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      Aspectos prácticos de la elección del producto y la titulación con cannabis medicinal para el dolor crónico Translated title: Practical aspects of product selection and titration with medical cannabis for chronic pain management

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          Abstract

          RESUMEN Años de experiencia y multitud de estudios observacionales proponen la eficacia del cannabis medicinal (CM) para aliviar el dolor. La experiencia clínica no se ha podido correlacionar con la evidencia científica. De los países donde el CM se ha legalizado provienen guías basadas en consensos que proporcionan al clínico interesado un conocimiento mínimo esencial para responder a las necesidades de sus pacientes. Esta revisión proporciona aspectos básicos de la selección de pacientes y productos del CM para el especialista en dolor.

          Translated abstract

          ABSTRACT Years of experience and multiple cohort studies suggest the efficacy of medical cannabis (MC) to relieve chronic pain. The clinical experience has not been linked with scientific evidence. In countries where CM has been legalized, guidelines based on consensus have been developed that provide the clinician with the minimum essential knowledge to respond to the needs of his or her patients. This review provides basic aspects of patient and product selection of MC for the pain specialist.

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          Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects.

          Tetrahydrocannabinol (THC) has been the primary focus of cannabis research since 1964, when Raphael Mechoulam isolated and synthesized it. More recently, the synergistic contributions of cannabidiol to cannabis pharmacology and analgesia have been scientifically demonstrated. Other phytocannabinoids, including tetrahydrocannabivarin, cannabigerol and cannabichromene, exert additional effects of therapeutic interest. Innovative conventional plant breeding has yielded cannabis chemotypes expressing high titres of each component for future study. This review will explore another echelon of phytotherapeutic agents, the cannabis terpenoids: limonene, myrcene, α-pinene, linalool, β-caryophyllene, caryophyllene oxide, nerolidol and phytol. Terpenoids share a precursor with phytocannabinoids, and are all flavour and fragrance components common to human diets that have been designated Generally Recognized as Safe by the US Food and Drug Administration and other regulatory agencies. Terpenoids are quite potent, and affect animal and even human behaviour when inhaled from ambient air at serum levels in the single digits ng·mL(-1) . They display unique therapeutic effects that may contribute meaningfully to the entourage effects of cannabis-based medicinal extracts. Particular focus will be placed on phytocannabinoid-terpenoid interactions that could produce synergy with respect to treatment of pain, inflammation, depression, anxiety, addiction, epilepsy, cancer, fungal and bacterial infections (including methicillin-resistant Staphylococcus aureus). Scientific evidence is presented for non-cannabinoid plant components as putative antidotes to intoxicating effects of THC that could increase its therapeutic index. Methods for investigating entourage effects in future experiments will be proposed. Phytocannabinoid-terpenoid synergy, if proven, increases the likelihood that an extensive pipeline of new therapeutic products is possible from this venerable plant. http://dx.doi.org/10.1111/bph.2011.163.issue-7. © 2011 The Author. British Journal of Pharmacology © 2011 The British Pharmacological Society.
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            Practical considerations in medical cannabis administration and dosing

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              A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol.

              This study examines the current knowledge of physiological and clinical effects of tetrahydrocannabinol (THC) and cannabidiol (CBD) and presents a rationale for their combination in pharmaceutical preparations. Cannabinoid and vanilloid receptor effects as well as non-receptor mechanisms are explored, such as the capability of THC and CBD to act as anti-inflammatory substances independent of cyclo-oxygenase (COX) inhibition. CBD is demonstrated to antagonise some undesirable effects of THC including intoxication, sedation and tachycardia, while contributing analgesic, anti-emetic, and anti-carcinogenic properties in its own right. In modern clinical trials, this has permitted the administration of higher doses of THC, providing evidence for clinical efficacy and safety for cannabis based extracts in treatment of spasticity, central pain and lower urinary tract symptoms in multiple sclerosis, as well as sleep disturbances, peripheral neuropathic pain, brachial plexus avulsion symptoms, rheumatoid arthritis and intractable cancer pain. Prospects for future application of whole cannabis extracts in neuroprotection, drug dependency, and neoplastic disorders are further examined. The hypothesis that the combination of THC and CBD increases clinical efficacy while reducing adverse events is supported.
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                Author and article information

                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                2022
                : 29
                : suppl 1
                : 43-51
                Affiliations
                [1] Montreal Quebec orgnameMcGill University Health Centre orgdiv1Alan Edwards Pain Management Unit Canadá
                Article
                S1134-80462022000200008 S1134-8046(22)02900000008
                10.20986/resed.2022.4031/2022
                ee33278a-19a3-47f6-87dc-586f2de35804

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 9
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                SciELO Spain

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                CBD,Cannabinoids,medical cannabis,THC,chronic pain,Cannabinoides,cannabis medicinal,dolor crónico

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