Author Archives: adminoacido

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Coffee and Cannabis

Category : Noticias

Coffee and cannabis are two of the most widely used psychoactive substances in the world. Whereas cannabis is often consumed to relax the body, enhance perception, and stimulate creativity, coffee – like tea and other caffeinated beverages – is typically used to energize and help people focus, particularly in the face of exhaustion.

Does it make sense to consume cannabis and coffee together? How do they interact? Is it fitting that decriminalized THC-rich cannabis was first sold over-the-counter in Amsterdam’s coffee shops?

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Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Category : Dolor

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Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Pain Physician. 2017 Sep;20(6):E755-E796

Authors: Aviram J, Samuelly-Leichtag G

Abstract
BACKGROUND: The management of chronic pain is a complex challenge worldwide. Cannabis-based medicines (CBMs) have proven to be efficient in reducing chronic pain, although the topic remains highly controversial in this field.
OBJECTIVES: This study’s aim is to conduct a conclusive review and meta-analysis, which incorporates all randomized controlled trials (RCTs) in order to update clinicians’ and researchers’ knowledge regarding the efficacy and adverse events (AEs) of CBMs for chronic and postoperative pain treatment.
STUDY DESIGN: A systematic review and meta-analysis.
METHODS: An electronic search was conducted using Medline/Pubmed and Google Scholar with the use of Medical Subject Heading (MeSH) terms on all literature published up to July 2015. A follow-up manual search was conducted and included a complete cross-check of the relevant studies. The included studies were RCTs which compared the analgesic effects of CBMs to placebo. Hedges’s g scores were calculated for each of the studies. A study quality assessment was performed utilizing the Jadad scale. A meta-analysis was performed utilizing random-effects models and heterogeneity between studies was statistically computed using I² statistic and tau² test.
RESULTS: The results of 43 RCTs (a total of 2,437 patients) were included in this review, of which 24 RCTs (a total of 1,334 patients) were eligible for meta-analysis. This analysis showed limited evidence showing more pain reduction in chronic pain -0.61 (-0.78 to -0.43, P < 0.0001), especially by inhalation -0.93 (-1.51 to -0.35, P = 0.001) compared to placebo. Moreover, even though this review consisted of some RCTs that showed a clinically significant improvement with a decrease of pain scores of 2 points or more, 30% or 50% or more, the majority of the studies did not show an effect. Consequently, although the primary analysis showed that the results were favorable to CBMs over placebo, the clinical significance of these findings is uncertain. The most prominent AEs were related to the central nervous and the gastrointestinal (GI) systems.
LIMITATIONS: Publication limitation could have been present due to the inclusion of English-only published studies. Additionally, the included studies were extremely heterogeneous. Only 7 studies reported on the patients’ history of prior consumption of CBMs. Furthermore, since cannabinoids are surrounded by considerable controversy in the media and society, cannabinoids have marked effects, so that inadequate blinding of the placebo could constitute an important source of limitation in these types of studies.
CONCLUSIONS: The current systematic review suggests that CBMs might be effective for chronic pain treatment, based on limited evidence, primarily for neuropathic pain (NP) patients. Additionally, GI AEs occurred more frequently when CBMs were administered via oral/oromucosal routes than by inhalation.Key words: Cannabis, CBMs, chronic pain, postoperative pain, review, meta-analysis.

PMID: 28934780 [PubMed – indexed for MEDLINE]

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Is Cannabidiol a Promising Substance for New Drug Development? A Review of its Potential Therapeutic Applications.

Category : Antiinflamatorio

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Is Cannabidiol a Promising Substance for New Drug Development? A Review of its Potential Therapeutic Applications.

Crit Rev Eukaryot Gene Expr. 2018;28(1):73-86

Authors: Noreen N, Muhammad F, Akhtar B, Azam F, Anwar MI

Abstract
The pharmacological importance of cannabidiol (CBD) has been in study for several years. CBD is the major nonpsychoactive constituent of plant Cannabis sativa and its administration is associated with reduced side effects. Currently, CBD is undergoing a lot of research which suggests that it has no addictive effects, good safety profile and has exhibited powerful therapeutic potential in several vital areas. It has wide spectrum of action because it acts through endocannabinoid receptors; CB1 and CB2 and it also acts on other receptors, such as GPR18, GPR55, GPR 119, 5HT1A, and TRPV2. This indicates its therapeutic value for numerous medical conditions because of its neuroprotective and immunomodulatory properties. Potential therapeutic applications of CBD include, analgesic, anti-inflammatory, anxiolytic, anti-arthritic, anti-depressant, anti-Alzheimer disease, anti-ischemic, neuroprotective, and anti-fibrotic. More promising areas appear to include diabetes and cancer where CBD exhibits lesser side effects and more therapeutic benefits as compared to recent available medical therapies. Hence, CBD is a promising substance for the development of new drug. However further research and clinical studies are required to explore its complete potential.

PMID: 29773016 [PubMed – in process]

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Altered attentional control strategies but spared executive functioning in chronic cannabis users.

Category : Antiinflamatorio

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Altered attentional control strategies but spared executive functioning in chronic cannabis users.

Drug Alcohol Depend. 2017 Dec 01;181:116-123

Authors: Nusbaum AT, Whitney P, Cuttler C, Spradlin A, Hinson JM, McLaughlin RJ

Abstract
BACKGROUND: Cannabis use has increased rapidly in recent decades. The increase in cannabis use makes it important to understand the potential influence of chronic use on attentional control and other executive functions (EFs). Because cannabis is often used to reduce stress, and because stress can constrain attentional control and EFs, the primary goal of this study was to determine the joint effect of acute stress and chronic cannabis use on specific EFs.
METHODS: Thirty-nine cannabis users and 40 non-users were assigned to either a stress or no stress version of the Maastricht Acute Stress Test. Participants then completed two cognitive tasks that involve EFs: (1) task switching, and (2) a novel Flexible Attentional Control Task. These two tasks provided assessments of vigilant attention, inhibitory control, top-down attentional control, and cognitive flexibility. Salivary cortisol was assessed throughout the study.
RESULTS: Reaction time indices showed an interaction between stress and cannabis use on top-down attentional control (p=0.036, np2=0.059). Follow-up tests showed that cannabis users relied less on top-down attentional control than did non-users in the no stress version. Despite not relying on top-down control, the cannabis users showed no overall performance deficits on the tasks.
CONCLUSIONS: Chronic cannabis users performed cognitive tasks involving EFs as well as non-users while not employing cognitive control processes that are typical for such tasks. These results indicate alterations in cognitive processing in cannabis users, but such alterations do not necessarily lead to global performance deficits.

PMID: 29045919 [PubMed – indexed for MEDLINE]

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Cannabis Dosing Conundrum

Category : Noticias

What’s the best way to take your medicine?

It’s relatively easy to experience medical benefits from cannabis. A puff or two of a resin-rich reefer can do the trick for a lot of people.

But smoking marijuana is not the be-all and end-all of cannabis therapeutics. One doesn’t have to smoke marijuana or get high to experience the medical benefits of cannabis.

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Review of the neurological benefits of phytocannabinoids.

Category : Dolor

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Review of the neurological benefits of phytocannabinoids.

Surg Neurol Int. 2018;9:91

Authors: Maroon J, Bost J

Abstract
Background: Numerous physical, psychological, and emotional benefits have been attributed to marijuana since its first reported use in 2,600 BC in a Chinese pharmacopoeia. The phytocannabinoids, cannabidiol (CBD), and delta-9-tetrahydrocannabinol (Δ9-THC) are the most studied extracts from cannabis sativa subspecies hemp and marijuana. CBD and Δ9-THC interact uniquely with the endocannabinoid system (ECS). Through direct and indirect actions, intrinsic endocannabinoids and plant-based phytocannabinoids modulate and influence a variety of physiological systems influenced by the ECS.
Methods: In 1980, Cunha et al. reported anticonvulsant benefits in 7/8 subjects with medically uncontrolled epilepsy using marijuana extracts in a phase I clinical trial. Since then neurological applications have been the major focus of renewed research using medical marijuana and phytocannabinoid extracts.
Results: Recent neurological uses include adjunctive treatment for malignant brain tumors, Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, neuropathic pain, and the childhood seizure disorders Lennox-Gastaut and Dravet syndromes. In addition, psychiatric and mood disorders, such as schizophrenia, anxiety, depression, addiction, postconcussion syndrome, and posttraumatic stress disorders are being studied using phytocannabinoids.
Conclusions: In this review we will provide animal and human research data on the current clinical neurological uses for CBD individually and in combination with Δ9-THC. We will emphasize the neuroprotective, antiinflammatory, and immunomodulatory benefits of phytocannabinoids and their applications in various clinical syndromes.

PMID: 29770251 [PubMed]

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Effect of Cannabidiol on Drop Seizures in the Lennox-Gastaut Syndrome.

Category : Epilepsia

Effect of Cannabidiol on Drop Seizures in the Lennox-Gastaut Syndrome.

N Engl J Med. 2018 May 17;378(20):1888-1897

Authors: Devinsky O, Patel AD, Cross JH, Villanueva V, Wirrell EC, Privitera M, Greenwood SM, Roberts C, Checketts D, VanLandingham KE, Zuberi SM, GWPCARE3 Study Group

Abstract
Background Cannabidiol has been used for treatment-resistant seizures in patients with severe early-onset epilepsy. We investigated the efficacy and safety of cannabidiol added to a regimen of conventional antiepileptic medication to treat drop seizures in patients with the Lennox-Gastaut syndrome, a severe developmental epileptic encephalopathy. Methods In this double-blind, placebo-controlled trial conducted at 30 clinical centers, we randomly assigned patients with the Lennox-Gastaut syndrome (age range, 2 to 55 years) who had had two or more drop seizures per week during a 28-day baseline period to receive cannabidiol oral solution at a dose of either 20 mg per kilogram of body weight (20-mg cannabidiol group) or 10 mg per kilogram (10-mg cannabidiol group) or matching placebo, administered in two equally divided doses daily for 14 weeks. The primary outcome was the percentage change from baseline in the frequency of drop seizures (average per 28 days) during the treatment period. Results A total of 225 patients were enrolled; 76 patients were assigned to the 20-mg cannabidiol group, 73 to the 10-mg cannabidiol group, and 76 to the placebo group. During the 28-day baseline period, the median number of drop seizures was 85 in all trial groups combined. The median percent reduction from baseline in drop-seizure frequency during the treatment period was 41.9% in the 20-mg cannabidiol group, 37.2% in the 10-mg cannabidiol group, and 17.2% in the placebo group (P=0.005 for the 20-mg cannabidiol group vs. placebo group, and P=0.002 for the 10-mg cannabidiol group vs. placebo group). The most common adverse events among the patients in the cannabidiol groups were somnolence, decreased appetite, and diarrhea; these events occurred more frequently in the higher-dose group. Six patients in the 20-mg cannabidiol group and 1 patient in the 10-mg cannabidiol group discontinued the trial medication because of adverse events and were withdrawn from the trial. Fourteen patients who received cannabidiol (9%) had elevated liver aminotransferase concentrations. Conclusions Among children and adults with the Lennox-Gastaut syndrome, the addition of cannabidiol at a dose of 10 mg or 20 mg per kilogram per day to a conventional antiepileptic regimen resulted in greater reductions in the frequency of drop seizures than placebo. Adverse events with cannabidiol included elevated liver aminotransferase concentrations. (Funded by GW Pharmaceuticals; GWPCARE3 ClinicalTrials.gov number, NCT02224560 .).

PMID: 29768152 [PubMed – in process]

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Chronic exposure to cannabidiol induces reproductive toxicity in male Swiss mice.

Category : Epilepsia

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Chronic exposure to cannabidiol induces reproductive toxicity in male Swiss mice.

J Appl Toxicol. 2018 May 16;:

Authors: Carvalho RK, Santos ML, Souza MR, Rocha TL, Guimarães FS, Anselmo-Franci JA, Mazaro-Costa R

Abstract
Children and adults with frequent and severe episodes of epilepsy that do not respond to standard treatments (such as carbamazepine, phenytoin and valproate) have long been prescribed cannabidiol (CBD) as an anticonvulsant drug. However, the safety of its chronic use in relation to reproduction has not been fully examined. This study aimed to assess the effects of chronic CBD exposure on the male reproductive system. CBD was orally administered to 21-day-old male Swiss mice at doses of 15 and 30 mg kg-1 daily (CBD 15 and 30 groups, respectively), with a control group receiving sunflower oil, for 34 consecutive days. After a 35 day recovery period, the following parameters were evaluated: weight of reproductive organs, testosterone concentration, spermatogenesis, histomorphometry, daily sperm production and its morphology. The CBD 30 group had a 76% decrease in total circulating testosterone, but it remained within the physiological normal range (240-1100 ng dl-1 ). CBD treatment induced a significant increase in the frequency of stages I-IV and V-VI of spermatogenesis, and a decrease in the frequency of stages VII-VIII and XII. A significant decrease in the number of Sertoli cells was observed only in the CBD 30 group. In both CBD groups the number of spermatozoa in the epididymis tail was reduced by 38%, sperm had head abnormalities, and cytoplasmic droplets were observed in the medial region of flagellum. These results indicated that chronic CBD exposure was associated with changes in the male reproductive system, suggesting its reproductive toxicity.

PMID: 29766538 [PubMed – as supplied by publisher]

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Medical Cannabis for Pediatric Moderate to Severe Complex Motor Disorders.

Category : Dolor

Medical Cannabis for Pediatric Moderate to Severe Complex Motor Disorders.

J Child Neurol. 2018 Jan 01;:883073818773028

Authors: Libzon S, Schleider LB, Saban N, Levit L, Tamari Y, Linder I, Lerman-Sagie T, Blumkin L

Abstract
A complex motor disorder is a combination of various types of abnormal movements that are associated with impaired quality of life (QOL). Current therapeutic options are limited. We studied the efficacy, safety, and tolerability of medical cannabis in children with complex motor disorder. This pilot study was approved by the institutional ethics committee. Two products of cannabidiol (CBD) enriched 5% oil formulation of cannabis were compared: one with 0.25% δ-9-tetrahydrocannabinol (THC) 20:1 group, the other with 0.83% THC 6:1 group. Patients aged 1 to 17 years (n = 25) with complex motor disorder were enrolled. The assigned medication was administered for 5 months. Significant improvement in spasticity and dystonia, sleep difficulties, pain severity, and QOL was observed in the total study cohort, regardless of treatment assignment. Adverse effects were rare and included worsening of seizures in 2 patients, behavioral changes in 2 and somnolence in 1.

PMID: 29766748 [PubMed – as supplied by publisher]

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No Brainer: CBD and THC for Head Injuries

Category : Noticias

Traumatic brain injury (TBI) is one of the leading causes of death worldwide in individuals under the age of 45. Triggered by concussions from car accidents, falls, violent contact sports, explosives or by gunshot and stab wounds, TBI affects 1.7 million Americans annually. It is the most commonly identified cause of epilepsy among adults.

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