Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
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The adequate cotreatment of chronic pain and addiction disorders is a complex and challenging problem for health care professionals. There is great potential for cannabinoids in the treatment of pain; however, the increasing prevalence of recreational cannabis use has led to a considerable increase in the number of people seeking treatment for cannabis use disorders. Evidence that cannabis abuse liability is higher than previously thought suggests that individuals with a history of substance abuse may be at an increased risk after taking cannabinoids, even for medicinal purposes. ⋯ Thus, there is a need for pharmaceutical-grade products of known purity and concentration using delivery systems optimized for safety. Another factor that needs to be considered when assessing the practicality of prescribing medicinal cannabinoids is the difficulty in differentiating illicit from prescribed cannabinoids in urine drug testing. Overall, a thorough assessment of the risk/benefit profile of cannabinoids as they relate to a patient's substance abuse history is suggested.
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Over the past five years, there has been a considerable increase in clinical research on cannabinoid use for a range of pain syndromes. Cannabinoid products are becoming available for research and clinical use, and pharmaceutical industry interest in the potential for cannabinoids in therapeutics is also gaining momentum. The present article summarizes recent clinical trial data in the field of pain management and suggests that the potential for cannabinoid therapy for chronic pain states is encouraging. Clinicians working in pain management should be aware of the options becoming available from the cannabinoid class of medications.
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Methadone, although having been available for approximately half a century, is now receiving increasing attention in the management of chronic pain. This is due to recent research showing that methadone exhibits at least three different mechanisms of action including potent opioid agonism, N-methyl-D-aspartate antagonism and monoaminergic effects. ⋯ The disadvantages of significant interindividual variation in pharmacokinetics, graduated dose equivalency ratios based on prerotation opioid dose when switching from another opioid, and the requirement for special exemption for prescribing methadone make it more complicated to use. The present review is intended to educate physicians interested in adding methadone to their armamentarium for assisting patients with moderate to severe pain.
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The present article reviews the main toxic effects of cannabis and cannabinoids in animals. Toxic effects can be separated into acute and chronic classifications. ⋯ Chronic toxicity involves lesions of airway and lung tissues, as well as problems of neurotoxicity, tolerance and dependence, and dysregulations in the immune and hormonal systems. Animal toxicity data, however, are difficult to extrapolate to humans.
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Review Meta Analysis
Treatment of whiplash-associated disorders--part I: Non-invasive interventions.
A whiplash-associated disorder (WAD) is an injury due to an acceleration-deceleration mechanism at the neck. WAD represents a very common and costly condition, both economically and socially. In 1995, the Quebec Task Force published a report that contained evidence-based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus-based recommendations. ⋯ There exists consistent evidence (published in two RCTs) in support of mobilization as an effective noninvasive intervention for acute WAD. Two RCTs also reported consistent evidence that exercise alone does not improve range of motion in patients with acute WAD. One RCT reported improvements in pain and range of motion in patients with WAD of undefined duration who underwent pulsed electromagnetic field treatment. Conflicting evidence in two RCTs exists regarding the effectiveness of multimodal intervention with exercise. Limited evidence, in the form of three non-RCTs, exists in support of chiropractic manipulation. Future research should be directed toward clarifying the role of exercise and manipulation in the treatment of WAD, and supporting or refuting the benefit of pulsed electromagnetic field treatment. Mobilization is recommended for the treatment of pain and compromised cervical range of motion in the acute WAD patient.