing better than I ever was when taking all those heavy duty opiates. There's a radio commercial that says, When you're living on pain meds, you're not really living. I can live again!

What would you like to tell people in the same position as you once were?

If you're in chronic pain and you want to get off opiates, but you're afraid to, I'd recommend finding a detox program that deals with chronic pain patients. After you get off the opiates, I recommend you try LDN. Hopefully you'll get better pain relief than you ever had before. It might set you free.

https://www.ldnscience.org/resources...onic-back-pain
 
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Ketamine more effective than opioids for acute pain*

by Brandon May | Clinical Pail Advisor | 18 Dec 2020

Ketamine may be a more effective treatment option than opioids for prehospital acute pain, according to findings from a systematic review study published in the BMJ Open. Ketamine likely decreased pain more than opioids, but had a notable higher risk for agitation.

The review included 8 studies comprising a pooled cohort of 2760 adult patients with prehospital acute pain who were treated with either ketamine, opioids, or nitrous oxide. Studies included in this review were 4 randomized controlled trials, 1 cluster randomized trial, 1 prospective cohort study, and 2 retrospective studies.

Across studies, comparisons were made between intravenous (IV) ketamine and IV opioids, IV ketamine with IV morphine vs IV morphine alone, continuous IV ketamine vs single-dose IV ketamine, intranasal ketamine with nitrous oxide vs nitrous oxide alone.

According to the investigators, there were 5 studies in the review that had high risks of bias. In a cluster randomized controlled trial of 308 patients and a retrospective cohort of 158 patients, treatment with ketamine was associated with probable lower pain scores compared with opioids (change in visual analogue scale, prior to hospitalization}.

The researchers also found that treatment with ketamine probably led to less nausea and vomiting compared with opioids, but greater agitation.

A limitation of the study, according to the researchers, was the potential lack of other studies that may have generated more relevant results, including studies not published in English. Also, none of the studies included in the review were powered to assess the safety of ketamine in this patient population.

Based on this review, the researchers concluded that treatment with IV ketamine in analgesic doses of 0.1 to 0.2mg/kg “appears to be at least as effective as opioids administered alone considering pain reduction.”

*From the article here:
 

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Medical cannabis for chronic pain sufferers with Fibromyalgia*

by dispensaries.com | 23 Sep 2021

When it comes to the health benefits of cannabis, better pain management always ranks high on the list. It’s the reason many people turned to medical cannabis in the first place (often as a replacement for opioids). But it’s of special importance to those with Fibromyalgia.

Chronic pain is one of the unfortunate characteristics of Fibromyalgia, a condition that also causes fatigue, memory problems, and difficulties sleeping. Patients suffer from the condition without any well-defined, underlying organic disease, and the exact cause of fibromyalgia remains unknown.

A new literature review of 22 scientific papers conducted by the California Institute of Behavioral Neurosciences and Psychology investigated the use of cannabis or synthetic cannabinoids with fibromyalgia patients. They report that the studies “suggest that medical cannabis is a safe and effective treatment for Fibromyalgia pain,” although there are some limitations.

Fibromyalgia impacts between 5 and 7 percent of the population.

Millions of people worldwide suffer from Fibromyalgia. In the United States and Europe, about 4 percent of the population has Fibromyalgia syndrome (FMS), according to the study. About twice as many women as men suffer from the syndrome. FMS can develop at any age, and often happens in connection with rheumatic diseases.

Because so many studies have found that cannabis provides effective treatment for pain - and promotes better sleep - it’s often mentioned as a possible medication for FMS patients. A handful of studies have looked at the issue through the years. They include:​
  • A 2008 study involving 40 fibromyalgia patients that found the synthetic cannabinoid nabilone had significant pain-relieving effects​
  • A 2011 study involving 28 patients who used cannabis for Fibromyalgia and found that 43 percent reported strong pain relief and 43 percent reported mild pain relief​
  • In that same 2011 study, 81 percent of participants reported that cannabis provided strong relief from Fibromyalgia-related sleep issues​
The recent review, however, took a comprehensive look at a wide range of studies over the years.

For FMS suffers, cannabis can provide relief with limited side effects.

Essentially, the researchers found that previous studies make a strong case for further research into the treatment of Fibromyalgia pain with weed. The aim of the study was to explore the potential for cannabis use, and the researchers concluded that potential is high.

They wrote, “Ultimately, we believe that the use of cannabis and cannabinoids for pain relief in Fibromyalgia has shown great potential and may be a source of hope for those suffering from chronic pain associated with this condition, and for the physicians treating them.”

However, they also wrote that the benefits must be weighed against any potential harmful effects, calling for more research conducted for longer periods to assess the long-term efficacy of cannabis for chronic pain.

Authors concluded "cannabis carries limited side effects, and can also improve some common and debilitating symptoms associated with FM, thus making them an adequate potential treatment option, when other treatment lines have been exhausted.”

Interest certainly remains high among those with Fibromyalgia. A survey in Canada found that 24 percent of Fibromyalgia patients reported a history of cannabis use. Of those, 61 percent classified themselves as current marijuana users and many reported substantial symptom relief.

*From the article here :
 
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Iboga saved me from chronic pain

Most people are not aware that Iboga is profoundly effective for treating severe pain caused by nerve damage. The majority of people I've talked to have only heard of it for treating addiction. The reason I am writing this is because I suffered from debilitating pain that made me feel like my life was over. I lost hope. Before my Iboga experience this summer, I had absolutely no idea it would do anything for my damaged nerve. Little did I know. For three whole months after taking a good dose of Iboga, the noribogaine was still flowing in my body, and I was able to do things that I had not been able to do in a long time.

I had got it into my head that my nerve was damaged, and there was nothing I could do. It is hard not to when everything you try doesn't help or only makes it worse. After 3 months, I began to notice my symptoms were coming back because the noribogaine metabolite was finally being flushed from my body. I made a conscious decision to break away from the beliefs I had about myself and my situation.

So for the past month or so I have been taking ~1g of potent Iboga bark per week. It allows me to function on a level I never thought possible. I feel more like myself now than ever before. I can live and be happy and not even think about my nerve. I am doing more than I ever could before with this disability, and I feel like it's exponential, the more I do, the more I can do. It's an exercise. A constant process.

Iboga allowed me to take a step back into my self unadulterated by the constructs of my mind and start working every day to be the better person that I have always wanted to be. It feels odd saying this, but I feel Iboga saved my life. My work with it keeps evolving, too.

I recently gave up an 11 year cannabis addiction, as well as coffee and nicotine overnight with 1g of potent bark, good food, lot of water, and meditation. I did this because I always told myself I never could, or I never wanted to. I just got fed up. I've been perfectly happy, and sober (except for Iboga effects, which are mild), for the first time in my life. I honestly never ever thought this was possible and I am loving it. I am sure I will use cannabis again, but it feels good to take a break and not be dependent.

So, in conclusion, if you are in a country where Iboga is legal, and you suffer from chronic pain that nothing else seems to help, you may want to consider this medicine.

https://www.dmt-nexus.me/forum/defau...=posts&t=27827
 
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