Medical Marijuana – Cannabis for Pain


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These references include links to peer reviewed journal articles on cannabinoids. They are taken from the Reference Library of the outstanding RSD Association in Connecticut, whose mission is to help relieve pain. They have grouped the articles in helpful folders by subject, and this is one of many folders on the immense subject of pain. Please donate to them as their research helps everyone with pain, not just nerve pain or CRPS. May the references help enrich your lives and help support congress and regulators in legalizing cannabis across the country — the attorney general just now voted in by congress opposes medical marijuana.

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Be aware that states should monitor the plant for bacteria, fungus, pesticides, and heavy metals as discussed in this Smithsonian article:

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“Washington, the second state to legalize recreational marijuana, does require such testing for microbial agents like E. coli, salmonella and yeast mold, and officials there rejected about 13 percent of the marijuana products offered for sale in 2014.”

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Concentrates may be made with toxic butane or heptane. If you have cancer or are immunosuppressed – cancer and autoimmune diseases fall into that category – it is safer not to inhale. Cannabis can be used on the skin or swallowed but be aware when swallowed, it takes 60 to 90 minutes before you feel the effect. It is easy to overdose when swallowed. Check your blood pressure and pulse before use and again while you feel its effect.

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The article also points out that on testing, many of the plants have high THC but no longer have CBD, one of the 86 known cannabinoids, the one that blocks the psychoactive side effects of THC. On its own, CBD has many medical benefits.

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For those who have allodynia, the most intense form of nerve pain, pain that is triggered by a light touch or breath of air:

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Keep in mind that chronic pain is much harder to treat than cancer pain and acute pain. Chronic nerve pain is the hardest of all to treat. We need to be able to prescribe anything that helps. Pain can lead to suicide in these extreme pain conditions.

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Watch out for the munchies – do not get fat.

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O’Shaunessy’s today published articles that may be useful for your Senators, healthcare insurers and states:

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“some additional articles published by cannabis clinicians in O’Shaughnessy’s showing the strength of aggregated case reports. We hope the MBC Marijuana Task Force will give them serious consideration.”

 

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Cannabinoids

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Insys Pharma fighting legal cannabis. Research shows big drop in opioid use with cannabis, & first proof large scale healing properties. LEGALIZE & watch pain get better


 

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Legalize Marijuana like Alcohol

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Stop blocking people who need it in order to work. Make it legal there too in reasonable circumstances. NFL players need access to Cannabis, not just to opioids made by Insys that has the ear of Congress. Insys has effectively torn a big breach in plans for healthcare needs that can be supplemented with cannabis, not just opioids, and with none of the overdoses especially with fentanyl, the most sought after high, preferred by addicts because 50 times more potent than heroin. The killer drug. Kills insurance companies too: $$$ x 6 per day.

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Case

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My patient got progressively worse and was unable to work for two years until seeing me recently. Opioids initially were a big relief, but high dose and not worth the cludgy brain feeling. Brain and body finally now free of pain, but not until she got off opioids. With cannabis, the depression due to pain and disability lifted, pain literally dropped to zero for 8 hours or more with just a tiny drop under tongue.

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Enormous disabling pain, low back, both shoulders, both hands, old body heavily used with joy in work. After one drop under tongue, zero pain, old body no more, able to take teams of people on strenuous adventures with no problem. Life back. No high. No brain effect. One drop under tongue. Eight hours free of any pain or side effect, young body back.

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So congress, deny access to cannabis so people with pain don’t even get educated on it, and doctors don’t learn. CDC now chops opioids with their guidelines, so where do people turn? Insys wants to stop American medicine from evolving with this plant, yet we have more cannabinoid receptors in our body than any other kind. Far more than opioid receptors that kill the immune system.

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For my patient, it is illegal to fly among homes in 3 states in order to work, but it is now sold at a local nutrition store — not a cannabis dispensary. It is not but must be available for use in hospitals and ICU’s.

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CASE

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Patient Friday, polymyalgia rheumatica, aged 20 years overnight from high dose prednisone. Arms and legs stained heavily with bruises it brings on. Heavy edema in legs making it difficult to get around. Started cannabis on the skin and overnight all of the massive edema was gone, and the nonhealing area on the ankle had healed. No more Scripps Wound Clinic that had worried so much about it.

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For Pete’s sake, the stupidity when anyone’s eyes can see how congress is pushing opioids, how this benefits addiction to opioids, the entry drug for heroin abuse, benefits a militarized police state and the racist overpriced and violent industrial police-prison complex. That’s the policy of this congress, perpetuate opioid addiction, remain blind to cannabis’ medical uses unless their pockets are lined, anti-science until their own healthcare is concerned. Opioid overdoses 130 a day, the size of a Boeing 737, I just posted on this, two days ago.

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Tell me how this is a Schedule I drug that our injured veterans must not use or they will be kicked out of pain clinics. Who set that up, the opioid pharma league with congressional oversight against those addicts who have pain or they would not be seeing help from drugs? Who warned doctors at pain meetings they must never treat a patient with opioids if they also use cannabis for pain and spasm and sleep.

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Could the influence of pharma money be causing your aging grandparents to suffer without being able to afford medication? A medicine anyone could grow in their home and bring up children with the knowledge that plants with 400 healing chemicals we will learn to use are better than any synthetic that has only one ingredient. I don’t want to risk addicting 10% of the population at age 10 when they get their wisdom teeth pulled or break their leg in soccer. Teach our children when they break a leg, plants heal .

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My valued and talented senior finds such joy in work which has brought a lifetime of awesome experiences, but it had looked like life was over, forever. 

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We need to learn new medicine using some or all of the 400 healing chemicals in the plant. Surely we cannot let a pharmaceutical company influence Congress and regulators to plant themselves firmly against valued medical research and healing medications.

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Must our pain patients in particular be denied care, be treated with such contempt as to have their opioid doses suddenly taken down, and see opioid use conflating them with addicts. Must our addicts be given felony jail rather than treatment for their deadly medical condition.

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Without legalizing use of cannabis for medical conditions, you will be forced to go monthly or at regular intervals to your doctor for a prescription of one synthetic chemical in the healing plant that has 400 different rich chemicals we need to learn about and harvest.

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Tell your congress persons that Kentucky farmers influenced their senior Senator running to save his seat, they can make 10 times more growing hemp than they can growing corn, and 3 times more than tobacco. Hemp is cannabis that has almost no THC—there is no high, but can it stop children from having 100 seizures a day? Let’s grow one that can. Their university agriculture departments are now hot on the science of Kentucky strains. Patent them.

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Let’s get this country hot on the science of healing medical conditions without running up costs such as frequent doctors visits. And lets stop forbidding hospital use for relief nothing else can provide.

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I presume the unnamed pharmaceutical company may be Insys Pharmaceuticals. They market a rapid acting opioid called, a fentanyl spray, and already market THC and got approval to test CBD. THC and CBD are only 2 or 400 chemicals in the plant. Insys is being accused of trying to ruin the market for patient access to naturally grown plants that are medicinal and actually healing.

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Hot research just published, see below, releases data showing that in states where cannabis is legal, proof that cannabis is actually healing and not used just used in place of pain medication.

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Well if that’s true, and opioids make people violent, then cannabis makes people relax and feel less stressed, less violent, able to relax so deeply, my patients have said it’s like those decades of fight-flight response instantly vanished and they were finally able to feel a deep calm. The kind that makes you want to listen to music. To find peace. Not shoot up heroin in dark corners, away from family, hiding addiction. To deny our pain patients is simply astonishing they get away with the lunacy.

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Everyone knows the only reason pain was recognized for the first time was with the discovery of pain receptors and endogenous opioids. And that was not funded because congress and consciousness cares about your pain, it was addiction research on addicts that legitimized pain for the first time in history, early 1970’s. Well, we have a powerful endogenous cannabinoid system with amazing healing mysteries to unlock.

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True healing.

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Like the patient with barely one drop on the skin, and severe edema in BOTH legs was gone overnight. and the nonhealing skin healed.

 

It seems Insys wants the market for a single synthetic cannabinoid and argues we mus prevent GW Pharmaceuticals from gaining legal market protections and FDA approval of plant based cannabis. You should prefer seeing your doctor for prescription of Insys’ synthetic THC or CBD and hospitals should never allow you to use what you have proven works for you. CBD and THC are only two of 400 chemicals in this healing plant that we must learn to use as soon as possible. Pharma costs are staggering. Farmers can grow cannabis hybrids for different medical uses. We need research, not 1920’s style attacks on cannabis and alcohol. Look where Prohibition led them. How many doctors were thrown in in jail in that era for trying to treat pain.

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Medicine and brain research would lose a critical opportunity to study the cannabinoid system in our body.

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We have more cannabinoid receptors in our body than any other type. What are those receptors doing in bone all over the body, while my body slowly dissolves from osteoporosis and my brain just read research showing cannabis helps Alzheimers plaques.

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GW Pharmaceuticals for decades has led the field of medical research in cannabis. They have been valued highly as a business and our patients need no avenues closed.

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It is brilliant timing for new research reported in the Washington Post. I trust you will consider how to use this work to sway the election campaign to help our patients and forward medical research. Many are not getting the help they need, especially as their opioids were slashed and we have no tools to help pain. We need a clinical pain research institute with all the science, research and tools to help people in extreme pain to continue functioning, at least enough to allow them to bend, stretch, bathe and dress themselves. To allow them to be able to relax deeply and let go of monstrous pain at the end of the day. Nerve pain is always worse at night. Cannabis is an essential plant requiring the best research minds.

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One striking chart shows why pharma companies are fighting legal marijuana

 

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There’s a body of research showing that painkiller abuse and overdose are lower in states with medical marijuana laws. These studies have generally assumed that when medical marijuana is available, pain patients are increasingly choosing pot over powerful and deadly prescription narcotics. But that’s always been just an assumption.

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Now a new study, released in the journal Health Affairs, validates these findings by providing clear evidence of a missing link in the causal chain running from medical marijuana to falling overdoses. Ashley and W. David Bradford, a daughter-father pair of researchers at the University of Georgia, scoured the database of all prescription drugs paid for under Medicare Part D from 2010 to 2013.

They found that, in the 17 states with a medical-marijuana law in place by 2013, prescriptions for painkillers and other classes of drugs fell sharply compared with states that did not have a medical-marijuana law. The drops were quite significant: In medical-marijuana states, the average doctor prescribed 265 fewer doses of antidepressants each year, 486 fewer doses of seizure medication, 541 fewer anti-nausea doses and 562 fewer doses of anti-anxiety medication.

But most strikingly, the typical physician in a medical-marijuana state prescribed 1,826 fewer doses of painkillers in a given year.

 

The tanking numbers for painkiller prescriptions in medical marijuana states are likely to cause some concern among pharmaceutical companies. These companies have long been at the forefront of opposition to marijuana reform, funding research by anti-pot academics and funneling dollars to groups, such as the Community Anti-Drug Coalitions of America, that oppose marijuana legalization.

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Pharmaceutical companies have also lobbied federal agencies directly to prevent the liberalization of marijuana laws. In one case, recently uncovered by the office of Sen. Kirsten Gillibrand (D-N.Y.), the Department of Health and Human Services recommended that naturally derived THC, the main psychoactive component of marijuana, be moved from Schedule 1 to Schedule 3 of the Controlled Substances Act — a less restrictive category that would acknowledge the drug’s medical use and make it easier to research and prescribe. Several months after HHS submitted its recommendation, at least one drug company that manufactures a synthetic version of THC — which would presumably have to compete with any natural derivatives — wrote to the Drug Enforcement Administration to express opposition to rescheduling natural THC, citing “the abuse potential in terms of the need to grow and cultivate substantial crops of marijuana in the United States.”

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The DEA ultimately rejected the HHS recommendation without explanation.

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In what may be the most concerning finding for the pharmaceutical industry, the Bradfords took their analysis a step further by estimating the cost savings to Medicare from the decreased prescribing. They found that about $165 million was saved in the 17 medical marijuana states in 2013. In a back-of-the-envelope calculation, the estimated annual Medicare prescription savings would be nearly half a billion dollars if all 50 states were to implement similar programs.

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“That amount would have represented just under 0.5 percent of all Medicare Part D spending in 2013,” they calculate.

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Cost-savings alone are not a sufficient justification for implementing a medical-marijuana program. The bottom line is better health, and the Bradfords’ research shows promising evidence that medical-marijuana users are finding plant-based relief for conditions that otherwise would have required a pill to treat.
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“Our findings and existing clinical literature imply that patients respond to medical marijuana legislation as if there are clinical benefits to the drug, which adds to the growing body of evidence suggesting that the Schedule 1 status of marijuana is outdated,” the study concludes.

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.One limitation of the study is that it only looks at Medicare Part D spending, which applies only to seniors. Previous studies have shown that seniors are among the most reluctant medical-marijuana users, so the net effect of medical marijuana for all prescription patients may be even greater.

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment

provided by a qualified health care provider.

Relevant comments are welcome.

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For My Home Page, click here: 

Welcome to my Weblog on Pain Management!

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Please be aware any advertising on this free educational website is

NOT advocated by me and NOT approved by me.

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Cannabis: CBD may help pain when rectal suppository morphine is a problem


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Marijuana, cannabis, is overlooked for pain control

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CBD – cannabidiol — is the immune/glial suppressor

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It is anti-inflammatory in brain and spinal cord

 

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Correction 3/28/16:

It is not legal to transport CBD to states where marijuana is illegal, though it has no psychoactive properties. This is explained in detail by two doctors who wrote in drugpolicy.org, March 2015. I recommend reading the article as it makes several important points.

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The cannabis plant, and everything in it, is illegal under federal law. And even in states where it is legal, it is not legal to ship cannabis products from state to state, or to leave the state with such a product.

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A recent study from Israel showed that CBD in its natural form as a whole plant extract is superior over a single, synthetic CBD compound for treating illness. The plant has continually outperformed synthetic versions in research studies.

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…There are many support groups for children with epilepsy whose parents are using medical cannabis, such as this forum run through the Epilepsy Foundation. Connecting with them can be a great resource for staying on top of the developments with CBD and the other therapeutic cannabinoids in the cannabis plant.

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Dr. Malik Burnett is a former surgeon and physician advocate. He also served as executive director of a medical marijuana nonprofit organization. Amanda Reiman, PhD, holds a doctorate in Social Welfare and teaches classes on drug policy at the University of California-Berkeley.

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Cannabis has been used for thousands of years. It has been in the U.S. pharmacopoeia since 1850. A medical textbook from the 1920’s lists medical uses for cannabis. A Mexican American grandfather on hospice in 1995, explained how cannabis had helped his arthritic joints decades before.

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When alcohol prohibition failed and was repealed in 1933, Harry J. Anslinger, head of the Federal Bureau of Narcotics from 1930 to 1962, created the word marihuana claiming it led to addiction, violence, overdosage. Anslinger used racist propaganda to instill fear in Americans that only Mexicans and Negros use cannabis which led to creation of the Marijuana Tax Act passed by congress in 1937. Not unlike the CDC Opioid Guideliness of March 2016, it was passed over the objections of the AMA.

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The American Medical Association (AMA) opposed the act because the tax was imposed on physicians prescribing cannabis, retail pharmacists selling cannabis, and medical cannabis cultivation/manufacturing. The AMA proposed that cannabis instead be added to the Harrison Narcotics Tax Act. The bill was passed over the last-minute objections of the American Medical Association. Dr. William Creighton Woodward, legislative counsel for the AMA objected to the bill on the grounds that the bill had been prepared in secret without giving proper time to prepare their opposition to the bill. He doubted their claims about marijuana addiction, violence, and overdosage; he further asserted that because the word Marijuana was largely unknown at the time, the medical profession did not realize they were losing cannabis. “Marijuana is not the correct term… Yet the burden of this bill is placed heavily on the doctors and pharmacists of this country.”

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Israel’s Professor Rafael Mechoulam is widely recognized for his work on cannabis over more than 40 years. He and his lab isolated and identified THC, CBD, cannabinoid receptors, endogenous cannabinoids – your brain makes two of them! Your body has more cannabinoid receptors than any other type. It was he who published 40 years ago that CBD controls certain types of epilepsy in children – and it was ignored until Dr. Sanjay Gupta publicized this in the last one or two years.

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Professor Mechoulam says CBD from the plant (the plant is illegal in the United States) outperforms synthetic CBD.

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However, standards for CBD products do not exist, assays may be unreliable, it may be extracted with harsh chemicals that are harmful to those who are ill, and FDA has warned against false claims of efficacy. 

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Nevertheless, there are indications CBD may help pain. It has no psychoactive properties. It does not cause intoxication. There is no THC in it.

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CBD, Cannabidiol, is one of the 86 known cannabinoids in the cannabis plant that has 400 chemicals. In addition, the plant has perhaps 100 or 200 unique terpenes, also said to help symptoms. 

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Topical CBD may help – keep that in mind when Blue Shield’s formulary offers only rectal suppository morphine (unless you wait days and hope they will approve a prior authorization).

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I received a note today about Colorado Hemp Farmers:

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a woman in her sixties suffering from sciatica who is having her nurse rub her back with a coconut oil extract of a specific strain of industrial hemp rich in CBD, but without significant THC. She reports that the pain alleviation is remarkable with the soothing extract, which she judged to be superior to when commercially available CBD oil was used. 

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Have any readers have tried CBD for pain?

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Your feedback would help to inform researchers to add an additional arm to the tests now being done in rats.

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I have heard from one man with severe pain today. He uses CBD in many forms. It helps pain a little, and also it is calming. He describes it like you know pain is better after you take ibuprofen. Similar with CBD. He does not feel at all drugged.

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This site is not for email.

If any questions, please schedule an appointment with my office.

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment

provided by a qualified health care provider.

Relevant comments are welcome.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please be aware any advertising on this free educational website is

NOT advocated by me and NOT approved by me.

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CRPS – Skeletal Cannabinoid System – Immune System


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What I’m really interested in is the Skeletal Cannabinoid System.

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We know cannabinoid receptors outnumber every receptor type in the human body.

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Cannabindoids are located primarily in immune tissue. 

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Perhaps one reason we have not found more insight into neuropathic pain, complex regional pain syndrome, is because we have not seriously looked at the cannabinoid system. It is the largest receptor system in the body and it is located in immune tissue. Our brain makes endocannabinoids like Anandamide, that relieve pain, that are made by glial tissue, which is immune tissue. And they relieve many other symptoms and life threatening seizures as well. Pain and depression are my key interests.

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Quoting from Nephi Stella:

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“Cannabinoids, the bioactive components produced by the marijuana plant Cannabis Sativa, have immunomodulatory properties that are quite distinct from currently available immunomodulatory drugs.”

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So, back to the Skeletal Endocannabinoid Sytem, please let me know of any references to the Skeletal Endocannabinoid system, especially key articles or a review of that system, or has access to funding and to Professor Mechoulam’s lab, so we could see some research funded in order to learn about this. I welcome comments with publications and references, below.

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Even if we could get more funding for regenerative research in bone, it may lead to discovery of a mechanism involved in the osteoporosis with CRPS or senility.

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Cannabinoids

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First, let me say I am not endorsing use of cannabinoids unless you have a full understanding of contraindications, and yes it can be dangerous if you have those conditions. That’s why I built a cannabis website in 2009. I cannot remember the scientific details I studied, but there were over 17,000 publications when I put that up. I had to build the website to educate myself, and be able to “put it together, to grasp it and learn it and be able to link back. It was a huge data base to reference after doing my analysis. Alas, I had to scrub most of it because it is illegal even to write about certain things or link to a video. It’s sad that doctors get persecuted for prescribing cannabis for desperate conditions. It’s sad it cannot be made legal for the poor and middle class to use responsibly and recreationally.

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Dr. Nephi Stella at University of Washington studies deep cannabinoid brain science:

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He was an invited speaker at an RSDSA sponsored conference in 2010  on glia. They convened what may be the largest number of most distinguished glial scientists in the world working on translational issues, translating science to the clinic as it relates to pain. Glial cells are important for inflammation and pain, depression, almost every known condition. As for glia, one of the endocannabinoids that your brain makes, is made by a glial cell, and reabsorbed by the cell.

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Dr. Stella’s faculty page reads:

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How can the medicinal properties of marijuana be improved to treat neurodegenerative diseases?

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The brain, being isolated from the rest of the body by the blood brain barrier, has its own specialized immune system consisting of the interplay between glial cells and small numbers of patrolling immune cells. This “brain specific immune system” is similar to the peripheral immune system in its ability to both destroy foreign agents and repair injured tissue, though it does so with much less efficacy. Indeed, while the brain’s immune system can probably cope with minor insults and infections, its unable to mount effective responses against more devastating neuropathological processes….

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Remarkably, these neuropathological processes are often associated with dysfunctional glial cells, limiting their ability to repair injured neurons and actually rendering them more hostile against healthy neurons. Thus, a promising therapeutic approach for the aforementioned neurodegenerative diseases is to develop pharmacological agents that target glial cells to reinstate their reparative function while tempering their hostility.
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My laboratory is interested in identifying the molecular machinery controlling changes in glial cell phenotype, with the aim of developing pharmacological tools that will minimize their harmful phenotype and reinstate – or even boost – their reparative function. Our current most promising target is the endocannabinoid signaling system.
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Cannabinoids, the bioactive components produced by the marijuana plant Cannabis Sativa, have immunomodulatory properties that are quite distinct from currently available immunomodulatory drugs. These compounds act through specific receptors named CB1 and CB2. CB1 receptors are expressed by neurons and mediate the drug of abuse properties of marijuana, while CB2 receptors are expressed by immune and glial cells and mediate its immunomodulatory properties. This dichotomy has tremendous therapeutic potential since it allows for the development of agents that specifically target CB2 receptors and thus regulate immune functions without inducing the drug of abuse adverse effects mediated through CB1 receptors. Cannabinoid receptors are normally activated by endogenous ligands, the endocannabinoids.
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We are currently testing the hypothesis that agents acting through CB2 receptors or blocking the degradation of endocannabinoids can temper the detrimental inflammatory responses occurring in Huntington’s disease, AIDS dementia and multiple sclerosis. We chose to study these pathologies because they remain without cure and thus demand regimented scientific efforts to relieve these patients. We are also using genetic and proteomics approaches to identify novel cannabinoid receptors and enzymes degrading endocannabinoids, with the hope that such proteins constitute promising targets for therapy. Our goal is to identify cannabinoid-based targets and agents devoid of drug of abuse properties that provide treatment of diverse neuropathologies.

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This field has been largely ignored for almost the entire 20th century. Even when it was discovered it is a major player in the immune system and so many systems it is yet to be discovered where and why.

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Nephi, if you are reading this, thank you for working with glia and the cannabinoid system!

Congratulations on your work!

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I know some of you ignore this, but I have to repeat:

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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This material is not a substitute for medical advice, diagnosis or treatment provided

by a qualified health care provider.

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This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Side Effects of Neridronic Acid – Neridronate


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Neridronate

Neridronic acid

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This is a long response to detailed comments from Julie who had a reaction to the neridronic acid protocol for CRPS.

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The clinical trial on neridronic acid is extremely important and unique. It is important because it does not just cover symptoms, it actually may put CRPS into remission.

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If I had CRPS, I would not hesitate to accept short term side effects if I thought I could get long term benefit, even possibly remission. We need this study. It will not be available for anyone unless many enroll in the double blind study and hopefully soon so that results can be submitted to the FDA for approval.

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Please read her comments first, at the end of my post. And then my comments below.

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And because neridronic acid relates to bone metabolism, much later I will mention an area of research that is likely to be be valuable because it is the largest receptor system in the body, the endocannabinoid receptor system, the body’s own cannabinoid system.  Two ideas from Raphael Mechoulam, professor of Medicinal Chemistry at the Hebrew University of Jerusalem in Israel are keenly interesting:

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The Skeletal Endocannabinoid System

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The Entourage Effect

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Glia make one of the cannabinoids in the brain, and glial research is where I suspect some of the best research will come

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Hopefully these ideas will stimulate  research.

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In response to Julie, I wrote:

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Julie, I am so sorry to hear of the difficulty you had to go through for such a long time. And relieved that you got through it. I and, I’m sure everyone else, thanks you for volunteering. We will all benefit. And we all hope that if any reaction is to occur, please let it be rare. It appears that yours is rare.

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I know everyone is with you, and we bring all our hopes for the unknown. No one has the answer of what to do with intractable pain of any kind, not just CRPS pain. We must, MUST, begin to do more research on intractable pain in humans. Neridronic acid is an important beginning to look at a new mechanism.

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CRPS has, in some people, escaped every known rational approach to treatment. Neridronate may be the best thing we can get. It takes time to learn how new medications work, and they have chosen wisely, I am sure.

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Be assured, I think good minds are working on the best. But it is unknown territory.  Numbers are needed – CRPS can be very dynamic. Flares and remissions wax and wane, so long term study must be done.

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We all see patients after CRPS flares and there is nothing more to offer. Not one thing. We urgently need something that works. We are hoping neridronic acid will be that rescue.

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Will remission last 12 months or 3 months or less?

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What are long term risks?

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How often could it potentially be given, or will remission really last for years in some? We all need to see numbers.

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Huge hopes are on this drug.

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We must balance hopes and fears.

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We recognize it is a new drug for a new purpose. We hope this research will drive many more studies on CRPS and/or intractable pain.

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Julie, thank you for allowing others to see details. It may help other volunteers to set aside time to recover any post infusion effects, if needed. Hope for the best, plan for the worst is the saying.

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No one yet knows how good the potential is for duration of effect. Remission could potentially be total, in some. How many?

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We are all learning how to treat chronic intractable pain.

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Skeletal Endocannabinoid System

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The highly decorated scientist who discovered THC and the body’s endocannabinoid system, Raphael Mechoulam, professor of Medicinal Chemistry at the Hebrew University of Jerusalem, recently mentioned the SKELETAL CANNABINOID SYSTEM in a 2014 documentary on his discoveries.

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The cannabinoid system interacts powerfully with the immune system in ways not yet studied. Why does your CRPS immune system affect the skeletal system and create pain?

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Cannabinoids are anti-inflammatory, analgesic, healing. The body makes its own. We need to study the biggest receptor system in the body. It is a gaping hole that is left out of existing work on the immune system.

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And how much are glia and our innate immune system in CNS— how much are they studied?

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Please let there somehow be funding for many studies on humans – but let’s begin one study, guided by Distinguished Professor Linda Watkin’s lab. She is the only scientist who is doing translational work from  basic research in the lab to humans.

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Professor Watkins has the best clinical solution I have seen: IL-10 has remarkable potential to bring your pain to zero for 3 months or more at a times. Your brain makes it. It is *the* anti-inflammatory cytokine. Her lab has been the world leader in glial research. Where is the funding for what may be the most important area of work for intractable mood disorders and treatment resistant depression?

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Glia

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How do hundreds of now usable drugs create pro-inflammatory cytokines thus make more pain or more major mood disorder?

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And which of these hundreds of drugs on our formulary reduce inflammatory cytokines?

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What is the role, if any, of some of the medications used by rheumatologists to dampen the hyperactive immune system in autoimmune disease? Risks, but possible gain. We will never have all the answers. ALL the answers for everyone is hard to imagine.

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How do hundreds of existing drugs affect the balance of CNS cytokines?

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Skeletal Endocannabinoid System – see Raphael Machoulam’s lab in Israel. May be critical for CRPS and for osteoporosis in seniors.

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Mechoulam’s lab would bite at the chance to get funded to work with the Italian and USA CRPS study.

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Julie — I am heartened that you may be able to see Professor Ott who may be one of the foremost researchers on bone metabolism if not number one.

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I posted three times on bisphosphonates last year and hope they are a good review for others.

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The Entourage Effect

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Mechoulam also has an important concept that probably applies to my method of trying to modulate these powerful intractable pain syndromes.

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Simple concept – brilliant:

The Entourage Effect. Drugs are like politicians. A famous politician may walk unrecognized, but when you surround him or her with many people, even of lesser status, the politician has a far more powerful effect.

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I don’t know how you guys do it.

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Respectful best wishes.

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