SLR - November 2018 - Brennan A. Menninger

Cannabinoid Delivery Systems for Pain and Inflammation Treatment

Reference: Bruni N, Pepa CD, Oliaro-Bosso S, Pessione E, Gastaldi D, Dosio F. Cannabinoid Delivery Systems for Pain and Inflammation Treatment. Molecules. 2018 September 27; 23(2478).

Scientific Literature Review

Reviewed By: Brennan A. Menninger, DPM
Residency Program: North Colorado Medical Center, Greeley, CO

Podiatric Relevance: The opioid abuse epidemic is a well-publicized crisis in the United States. Faced with treating both chronic and acute pain, physicians of all specialties are pressured away from the use of opioid medications. Recent literature and discussion have been devoted to developing multimodal therapeutic regimens that avoid opioids in the management of pain. Much interest has been given to cannabinoids, which have been shown to offer benefit in the treatment of epilepsy, sleep disorders, multiple sclerosis and schizophrenia. Pertinent to the podiatric physician is the potential role of cannabinoids for the treatment of both acute and chronic pain and inflammation.

Methods: This is a review of the current literature in the development of cannabinoid delivery systems. The particular focus is on the treatment of pain and inflammation. Recent developments along with future directions for study are discussed.

Results: There are several important findings from this review. With regard to physiological pain, studies have indicated that endocannabinoids play a role during the pro-inflammatory process with a potential use in mitigating the painful progression of osteoarthritis-associated pain. With regard to neuropathy-associated pain, cannabinoid receptor agonists may play a role in symptomatic relief for patients. Routes of administration for cannabinoid products include oral, oromucosal, transdermal, pulmonary and intranasal. Patents and research into the optimal routes are ongoing. There currently exist licensed products for use in patients with chronic neuropathic pain in Canada, Germany and Israel, while heated debate continues in all parts of the world as to the true efficacy. High-quality evidence is mostly lacking due to illegal status of cannabinoids in most countries. Confounding factors include mixed-study patient populations, varying preparations and a wide range of dosage parameters.

Conclusion: The use of cannabinoids and their potential therapeutic effects in the management of acute and chronic pain continues to be a hot topic. Preliminary evidence has indicated that a theoretical role for these preparations likely exists. Transdermal preparations may be of most interest to the podiatric physician, similar in the way that topical and local administrations of anti-inflammatory and analgesics medications (i.e., diclofenac cream and lidocaine patches) currently has efficacy for some patients. With more than 1,000 new articles per year, cannabinoids may soon become widespread therapeutics in the management of acute and chronic pain and inflammation, and podiatric physicians should keep themselves informed of their potential use in their practice.

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