Cannabinoids and their effects on pain physiology
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Analgesic efficacy of cannabinoids.
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Cannabinoids and their effects on pain physiology
- 1. Cannabinoids and their effects on pain physiology Peter Kamerman Brain Function Research Group, School of Physiology, University of the Witwatersrand PainSA Congress 2021 Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
- 4. CB receptor affinity CB1 CB2 D9-tetrahydrocannabinol (THC) 2-arachidonoyl glycerol (2-AG) Anandamide (AEA) Cannabidiol (CBD)
- 5. Pain: Supra-spinal distribution of CB receptors RVM PAG Amygdala PFC Thalamus CB1 (neuronal) CB2 (microglia) Finn et al. PAIN 162 (supplement 1): S5-S25, 2021. DOI: 10.1097/j.pain.0000000000002268
- 6. Pain: Spinal and peripheral distribution of CB receptors Peripheral nerve endings DRG Dorsal horn CB1 (neuronal) CB2 (microglia) CB2 (neuronal) Finn et al. PAIN 162 (supplement 1): S5-S25, 2021. DOI: 10.1097/j.pain.0000000000002268
- 8. Fisher et al. PAIN 162 (supplement 1): S45-S66, 2021. DOI: 10.1097/j.pain.0000000000001929 Evidence from clinical studies Effect size (Hedge’s g standardised mean differences) Proportion of placebo group with ≥30% pain reduction Proportion of cannabinoid group with ≥30% pain reduction Sample size
- 9. Presidential Task Force on Cannabis and Cannabinoid Analgesia PAIN 162 (supplement 1): S1-S2, 2021. DOI: 10.1097/j.pain.0000000000002265
- 10. Soliman et al. PAIN 162 (supplement 1): S26-S44, 2021. DOI: 10.1097/j.pain.0000000000002269 Evidence from animal studies Effect size (Hedge’s g standardised mean differences) Mean = 1.32
- 11. Presidential Task Force on Cannabis and Cannabinoid Analgesia PAIN 162 (supplement 1): S1-S2, 2021. DOI: 10.1097/j.pain.0000000000002265
- 12. Data from animal experiments
- 13. Maldonado et al. PAIN 157 (supplement 1): S23-S32, 2016. DOI: 10.1097/j.pain.0000000000000428 Summary: Data from animal experiments
- 14. Data from human experiments
- 15. Cencioni et al. PLoS 5: e8688, 2010. DOI: 10.1371/journal.pone.0008688 Peripheral: Inhibition of inflammation INF-gamma TNF-alpha
- 16. Weizman et al. Neurology 91: e1285-e1294, 2018. DOI: 10.1212/WNL.0000000000006293 Supraspinal: Reduced brain region connectivity 15 men, chronic radicular neuropathic pain N = 9 N = 6
- 17. Weizman et al. Neurology 91: e1285-e1294, 2018. DOI: 10.1212/WNL.0000000000006293 Supraspinal: Reduced brain region connectivity Error bars = standard errors of the mean
- 18. Weizman et al. Neurology 91: e1285-e1294, 2018. DOI: 10.1212/WNL.0000000000006293 Supraspinal: Reduced brain region connectivity Connectivity between anterior cingulate cortex and secondary somatosensory cortex
- 19. Lee et al. PAIN 154: 124–134, 2013. DOI: 10.1016/j.pain.2012.09.017 Supraspinal: Reduced pain unpleasantness THC Sensitised Placebo Sensitised THC No sensitisation Placebo No sensitisation Capsaicin (1% cream) Control (placebo cream) Randomised order Agent State 15 healthy men
- 20. Lee et al. PAIN 154: 124–134, 2013. DOI: 10.1016/j.pain.2012.09.017 Supraspinal: Reduced pain unpleasantness Error bars = standard errors of the mean THC Placebo
- 21. Lee et al. PAIN 154: 124–134, 2013. DOI: 10.1016/j.pain.2012.09.017 Supraspinal: Reduced pain unpleasantness Error bars = standard errors of the mean
- 22. Lee et al. PAIN 154: 124–134, 2013. DOI: 10.1016/j.pain.2012.09.017 Supraspinal: Reduced pain unpleasantness
- 23. Opioid placebo analgesia Benedetti et al. Nature Medicine 17:1228-1230, 2011. DOI: 10.1038/nm.2435 Day 1 (torniquet) No intervention No intervention Day 2 (torniquet) Morphine Morphine Day 3 (torniquet) Morphine Morphine Day 4 (torniquet) Placebo Placebo + Rimonabant (CBR inhibitor) Analgesic response to morphine Analgesic response to placebo
- 24. Opioid placebo analgesia Benedetti et al. Nature Medicine 17:1228-1230, 2011. DOI: 10.1038/nm.2435
- 25. Non-opioid placebo analgesia Benedetti et al. Nature Medicine 17:1228-1230, 2011. DOI: 10.1038/nm.2435 Day 1 (torniquet) No intervention No intervention Day 2 (torniquet) Ketorolac Ketorolac Day 3 (torniquet) Ketorolac Ketorolac Day 4 (torniquet) Placebo Placebo + Rimonabant (CBR inhibitor) Analgesic response to ketorolac Analgesic response to placebo
- 26. Non-opioid placebo analgesia Benedetti et al. Nature Medicine 17:1228-1230, 2011. DOI: 10.1038/nm.2435
- 27. Conclusion • Clinical evidence is weak • Animal data indicates functional relationship • Human experimental data for a weak effect