Abstract
Introduction:
Up to 70-80% of patients with advanced cancer experience moderate to severe pain. It has also been shown that many of these patients do not receive adequate pain relief with 50% of cancer patients pain being undertreated.
Current Practice – Opioids:
The current first-line analgesic for moderate to severe cancer pain is oral morphine recommended by WHO as a treatment for cancer related pain since 1980.
Current practice for moderate to severe pain management is prescription of morphine or codeine as the first-line treatment however, this is not due to any pharmacological rational. When using morphine to treat chronic pain as a long-term therapy dose escalation may be necessary if the patient develops tolerance to the opioid.
Cannabinoids – future analgesic?
At least 60 active components are found in cannabis. Studies have shown that tetrahydrocannabinol: cannabidiol (THC:CBD) extract is efficacious in the management of pain in advanced cancer patients that is not relieved by strong opioid therapy.
Along with analgesic properties cannabinoids can have anti-emetic and appetite inducing properties which are beneficial for palliation. These properties all indicate that further research should be carried out to assess the use of cannabinoids in controlling chronic cancer pain in palliative pathways. One of the most interesting properties is cannabinoid’s opioid sparing agents. This could potentially allow the opioid dose to be reduced thereby reducing the side effects of chronic opioid use.
Conclusions:
The current practice for the management of palliative pain in cancer patients is due for review since current custom and practice appears to take precedence over evidence base.
Studies have shown that the interactions of opioids and cannabinoids may have an additive or synergistic antinociceptive effect when used in combination therapy. The practical application of this may allow for reduced doses which could reduce side effects while achieving satisfactory pain relief in palliation. This potentially indicates that cannabinoids can be used to reduce opioid dependence and tolerance. If this therapy proves to be achievable it could improve the quality of life for palliative patients.
Up to 70-80% of patients with advanced cancer experience moderate to severe pain. It has also been shown that many of these patients do not receive adequate pain relief with 50% of cancer patients pain being undertreated.
Current Practice – Opioids:
The current first-line analgesic for moderate to severe cancer pain is oral morphine recommended by WHO as a treatment for cancer related pain since 1980.
Current practice for moderate to severe pain management is prescription of morphine or codeine as the first-line treatment however, this is not due to any pharmacological rational. When using morphine to treat chronic pain as a long-term therapy dose escalation may be necessary if the patient develops tolerance to the opioid.
Cannabinoids – future analgesic?
At least 60 active components are found in cannabis. Studies have shown that tetrahydrocannabinol: cannabidiol (THC:CBD) extract is efficacious in the management of pain in advanced cancer patients that is not relieved by strong opioid therapy.
Along with analgesic properties cannabinoids can have anti-emetic and appetite inducing properties which are beneficial for palliation. These properties all indicate that further research should be carried out to assess the use of cannabinoids in controlling chronic cancer pain in palliative pathways. One of the most interesting properties is cannabinoid’s opioid sparing agents. This could potentially allow the opioid dose to be reduced thereby reducing the side effects of chronic opioid use.
Conclusions:
The current practice for the management of palliative pain in cancer patients is due for review since current custom and practice appears to take precedence over evidence base.
Studies have shown that the interactions of opioids and cannabinoids may have an additive or synergistic antinociceptive effect when used in combination therapy. The practical application of this may allow for reduced doses which could reduce side effects while achieving satisfactory pain relief in palliation. This potentially indicates that cannabinoids can be used to reduce opioid dependence and tolerance. If this therapy proves to be achievable it could improve the quality of life for palliative patients.
| Original language | English |
|---|---|
| Publication status | Published (in print/issue) - 24 Jan 2019 |
| Event | Annual Radiotherapy Conference (2019) - Gateshead Hilton Hotel, Newcastle, United Kingdom Duration: 25 Jan 2019 → 27 Jan 2019 |
Conference
| Conference | Annual Radiotherapy Conference (2019) |
|---|---|
| Country/Territory | United Kingdom |
| City | Newcastle |
| Period | 25/01/19 → 27/01/19 |
Keywords
- Palliation
- pain management
- cannabinoids
- opioids
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Cannabinoids: a possibility for pain management in the palliative cancer pathway
Gilleece, T. (Recipient), 27 Jan 2019
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