Geneology International

Tag: Pain

  • CBD for Joint Pain: Effectiveness, Safety, and More

    CBD for Joint Pain: Effectiveness, Safety, and More

    With the emergence of medical and recreational cannabis, an increasing number of people have started using cannabinol, or CBD, for arthritis and pain in the joints. CBD is a nonpsychoactive compound derived from the cannabis plant; while it can cause drowsiness, it doesn’t cause a “high” like its cousin, THC (tetrahydrocannabinol).

    For arthritis and chronic pain, people often apply topical creams or oils directly to the joints, take oral formulations, or inhale CBD to ease pain and inflammation.

    Though more clinical research is needed on dosage and efficacy, CBD has been shown to have direct anti-inflammatory and pain-management properties in animals. Well-tolerated and with few side effects, CBD reportedly helps relieve pain in affected joints, among other benefits.

    This article provides an overview of CBD for joint pain, including what we know about safety and efficacy, the available products and formulations, as well as how to use it.

    Sergey Mironov / Getty Images


    What’s CBD Used For?

    CBD isn’t just used to treat joint pain and inflammation; it may also help with other conditions. Other common reasons people use it are insomnia (trouble sleeping), anxiety, and chronic pain conditions. In addition, a form of CBD approved by the Food and Drug Administration (FDA) called Epidiolex can be prescribed for epilepsy.

    CBD for Joint Pain

    Does CBD actually work for pain and inflammation? Research on anti-inflammatory properties has found positive effects in animal models, though the clinical evidence is less clear for efficacy in humans. Notably, some researchers have found some varieties of CBD effective for chronic pain patients, which can arise with arthritis and joint-related conditions.

    In the absence of sufficient evidence, the FDA labels CBD as a “cosmetic” product, rather than a nutritional supplement or therapy.

    Regardless, for chronic pain in the joints, especially when due to arthritis, CBD has grown in popularity. A 2019 Gallup poll reported that 14{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of American adults used CBD products, with 40{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} using them for pain, and 8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} specifically for arthritis. Another survey of rheumatoid arthritis and osteoarthritis patients found almost 80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} had tried, actively used, or planned on using these products for pain.

    With regular direct application to the affected joints of topical solutions or oral or inhaled CBD oils or other products, users report reductions in discomfort and improved mobility over the long term. Some also find it to help with sleep and ease anxiety, something that can prove necessary to cope with chronic pain.

    THC and CBD

    Notably, the psychoactive component of cannabis, THC, may also have a pain-relieving effect, especially when combined with CBD. Certain cannabis strains and products are available that aim to balance these levels.

    Studies of this combination have shown efficacy in managing chronic pain and improving mobility. That said, THC will have a psychoactive effect, and the side effects are more prevalent when the two are used together.

    Is CBD Safe?

    Overall, CBD is well-tolerated. Unlike other components of the cannabis plant, it isn’t intoxicating, and there are no significant medical concerns about moderate use. Daily oral doses of 200 milligrams (mg) of CBD or less were found to be safe for up to 13 weeks. Research is ongoing, but most indications are that CBD doesn’t pose many risks.  

    However, CBD may cause some side effects, which can range in severity from person to person. These have been reported to include:

    • Dry mouth
    • Drowsiness or sleepiness
    • Nausea and vomiting
    • Decreased appetite
    • Diarrhea
    • Changes in mood
    • Dizziness

    In addition, CBD may interact with certain medications. Before starting this therapy, let your healthcare provider know if you’re taking:

    Risks for Certain Patients

    The safety of CBD has not been established for certain patients, including:

    • Children and infants (though some prescribed forms are safe to take)
    • Pregnant or breastfeeding people
    • People with liver disease or liver problems
    • People with Parkinson’s disease

    Tips for Safe Use

    Since CBD isn’t approved for use by the FDA—and since research is ongoing—clinical guidelines are lacking. If you’re considering this treatment, the Arthritis Foundation has laid out these recommendations for safe use:

    • Talk to your healthcare provider if you’re thinking about using CBD; seek follow-up care with them after three months of use.
    • Start with a low dose; after a week, gradually increase the amount if you aren’t satisfied with the results.  
    • CBD is not meant to replace medications or therapies that treat joint damage; it’s best used as part of a broader therapy regimen.
    • CBD may interact with medications you’re taking; be ready to call your provider or stop use if you experience side effects.
    • Use products from trusted companies that have undergone independent laboratory testing of purity and potency.

    Is CBD Legal?

    Because it derives from the same kind of cannabis plant that produces THC, a schedule I substance that’s federally banned but available in certain states, the laws surrounding CBD and its availability vary. In 2018, the federal government allowed the sale of CBD and hemp products, but that doesn’t mean that the product you find is legally produced.

    Specific rules around CBD products vary, especially as some states allow medical and recreational use of cannabis, while others do not. Before purchasing, make sure you understand what the regulations are in your area.  

    Types of CBD Products

    There are many CBD products available as the market continues to grow. These can be broken down by how you take them. For arthritis or chronic pain, common types include:

    • Topical formulations: There is a range of CBD creams and oils designed to be applied directly to affected joints. Combined with other ingredients, these may help ease inflammation and pain in the area with daily use.
    • Oral formulations: CBD can be taken in pill form and is available in gummies, candies, or other edible forms. Oils can also be added to food or drink or put under the tongue. A prescribed spray is also available. Dosages can be difficult to manage with this route, and it’s important to keep CBD from children.
    • Inhalation: There are strains of cannabis that are designed to have a very high CBD content and only trace THC, which can be smoked. Concentrations of CBD can also be inhaled by using a vaporizer pen or vaping. Notably, certain ingredients of the latter may pose health risks, and healthcare providers tend to recommend against this route.

    Given the wide range of CBD products available, take care to ensure you’re taking a good, safe product. This is done by:

    • Using products manufactured in the United States that are made from domestically grown plants
    • Ensuring your products conform to voluntary manufacturing standards or those established in your state
    • Buying products that have undergone an independent clinical evaluation of potency, safety, and efficacy using methods established by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (UP), or the Association of Agricultural Chemists (AAC)
    • Avoiding products that advertise specific medical benefits

    How Does CBD Work?

    CBD and the other constituents of cannabis work by stimulating the endocannabinoid receptors located in the brain and nerves throughout the body. When these are stimulated, they release neurotransmitters, or chemical messengers called endocannabinoids. This helps regulate a wide range of functions, including sleep, memory, appetite, mood, reproduction and fertility, as well as immune and inflammatory responses.

    There are two types of endocannabinoid receptors: CB1 receptors are found in the brain, whereas CB2 receptors are found on nerves in the rest of the body. CBD’s anti-inflammatory properties have been attributed to its activity on the latter. Notably, whereas THC stimulates the activity of these receptors, CBD primarily slows down the degradation of endocannabinoids. This accounts for their differing effects on the body.  

    Summary

    Cannabinol, or CBD, is a nonpsychoactive compound of the cannabis plant. Though more research is needed, some evidence suggests CBD may help ease joint pain and inflammation. Designed to be applied topically, inhaled, or ingested, a wide range of products are now available, and federal bans on their sale have been lifted.

    While CBD isn’t an FDA-approved therapy, it’s relatively safe and causes few side effects. Many report reductions in pain and swelling with prolonged, regular use.

    A Word From Verywell

    For an increasing number of people with persistent arthritic joint pain and swelling, topical and other forms of CBD have emerged as an option for managing symptoms. Working without the intoxicating effects of THC, this compound has shown promise as an anti-inflammatory and pain-managing agent.

    However, as the science is new and evolving—and because this therapy isn’t FDA regulated—care should be taken. If you’re thinking about using CBD for joint pain, talk to your healthcare provider about whether this option is appropriate for your case.

     

    Frequently Asked Questions


    • How quickly does CBD work for joint pain?

      CBD isn’t expected to provide quick pain relief, and it doesn’t treat the underlying cause of the pain. CBD formulations are known to have a cumulative effect: one that sets on after a period of daily or regular use. When trying this approach, it can take up to two weeks to see sustained results. However, immediate effects set in quicker based on the route of administration; inhaled CBD takes a couple of minutes, topical forms about 10 minutes, sublingual forms between 15 and 45 minutes, with edibles taking between 30 minutes and two hours.


    • Which is better for pain CBD or hemp?

      Hemp is a male form of the cannabis plant that has a very high CBD content and negligible THC levels. Hemp seed oil is derived from parts of the hemp plant, whereas CBD oils and other products are derived from the whole hemp plant, or from some strains of the female form. While CBD extractions may help with pain and inflammation, hemp seed oil provides mostly nutritional value.


    • What strength of CBD oil is best for joint pain?

      Since there are no exact medical guidelines for CBD use, the best option is to start with smaller amounts and concentrations, scaling up only if you aren’t feeling the effects after several weeks. Most products will have CBD content information measured in milligrams (mg). If taken orally, start with between 25 and 35 mg a day, split over two doses; topically, up to 250 mg can be applied daily.   

  • Acupuncture Therapy for Postoperative Pain

    Acupuncture Therapy for Postoperative Pain

    Introduction

    Postoperative pain foremost refers to the acute pain that occurs immediately after surgery and consists mainly of pain from somatic and visceral trauma caused by surgical operations and pain from inflammatory irritation around nerve endings,1 which attributes to injurious pain.2 If it continues to be poorly controlled, pathological remodeling of the central and peripheral nervous system occurs3 and the nature of the pain changes to neuropathic pain or mixed pain, then it progresses to chronic postoperative pain. More than 300 million patients undergo surgery worldwide each year.4 Between 30{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and up to 80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of patients report moderate to severe pain in the days following surgery, and approximately 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} developing chronic pain.5 Persistent pain not only affects the patient’s recovery and leads to longer hospital stays,6 but also adds to the psychological burden of the patient, causing anxiety and depression.7,8 For families and society, both the direct increase in hospitalization expenses and consumption of medical resources, and the consequent indirect decline of individual labor force and even unemployment,9 are issues that should not be underestimated.

    Currently, pharmacological analgesia remains the dominant modality for the treatment of postoperative pain. Analgesics can meet the requirements of short-term and rapid analgesia, however, their side effects such as the addiction of opioids,10 the gastrointestinal harm and possible cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs),11,12 are also evident. Furthermore, although numerous postoperative pain management recommendations have been available over the years, the drugs recommended are generalized for all procedures.13 The efficacy of pain medication may vary depending on the type of surgical procedure,14 so it is difficult for specialists to find an effective solution for a particular procedure, and many patients report unsatisfactory results in terms of postoperative pain control.15 This all indicates to the fact that pharmacological analgesia is not a long-term solution. Searching for green, safe, low adverse effects and targeted analgesia gradually becomes one of the most important concerns of clinicians.

    Acupuncture therapy, a series of traditional Chinese medical treatment internationally accepted and applied for its undeniable effectiveness of therapeutic effects in the treatment of various pain-related conditions and nerve disorders,16,17 is one of the ideal non-pharmacological treatments to control post-operative pain. Studies have found that acupuncture therapy can intervene in pain through mechanisms such as increasing endogenous opioid peptides in the brain,18,19 modulating abnormal neurological function,20 and influencing intracellular signaling pathways.21 A randomized controlled trial (RCT) showed that acupuncture was effective in relieving postoperative pain in patients undergoing hemorrhoidectomy.22 Another RCT also found that acupuncture therapy was safe and effective in the management of post-cesarean pain.23

    Bibliometric analysis is a method for evaluating and quantifying literature information using mathematical and statistical methods,24 which can help to recognize the research advances in a specific field of science comprehensively.25 This analytical method has been applied to many areas with a large body of research accumulated, including pain management. In one of these studies, Gao et al26 analyzed the field of acupuncture for analgesia, and it can be seen in this study that acupuncture therapy for postoperative pain has also received considerable attention. However, despite the heat in the clinical and research area, no studies have yet explored current research trends in the treatment of postoperative pain with acupuncture therapy and continued in-depth study of this field using bibliometric analysis is highly warranted.

    The approach of bibliometric was applied in this study to analyze the literatures about acupuncture therapy for postoperative pain over the last 20 years, through multiple perspectives such as journals, authors, institutions, countries, keywords, and references. And the results were presented in the form of scientific knowledge maps by using the CiteSpace software, then the maps were further interpreted and analyzed, to gain an intuitive and comprehensive understanding of the research in the field, identify research hotspots and provide new research ideas.

    Methods

    Data Sources and Search Strategy

    All data for this study were obtained from the Web of Science (WoS) core collection database on 1 March 2022. The data search strategy included the topics “postoperative pain” and “acupuncture therapy”, with the publications period of the literatures ranging from 2001–01-01 to 2022–02-28. Only English-language papers were included, the country and category of the study were not restricted. Duplicates and articles without full text were excluded. Secondary search for references and relevant reviews in the literatures was conducted in order to avoid omissions. The specific search strategies and results were shown in Table 1. Eventually, 840 articles were obtained.

    Table 1 The Topic Search Query

    Analysis Tool

    This research applies CiteSpace (V5.8.R3 64-bits) combined with Excel to organize and visualize data for analysis, including: (1) statistical and descriptive analysis: for parameters such as annual publication volume, authors, countries, institutions and journals; (2) collaborative network analysis: mainly for the three dimensions of countries (regions), institutions and authors;(3) co-occurrence analysis: for keywords; (4) co-citation analysis: for authors, journals and references; (5) citation burst analysis: mainly for keywords and references; (6) cluster analysis.

    The specific parameters for the visualization analysis were set as follows. The threshold of “Top N{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} per slice” was 50 for all calculations. The time span was from January 2001 to February 2022, and the time slice setting for all analyses conducted with CiteSpace was “1 year per slice”. Clustering labels were extracted by using the LLR algorithm.

    Charts Interpretation

    The nodes in the maps generated by CiteSpace represent the objects being analyzed (such as different authors, institutions, or keywords); the size of the diameter of the nodes reflects the frequency (such as the output or citation frequency.); different colors correspond to different years (such as the year of publication); the lines between the nodes indicate the collaboration or co-occurrence relationship between the two, the color of the line indicates the time of the first collaboration and the thickness of the line reflects the strength of the relationship between the two.

    Results

    Annual Publications and Trends

    The retrieval of database found that a total of 860 articles have been published in the field of acupuncture therapy for postoperative pain in the past 20 years, and the number and trend of annual articles are shown in Figure 1. 2001 to 2014 could be seen as one phase. During this period, the annual number of articles published showed a fluctuating and slow growth trend, with an annual average of about 24 articles. There were four small peaks of growth successively, but all of them were quickly followed by a fall back. 2015 to the present is another phase. The number of publications in 2015 surged to 60, and after a small rebound, 2016 to 2019 saw a sustained and significantly accelerated increase in the number of publications, with the heat of attention increasing and stabilizing at an average of over 80 publications per year for the period 2019 to 2021, which was the highest record over the past 20 years. Only two months of data are currently available for 2022, but based on the above, it can be deduced that the number of publications this year will also be considerable and the research fever in the field of acupuncture for postoperative pain will continue.

    Figure 1 The number of annual publications on acupuncture treatment for postoperative pain.

    Note: In this figure, the number of articles published in 2022 is marked with an “*” and indicated by a dashed line, since only two months of data are available for this year.

    Analysis of Journals and Cited Journals

    Journals

    The total number of journals that published these 860 articles on acupuncture treatment for postoperative pain was 344 and the top 10 journals with the highest cumulative number of publications were listed in Table 2. The most published journals, accounting for about 14{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the total number of articles published, were Evidence-Based Complementary and Alternative Medicine (40 articles), Acupuncture in Medicine (39 articles), and Medicine (38 articles). Anesthesia and Analgesia had the highest impact factor (IF) of 5.178, with 21 articles published, ranking 5th.

    Table 2 The Top 10 Journals with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

    Cited Journals

    In conjunction with centrality, CiteSpace was used to generate a map of cited journals with 645 nodes and 5770 links (Figure 2), reflecting the co-citation relationships between journals. A node represented a journal, which gave a total of 645 journals involved in co-citation in the field of acupuncture therapy for postoperative pain. Shown in Table 3, the top five contributing journals as cited are Pain, Anesthesia and Analgesia, Anesthesiology, British Journal of Anaesthesia, and Acupuncture in Medicine. In the cited journal map, the purple ring outside the node reflected the size of the centrality of the journal it represented. Table 4 listed the journals with the highest centrality in the field of acupuncture therapy for postoperative pain, with Clinical Journal of Pain and European Journal of Anaesthesiology being the top, both at 0.07.

    Table 3 Top 5 Cited Journals with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

    Table 4 Top 7 Cited Journals with the Highest Centrality on Acupuncture Treatment for Postoperative Pain

    Figure 2 Co-citation map of journals on acupuncture treatment for postoperative pain.

    Analysis of Countries

    Statistically, articles on acupuncture therapy for postoperative pain mainly came from 53 countries. The five countries with the highest contribution to the number of articles and the highest centrality were shown in Table 5 respectively, and a map of country cooperation networks was generated accordingly (Figure 3). As seen from it, China, the top publisher, has a weak chain of partnerships with other countries and need more international cooperation to enhance the global promotion of acupuncture therapy for postoperative pain. As the first of the pivot nodes, the US published a large amount of relevant literature and established collaborative relationships with quite a few countries. In addition, several countries forming a salient hexagonal circle of cooperation were visible in the upper right of the map. The mutual cooperation between these countries was developed early and closely. Meanwhile, they also maintained a certain cooperative relationship with Germany, one of the pivot nodes.

    Table 5 Top 5 Countries with the Highest Frequency and Centrality on Acupuncture Treatment for Postoperative Pain

    Figure 3 Map of countries cooperation network on acupuncture treatment for postoperative pain.

    Analysis of Institutions

    The top five institutions in terms of volume and centrality were listed in Table 6. China Medical Univ and Kyung Hee Univ both ranked first with 25 articles, followed by Korea Inst Oriental Med, Chinese Acad Sci and Shanghai Univ Tradit Chinese Med. China Med Univ, which had the highest number of articles, had the the highest centrality meanwhile, and Shanghai Univ Tradit Chinese Med was also tied. The inter-institutional collaboration network was generated accordingly, as shown in Figure 4. During this process, it was found that there were many instances where the names of institutions were not written normally, causing CiteSpace to identify the same institution as a different node. Such cases were all merged manually.

    Table 6 Top 5 Institutions with the Highest Frequency and Centrality on Acupuncture Treatment for Postoperative Pain

    Figure 4 Map of inter-institutional collaboration network on acupuncture treatment for postoperative pain.

    Analysis of Authors and Cited Authors

    Authors

    A total of 623 authors contributed to these 840 articles in the field of acupuncture therapy for postoperative pain and a map was generated using CiteSpace to show the collaborative relationships between the different authors (Figure 5). The nodes marked with names in the graph were the authors with three or more publications. And the authors with more than five publications, seven in total, were the core authors in this field. The most prolific author was Inhyunk Ha, with 10 publications. With him at the center, the graph presented a collaborative block linking up highly productive authors such as Byungcheul Shin (8 publications) and Meriong Kim (6 publications). Man Zheng was also active, with 6 publications, and he was part of the same team as Zhen Zheng, who had 5 publications. Lianbo Xiao and Di Sessler also had 5 publications. The map also manifested some loosely linked teams, most of which were multiple authors of the same paper. The collaborations between the different teams were less. Other relevant information about core authors were listed in Table 7. The “Year” column in the table manifested when the author first published, reflecting how early the author had been interested in the field. The “Nationality” column showed that the core authors were mainly from Korea and China. Moreover, the “Author” and “Country” modules were overlaid to obtain a new graph (Figure 6), where the distribution of authors by nationality can also be observed.

    Table 7 Top 7 Authors with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

    Figure 5 Map of authors cooperation network on acupuncture therapy for postoperative pain.

    Figure 6 Authors-countries collaboration map on acupuncture therapy for postoperative pain.

    Cited Authors

    In combination with centrality and applying “pathfinder” and “pruning sliced networks”, CiteSpace was used to generate a co-citation map of authors from the field of acupuncture therapy for postoperative pain with 745 nodes and 2824 connected lines (Figure 7). The five most frequently co-cited authors whose articles had the highest impact were Han JS, Sun Y, Lee A, Lin JG and Wang SM, listed in Table 8. The seven authors with the highest centrality were demonstrated in Table 9, with four of them, Han JS, Vickers AJ, Wang SM and Ernst E, having centrality greater than or equal to 0.1.

    Table 8 Top 5 Cited Authors with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

    Table 9 Top 6 Cited Authors with the Highest Centrality on Acupuncture Treatment for Postoperative Pain

    Figure 7 Co-citation Map of Authors on Acupuncture Therapy for Postoperative Pain.

    Keywords Co-Occurrence Analysis

    The 840 articles of acupuncture therapy for postoperative pain brought together a total of 517 keywords. “Pathfinder” and “pruning sliced networks” applied, a co-occurrence map of keywords, Figure 8, was generated. The 10 most frequently occurring words have been listed in Table 10, and 6 keywords occurred more than 100 times. Of interest were the “electroacupuncture” ranked 4th and “auricular acupuncture” ranked 8th. The frequency of these two keywords about therapeutic techniques was particularly high. Meanwhile, the keyword “auricular acupuncture” and two keywords related to electroacupuncture research, “electrical stimulation” and “electrical nerve stimulation”, had a high centrality (Table 11).

    Table 10 Top 10 Keywords with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

    Table 11 Top 11 Keywords with the Highest Centrality on Acupuncture Treatment for Postoperative Pain

    Figure 8 Co-occurrence map of keywords on acupuncture therapy for postoperative pain.

    Further clustering based on the co-occurrence map resulted in a total of 12 clusters presented in Figure 9. The five largest clusters were “#0 postoperative nausea”, “#1 spinal nerve ligation”, “#2 systematic review”, “#3 postoperative ileus”, “#4 gi endoscopy”, “#5 undergoing autologous hematopoietic stem cell transplantation”. These were the most talked about topic in this area. Transforming the map into a Timeline view (Figure 10) allowed to observe the evolution of hot spots in the field of acupuncture therapy for postoperative pain research over the last 20 years.

    Figure 9 Cluster map of keywords co-occurrence on acupuncture therapy for postoperative pain.

    Figure 10 Timeline map of keywords co-occurrence on acupuncture therapy for postoperative pain.

    References Co-Citation Analysis

    A total of 855 references were extracted from the 840 articles of acupuncture therapy for postoperative pain to analyze cited references. The earliest cited literature was published in 1996 and the most recent reference was published in 2020. The five most frequently cited publications were listed in Table 12. Three of these were systematic reviews, one clinical randomized controlled trial, and one review. The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis by Wu MS et al,27 published in 2016 topped the list with 44 citations. Table 13 demonstrated the top 5 papers ranked according to centrality. Three of these were clinical randomized controlled trials, one was a systematic review, and one was a review article. Written by Sun Y et al, Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials,28 published in 2008 had the highest centrality of 0.22.

    Table 12 Top 5 Cited References with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

    Table 13 Top 5 Cited References with the Highest Centrality on Acupuncture Treatment for Postoperative Pain

    As shown in Figure 11, there was a co-citation map of references generated by CiteSpace. All references marked on the graph were those with more than 8 citations, and it can be seen that a large number of highly cited literatures were published in the last 10 years. Based on this, 19 valid clusters were obtained (Figure 12). The five largest clusters were #0 acupuncture analgesia, #1 evidence-based nonpharmacologic strategies, #2 postoperative complication, #3 randomized controlled trail, #4 ambulatory anesthesia, #5 capsicum plaster.

    Figure 11 Co-citation map of references on acupuncture therapy for postoperative pain.

    Figure 12 Cluster map of references co-citation on acupuncture therapy for postoperative pain.

    Citation Burst Analysis

    Burst keywords refer to keywords that have seen a spike in citations over a period and represent the research hotspot for the corresponding time. The 840 included articles were measured via CiteSpace and a total of 16 burst keywords were extracted, as shown in Figure 13. These keywords first appeared in 2001 or before, but the burstness began and ended at different times (shown as the red bars). Among them, “postoperative nausea” had the highest value of burst intensity, with a “Strength” of 8.36. Keywords having the longest duration of the burstness were “acupuncture analgesia” and “trial”, both beginning in 2008 and ending in 2016. The three latest burst keywords, “pain relief” from 2018, “systematic review” from 2019 and “osteoarthritis” from 2020, have been still ongoing.

    Figure 13 Top 16 keywords with the strongest citation bursts.

    A reference citation burst is a surge in the frequency of the reference being cited over a period, which can help to identify areas at the forefront of current research. A total of 15 references of citation burst were extracted for this study and were displayed in Figure 14. Four references with the latest burstness were identified. An article by Zhang RX published in 201429 and an article by Lee A published in 201530 both began bursting in 2017, with the former ending bursting in 2019 and the latter in 2020. The next burst reference was the same as the most frequently cited article (Wu MS, 2016),27 and meanwhile it had the highest value of burst intensity (15.32). This reference and another one by Chou R were both published in 2016,31 with their citation bursts beginning in 2018 and continuing until now.

    Figure 14 Top 15 references with the strongest citation bursts.

    Discussion

    General Information on Publications

    The 840 publications included spanned the period from January 2001 to February 2022. Analysis of the annual volume of literature published revealed that the volume of publications in the field of acupuncture for postoperative pain had increased to varying degrees each year. This increase was relatively steady in the early stage, more prominent after 2015, and stabilized at its highest level during the latest 3 years. This indicates that the field is in a period of rapid development and has great scope for exploration and research value. From the analysis of journals, the impact factors (IF) of the top ten journals with the highest cumulative number of publications are generally low. This indicates that the influence of acupuncture techniques for postoperative pain control in international applications is still relatively limited, and the quality of relevant publications needs to be improved. The highly cited journals mainly reflect the sources of journals that are the knowledge base of the relevant literatures. Most of them are comprehensive medical journals that serve as a bridge of knowledge between conventional and complementary alternative therapies, and they are more influential, with having a higher impact factor.

    In terms of the number of national publications, the contributions of China and USA are the most prominent. The parameters of the cooperation map show that the density of national collaborative networks is not low, which means that to some extent an international environment for collaborative research in the field of acupuncture for postoperative pain has been formed, with European and American countries such as the USA, UK and Germany playing a larger role, while Asian countries, represented by China and Korea, have more fragmented links. Institutions in Chinese and Korean are the main locations for research in this field. Medical schools and their affiliated medical institutions are the main institutional form. None of the top five institutions in the centrality ranking has a value above 0.10, suggesting that even the representative institutions are only collaborating on a small scale.

    In terms of authors, Inhyuk Ha and his partners have published the most articles, focusing on the application of acupuncture therapy for postoperative pain in the low back, with the most influential article being cited 42 times. This meta-analysis has provided evidence to support the use of acupuncture for acute pain occurring within one week of back surgery.32 From China, Man Zheng is member of a research team investigating the role of acupuncture therapy in perioperative pain prevention, particularly in thoracic and abdominal surgery. A randomized controlled trial conducted by the team demonstrated that in patients undergoing gynecological laparoscopy surgeries, a single electroacupuncture session within 24 hours before surgery was effective in preventing postoperative pain.33 The author who has the highest frequency of being cited and centrality is Han JS, whose most cited paper is a review published in Pain in 2011,34 which focuses on the consensus and controversy surrounding the research on the efficacy and mechanisms of acupuncture-related therapy, including the selection of acupoints, stimulation methods and intensity, and neurological effects, providing a reference for both clinical application and trial protocols.

    Research Hotspots and Frontiers

    Keywords and references reflect the content of the research from different aspects. Observed in the spatial dimension, the level of their frequency, centrality and burst intensity, and clustering distribution can suggest research hotspots. And in the temporal dimension, the dynamic changes of them can reflect research trends and help identify research frontiers.

    Highly Concerned Treatment Techniques and Types of Surgery

    Based on the frequency and centrality of the keywords, it can be determined that electroacupuncture and auricular acupuncture are probably the therapeutic techniques that have received the most attention from researchers in this field. A multicenter randomized controlled trial demonstrated that electroacupuncture combined with conventional care was superior to conventional care alone for the relief of non-acute pain following back surgery.35 Another randomized controlled trial also showed that auricular acupuncture could provide postoperative analgesia and reduce the application of analgesic medication and was safe to perform.36

    Studies on the control of postoperative pain with acupuncture have covered a variety of surgical types, including low back surgery, osteoarthritis surgery, lung cancer surgery, cardiac surgery, brain surgery, laparoscopic surgery, tonsillectomy, hysterectomy, total knee replacement, hip replacement, caesarean section, oral surgery, spinal surgery, shoulder and neck surgery, gastric cancer surgery, and anorectal surgery. The studies on chronic lower back pain due to the aftermath of low back surgery are the most, with 58 occurrences of related keywords.

    Hot Research Topics and Directions

    The results of clustering and burstness of keywords revealed a consistently high level of concern for postoperative nausea. The largest cluster was “postoperative nausea”. Of the 16 burst keywords, “postoperative nausea” was the keyword with the earliest occurrence (beginning in 2002) and the greatest intensity of burstness. Moreover, the keyword “nausea” had a second citation burst in 2014. Both nausea and pain are the most common complications after surgery. Meanwhile, there is also a degree of causality between the two. Opioid analgesics have been found to be one of the main causes of postoperative nausea and vomiting.37,38 The problem of nausea can be addressed to a great extent if postoperative pain can be relived with minimal use of such medications. Acupuncture therapy has attracted the attention of researchers as an excellent complementary and alternative therapy. A systematic review by Pouy S et al showed that acupuncture therapy can prevent and reduce the occurrence of post-tonsillectomy pain and nausea in pediatric patients.39 A popular direction of research derived from this research hotspot is PC6 acupoint stimulation. The acupoint of Neiguan (PC6), located on the pericardium meridian, is a specific point for the treatment of nausea and vomiting.40 Studies on the relief of postoperative complications of pain and nausea have been conducted as early as 1996 by applying pressure to the Neiguan point.41 A systematic review and meta-analysis by Cheong KB et al demonstrated the safety and effectiveness of acupuncture stimulation of the PC6 acupoint or with the combination of other acupuncture points to alleviate postoperative vomiting associated with anesthetic analgesia.42

    In addition, transcutaneous electrical nerve stimulation (TENS) is another hot direction of research in this field, as reflected in the keyword clustering and burstness. This technique is also combined with auricular acupuncture techniques.43 A similar technique arising from the disciplinary crossover is transcutaneous electrical acupoint stimulation (TEAS).44–46

    Research Trends and Forefront

    From an overall perspective, keywords whose burstness occurred in the first decade mainly reflected a concentrated discussion of postoperative pain management and acupuncture analgesic techniques, with the main form of research being mostly RCTs. In the recent decade the main focus has been on pain symptom relief and postoperative quality of life, with a gradual increase in the number of systematic reviews. Moreover, animal experiments, as well as mechanism-related studies, also have a place, as evidenced by the burst keyword “rat” and the second largest cluster “#1 spinal nerve ligation” (a kind of rat modelling technique). Looking at the three newest burst keywords, “pain relief” shows the constant attention received by the topic of postoperative pain management. The rise in heat of “systematic review” reflects the development of evidence-based medicine in this field. 2020 saw the burstness of the term “osteoarthritis”, indicating that in the last two years acupuncture analgesic techniques have started to be used in osteoarthritis surgery more often and intensive research has been conducted.47,48

    The citation status of the references also manifests a distinctly evidence-based medical color. The most influential literatures in this field are of a variety which is dominated by RCTs and systematic reviews of clinical studies. In the results of clusters, both “#1 evidence-based nonpharmacologic strategies” and “#3 randomized controlled trail” have a relatively large size. The most frequently cited reference suggested that certain modes of acupuncture did have implications for alleviating postoperative pain and reducing opioid use.27 That acupuncture could control acute postoperative pain and reduce the side effects of pharmacological analgesia was supported by the reference with the highest centrality.28

    According to the newest burst references, electroacupuncture could alleviate pain by activating a range of bioactive substances including opioids, N/OFQ, 5-hydroxytryptamine, norepinephrine and others.29 Lee A et al evaluate the preventive effect of several methods of stimulating the PC6 acupoint on nausea and vomiting resulted from surgical analgesia and anesthesia.30 This fits in with the direction of research embodied in the keywords. The last is a guideline on postoperative pain management published in 2016.31 In this guideline, TENS is supported by moderate quality evidence and is recommended as a complementary therapy. In contrast, the effectiveness of other acupuncture therapies remains controversial, although there is adequate evidence for their safety. However, most of their citations and evidence are of results published before 2005 and their evidence needs to be updated. This suggests that the current focus in the field of acupuncture therapy for postoperative pain is still on proving the effectiveness of acupuncture therapy and that there is a long way to go in terms of conducting high quality clinical research.

    Conclusion

    In this study, the analysis of annual volume of publications and journals suggests that the field of acupuncture therapy for postoperative pain relief is currently in a period of rapid development. The analysis from country to institution to author shows a progressively more microscopic perspective of observation and consistency is evident among them: there may be more localized individual collaborations, but the overall collaborative network is not yet mature. In terms of keywords and references, electroacupuncture and auricular acupuncture (therapeutic techniques), low back surgery (types of surgery), “postoperative pain, nausea and vomiting” and their derivatives are research hotspots in this field. Improvement of postoperative life quality, proof of clinical efficacy and evidence-based evaluation are the current research trends and frontiers. Overall, the field of acupuncture for postoperative pain has great potential for development, and more international exchanges and collaborations as well as high-quality research results are needed in the future.

    Strength and Limitation

    The strength of this study is that literatures on acupuncture therapy for postoperative pain were analyzed by applying bibliometrics and visualization for the first time, and the results were interpreted from multiple perspectives, with the information presented in the macroscopic perspective sufficiently explored, revealing the research hotspots and trends in the field. The limitation of this study is that only literature from the Web of Science was analyzed. This is because CiteSpace cannot combine and analyze data from multiple sources at the same time, and other databases cannot export the corresponding citation formats for citation analysis.

    Abbreviations

    NSAIDs, non-steroidal anti-inflammatory drugs; RCT, randomized controlled trial; WoS, Web of Science; IF, impact factor; TENS, transcutaneous electrical nerve stimulation; TEAS, transcutaneous electrical acupoint stimulation.

    Data Sharing Statement

    The raw data of this article was collected from the online database WoS, which can be obtained directly by logging in or contacting the authors.

    Ethics Approval and Informed Consent

    This study did not contain any human or animal test subjects. Thus, the requirement for ethics approval was waived.

    Acknowledgments

    The authors would like to express their appreciation to Prof. Chaomei Chen for developing CiteSpace and opening its access.

    Author Contributions

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Funding

    This study was supported by the National Natural Science Foundation of China (U21A20404); the Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (ZYYCXTD-D-202003).

    Disclosure

    The authors report no potential conflicts of interest in this work.

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  • Love wearing heels? Here are some health tips to avoid pain or risk of injury | Health

    Love wearing heels? Here are some health tips to avoid pain or risk of injury | Health

    Heels are certainly a single of the most attractive footwear for ladies and investigate has demonstrated that when they did a biomechanical examination of a woman’s gait in heels, it was identified to be far more female. She had shorter strides and far more rotation at the pelvis adding to the appeal and charm but heels can lead to a lot of musculoskeletal issues if correct treatment is not taken.

    In an interview with HT Way of living, Dr Nidhi Bajaj Gupta, Physiotherapy Healer, Holistic Wellness Mentor and Founder of Merahki Holistic Wellness, shared, “Since heels set your calf muscle mass in a shortened placement it can bring about calf tightness and protruding veins in the calves. The whole system weight is shifted ahead in heels and consequently it qualified prospects to too much force on the toes main to hammer toes and bunions. Heels also result in an extreme arch in the back known as lumbar lordosis hence it can also guide to low again and knee pain.”

    The fantastic information is that if care can be taken the facet consequences of carrying heels can be reduced. She instructed a few recommendations:

    1) Please be certain that you often stretch your calf muscle tissues for 60 seconds each and every and do 2-3 repetitions each working day. It can be finished at any time of the working day or preferably as you take away the heels.

    2) You can also gently therapeutic massage your calf and foot location. A foam roller can be utilised 2-3 times a week to release the calf muscle mass bring about details. The foam roller can be made use of on the hamstrings, iliotibial band and very low back muscle mass too.

    3) Remember to do some ankle vary of motion routines like having the foot up, down, sideways and rotations clockwise and anti-clockwise. Also add some ankle steadiness routines like standing on 1 leg with eyes open and then eyes near. This improves the proprioception of the ankle joint and hence cuts down the instability triggered thanks to heels.

    4) Although walking in superior heels do your ideal to wander as ordinary as feasible, that is heel to toe strolling. In heels ladies are inclined to do toe to heel strolling which is inappropriate biomechanics. Consciously observe initially putting the heel to the floor then roll around to the toe in the course of gait. If practiced continually ladies can have the correct gait with heels much too.

    5) Strengthen your posture as though wearing heels the centre of gravity shifts ahead which is damaging for all the joints. Near your eyes, envision there is an invisible string which is retaining your head upright. The head really should be in line with your spine, chin shoulder be parallel with the ground. You need to have to steer clear of on the lookout down. Let your shoulders be back, arms peaceful and really don’t let the knees be locked. You can a little suck in your belly to stay away from excessive arching at the reduced back again. This can be practiced a handful of occasions in advance of walking in heels and it will grow to be a pure element of your posture.

    Asserting that wearing large heels may well be trendy and make you really feel taller and sexier but it does arrive at a value, Dr Manan Vora, Sports Medication Specialist and Orthopaedic Surgeon, pointed out, “High-heeled sneakers can lead to a myriad of foot challenges even though impairing balance and growing the hazard of injury. Leg, back again, and foot suffering are among the some of the additional popular grievances. Long-term use can even induce structural improvements in the foot by itself, main to bunions, hammertoe, neuroma, equinus and other disorders that might demand surgical correction. In addition to personal injury, higher heels put extreme strain on the back and decrease extremities that can profoundly have an impact on posture, gait, and equilibrium.”

    While fully halting to dress in heels is not feasible, he advised a several ideas that you can continue to keep in brain though acquiring and putting on your favourite heels:

    1. While acquiring heels, make confident you buy the correct sizing that suits you nicely. If you acquire a greater size, you can fall. If you invest in a scaled-down dimension, it can be restricted therefore leading to suffering.

    2. Some of us have slim feet, some have huge, some have scaled-down toes, when some could possibly have lengthy toes. There are so lots of variations. If you have huge toes, do not to put on shut tapered footwear, don huge front shut types or open toe kinds. Even these with scaled-down toes should really decide for shut large front footwear. The pointed front shoes will pinch your toes and make it incredibly awkward. Heels that cramp your toes will trigger ache when walking and raise the possibility of getting bunions, corns and building hammertoes and even arthritis later on in daily life.

    3. Donning heels places much more stress on your feet, in particular the balls of the ft. Prior to getting that coveted pair, examine that they have proper padding and cushioning in the area that supports the balls of feet. Large heels with great cushioning and padding provide great assist and consolation to your ft.

    4. When deciding upon significant-heels, check where the heel is put. The heel need to ideally be positioned under your possess heel. Don’t forget, thicker the heel, the increased the assistance it supplies for your entire body. Seem for platforms that will distribute your fat throughout the full foot evenly alternatively of concentrating it at the ball of the foot or the heel. So, go for broader, thicker heels if you want to decrease the danger of sprained ankles.

    5. Large heels that are 3 cm to 9 cm substantial are the most comfortable to walk in. Heels more than that peak place much more force on your lower back again, knees, ankles and do not give any aid for balancing.

    6. Give your toes a break. When wearing significant heels, the most effective guidance you can consider to prevent soreness is just to sit down each time possible! This will give your ft a crack and will quit any pain or pain from creating, keeping your toes contemporary.

    7. Will not don higher heels too often. Superior heels seem fantastic but help save them for particular situations only.

    Come permit us collectively ‘heal’ the ‘heel’ troubles!

  • Efficacy, Safety, and Regulation of Cannabidiol on Chronic Pain: A Systematic Review

    Efficacy, Safety, and Regulation of Cannabidiol on Chronic Pain: A Systematic Review

    According to Forbes, in October 2020, cannabidiol (CBD) sales in the United States reached $4.2 billion after the federal government legalized hemp-derived CBD in 2018 [1]. In addition, the World Health Organization (WHO) in 2019 re-classified CBD and <0.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of delta-9-tetrahydrocannabinol (THC) as not under international control and recognized its medical value in 2020 [2]. Hence, CBD is a rapidly expanding business expected to increase its value to $20 billion in 2025 [1].

    CBD is a nonintoxicating chemical ingredient from the Cannabis sativa plant [3]. CBD’s medical value was a hot topic for debate before being recognized in the medical field. One preparation of CBD approved by the U.S. Food and Drug Administration (FDA) is Epidiolex, an oral solution given to patients less than two years old to treat two rare and severe forms of seizure, Lennox-Gastaut syndrome and Dravet syndrome [4]. In addition, dronabinol [a synthetic delta-9-tetrahydrocannabinol (THC) product] and nabilone (like THC) were regulated by the FDA for the treatment of chemotherapy-induced nausea and vomiting [5]. Dronabinol is also used for AIDS-associated anorexia. With its federal legalization, CBD dispensaries continue to open one after another. People have more access to a wide variety of CBD products like cannabis flowers, tinctures, concentrates, topical lotion/creams, and edibles which are self-administered and with little or no supervision by a physician [6]. CBD oils provide relief for various conditions, including pain without intoxication [3]. Regulations of cannabis products remain a challenge for most countries.

    Chronic pain is a continuous or recurring pain for three months or longer experienced by a patient due to various causes. Different types of chronic pain are identified based on their nature, location, and characteristics. It is a significant cause of disability globally, and billions of dollars are spent annually to alleviate its outcomes [7]. While the opioid crisis increases, CBD’s role in pain management unveils as animal studies show promising evidence [8]. Further investigation and trials into CBD’s therapeutic value are ongoing due to its natural source, numerous usages, lower risk of addiction or dependency, and relative safety [7]. FDA regulation of CBD needs more clinical trials to determine its effectiveness and safety and should meet proper standards for authorization [9].

    This paper aims to answer the efficacy and safety of CBD in chronic pain using a systematic review of articles from five databases. This study will fill the existing gap and update knowledge on CBD’s role in chronic pain.

    Methods

    Protocol

    This descriptive systematic review was done according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 checklist [10]. Before the search of the databases, a protocol was made and shared with the research team to analyze and finalize. The main question of the review: What is the efficacy and safety of CBD in adult patients with chronic pain? The PICO strategy was used to formulate the question of this review. The review protocol can be acquired with a request addressed to the lead author.

    Search Strategy

    PubMed, PubMed Central (PMC), Medline, Cochrane Library, and ScienceDirect were utilized as the major databases and search engines. In PubMed, the search was done using keywords and a medical subject heading (MeSH). The keywords “Cannabidiol” and “chronic pain” were applied to obtain related literature. The MeSH strategy used in PubMed and PMC were: (“Cannabidiol/adverse effects”[Majr] OR “Cannabidiol/isolation and purification”[Majr] OR “Cannabidiol/metabolism”[Majr] OR “Cannabidiol/pharmacokinetics”[Majr] OR “Cannabidiol/pharmacology”[Majr] OR “Cannabidiol/poisoning”[Majr] OR “Cannabidiol/therapeutic use”[Majr] OR “Cannabidiol/toxicity”[Majr]) AND (“Chronic Pain/drug therapy”[Mesh] OR “Chronic Pain/prevention and control”[Mesh] OR “Chronic Pain/therapy”[Mesh]). Booleans “AND” and “OR” were used.

    Additionally, keywords such as Cannabidiol, CBD, Hemp, Marijuana, Chronic Pain, and other synonyms were applied to the other databases. Furthermore, other publications in the reference list and related studies were also examined to see if they were relevant and could be included in this review.

    There were a total of 2298 articles extracted from all the databases. PubMed, PMC, and Medline have 289 articles. The Cochrane Library and Science Direct gave 73 and 1936 articles, respectively. The databases were last accessed on April 2022.

    Eligibility Criteria

    A PRISMA flow diagram 2020 was used to show the study’s inclusion and exclusion of articles found in the databases used. The inclusion criteria for eligibility were: (i) studies in an adult population >18 years old; (ii) patients with pain symptoms of less than three months duration; (iii) all available preparations of CBD; (iv) human studies only; (v) publication in English; and (vi) publication in the last five years. Studies with pediatric patients, acute pain, and animal studies were excluded. Studies with no available full text were also excluded from the review.

    Data Collection Process: Synthesis, Extraction, and Management

    All titles of the articles initially obtained from databases were selected by applying the eligibility criteria set. Duplicates were eliminated. The titles were read, and unrelated articles were excluded. The abstracts of the remaining articles were further screened for relevance. The full text of the publications left was obtained, and those without full text were excluded.

    Quality Assessment in Included Studies

    The Scale for the Assessment of Narrative Review Articles (SANRA) [11], Assessment of Multiple Systematic Reviews (AMSTAR) [12], JBI tool for Case Reposts [13], New Castle Ottawa [14], and Risk of Bias 2 [15] in the Cochrane Risk Assessment Tool (RoB 2) were used to identify the eligible articles based on the kind of study for each publication. Two co-authors (NJ and NV) assessed the eligibility of the articles.

    Results

    Search Results

    Five databases (PubMed, PubMed Central, Medline, Cochrane Library, and ScienceDirect) were used to identify publications included in the review. Figure 1 is a PRISMA 2020 flow diagram showing how related studies included in the review were identified [10].

    Efficacy, Safety, and Regulation of Cannabidiol on Chronic Pain: A Systematic Review
    Figure
    1:
    PRISMA 2020 flow diagram for new systematic reviews

    From: Page et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71 [10]

    Using MeSH and keywords like cannabidiol, CBD, hemp, and chronic pain, 2298 publications were obtained. PubMed, PMC, and Medline have 289 publications. The Cochrane Library and Science Direct listed 73 and 1936 publications, respectively. A preliminary screening was done. Upon checking for duplicates, 22 publications were excluded. Filters were applied using the exclusion and inclusion criteria to exclude 1704 publications. Other reasons include manual screening and protocol articles that eliminated 523 publications. Abstracts were screened, and 25 publications out of 49 were excluded. Fifteen full papers were retrieved, while nine were not. Two do not have full texts, and one is an animal study, hence excluded. The remaining publications were assessed for eligibility using the appropriate assessment tool. A total of 12 studies were found eligible for this review.

    Results of Quality Appraisal

    A summary of the studies and the quality appraisal tool used for each one is shown in Table 1.

    Kind of study Quality assessment tool Number of articles
    Review  SANRA 5
    Systematic review AMSTAR 3
    Case report JBI tool 1
    Observational New Castle Ottawa 2
    Randomized controlled trial Cochrane Bias Assessment tool (RoB 2) 1
    Table
    1: Overview of the publications and the corresponding quality assessment tool

    SANRA: Scale for the Assessment of Narrative Review Articles, AMSTAR: Assessment of Multiple Systematic Reviews, JBI: Joanna Briggs Institute, RoB: Risk of Bias

    The study must get a 70{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to be eligible for this review. Detailed quality appraisals with the corresponding tools used for each study are shown below. Table 2 shows the use of SANRA for five review articles.

    Publication Boyagi et al. [8] Mauer et al. [5] VanDolah et al. [3] Mücke et al. [16] Fisher et al. [17]
    Justification of the article’s importance in the readership 2 2 2 2 2
    Statement of concrete aims or formulation of questions 1 1 1 2 1
    Description of the literature search 2 2 2 2 2
    Referencing 2 2 2 2 2
    Scientific reasoning 2 2 2 2 2
    Appropriate presentation of data 1 2 2 2 2
    Table
    2: SANRA quality assessment tool

    SANRA: Scale for Assessment of Narrative Review Articles [11]

    AMSTAR is utilized to assess the eligibility of three systematic reviews shown in Table 3.

    Publication Rabgay et al.[18] Pagano et al. [19] Scuteri et al. [20]
    Did the research questions and inclusion criteria for the review include the components of PICO? Y Y Y
    Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review, and did the report justify any significant deviations from the protocol? Unclear Unclear Unclear
    Did the review authors explain their selection of the study designs for inclusion in the review? Y Y Y
    Did the review authors use a comprehensive literature search strategy? Y Y Y
    Did the review authors perform study selection in duplicate? Y Y Y
    Did the review authors provide a list of excluded studies and justify the exclusions? Unclear Unclear Unclear
    Did the review authors describe the included studies in adequate detail? Y Y Y
    Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?  Y Y Y
    Did the review authors report on the sources of funding for the studies included in the review? Y Y Y
    Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? Unclear Y y
    Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? Y Y Y
    Table
    3: AMSTAR 2 quality assessment tool

    AMSTAR: Assessment of Multiple Systemic Reviews [12]

    Table 4 illustrates JBI as a quality assessment tool for case reports.

    Publication Diaz et.al. [21]
    Demographic characteristics Y
    History and timeline Y
    Presentation of clinical condition Y
    Diagnostic test and results Y
    Intervention and treatment Y
    Post-intervention clinical condition Y
    Adverse events N
    Take-away lessons Y
    Table
    4: JBI quality assessment tool for case report

    JBI: Joanna Briggs Institute [13]

    New Castle Ottawa Tool is used to evaluate the eligibility of two observational studies in Table 5.

    Publication Capano et.al. [7] Boehnke et.al. [6]
    Representativeness of the exposed cohort * *
    Selection of the non-exposed cohort    
    Ascertainment of exposure * *
    Demonstration that outcome of interest was not present at start of study * *
    Comparability of cohorts on the basis of the design or analysis * *
    Assessment of outcome * *
    Adequacy of follow up of cohorts * *
    Table
    5: New Castle Ottawa quality assessment tool for observational studies [14]

    *Indicates a yes as the answer

    The RoB 2 tool is a revised Cochrane RoB employed for RCT assessment as shown in Table 6.

    Publication Lichtman et al. [22]
    Randomization process Low
    Deviations from the intended interventions (effect of assignment to intervention) Low
    Missing outcome data Low
    Measurement of the outcome Low
    Selection of the reported result Low
    Overall risk of bias  Low
    Table
    6: RoB 2 quality assessment tool for RCT

    RoB: risk of bias [15]; RCT: randomized clinical trial

    Data Extraction

    A total of 12 publications were found eligible for this systematic review. Each article included in this review was read and scrutinized. Relevant information was summarized in Table 7 to show an overview of each study collected from the databases.

    Author and year of publication Purpose of the study Number of patients/studies Type of study Main findings
    Boyaji et al. [8] To find an alternative treatment that is safer and more effective than opioids to combat chronic pain challenges. 7 studies Review Cannabidiol is a promising alternative to manage pain but hard to make recommendations due to the difficulty of attributing the therapeutic properties to CBD alone.
    Fischer et al. [17] To identify new scientific advances to make an updated ‘Lower Risk Cannabis Use Guideline’ (LRCUG).  Not specified Review The high-risk group (early adolescent, patient with comorbidity, and pregnant or breastfeeding women) can have a harmful outcome from CBD use; hence, lowering the risk factor can also lessen the adverse outcome.
    Mauer et al. [5] To know the safety, efficacy, and adverse effect of cannabis-based products on athletes. 2224 patients Review Recommendations from physicians are promising but hard to do since studies available are from non-athletic subjects.
    VanDolah et al. [3] To identify a non-intoxicating alternative to opioids in chronic pain management. 102 studies Review CBD and hemp oil have a positive potential benefit in managing chronic pain, and more research is required.
    Mücke et al. [16] To compare if cannabis-based medication versus placebo or conventional drugs are safe, efficient, and tolerable. 16 studies, 1750 patients Review Some patients with neuropathic pain may benefit from cannabis-based medicine (3rd or 4th line therapy), and no high-quality evidence to show how efficacious cannabis-based drugs are.
    Pagano et al. [19] To evaluate the safety level, dosing, and timing of CBD on healthy cells. 29 studies Systemic review Dose-dependent inhibition of cell viability above two micrograms while apoptosis is observed in 10 micrograms CBD. Anti-inflammatory effects and decreased ROS production were also noted.
    Rabgay et al. [18] To determine the role of the route of administration of cannabis and cannabinoids on pain and its side effects. 25 studies, 2270 patient Systemic review Among different routes of administration of THC/CBD, the Oro-mucosal route was dominant in controlling pain from different causes like cancer, neuropathic, and nociceptive pain.
    Scuteri et al. [20] To know the efficacy of cannabinoid-based products in ocular pain regimens. 4 studies Systemic review Preclinical studies are needed to establish the efficacy of CBD in ocular inflammation and neuropathic pain, although analgesia is observed using CBD oil. It is noted that the is analgesia as well on the topical formulation.
    Diaz et al. [21] To describe a patient with chronic pressure injury treated with medical cannabis oil (THC and CBD) for pain relief and sleep improvement. 1 patient Case report Medical Cannabis oil containing THC and CBD taken orally improves pain and sleep with direct or indirect effect on wound healing.
    Boehnke et al. [6] To describe naturalistic cannabis use routine and its benefits. 1087 patients Observational (cross-sectional) The risk and benefits of medical cannabis can be further observed when administration route profiles are used to make subgroups.
    Capano et al. [7] To determine the effect of CBD (full hemp extract) on chronic pain regarding the quality of life and opioid use. 131 patients Observational (prospective cohort) CBD improves pain, quality of life and sleep quality and decreases opioid use in patients who have chronic pain on narcotics.
    Lichtman et al. [22] To assess the use of nabiximols as an adjunct to opioids in advanced cancer patients with poorly controlled pain. 397 patients RCT Advanced cancer patients on lower opioid therapy with early intolerance to opioid may benefit more from CBD as adjunct medication, although CBD is not superior to placebo on primary efficacy.
    Table
    7: Summary table for the included Studies

    CBD: cannabidiol; ROS: reactive oxygen species; THC: tetrahydrocannabinol; RCT: randomized clinical trial

    Discussion

    CBD is a fast-growing business following its federal legalization in 2018. With this, more people have gained access to CBD, especially those with chronic pain on pain medications, and have experienced promising outcomes. Hence, more research and studies are being done to give patients with chronic pain an efficacious and safe alternative to the existing kinds of pain medication available on the market.

    Cannabidiol versus Tetrahydrocannabinol

    The Cannabis sativa plant has many strains, but the more popular ones are marijuana and hemp. Phytocannabinoids can be extracted from the cannabis plant, and this active chemical, when combined with the receptor, affects the functioning of the body in many ways. THC and CBD are famous examples of these phytocannabinoids obtained from marijuana and hemp, respectively. THC attaches to cannabinoid receptor 1 (CB1) while CBD attaches to several receptors like CB receptors, transient receptor potential vanilloid 1, G protein-coupled receptor 55, and serotonin 5-HT1A [3]. CBD and THC have the same molecular formula, C21H30O2, and an almost identical molecular mass of 314.464 g/mol and 314.469 g/mol, respectively [23]. Figure 2 illustrates the structural formulas of CBD and THC, highlighting a vital difference between the two: a cyclic ring for THC and a hydroxyl group for CBD.

    Chemical-structure-of-tetrahydrocannabinol-and-cannabidiol
    Figure
    2:
    Chemical structure of tetrahydrocannabinol and cannabidiol

    Source: Analytical Cannabis: CBD vs THC – What are the Main Difference? with permission [23]

    This difference makes THC a potential partial agonist to the CB1 receptor and CBD a negative allosteric modulator, on the other hand [23]. The stimulation of CB1 receptors produces the psychotropic effects experienced with THC consumption but is not evident in CBD use. Metabolism is by the cytochrome P450 superfamily; hence many drug interactions are possible.

    In a review done by VanDolah et al., more studies focused on the benefits of prescribed THC drugs; on the other hand, four studies were linked to CBD’s potential therapeutic actions, safety, and adverse effects [3]. Some of the potential therapeutic actions of CBD include relief of chronic pain, sleep disorders, spasticity and Tourette syndrome, nausea and vomiting in chemotherapy, and weight gain in HIV patients, to name a few. Its adverse effects include liver toxicity, somnolence, decreased appetite, diarrhea, and low blood pressure [3]. In addition, Scuteri et al., a systematic review of four studies, revealed that CB2 agonist HU308 alleviates inflammation in the eyes by reducing uveitis-induced leukocyte adhesion and lipidome profile changes [20]. It also highlights the antinociceptive and anti-inflammatory effects of D8-THC, cannabidiol, derivative HU308, and the new racemic CB1 allosteric ligand [20]. Another study with 2224 patients by Maurer et al. revealed that the patients’ post-injury three and four-week use of cannabis after concussions resulted in a lower severity score but not faster recovery from concussion symptoms [5]. The case report of Diaz et al. on a patient with pressure injury exhibiting pain and sleep problems was given with three different medical cannabis oils (1 CBD-dominant and 2 THC-dominant) in increasing doses and revealed an improvement in sleep quality with a decrease in pain and anxiety [21]. An incidental wound improvement was noticed starting at two weeks post-treatment [21]. These studies highlighted different benefits of CBD on different areas of the body, making the potential value of the CBD product even greater. The studies complement each other in strengthening the value of CBD medically when used on different body parts.

    Regulation on Cannabis

    In the 2014 Agricultural Act, hemp and marijuana differences are notable, defining the legality of “industrial hemp” (Cannabis sativa L.) and any parts of the plant (with THC content <0.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} dry weight) for research purposes [3]. The use of medical cannabis is permitted in 37 states, four territories, and the District of Columbia and is prohibited in three states and one territory [24]. Figure 3 shows a clear picture of the regulation of cannabis per state in the United States.

    Cannabis-regulation-per-U.S.-states-and-territories
    Figure
    3:
    Cannabis regulation per U.S. states and territories

    Source: National Conference of State Legislatures with permission [24]

    With more states opening their doors to the medical benefit of CBD, the issue of obtaining good quality CBD poses a risk for those who want to use it as an alternative to their current pain medications [25]. There is a high price tag on good quality CBD available, and affordable CBD products are not 100{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} reliable due to some manufacturers’ mislabeling issues about their exact content. In addition, the FDA still cannot impose strict regulations because CBD is not considered a pharmaceutical agent anymore [9].

    Efficacy and Safety of CBD

    In comparison to THC, CBD is a relatively new drug, and studies are limited to establishing its safety and efficacy. Moreover, the regulations surrounding the use of CBD are still highly debatable. In a systematic review of 229 studies done by Pagano et al., the effects of CBD on healthy cell characteristics such as cell viability, cell proliferation, wound repopulation, apoptosis, and cell cycle were tackled [19]. Dose-dependent administration showed a significant reduction of cell viability (above 2 mM); oral cells are inhibited at 10 mM, while cell proliferation inhibition is evident in all doses used (2, 6, and 10 mM). Cell migration decreased after giving 10 mM for 24 hours [19]. However, there was no significant change at 6 mM. Lastly, an increase in apoptosis is observed at 10 mM [19]. These observations show that a variable amount of CBD exerts different effects on a healthy cell. The dosage mainly dictates the extent of the results. It can be noted that a higher dose means more inhibition of cell processes but more stimulation of apoptosis.

    Furthermore, Rabgay et al. conducted a systematic review of 25 studies with 2270 patients regarding the different dosages and routes of administration for CBD [18]. They found out that cannabis and cannabinoids act on different types of pain depending on the dosage and route of administration. A low dose for pain relief was used for all studies reviewed and exhibited an average dose of 19.82 mg/day [18]. Furthermore, they discovered that the difference in the dosage administered elicited relief in different pain types, such as neuropathic pain, which is 23.56 mg/day, cancer pain, which is 19.69 mg/day, and nociceptive pain, which is 13.75 mg/day [18]. In addition, different routes of administration showed other forms of pain relief. The oromucosal route is THC/CBD and THC for neuropathic and cancer pain; the oral route is THC for cancer pain; and the inhalation of standardized cannabis with THC (SCT) for neuropathic and oral standardized cannabis extract with THC (SCET) for nociceptive pain [18]. Rabgay et al. concluded that there is no sufficient evidence to fully establish CBD’s efficacy on pain. In a review done by Boyaji et al. on seven studies using nabiximols (CBD+THC) spray as a medication for pain, four RCT studies concluded a positive effect on their pain while on nabiximols spray compared to placebo [8]. While Rabgay concluded that the evidence is insufficient to determine CBD’s efficacy in pain, Boyaji found it challenging to recommend CBD’s use in chronic pain. Access to pure CBD alone is the main reason for these conclusions.

    Some studies showed promising evidence to support the safety of CBD. A review of 16 RCTs conducted by Mücke et al. in 1750 adult participants with neuropathic pain showed that cannabis-based medicine might help achieve >50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} pain relief (primary outcome) compared with placebo [16]. It also increases nervous system adverse reactions, including psychiatric disorders, in 17{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of participants [16]. In addition, Fisher et al., in their review, made a recommendation to delay the use of cannabis until adolescence, avoid highly potent and widespread use, and prevent smoking cannabis from reducing its adverse effects like cardiovascular, physical, neurocognitive, psychosis, and mental problems [17]. In comparison, it can be deduced that proper dosage and route of administration are essential to gain the maximum effect from CBD use. CBD for pain relief still has a long way to be fully established, but the majority of studies possess promising outcomes. Therefore, formulation of the safety standard used for CBD could be a possibility soon if the growing evidence from more studies points to the efficiency and safety of CBD. Weighing the benefit versus the risk, backed by evidence, is a crucial step. The outcome of each study mentioned above can set a new playing field for pharmaceutical companies for drug development to explore and investigate using clinical trials in a large sample population.

    Chronic pain is persistent pain for more than or equal to three months in duration. It has been a complex issue, especially with its variable causes, the complexity of the associated symptoms, and opioid dependence [26]. Scientists and researchers are looking for alternative means to address chronic pain using more substantial evidence from clinical trials and observational studies. In an RCT done by Lichtman et al., nabiximols (THC+CBD) oromucosal spray was used as an adjunct treatment in 291 patients with advanced cancer and chronic pain on opioids [22]. The primary endpoint is the improvement of the average pain Numerical Rating Score (NRS) from baseline. NRS is calculated as the median difference between groups, which showed a positive value of 3.41{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI: 0.00{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}-8.16{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}; p=0.0854) in favor of the nabiximols group. No statistical significance was noted in the primary outcome [22]. However, there is improvement in other aspects such as Subject Global Impression of Change (SGIC), Physician Global Impression of Change (PGIC), and Patient Satisfactory Questionnaire (PSQ) from nabiximols compared to the placebo group [22]. Clinical improvement was noticed in the nabiximols group, though not statistically significant.

    On the other hand, Capano et al. did a prospective cohort study (with 97 participants) about the effect of CBD hemp extract on patients with chronic pain taking opioid medication [7]. The primary outcome showed that at week 8, 50 out of 94 (53.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) had decreased their opioid medications [7]. The secondary outcome reported that 89 (94{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) improved quality of life as measured by pain and sleep-related open-ended questions. In a similar cross-sectional survey with 1087 patients, Boehnke et al. determined the relationship between the route of administration, CBD content, and timing of use in managing chronic pain [6]. It was noted that the younger population uses inhalation while older people prefer the non-inhalational route. The mixed (inhalation + non-inhalation) route is preferred (45{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of respondents), and this is attributed to the tailored pain relief experienced [6]. The content of CBD and timing of use showed that CBD with sedation effects (Indicas) is usually taken at night. Boehnke et al. reiterated in this study that subgroups in the sample population are essential in analyzing the results of CBD use [6]. These two observational studies mentioned above hold decent evidence of the positive effect of CBD on chronic pain, like reduced opioid intake and improved sleep. However, there is a challenge for patients to report the actual outcome observed because health insurance covers opioid medication but not CBD. Therefore, there is fear on the patients’ part about CBD’s availability after research and the financial cost they would have.

    Management of chronic pain poses many challenges. With the crisis of opioid use and dependence, medical providers and the government need to work hand in hand to urgently find alternatives to the treatment of chronic pain, whatever the reason may be [27]. More studies and research are rolling in to provide evidence-based solutions to the current crisis. However, more minor studies are focused on using pure CBD products, which are nonintoxicating. As this systematic review proceeded, challenges and questions about CBD use in chronic pain were revealed. More published reviews and studies show promising results for the effect of CBD on pain relief, yet there is difficulty in making any recommendations. Regulations and categories of CBD need to be updated to make clinical trials easier. When evidence of CBD’s pain relief is fully recognized, guidelines need to be applied to the health insurance business to lessen its financial burden on the patient. An opioid is covered by most insurance, while CBD is not. In addition, good-quality and affordable CBD products should be available once everything is in place.

    Limitations

    A systematic review of the efficacy and safety of pure CBD products was initially planned, but there are limited studies and articles available. Clinical trials on CBD are also scarce because it is relatively new and obtaining a good quality product is still a problem. In addition, it was difficult to find studies that focused on CBD alone since THC is often mixed with it. Access to free full-text papers is constrained as some good-titled articles need payment to gain access. The language of the publication is also limited to English. Although the business of medical marijuana and CBD dispensaries is old, most countries worldwide are still regulating it to make it legal. Hence, there is a limitation in conducting studies on CBD products.

  • Cannabis for chronic pain relief: How effective is it?

    Cannabis for chronic pain relief: How effective is it?

    • Hashish can at times be used as a system of persistent soreness relief, but there is a ton about cannabis’ well being gains and related dangers that scientists even now don’t comprehend.
    • New research located that some hashish merchandise made up of THC and CBD factors might support with the small-phrase advancement of persistent soreness.
    • The conclusions also advise a danger of sedation and dizziness involved with use, and there desires to be additional information on the very long-term influence.

    Lots of persons encounter long-term discomfort or pain that lasts for an prolonged period of time. Professionals are continually looking into new methods of suffering reduction and new medicine alternatives. One spot of fascination is the use of cannabis items as a strategy of suffering reduction.

    A current systematic evaluation published in the Annals of Interior Drugs located that hashish products and solutions could possibly help take care of chronic agony in the short phrase. Even so, professional medical pros need to have to weigh this against the potential disadvantages of enhanced dizziness and sedation. It is also unclear whether or not these merchandise are valuable in the extended time period.

    Persistent suffering lasts for months or extended, and tens of millions of adults in the U.S. working experience serious pain. For the reason that quite a few men and women practical experience long-term ache, gurus are constantly operating to assess prospective treatments and therapies. As experts continue to study the medicinal employs of cannabis, one particular space of fascination is how doctors could use it to treat chronic suffering.

    Cannabis is a plant, and individuals can use distinctive plant portions to produce several merchandise. The two major compounds of cannabis are cannabidiol (CBD) and tetrahydrocannabinol (THC).

    Some goods have both of those THC and CBD. The CBD part does not result in brain-altering results, whilst the THC portion causes the high persons to expertise when they use cannabis. Some of these related merchandise are obtainable in the U.S., although some are not. Presently, the Meals and Drug Administration has approved utilizing two medicines that comprise THC: Marinol and Syndros.

    This systematic overview sought “To assess the gains and harms of cannabinoids for continual pain.” The phrase Cannabinoids refers to compounds that incorporate equally THC and CBD.

    Researchers utilized quite a few databases to accumulate the experiments they reviewed. They integrated studies published in English that resolved the use of hashish products and solutions as a procedure for persistent soreness. Especially, the examine involved a abide by-up or treatment time of 4 months or far more. The examination integrated placebo-controlled randomized controlled trials and cohort scientific studies in which the use of cannabis had a concurrent regulate team.

    They incorporated a whole of 25 experiments in their investigation. Researchers examined the merchandise used in the scientific studies and looked at the THC-to-CBD ratio. Did the products comprise a significant THC amount of money and a low CBD amount, was the total about equivalent or did the solution have a low THC amount and a significant CBD quantity?

    The benefits of the review had been rather missing. The data was inadequate for some products and solutions to ascertain if they successfully handled continual soreness. Nonetheless, researchers did discover some results that supported the efficiency of hashish goods:

    • Synthetic oral products and solutions with a superior THC-to-CBD ratio could lead to short-term chronic suffering relief.
    • Sublingual extracted cannabis products with nearly equal THC-to-CBD proportions could possibly be connected with short-term enhancements in chronic ache.

    Nonetheless, they located that individuals who use these items may possibly also encounter an increased hazard for dizziness and sedation, which physicians will will need to weigh towards the likely positive aspects. Total, they also discovered that authorities require to conduct much more experiments about the very long-time period outcomes of cannabis use.

    Study author Marian S. McDonagh located the absence of info stunning. She described:

    “With so substantially excitement all around hashish-associated items, and the uncomplicated availability of leisure and medical marijuana in several states, buyers and sufferers may well think there would be more proof about the benefits and side results. Regrettably, there is really little scientifically valid analysis into most these items.”

    Professor Winston Morgan, pharmacology and toxicology specialist with the University of East London, not associated with the research, mentioned the next to Healthcare Information Right now:

    “For any new mediation it need to improve on recent treatments in phrases of each efficacy and basic safety. For decades cannabinoids have promised but never ever really deliver. This evaluation which requires an attention-grabbing solution on the advantages and harms of cannabinoids for continual agony, advise that only average added benefits can be attained with merchandise with higher THC ratios, but these are far more probable to result in adverse effects. Regrettably these adverse outcomes may well also restrict extended phrase use.”

    This systematic critique yielded some beneficial information. Even so, it also experienced quite a few limitations. Initial of all, researchers built particular selections throughout the review process that may perhaps have impacted the evaluate benefits, these kinds of as how sure cannabis merchandise ended up classified. The procedures of examining the details do have a danger of imprecision.

    They have been also unable to assess publication bias on quite a few results owing to out there information and did not contain studies that weren’t prepared in English. Last but not least, different reports utilized distinctive interventions, and some scientific tests lacked particulars. For some merchandise, there was basically insufficient proof.

    Scientists of the systematic overview approach to update the overview quarterly so that they can insert new proof as it emerges. In general, this paper demonstrates some of the recent understandings of cannabis and the need to have for even further analysis. Physicians can take a look at evaluations like this a single to assist guideline their clients in the remedy of chronic agony.

    Analyze author Devan Kansagara, MD, M.C.R defined:

    “This new dwelling proof assessment is just the sort of resource clinicians need to explain for people the
    locations of likely guarantee, the cannabis formulations that have been analyzed and, importantly, the
    major gaps in know-how.”

  • Medical Marijuana: CBD, THC Content Matters for Chronic Pain

    Medical Marijuana: CBD, THC Content Matters for Chronic Pain

    Distinct cannabinoid mixes could be tied to various degrees of soreness aid and aspect effects professional by end users of cannabis, a systematic overview found.

    Some items may perhaps be better suited than others for brief-expression enhancement in serious suffering relying on their formulation and proportion of THC to CBD, the two major cannabinoids in marijuana:

    • Synthetic items with high THC (>98{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) and very little or no CBD: moderate advancement in agony, but an elevated possibility of sedation and a probable uptick in dizziness
    • Extracted products with vast majority THC (THC:CBD ratio ranging from 3:1 to 47:1): no substantial enhancement in discomfort, but a big greater possibility of review withdrawal thanks to adverse events and dizziness
    • Sublingual sprays with equivalent THC and CBD amounts: modest advancement in agony but a significantly larger elevated risk of dizziness and sedation and a reasonable enhance in nausea

    “The strongest evidence to day is for artificial merchandise with high THC-to-CBD ratios and extracted solutions with equivalent THC-to-CBD ratios, each of which resulted in advancements in suffering severity,” according to research investigators led by Marian McDonagh, PharmD, of Oregon Health and fitness & Science University in Portland.

    Proof on other hashish solutions was inadequate or lacking, the authors claimed in the Annals of Internal Medication.

    McDonagh’s group expressed the have to have for much more cannabis analysis at a time when roughly 100 million Us citizens suffer from continual agony (outlined as pain lasting for a longer period than 3 to 6 months) that can be damaging to individual physical and mental health and fitness, as effectively as general excellent of life.

    The opioid disaster continues to grow. In 2021, there were being 75,673 fatalities similar to opioids, up from 56,064 in 2020. Industry experts have projected much more than 1.2 million opioid-related deaths in the future 10 yrs, and strongly recommended research into option treatments for long-term pain. The appeal of cannabis-dependent goods is their opportunity to deliver such possibilities.

    Even when health-related hashish is starting to be extra accessible, regulations continue to impede good study on cannabinoids. Healthcare cannabis is lawful to many (and conflicting) degrees in 37 states and the District of Columbia, but stays a Program I substance federally.

    “Offered the slow speed of clinical trials, we think it probably that McDonagh and colleagues’ conclusions will be the best offered evidence for some time. Even though we await improved proof, we believe that that clinicians ought to satisfy people with chronic soreness ‘where they are,’” in accordance to Kevin Boehnke, PhD, and Daniel Clauw, MD, of College of Michigan Health-related College in Ann Arbor.

    “Standard analgesic medicines are efficient only in a subset of persons, so it is no speculate that numerous clients are drawn to broadly available hashish products. Clinicians can compassionately witness, report, and give direction to support people with persistent ache use hashish correctly,” the pair wrote in a corresponding editorial.

    McDonagh’s staff performed a systematic assessment utilizing seven cohort studies and 18 randomized placebo-controlled trials, which bundled just about 15,000 sufferers with mostly neuropathic agony. They famous that they had to count on experiments with major methodological constraints and merchandise heterogeneities, and inadequate reporting of selected essential adverse celebration results (i.e., psychosis, hashish use disorder, and cognitive deficits).

    “These limits are nicely documented in the cannabinoid and serious discomfort literature and are thanks in portion to ‘War on Drugs’ guidelines that have overwhelmingly favored studying cannabis-related harms over therapeutic outcomes,” Boehnke and Clauw wrote. “Sad to say, this usually means that this effectively-executed evaluation observed limited generalizable evidence to tell prolonged-phrase use of out there cannabis products and solutions for long-term agony, which is the most frequent reason for clinical cannabis licensure in the United States.”

    Long run scientific tests are desired to evaluate very long-term outcomes of hashish use and more probe products formulation effects, McDonagh’s crew mentioned.

    • author['full_name']

      James Lopilato is a staff author for Medpage These days. He handles a wide range of matters being explored in present health care science study.

    Disclosures

    The study was funded by the Agency for Health care Investigate and High-quality.

    McDonagh experienced no disclosures.

    Boehnke described institutional grants from the NIH and Tryp Therapeutics, as well as private fees from the Healthcare Hashish Exploration Advocacy Alliance, Michigan Middle of Scientific Methods Enhancement, College of Michigan Retirees Association, and Providence Holy Cross Clinical Center.

    Clauw disclosed post support from the Care Innovation and Neighborhood Improvement Program of Ohio Office of Medicaid consulting fees from Pfizer, Cerephex, Tonix, Abbott, Aptinyx, Daiichi Sankyo, Samumed, Zynerba, Astellas Pharma, Williams & Connolly LLP, Intec Pharma, and Theravance and research assist from Pfizer, Aptinyx, and Cerephex.