The Use of Cannabinoids in Pediatric Palliative Care—A Retrospective Single-Center Analysis

This data analysis aimed to systematically analyze a pediatric patient population with a life-limiting disease who were administered cannabinoids. It was a retrospective single-center analysis of patients under supervision of the specialized outpatient pediatric palliative care (SOPPC) team at the Department of Pediatrics and Adolescent Medicine of the Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU). Thirty-one patients with a primary diagnosis of neuropediatric, oncologic, metabolic, and cardiologic categories were included. The indications we identified were spasticity, pain, restlessness, anxiety, loss of appetite, epilepsy, and paresis. Certain aspects of quality of life were improved for 20 of 31 patients (64.5%). For nine patients (29%), no improvement was detected. No conclusions could be drawn for two patients (6.5%). Adverse events were reported for six of the thirty-one patients (19.4%). These were graded as mild, including symptoms such as restlessness, nausea, and behavioral issues. We detected no clinically relevant interactions with other medications. We collected fundamental data on the use of cannabinoids by pediatric palliative patients. Cannabinoids are now frequently administered in pediatric palliative care. They seem to be safe to use and should be considered an add-on therapy for other drug regimens.

Tetrahydrocannabinol and Cannabidiol for Pain Treatment—An Update on the Evidence

In light of the current International Association for the Study of Pain (IASP) clinical practice guidelines (CPGs) and the European Society for Medical Oncology (ESMO) guidelines, the topic of cannabinoids in relation to pain remains controversial, with insufficient research presently available. Cannabinoids are an attractive pain management option due to their synergistic effects when administered with opioids, thereby also limiting the extent of respiratory depression. On their own, however, cannabinoids have been shown to have the potential to relieve specific subtypes of chronic pain in adults, although controversies remain. Among these subtypes are neuropathic, musculoskeletal, cancer, and geriatric pain. Another interesting feature is their effectiveness in chemotherapy-induced peripheral neuropathy (CIPN). Analgesic benefits are hypothesized to extend to HIV-associated neuropathic pain, as well as to lower back pain in the elderly. The aim of this article is to provide an up-to-date review of the existing preclinical as well as clinical studies, along with relevant systematic reviews addressing the roles of various types of cannabinoids in neuropathic pain settings.

A Case Series of the Role of Cannabis Based Medicine in the Palliative Care Setting

Complex refractory pain is highly prevalent in the palliative care setting. Opioid therapies play a pivotal role in pain management, but have an extensive side effect profile and frequently fail to provide sufficient relief, despite dose optimisation or concurrent use of standard adjuvant analgesics.(1) Therefore, identification of novel analgesics to alleviate pain would be very beneficial.(2)Currently, there is equipoise within the available clinical evidence of the efficacy and safety of cannabis-based medications in the management of pain.(3) This is a case series of three patients with complex pain, with inadequate pain relief with standard multimodal analgesia. Each of these patients were commenced on Sativex, an oromucosal spray composed of two cannabis extracts, delta-9- tetrahydrocannabinol and cannabidiol, and the dose was titrated until therapeutic benefit was
achieved. All three cases demonstrated a positive analgesic effect without any adverse symptoms.

Experience With Medical Marijuana for Cancer Patients in the Palliative Setting

Authors Karna T. Sura, Leslie Kohman, Danning Huang, Silviu V. Pasniciuc Published June 28, 2022 DOI: 10.7759/cureus.26406 Citations Sura K T, Kohman L, Huang D, et al. (June 28, 2022)…

Mini-Review Cannabis in palliative care: current challenges and practical recommendations

Pain and symptom control challenges are common in palliative care, and the search for other therapeutic strategies is ongoing. Unfortunately, patients and their caregivers are receiving little information or support from healthcare providers regarding the increasingly popular cannabinoid-based medicines (CBM). Clinicians, meanwhile, feel understandably perplexed by the discrepancy between the available evidence and the rapid interest in which patients and their families have demonstrated for CBM. There is an urgent need to address the many challenges that are delaying the appropriate integration of CBM into clinical practice, notwithstanding the obvious need for a solid general knowledge of pharmacology, mechanism of action and available clinical evidence supporting its use

Benefit of Tetrahydrocannabinol versus Cannabidiol for Common Palliative Care Symptoms.

Authors: David J. Casarett, Jessica N. Beliveau, and Michelle S. Arbus
Journal of Palliative Medicine, 6 August 2019

Objectives: To determine the relative contributions of tetrahydrocannabinol (THC) and cannabidiol (CBD) to patients’ self-ratings of efficacy for common palliative care symptoms. Design: This is an electronic record-based retrospective cohort study. Model development used logi…

Opportunities for cannabis in supportive care in cancer.

Authors: Amber S. Kleckner, Ian R. Kleckner, Charles S. Kamen, Mohamedtaki A. Tejani, et al
Therapeutic Advances in Medical Oncology, 1 August 2019

Cannabis has the potential to modulate some of the most common and debilitating symptoms of cancer and its treatments, including nausea and vomiting, loss of appetite, and pain. However, the dearth of scientific evidence for the effectiveness of cannabis in treating these symp…

A hunger for hunger: a review of palliative therapies for cancer-associated anorexia.

Authors: Daniel S. Childs, Aminah Jatoi
Annals of Palliative Medicine, January 2019

Cancer-associated anorexia, or loss of appetite, is prevalent, distressing to patients and their families, and associated with poorer outcomes in patients with advanced cancer. A well-defined therapeutic strategy remains to be defined. We present here a review of appetite loss…

Cannabis in palliative care: current challenges and practical recommendations

Authors: Claude Cyr, Maria Fernanda Arboleda, Sunil Kumar Aggarwal, Lynda G. Balneaves, Paul Daeninck, Andrée Néron, Erin Prosk, Antonio Vigano
Annals of Palliative Medicine, October 2018

Pain and symptom control challenges are common in palliative care, and the search for other therapeutic strategies is ongoing. Unfortunately, patients and their caregivers are receiving little information or support from healthcare providers regarding the increasingly popular…

Use of cannabinoids in cancer care: palliative care.

Authors: S.K. Aggarwal
Current Oncology, March 2016

Integrating cim into oncologic palliative care promises to improve overall health-related quality of life, to provide further relief from distressing symptoms and spiritual suffering, and to bring hope to patients and families facing terminal illness. O’Shaughnessy offers the…

The medical necessity for medicinal cannabis: prospective, observational study evaluating the treatment in cancer patients on supportive or palliative care.

Authors: Gil Bar-Sela, Marina Vorobeichik, Saher Drawsheh, Anat Omer, Victoria Goldberg, Ella Muller
Evidence-Based Complementary and Alternative Medicine, 2013

BACKGROUND: Cancer patients using cannabis report better influence from the plant extract than from synthetic products. However, almost all the research conducted to date has been performed with synthetic products. We followed patients with a medicinal cannabis license to eval…

Cannabis in palliative medicine: improving care and reducing opioid-related morbidity.

Authors: Gregory T. Carter, Aaron M. Flanagan, Mitchell Earleywine, Donald I. Abrams, et al
American Journal of Hospice and Palliative Medicine, August 2011

Unlike hospice, long-term drug safety is an important issue in palliative medicine. Opioids may produce significant morbidity. Cannabis is a safer alternative with broad applicability for palliative care. Yet the Drug Enforcement Agency (DEA) classifies cannabis as Schedule I…