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Lock him up!
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  # 2161776 15-Jan-2019 21:26
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Just like those convinced that cannabis must be bad, so they go looking for evidence to confirm that.

 

 





I don't think there is ever a bad time to talk about how absurd war is, how old men make decisions and young people die. - George Clooney
 


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  # 2161778 15-Jan-2019 21:34
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nakedmolerat:

Personal experience means nothing.

 

Let's hear you say that after 28 years of chronic pain.  You're barking up the wrong tree if you think I treat life any other way than logically.  

 

 


 
 
 
 


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  # 2161782 15-Jan-2019 21:41
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Rikkitic:

The above documentation/studies are one-sided and can be countered by other evidence. However, it is a lot to go through and I can't do that right now. I will try to give it a proper going over in the coming days.


In the meantime, it is worth noting that this data only deals with the effectiveness of pain relief. Even if cannabis is not a good for that, which is questionable in view of the considerable evidence to the contrary, many people who use it do so to combat nausea and lack of appetite from treatments like chemotherapy. These benefits alone justify the use of cannabis or any other substance to relieve suffering.


 



There is evidence for anti emetics - just like metoclopramide, domperidone, ondansetron, cyclizine, perchlorperazine etc. Nothing special about it. Just pick one.

I specifically respond to the op with regards to "pain" control.





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  # 2161851 16-Jan-2019 08:14
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nakedmolerat:

 

out of 14 patients that take cannabis as pain med, only 1 will get benefit. so yeah...

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549367/

 

https://www.acfp.ca/wp-content/uploads/tools-for-practice/1510681044_tfp199mmandpainfv.pdf

 

Are medical cannabinoids (MC) effective for the treatment of pain?

 

 

Bottom Line: Evidence for inhaled marijuana for pain is too sparse and poor to provide good evidence-based guidance. Synthetic MC-derived products may modestly improve neuropathic pain for one in 11-14 users but perhaps not for other pain types. Additionally, longer and larger studies (better evidence) show no effect. Adverse events are plentiful.

 

 

The full document is available here.

 

  • Chronic pain: 39% experience pain reduction of >30% versus 30% with placebo, resulting in a number needed to treat (NNT)=11. Larger and longer RCT show no effects. The mean pain improvement is 0.5 on a 0-10 scale, which isn’t clinically meaningful.
  • Neuropathic pain: With inhaled MC, the NNT=6. With any MC, the NNT=14.
  • Cancer pain: In six randomized controlled trials, the pain reduction was not statistically significant.
  • HIV neuropathy: with smoked MC: NNT=4.
  • Pain from multiple sclerosis: Mean pain improvement over placebo was 0.8 on a 1-10 scale which was borderline insignificant.
  • Acute pain: One positive trial, one negative trial, and five trials showing MC is equivalent to placebo.
  • When compared to medication, MC was no better than amitriptyline (with more adverse events), or worse than dihydrocodeine with similar adverse events.
  • No overall differences shown in quality of life.
  • Little evidence for back pain, fibromyalgia, or osteoarthritis.

https://sciencebasedmedicine.org/medical-marijuana-where-is-the-evidence/

 

 

I'm also a a fan of “science based medicine” (and an avid reader of SBM's articles) but the linked studies, the article by Scott Gavura and it's link to David Gorski's articles basically just say “more study is recommended”  - and required - before definitive results can be proven.

I could cherry pick scientific articles all day long that do appear to point to Cannabinoids having a statistically significant effect on pain, but the takeaway is that they all include that caveat. Here's a recent (2018) article:
Cannabinoids and Pain: New Insights From Old Molecules

One of the issues with even recent studies to date, as David Gorski points out, is that in the USA: “studying the medicinal properties of marijuana and its constituents is not easy, given that it is currently an illegal drug, as was discussed in the NYT article. It’s not for lack of interest, but mainly because the law (and therefore the Drug Enforcement Agency) classifies it as a schedule 1 drug with “no currently accepted medical use.”

 

In particular he points out with studies of 'inhaled marijuana' and 'inhaled MC' (in your links) is “The active ingredient is usually a minor constituent, embedded in thousands of other constituents that make up herbs, and it’s almost impossible to control lot-to-lot consistency with respect to content or active ingredients”

That shortage of Good Science is also why the abstract of your linked 2017 PubMed Central article  "Cannabis and Pain: A Clinical Review" states: "There is a theoretical rationale for cannabis' efficacy for pain management, although the subjective pain relief from cannabis may not match objective measurements of analgesia. As more patients turn to cannabis for pain relief, there is a need for additional scientific evidence to evaluate this increase."

 

With full Legalization in Canada, restrictions on research (partly caused by the substance's illegality and consequent lack of funding, inability to register Cannabis based patents in the US) have lifted. Canadian Companies have become (perhaps temporary) world leaders in research.

It's a huge business. There's an absolute Gold Rush into Cannabis related studies and Clinical Trials by the Pharmaceutical industry.

Seven of Canada’s top 10 cannabis patent holders are major multi-national pharmaceutical companies led (in volume of Patents) by Ciba-Geigy and Pfizer.
Companies researching Cannabis products - Giants like Canopy Growth Corp, Aurora, Tilray, and GW Pharmaceuticals are worth Billions, and throwing 'Hundreds of millions' into research.

The search for novel compounds in Cannabis, the efficiacy of new combinations of known compounds -specific terpenes and cannabinoids - and in particular studies of new methods of delivery, not just for pain relief, but many other purposes, is just beginning.

In the next couple of years we'll see whether Cannabinoids are actually proven effective for the treatment of pain.

 

TL/DR: It's too early to tell if Medical Cannabis, it's extracts and active compounds will be scientifically proven as viable pain relief options.

 

 

 

 


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  # 2161855 16-Jan-2019 08:23
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Slightly off topic but a friend who has a condition I spoke around earlier has been gaining traction to go to Canada to trial some MC for a few weeks.

 

https://givealittle.co.nz/cause/help-rubys-fight-against-gastroparesis
Not looking to spread this around for the purpose of gaining donations but as a testament that MC is supported by a lot and there are people who benefit from it. Will keep people posted regarding Ruby and her developments when in Canada.




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  # 2161916 16-Jan-2019 10:48
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Pain relief has never been an issue for me and I have never delved into this, but all the anecdotal accounts have persuaded me that there must be something to it. I decided to start looking into it last night to see if there was really any evidence for or against. A quick Google search turned up several papers supporting both sides of the argument. No surprises there. I was going to go through them today but I think the above post by @sidestep already covers it quite well and I doubt there is anything I could add. Some studies indicate that cannabis does have significant pain relief qualities, especially for pain related to cancer. The main one that shows little or no pain relief from cannabis excludes those with cancer. The conclusions reached have a lot to do with the way the studies are conducted, and the methodology is not always that rigorous in many cases, partly because of the issues around illegality already cited. The studies also all seem to reply on self-reporting by cannabis users, which is hardly precise. I agree that the jury is still out and anyone who draws conclusions at this stage is being premature. 

 

Medical cannabis has already been legalised in many jurisdictions. That did not come from nowhere. Many, many, many pain sufferers swear by it. To me that says something. Whether it is subjective or not, whether it is placebo effect or not, if it helps people feel better I am all for it. Why not?

 

Here are some interesting links on pain relief that a quick cursory search turned up last night:

 

https://www.ncbi.nlm.nih.gov/books/NBK224384/

 

https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950205/

 

https://www.webmd.com/a-to-z-guides/news/20180420/can-marijuana-be-the-answer-for-pain

 

And just for balance, here is the authoritative study that concludes that cannabis has no value at all for relieving pain, and may even make things worse. However, even this study says more research is needed before any definitive conclusions can be drawn. People will believe what they want to:

 

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30110-5/fulltext

 

Those who just don't like the idea of cannabis being legalised and made available will look for any 'evidence' they can find to dispute any positive qualities it is reputed to have. I also believe in scientific evidence and I think research should continue. Knowledge is always good. But in this specific case, I doubt it will make much difference. For whatever reason, many many people use cannabis and have done so throughout history whether it was legal or not. Many of those believe it is an effective pain reliever. And I think the experience of those who do also deserves to be respected.

 

 

 

 





I don't think there is ever a bad time to talk about how absurd war is, how old men make decisions and young people die. - George Clooney
 


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  # 2161932 16-Jan-2019 11:54
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Rikkitic:

 

Those who just don't like the idea of cannabis being legalised and made available will look for any 'evidence' they can find to dispute any positive qualities it is reputed to have.

 

 

Just as those who do like the idea, will look for any 'evidence" they can find to dispute the negative qualities it's reputed to have.

 

 

 

 


 
 
 
 


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  # 2161935 16-Jan-2019 12:03
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So who is right? Where do we go from here? Does it matter?

 

 





I don't think there is ever a bad time to talk about how absurd war is, how old men make decisions and young people die. - George Clooney
 


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  # 2161941 16-Jan-2019 12:09
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Rikkitic:

 

So who is right? Where do we go from here? Does it matter?

 

 

 

 

Who knows.

 

I don't think personally the evidence is conclusive either way, and as such cautious approach should be adopted. However, as I have said earlier, I support legalization for medical purposes (but in my view should be an option limited to pain clinic attendees and suffers properly validated and those with terminal illness who meet the critera at least initially).

 

The rest should be done in stages as evidence supports it.

 

 


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  # 2161946 16-Jan-2019 12:14
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networkn:

 

Rikkitic:

 

Those who just don't like the idea of cannabis being legalised and made available will look for any 'evidence' they can find to dispute any positive qualities it is reputed to have.

 

 

Just as those who do like the idea, will look for any 'evidence" they can find to dispute the negative qualities it's reputed to have.

 

 

 

 

 

 

 

 

I will take my lead and guidence from my medical team and not the Internet.





Mike
Retired IT Manager. 
The views stated in my posts are my personal views and not that of any other organisation.

 

There is no planet B

 

 


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  # 2161949 16-Jan-2019 12:16
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MikeB4:

 

I will take my lead and guidence from my medical team and not the Internet.

 

 

Chances are they looked it up there anyways :)

 

 


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  # 2161968 16-Jan-2019 12:40
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I don't know if cannabis will be legalised here in the near future. The referendum could go either way, I suppose. At the least, I think it will be decriminalised and that is a big step in the right direction. I still believe that legalisation should be the ultimate goal, but looking at the experience with alcohol, I would not be opposed to doing it in stages. The problem I have with that, is that it can also become an excuse to do nothing. Those opposed to change for no better reason than that they fear it, could easily use this as a blocking tactic. (When does the evidence support it? How much evidence is needed? What are the research time lines?)

 

Until I see convincing proof to the contrary, and so far I have not, I continue to believe (no, I am not an 'expert') that cannabis, though not harmless, is relatively less harmful than many other substances. I think the individual harm it does causes less social harm than banning it. I think it is worth bearing in mind that if cannabis had been legal a few years ago, the truly nasty and deadly synthetic alternatives would never have found a market and therefore would never have been developed.

 

At some point this discussion becomes like debating the number of angels who can dance on the head of a pin. Whether social conservatives like it or not, whether politicians agree or not, whether police prioritise it or not, whether moralists accept it or not, people will use cannabis. They have for thousands of years and they will continue to do so, whether for pain relief or to get high, or some other reason they find. It is part of our society and it always will be. Harmful or not, I would rather see any financial returns from it going to benefit society than being used to feed gangs and their other illegal activities. Keeping cannabis illegal just doesn't make sense to me. It hasn't worked in the past and it won't work in the future.

 

 

 

 

 

 

 

 

 

 

 

 





I don't think there is ever a bad time to talk about how absurd war is, how old men make decisions and young people die. - George Clooney
 


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  # 2161984 16-Jan-2019 13:43
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As has been pointed out to me, this thread is about pain, but as some here are trying to use doubts about pain control to question the value of cannabis at all, it is worth reminding that it may also have other uses:

 

https://edition.cnn.com/2017/05/24/health/cannabidiol-epilepsy-study/index.html

 

 





I don't think there is ever a bad time to talk about how absurd war is, how old men make decisions and young people die. - George Clooney
 


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  # 2161999 16-Jan-2019 14:07
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Rikkitic:

 

Pain relief has never been an issue for me and I have never delved into this, but all the anecdotal accounts have persuaded me that there must be something to it. I decided to start looking into it last night to see if there was really any evidence for or against. A quick Google search turned up several papers supporting both sides of the argument.

 

 

There are enough people, in pain, who say it provides them with relief. What better evidence should we need to seek out?


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  # 2162073 16-Jan-2019 16:32
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Sidestep:

 

nakedmolerat:

 

out of 14 patients that take cannabis as pain med, only 1 will get benefit. so yeah...

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549367/

 

https://www.acfp.ca/wp-content/uploads/tools-for-practice/1510681044_tfp199mmandpainfv.pdf

 

Are medical cannabinoids (MC) effective for the treatment of pain?

 

 

Bottom Line: Evidence for inhaled marijuana for pain is too sparse and poor to provide good evidence-based guidance. Synthetic MC-derived products may modestly improve neuropathic pain for one in 11-14 users but perhaps not for other pain types. Additionally, longer and larger studies (better evidence) show no effect. Adverse events are plentiful.

 

 

The full document is available here.

 

  • Chronic pain: 39% experience pain reduction of >30% versus 30% with placebo, resulting in a number needed to treat (NNT)=11. Larger and longer RCT show no effects. The mean pain improvement is 0.5 on a 0-10 scale, which isn’t clinically meaningful.
  • Neuropathic pain: With inhaled MC, the NNT=6. With any MC, the NNT=14.
  • Cancer pain: In six randomized controlled trials, the pain reduction was not statistically significant.
  • HIV neuropathy: with smoked MC: NNT=4.
  • Pain from multiple sclerosis: Mean pain improvement over placebo was 0.8 on a 1-10 scale which was borderline insignificant.
  • Acute pain: One positive trial, one negative trial, and five trials showing MC is equivalent to placebo.
  • When compared to medication, MC was no better than amitriptyline (with more adverse events), or worse than dihydrocodeine with similar adverse events.
  • No overall differences shown in quality of life.
  • Little evidence for back pain, fibromyalgia, or osteoarthritis.

https://sciencebasedmedicine.org/medical-marijuana-where-is-the-evidence/

 

 

I'm also a a fan of “science based medicine” (and an avid reader of SBM's articles) but the linked studies, the article by Scott Gavura and it's link to David Gorski's articles basically just say “more study is recommended”  - and required - before definitive results can be proven.

I could cherry pick scientific articles all day long that do appear to point to Cannabinoids having a statistically significant effect on pain, but the takeaway is that they all include that caveat. Here's a recent (2018) article:
Cannabinoids and Pain: New Insights From Old Molecules

One of the issues with even recent studies to date, as David Gorski points out, is that in the USA: “studying the medicinal properties of marijuana and its constituents is not easy, given that it is currently an illegal drug, as was discussed in the NYT article. It’s not for lack of interest, but mainly because the law (and therefore the Drug Enforcement Agency) classifies it as a schedule 1 drug with “no currently accepted medical use.”

 

In particular he points out with studies of 'inhaled marijuana' and 'inhaled MC' (in your links) is “The active ingredient is usually a minor constituent, embedded in thousands of other constituents that make up herbs, and it’s almost impossible to control lot-to-lot consistency with respect to content or active ingredients”

That shortage of Good Science is also why the abstract of your linked 2017 PubMed Central article  "Cannabis and Pain: A Clinical Review" states: "There is a theoretical rationale for cannabis' efficacy for pain management, although the subjective pain relief from cannabis may not match objective measurements of analgesia. As more patients turn to cannabis for pain relief, there is a need for additional scientific evidence to evaluate this increase."

 

With full Legalization in Canada, restrictions on research (partly caused by the substance's illegality and consequent lack of funding, inability to register Cannabis based patents in the US) have lifted. Canadian Companies have become (perhaps temporary) world leaders in research.

It's a huge business. There's an absolute Gold Rush into Cannabis related studies and Clinical Trials by the Pharmaceutical industry.

Seven of Canada’s top 10 cannabis patent holders are major multi-national pharmaceutical companies led (in volume of Patents) by Ciba-Geigy and Pfizer.
Companies researching Cannabis products - Giants like Canopy Growth Corp, Aurora, Tilray, and GW Pharmaceuticals are worth Billions, and throwing 'Hundreds of millions' into research.

The search for novel compounds in Cannabis, the efficiacy of new combinations of known compounds -specific terpenes and cannabinoids - and in particular studies of new methods of delivery, not just for pain relief, but many other purposes, is just beginning.

In the next couple of years we'll see whether Cannabinoids are actually proven effective for the treatment of pain.

 

TL/DR: It's too early to tell if Medical Cannabis, it's extracts and active compounds will be scientifically proven as viable pain relief options.

 

 

 

 

 

 

This reminds me of something. I want to buy shares in cannabis, where/how does one buy shares? (serious question)





Involuntary autocorrect in operation on mobile device. Apologies in advance.


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