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Cannabis is linked to lower opioid use in back pain and osteoarthritis

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A couple of studies have found that medical cannabis can significantly reduce or eliminate the need for opioid pain relievers in patients with chronic back pain and arthritis.

Studies reported at the annual meeting of the Society American Academy of Orthopedic Surgeons Annual meeting and published in treat usIt is limited because it does not include control groups and cannot provide insight into whether patients would wean themselves off opioids in any case without cannabis use. However, co-author of both studies, Ari Grace, of the Rothman Orthopedic Institute at Thomas Jefferson University in Philadelphia, said, MedPage today The findings suggest that “cannabis is a viable alternative to opioids for the treatment of chronic pain.”

“We need to make a shift in the way we deal with chronic pain and really limit opioid use to people with acute pain and postoperative pain,” he added, explaining that cannabis works as a long-term alternative because it has lower rates of side effects and addiction. . He said, unlike opioids, that cannabis does not kill patients.

Studies have found that nearly 39% of chronic back pain sufferers have stopped using opioids after 6 months, as have 37.5% of those with osteoarthritis.

to me Chronic back pain studyFrom 2018 to 2019, researchers recruited 186 patients with spinal disorders who had taken opioids (46.8% male, mean age 64) who had not had recent surgery. Of these, 135 patients used less than 15 milligram morphine equivalents (MME)/day of opioids, while 52 used more.

Participants used medical cannabis, which is permitted in Pennsylvania, and were monitored for 9 months after enrollment.

From 6 months before cannabis use to 6 months after, average MME/day decreased from 15.1 to 11.0 (-27%, s<0.01), and 38% of patients stopped using opioids completely, the researchers reported. Pain scores also decreased.

Investigators sent questionnaires about pain and disability to participants 3, 6 and 9 months after their medical cannabis certification.

Among the 144 respondents, 47% reported using a single route of administration. The most common forms among all patients were vaporized oil and sublingual tincture (both 41.7%), topical (34.7%), oral (29.9%) and vaporized flower (21.5%). Of the 71 patients surveyed, 56.3% said they did not feel intoxicated or high, while 43.7% said they did. Among the latter group, most said the treatment did not interfere with their daily activities.

to me Osteoporosis Study During the same time period, the investigators recruited 40 patients (77.5% women, mean age 67.9) – 18 with primary knee pain and 12 with primary shoulder pain. Average MME/day decreased from 18.2 to 9.8 (-46.3%, s< 0.05) from 6 months before cannabis use to 6 months after. The percentage of patients in the study who stopped using opioids completely was 37.5%. Pain scores also decreased.

About two-thirds of patients took the drug via a sublingual tincture, followed by a third who used a topical route, 21% used the vaporized oil and 9% used the vaporized flower. Of these, 57.1% of the 21 participants said they did not feel lethargic/high. Of the nine who said they felt drunk/high, three said it did not interfere with their daily activities.

“Many patients experienced relief from symptoms without intoxication or found that even mild intoxication either did not interfere with their daily activities or was moderately enjoyable,” Grace said.

He added that research suggests that cannabis works on pain by making people more relaxed “and they may notice other pleasurable feelings in the body so they don’t focus on the pain. It changes their perception of pain or their attitude toward pain.”

Jeffrey S. Mariske, MD, a physician with Cedars-Sinai in Los Angeles, who was not involved in either study, said the results appear to hold true, although the larger numbers would make them more generalizable.

He said the findings add to a large body of evidence that medical cannabis is beneficial for chronic pain MedPage today. However, “we are beginning to accumulate data that medical cannabis does little for acute pain – for example, after a fracture or surgery, although I think the jury is still out.”

“We also don’t know much about the potential side effects for patients recovering from orthopedic surgery or other procedures that require a curative response – such as a fracture -,” added Marisek.

The study’s limitations include that the team did not have detailed information about the cannabis products the patients were using or the doses of THC (which makes people energized) and CBD (CBD, which makes people relaxed).

However, Grace said, “In my experience, patients who are really looking for some relief from symptoms — and not getting poisoned — generally follow the directions I give them: start with lower doses of THC, usually combined with CBD.” I generally recommend methods Oral delivery or topical cannabinoids rather than inhalation methods such as vaporization, [which] It may be irritating to the patient’s lungs.”

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