All posts by walksabina

Dear Pain Matters blog readers, My name is Sabina Walker, and I completed a Master in Applied Science (Neuroscience). I chose to focus on the topic of nerve pain because someone close to me had complex regional pain syndrome (CRPS) following crush injury to several fingers. My current goals are to expand this blog called Pain Matters including blog readership. Thereafter, I may pursue a PHD involving Heart Rate Variability in Nerve Pain Patients. I may also write a book on chronic pain including nerve pain. After all, Pain Matters to all of us! Please seek as much help as you can if you are suffering from chronic pain including nerve pain. There are many References included in this blog to assist. Also, please feel free to share your own nerve pain experiences (and any recoveries) via this blog! After all, if you suffer from nerve pain, your experience is worth a 1000 words in any textbook! Wishing hope, inspiration and less pain in this world! Sabina Walker Master Applied Science (Neuroscience) PS If you find any of my Blog Posts interesting or useful, please feel free to share it around amongst your family, friends, colleagues and/or others, via Facebook, LinkedIn, etc. At the end of the day, pain matters to everyone including: - People who live with chronic pain; - People who care for people who live with chronic pain; - People who know people who live with chronic pain; and/or - People who are simply interested in pain matters. So please help get the word out....pain matters to all of us, directly or indirectly! PPS For interested readers, the respected Prof. Peter Drummond and I published the following 24-page Review Paper: Sabina Walker, Peter D. Drummond. Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper, 24 pages]. Pain Medicine (Dec 2011), 12 (12), 1784–807. DOI: 10.1111/j.1526-4637.2011.01273.x http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01273.x/abstract

What Do Three Wise Men Bearing Gifts Have In Common With Pain Relief? (The Answer: Frankincense/Boswellia.)

Feature Image sourced from:

https://www.insidescience.org/news/molecules-responsible-fragrance-frankincense-discovered

INTRODUCTION

Dear Pain Matters blog readers,

After a close friend credited Boswellia and targeted exercise for complete relief of his severe acute back pain, I was inspired to blog about this amazing pain-relieving extract.

Boswellia serrata extract is widely appreciated for its therapeutic effects on inflammation, arthritis and pain.

Also known as frankincense oil or olibanum, the Boswellia serrata extract is produced from gum resin (a.k.a. oleogum resin) obtained via incisions in the trunk of the Boswellia serrata tree that commonly grows in India.

Most people are familiar with the story of the three wise men bearing gifts of gold, frankincense and myrrh for the Baby Jesus on the eve of his birth in Bethlehem.

In addition to Christianity, frankincense is also highly regarded by other religions and cultures including by Jewish, Muslims, Indians, Egyptians and Greeks.

But did you know that the Boswellia serrata extract can also offer significant pain relief?  Specifically, the resin from the Boswellia serrata tree may be effective in treating chronic pain including osteoarthritis, soft tissue rheumatism, low back pain, gout, rheumatoid arthritis and inflammatory bowel disease.

Boswellia treatment can lead to enhanced movement and mobility as well as reduced inflammation.  Reduced leucocyte infiltration in the knee joint and decreased release of pro-inflammatory mediators occurs following daily Boswellia intake.

Boswellia serrata extract may be a viable alternative to non-steroidal anti-inflammatory drugs (NSAIDs), with fewer severe side effects (Abdel-Tawab et al, 2011; Pawar et al, 2011).

CASE STUDIES

(1) A Study Involving Boswellia-Treated Knee Osteoarthritis Patients

A study involving 70 knee osteoarthritis patients was done to evaluate the effectiveness and safety of a Boswellia serrata extract called 5-Loxin®.  Specifically,  5-Loxin® (100 mg or 250 mg) or a placebo was offered daily for 90 days.  Pain and physical function assessments were made on Days 0 (baseline), 7, 30, 60 and 90.

Pain levels and physical function were significantly improved in treated patients regardless whether 100 mg or 250 mg 5-Loxin® was offered.  It is noteworthy that patients who received the higher dosage enjoyed substantial pain relief and other benefits within only 7 days of treatment.

Boswellia serrata-treated patients also had decreased levels of the cartilage-degrading enzyme, matrix metalloproteinase-3.  Reduced pro-inflammatory mediators in the synovial fluid may lead to improved knee joint health including less cartilage damage in osteoarthritis patients (Sengupta et al, 2008).

(2) A Second Study Involving Boswellia-Treated Knee Osteoarthritis Patients

An Indian study involving 30 knee osteoarthritis patients was done to ascertain the efficacy, side effects and safety of Boswellia serrata extract.  Specifically, 15 patients were offered Boswellia serrata while the remaining 15 patients were given placebo treatment for 8 weeks.  The second half of the study involved switching the 30 patients to the opposite intervention for a further 8 weeks.

All Boswellia serrata-treated patients enjoyed decreased knee pain, reduced knee joint swelling, enhanced knee flexion and increased walking distance.

While minor gastrointestinal side effects may arise in some patients, Boswellia serrata extract may be an effective treatment option for knee osteoarthritis and other arthritic conditions (Kimmatkar et al, 2003).

(3) An Indian Study Involving Boswellia For Osteoarthritis  

An Indian trial led by Raychaudhuri and her colleagues evaluated the efficacy of the Boswellia serrata extract enriched with a form of boswellic acid in osteoarthritis patients.  The researchers concluded that Boswellia serrata can reduce pain and improve knee joint function in as little as 7 days (per Indian newspaper article).

SUMMARY

Boswellia serrata extract may be effective in treating chronic pain, arthritis and osteoarthritis.  Its therapeutic effects are achieved via dampening of the inflammatory response.  

Boswellia serrata extract may be a viable alternative to NSAIDs, with fewer severe side effects.

What could be better than this??

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS Please feel free to share your personal experience with Boswellia serrata extract via this blog.

Also feel free to share this post on Facebook and other social media.

REFERENCES

ARTICLES

(1) Schultz, Colin. There’s More to Frankincense and Myrrh Than Meets the Eye. Smithsonian.com (24 Dec 2014).

https://www.smithsonianmag.com/smart-news/chemically-theres-lot-more-frankincense-and-myrrh-meets-eye-180953727/

(2) Blanco, Julia. Boswellia New Studies Show Effective Pain Relief. Life Extension Magazine (December 2014).

https://www.ncbi.nlm.nih.gov/pubmed/20108844

SCIENCE PAPERS

Clinical Cases and Studies 

(1) Sengupta et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther. (2008); 10: R85.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575633/

(2) Kimmatkar et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial. Phytomedicine (Jan 2003); 10(1): 3-7.

(3) Indian herb hope for arthritis relief. The Telegraph Calcutta. (4 Aug 2008); Page 7.
(4) Not discussed in this blog post:

(A) Kizhakkedath et al. Clinical Evaluation of an Herbal Formulation, Rhulief®, in the Management of Knee Osteoarthritis. Osteoarthritis and Cartilage; 19 (Supplement 1): S145-S146.

https://pdfs.semanticscholar.org/e8d4/76ea39303de736eb353d9f31e85b43c3f183.pdf

(B) Kizhakkedath et al. Clinical evaluation of a formulation containing Curcuma longa and Boswellia serrata extracts in the management of knee osteoarthritis. Mol Med Rep. (Nov 2013); 8(5): 1542-8.

Underlying Mechanisms

(1) Pawar et al. Physico-chemical standardization and development of HPTLC method for the determination of β-boswellic acid from Boswellia serrata Roxb. (exudate). Int J App Pharm (2011); 3(1): 8–13.

(2) Hamidpour et al. Frankincense (乳香 Rǔ Xiāng; Boswellia Species): From the Selection of Traditional Applications to the Novel Phytotherapy for the Prevention and Treatment of Serious Diseases. Journal of Traditional and Complementary Medicine (2013); 3(4): 221-226.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924999/

(3) Ammon. Modulation of the immune system by Boswellia serrata extracts and boswellic acids. Phytomedicine (Sept 2010); 17(11): 862-867.

https://www.sciencedirect.com/science/article/pii/S0944711310000620?via%3Dihub

(4) Siddiqui. Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview. Indian J Pharm Sci (May-June 2011); 73(3): 255–261.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309643/

(5) Abdel-Tawab et al. Boswellia serrata: an overall assessment of in vitro, preclinical, pharmacokinetic and clinical data. Clin Pharmacokinet. (June 2011); 50(6): 349-69.

Advertisements

Hyperbaric Oxygen Therapy for Pain

Feature Image sourced from:

https://pixabay.com/en/diving-air-oxygen-kringel-air-ring-378214/

Dear Pain Matters blog readers,

INTRODUCTION

Hyperbaric oxygen therapy (HBOT) involves the delivery of 100% oxygen at increased atmospheric pressures inside a pressure chamber.

Pressures greater than normal air pressure (i.e. 1 Atmosphere Absolute, or 1 ATA) may be offered by trained personnel.  Many patients are exposed to 2 to 2.4 ATA per session.  Each session may last 1.5 to 2 hours and patients may complete a total of 20 to 30 HBOT sessions.

For those of you who have scuba dived, free dived or snorkelled, 2 ATA is the pressure that one would feel 10 meters (33 feet) under the ocean.  Thus, every 10 meters (33 feet) of sea water is equivalent to an increase of 1 ATA of pressure.

http://www.vhbo2.com/companion/hyperbaric-oxygen-therapy/understanding-hbot/

88232418.jpg

Source:

https://media.gettyimages.com/photos/students-breath-oxygen-in-a-hyperbaric-oxygen-chamber-to-help-relax-picture-id88232418?k=6&m=88232418&s=612×612&w=0&h=tCQk-S4brc2Dv7E9mF5XGVPp-USamsbrQgspKAf_agE=

Also called hyperbaric medicine or hyperbaric treatment, HBOT can increase oxygen concentration, reduce inflammation and decrease the number and sensitivity of tender and painful points.

This is a cute 2-minute video of a dog inside a pressure chamber (with great background music):

Hyperbaric oxygen therapy can alleviate chronic pain in:

  • Complex regional pain syndrome;
  • Fibromyalgia;
  • Myofascial pain syndrome;
  • Idiopathic trigeminal neuralgia;
  • Migraines and cluster headaches; and
  • Other pain conditions (Yildiz et al, 2006; Yildiz et al, 2006; Efrati et al, 2015)

as well as reduce pain following crush injuries.

PAINFUL CONDITIONS TREATED BY HYPERBARIC OXYGEN THERAPY

LOWER LIMB COMPLEX REGIONAL PAIN SYNDROME (CASE 1) 

A 41-year old man, ‘G.G.’, suffered from Complex Regional Pain Syndrome Type 2 (CRPS Type 2), left foot, caused by a traumatic ‘Weber B’ left ankle fracture that occurred more than a year ago on 21 February 2014.  Specifically, G.G. slipped and fell on ice in a parking lot at the end of a working day.  He immediately suffered severe pain in his left ankle and foot.

Two days later, on 23 February 2014, G.G. had surgery involving open reduction internal fixation of his ankle.  Complications set in including a cellulitis infection that was treated with antibiotics.

Post-surgery, G.G. endured ongoing and severe pain including intermittent shooting pains and severe electric shocks in his left ankle and foot.  Other symptoms included allodynia, swelling, temperature changes and discoloured skin in the left lower limb.

Despite undergoing a rehabilitation program and taking pain medication including pregabalin (75 mg twice daily), acetaminophen and NSAIDs (as needed), multivitamins, calcium, magnesium and glucosamine, G.G.’s severe pain persisted.

A diagnosis of CRPS, left foot, was made in April 2014.

On 5 February 2015, almost one year after his injury, G.G. had surgery to remove the plateau in his left lower limb in an effort to relieve his pain.  Sadly, G.G.’s symptoms including pain and allodynia, swelling, purple discolouration, lower skin temperature as well as muscle weakness in his left lower leg and ankle continued.  With average pain levels at 6 that often rose to 8, G.G. described his pain as (quoting) ‘constant, dull, aching pain with intermittent shooting sensations’.   

Desperate for some pain relief, G.G. decided to try HBOT for his CRPS in his left foot.

After 15 HBOT sessions over 3 weeks, G.G. had significantly less pain and allodynia, reduced swelling, enhanced skin colour and improved range of motion in his left foot.  Following 3 weeks of HBOT, G.G. was able to return to work after more than a year off due to severe left foot pain.

Hyperbaric oxygen therapy may be a valuable therapeutic option for treating chronic CRPS (Katznelson, 2016).

LOWER LIMB COMPLEX REGIONAL PAIN SYNDROME (CASE 2)

A 44-year old woman had CRPS, left foot and ankle.  Her foot and ankle had restricted range of motion, appeared cyanotic and was tender and cool upon touch.

Within only 15 minutes of her first HBOT treatment, she enjoyed complete pain relief in her foot!  Furthermore, her foot felt warm on palpation and (quoting her) ‘pinker than it’s been in years’.  The foot remained pink and warm for 8 hours.  Best of all, she enjoyed nil pain for 18 hours after her first HBOT treatment!

Following amendments to her second HBOT session on the following day, her foot became pink and warm for 1 hour as well as painless for 2 hours.

Further adjustments made to her third HBOT protocol in the following week resulted in her foot remaining painless, warm and pink for 30 hours (!) (Peach, 1995).

COMPLEX REGIONAL PAIN SYNDROME

A double-blind, randomized, placebo-controlled study compared 37 CRPS patients who had HBOT treatment against 34 CRPS patients who received normal air (Control Group).  All 71 CRPS patients underwent 15 sessions inside a hyperbaric chamber.

The HBOT-treated patients enjoyed significantly less pain and edema as well as enhanced range of motion of the wrist. 

Hyperbaric oxygen therapy may offer pain relief, decreased swelling and improved range of motion in CRPS patients (Kiralp et al, 2004).

FIBROMYALGIA

A study involving 60 women aged 21 to 67 who suffered fibromyalgia for more than 2 years underwent 40 HBOT sessions.  These 90-minute sessions were offered 5 days a week and each session involved 100% oxygen at 2 ATA.  Hyperbaric oxygen therapy led to significant improvement in all fibromyalgia symptoms including improved quality of life (Efrati et al, 2015).

MYOFASCIAL PAIN SYNDROME

A study evaluated the effects of HBOT on 20 patients with myofascial pain syndrome (MPS) compared to 10 patients in the control group.  The patients in the HBOT group were offered 10 HBOT sessions over 2 weeks.

There were no complications following hyperbaric oxygen therapy.  The pain threshold was significantly improved as were visual analogue scale (VAS) scores in patients in the HBOT group.  

The researchers concluded that HBOT may offer benefits for patients with MPS (Kiralp et al, 2009).

IDIOPATHIC TRIGEMINAL NEURALGIA

Patients with severe nerve facial pain (i.e. idiopathic trigeminal neuralgia) were offered HBOT sessions for 10 consecutive days.  Specifically, 42 patients aged 40 to 70 (8 men, 34 women) who suffered trigeminal neuralgia for 2 to 20 years were selected for this study.

The researchers concluded that HBOT treatment offered quick, dose-dependent and lasting pain relief.  Thus, HBOT may be an effective treatment for some nerve pain conditions including trigeminal neuralgia (Gu et al, 2012).

MIGRAINES 

Female migraine sufferers were offered either:

  • 100% oxygen and nil pressure (control group); or
  • Hyperbaric oxygen therapy comprising 100% oxygen and pressure.

The HBOT-treated migraineurs enjoyed some pain relief.  Pain levels remained unchanged in the control group.  

Hyperbaric oxygen therapy may reduce the intensity of migraines and headaches (Wilson et al, 1998).

CRUSH INJURY

Due to their traumatic nature, crush injuries can result in severe injury and pain to various body regions.  Crush injuries can range from minor contusions to limbs facing amputation due to tissue necrosis.

Crush injuries may affect different tissue regions including skin, subcutaneous layers, muscle, tendons, ligaments, cartilage, vasculature including capilliaries, nerves, bones and joints.  Physical trauma can lead to prolonged swelling and edema, stasis and/or internal bleeding including bleeding within myofascial envelopes.  The latter may lead to increased tissue fluid pressure in the skeletal muscle compartment.

Affected tissues may become ischemic due to hypoxia if the tissue fluid pressure (edema) exceeds the capillary perfusion pressure to the muscles and nerves inside the skeletal muscle compartment.

Ongoing edema may result in increased pressure as well as severely compromised microcirculation and limited or nil oxygen transfer across the capillary endothelium.  This may ultimately lead to ischemia and hypoxia.

Complex regional pain syndrome, skeletal muscle compartment syndrome and other painful conditions may develop and/or limb amputation may occur if urgent and effective treatment to prevent hypoxia and ischemia following crush injury is not provided.

Thus, time is of the essence that appropriate treatments are undertaken to reduce localised inflammation and swelling.

Importantly, hyperbaric oxygen may be used as an adjunct treatment to reverse ischemic and hypoxic conditions in crush injuries.  

https://www.uhms.org/4-crush-injury-compartment-syndrome-and-other-acute-traumatic-ischemias.html

WHY MIGHT HYPERBARIC OXYGEN THERAPY WORK?

Note:  This section is written for scientifically-minded readers, and may be skipped altogether by others who may not be so inclined. 

Animal research shows that HBOT blocks the production of tumor necrosis factor (TNF)-α in rats with chronic constriction injury.  Reduced TNF-α levels may lead to decreased nerve pain (Li et al, 2011).  Local overproduction of TNF-α, on the other hand, may play a role in promoting CRPS (Walker and Drummond, 2011).

Many chronic pain conditions include an inflammatory component that may lead to tissue hypoxia, ischemia and microvascular deficits (i.e. inflammatory hypoxia).  Re-oxygenation of injured or diseased tissues is a prerequisite before regeneration can occur.  Therapies such as HBOT may promote tissue re-oxygenation, reversal of inflammatory hypoxia and regeneration (Perdrizet, 2017) that may lead to pain relief.

Ten divers (9 males, 1 female) underwent pressures of 1, 2, 3 and 4 ATA in a supine position for 10 minutes per pressure in a hyperbaric chamber.  The Spanish study found that as the pressure increased, heart rate (HR) decreased and heart rate variability (HRV) moved into the high frequency range, especially after 2, 3 and 4 ATA.  Pressure-evoked increased HRV is indicative of enhanced parasympathetic (vagal) activity  (Barbosa et al, 2010).  Increased parasympathetic activity including enhanced vagal tone may lead to reduced pain, decreased inflammation and other medical benefits (Walker and Drummond, 2011).

Researchers recently suggested that nerve cells may actually communicate via mechanical pulses instead of electric pulses (Fox, 2018).  If true, is it possible that increased atmospheric pressures via HBOT inside a pressure chamber may lead to increased mechanical pulses?  If so, could this result in increased cutaneous sympathetic vasoconstrictor activity?  If yes, could this induce tissue re-oxygenation and reversal of inflammatory hypoxia in some pain patients including CRPS patients?  Research is warranted.

SUMMARY

Hyperbaric oxygen therapy may offer pain relief for some pain patients.

Please ensure that HBOT is done under medical supervision only and by trained personnel.  Refer to References for complications that may arise from HBOT. 

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS Please feel free to share your personal experience with HBOT via this blog. 

REFERENCES

TEXTBOOK

(1) Undersea and Hyperbaric Medical Society (UHMS). Hyperbaric Oxygen Therapy Indications, Thirteenth Edition (April 2014).

ISBN 978-1930536-73-9

https://www.bestpub.com/books/hyperbaric-a-undersea-medicine/product/436-hyperbaric-oxygen-therapy-indications-thirteenth-edition/category_pathway-31.html

PAIN CONDITIONS TREATED BY HBOT

Complex Regional Pain Syndrome

(2A) Katznelson. Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy. Pain Research and Management (2016); Volume 2016, Article ID 3458371, 4 pages.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904619/

https://www.hindawi.com/journals/prm/2016/3458371/

(2B) Peach G. Hyperbaric oxygen and the reflex sympathetic dystrophy syndrome: a case report. Undersea Hyperb Med. 1995; 22(4): 407–8.

https://www.o2oasis.com/wp-content/uploads/2014/11/RSD-Case-Report.pdf

(2C) Kiralp et al. Effectiveness of hyperbaric oxygen therapy in the treatment of complex regional pain syndrome. J Int Med Res. (May-June 2004); 32(3): 258-62.

https://www.ncbi.nlm.nih.gov/pubmed/15174218

Fibromyalgia

(3) Efrati et al. Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome – Prospective Clinical Trial. PLoS ONE (26 May 2015); 10(5): e0127012.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127012

Myofascial Pain Syndrome

(4) Kiralp et al. A novel treatment modality for myofascial pain syndrome: hyperbaric oxygen therapy. J Natl Med Assoc. (Jan 2009); 101(1): 77-80.

https://www.ncbi.nlm.nih.gov/pubmed/19245076

Idiopathic Trigeminal Neuralgia

(5) Gu et al. Hyperbaric oxygen therapy attenuates neuropathic hyperalgesia in rats and idiopathic trigeminal neuralgia in patients. Eur J Pain. (2012); 16(8): 1094–105.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/j.1532-2149.2012.00113.x

Migraines 

(6) Wilson JR, Foresman BH, Gamber RG, Wright T. Hyperbaric oxygen in the treatment of migraine with aura. Headache. 1998; 38(2): 112–5.

https://www.ncbi.nlm.nih.gov/pubmed/9529766

Crush Injury

(1) Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemias. Undersea and Hyperbaric Medical Society (UHMS).

https://www.uhms.org/4-crush-injury-compartment-syndrome-and-other-acute-traumatic-ischemias.html

Other Pain Conditions

NB The following 2 papers are not discussed in this blog post:

(7A) Yildiz et al. Hyperbaric oxygen therapy in chronic pain management.  Curr Pain Headache Rep. (May 2006); 10(2): 95-100.

https://www.researchgate.net/publication/7238531_Hyperbaric_oxygen_therapy_in_chronic_pain_management

(7B) Yildiz et al. Pain management and hyperbaric oxygen therapy. Therapy (2006); 3(5): 597–603.

https://pdfs.semanticscholar.org/6776/ae1e93f42de7371a28774221967dcf67fa0e.pdf

Possible Complications

(1) Complications of Hyperbaric Oxygen Treatment.  Johns Hopkins Medicine

https://www.hopkinsmedicine.org/healthlibrary/conditions/physical_medicine_and_rehabilitation/complications_of_hyperbaric_oxygen_treatment_134,148

Why Might Hyperbaric Oxygen Therapy Offer Pain Relief? 

(1) Li et al. Hyperbaric oxygenation therapy alleviates chronic constrictive injury-induced neuropathic pain and reduces tumor necrosis factor-alpha production. Anesth Analg. (Sept 2011); 113(3): 626-33.

https://www.ncbi.nlm.nih.gov/pubmed/21596875

(2) Perdrizet. Chronic Diseases as Barriers to Oxygen Delivery: A Unifying Hypothesis of Tissue Reoxygenation Therapy. Adv Exp Med Biol. (2017); 977: 15-20.

https://www.ncbi.nlm.nih.gov/pubmed/28685422

(3) Barbosa et al. Effect of hyperbaric pressure during scuba diving on autonomic modulation of the cardiac response: application of the continuous wavelet transform to the analysis of heart rate variability. Mil Med. (Jan 2010); 175(1): 61-4.

https://www.ncbi.nlm.nih.gov/pubmed/20108844

(4) Sabina Walker, Peter D. Drummond; Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper, 24 pages]; Pain Medicine (Dec 2011), 12 (12), 1784–1807.

http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01273.x/abstract

(5) Fox, Douglas. The Brain, Reimagined. Scientific American (April 2018); 318(4): 60-67.

http://www.nature.com/scientificamerican/journal/v318/n4/full/scientificamerican0418-60.html

 

Can the Butterfly Enzyme (ie Serrapeptase) Reduce Chronic Pain, Swelling and Inflammation?

Feature Image sourced from:

Getty Images and https://www.elle.de/serrapeptase

Dear Pain Matters blog readers,

A couple of years ago, I sat next to an elderly lady in her 80’s during a flight between Los Angeles and San Francisco.  The woman told me that she used to have severe pain in both knees.

Then one day, the woman heard about serrapeptase for chronic pain.  After taking serrapeptase on a daily basis, she no longer has knee pain.  Because there were no side effects, she intended to take serrapeptase for the rest of her life.  Since no prescription was required, serrapeptase can be purchased online or in specialty health shops.

Struggling to keep up with her as I said goodbye (and I jog daily!), I took notice of her fast stride as she quickly walked out of the airport terminal.  She said she was in a big hurry as her friends were waiting for her at the cruise ship terminal!

After listening to her amazing story about serrapeptase’s beneficial effects on her knee pain and after watching her race out of the airport terminal, I decided to dedicate a blog post to her favourite pain medicine, serrapeptase.

BACKGROUND

So what exactly is serrapeptase?

The saliva of silkworms contains an enzyme called serrapeptase.  This enzyme is secreted by friendly bacteria called Serratia sp. E-15 that live in the intestines of silkworm.

The serrapeptase enzyme is sometimes called the silkworm-butterfly enzyme, silkworm enzyme or (my personal favourite) butterfly enzyme.  Scientifically, it may also be called serrapeptidase, serratiopeptidase, serratiapeptase, serralysin and serratia E-15 protease (the latter named after the bacteria from which it was first isolated).

Serrapeptase’s principal function is to break down and dissolve dead cocoon tissue during the silkworm’s transformation into a butterfly.  Serrapeptase plays a significant role in dissolving the non-living (‘avital’) proteins that make up the strong silk threads of the dead cocoon.

Serrapeptase’s strong protein-dissolving capabilities enables the silkworm-turned-butterfly to finally break loose from its old cocoon tissue (instead of remaining stuck in there forever).

whatisserrapeptasegraphic2.jpg

Source: http://www.serrapeptase.org/serrapeptase-research/serrapeptase-medical-research/

ANTI-INFLAMMATORY AND ANTI-EDEMIC EFFECTS OF SERRAPEPTASE

Researchers found that when taken orally on an empty stomach, serrapeptase is absorbed by the small intestine where it enters the bloodstream.

Serrapeptase facilitates the breakdown of cellular debris and dead proteins within the bodily fluid and certain biofilms (via proteolysis).  It can dissolve proteins including fibrin in blood clots, arterial plaques and scar tissue.  Excess scar tissue near injury sites can often lead to pain, limited range of motion and nerve blockages.

NB Research is warranted whether serrapeptase’s deleterious effects on fibrin could alleviate certain painful conditions including endometriosis.

It reduces swelling, inflammation and pain as well as enhances tissue repair and regeneration.

The enzyme promotes the drainage of excess fluid including mucous via its anti-edemic effects hence improving sinusitis and other mucousal conditions.  It can reduce or eliminate cysts (e.g. breast cysts, ovarian cysts).

Serrapeptase does not target proteins in living tissue.  As such, it does not pose any risk to healthy tissue or cells.

There are no known side effects pertaining to serrapeptase intake (unlike non-steroidal anti-inflammatories that often causes gut wall damage and other adverse effects).

250x250-what-is-serrapeptase-1.jpg

Credit:   http://www.serrapeptase.org/serrapeptase-research/what-is-serrapeptase/

More details on serrapeptase are provided in the following video:

PAIN PATIENT STORIES

(1) Amba Carrington 

Amba Carrington (28) suffered severe stabbing pain in her lower back following a motorbike accident 6 years earlier.  One day, Amba’s doctor suggested that Amba try serrapeptase (SP-Zyme).  Six (6) weeks later, Amba was completely pain-free.  Quoting Amba:

‘For years, I took strong prescription painkillers and had injections to relax my back muscles, but nothing cut out the pain effectively … I was unable to drive, walk long distances or exercise. The pain was crippling and wiped me of energy. It was horrible – I felt like an old woman.’

‘… after a few days, I felt my back pain easing off, and after ten days, it had gone completely. I can barely believe it, but today I am free from chronic pain.’

http://www.dailymail.co.uk/health/article-84202/How-silkworms-end-pain.html

(2) Jann Barry

A patient named Jann suffered ongoing pain and stiffness due to rheumatic arthritis (RA)  diagnosed 2 years earlier.  

Jann started taking Serraenzyme (250,000IU) 8 months ago.  His dose during the first 2 months was 6×250,00IU daily.  This was decreased to 4×250,000IU/day during the next 2 months, and further reduced to 2×250,000IU/day for the last 4 months.

Quoting Jann,

‘The change in me is nothing short of miraculous. Apart from a bit or morning stiffness, I have no pain what so ever.  A fungal infection in both my big toenails, which [until now had] responded to nothing … , disappeared within the first month.  My nails, which spent 80 years splitting, peeling and breaking, are now like steel tallons – well almost! I actually have to file them down every day.

I now have 5 friends on Serraenzyme and I’ll be on it for the rest of my life.’

http://www.serrapeptase.org/serrapeptase-research/what-is-serrapeptase/

(3) Other Serrapeptase Stories

Chronic Pain Relief – Serrapeptase Testimonial Video (3-minutes)

This patient’s back pain as well as neck and shoulders pain is now ‘dramatically reduced … feels better’ (quoting patient) after only 1 week of serrapeptase (refer to 1:14 minutes on).

Benefits of Serrapeptase – 3 Amazing Serrapeptase Testimonial Videos (3-minutes)

SUMMARY

Given its anti-inflammatory, anti-edemic, proteolytic and fibrinolytic effects, serrapeptase is increasingly being considered as a safer alternative than non-steroidal anti-inflammatories by patients suffering from pain and inflammation.

Serrapeptase can reduce swelling and fluid (edema) at wound and infection sites as well as decrease mucus and other secretions at mucosal membranes (e.g., ear, nose, throat).

Athletes often take serrapeptase as a supplement to treat injuries and prevent swelling after surgery.

Subject to medical supervision, pain patients including patients with arthritis and localised edema are encouraged to try serrapeptase for pain relief (given very little or nil side effects).

Could the silkworm become one of humankind’s new best friends??

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS Please feel free to share your personal experience with serrapeptase via this blog. 

REFERENCES

SCIENCE PAPERS

(1) Tiwari. The role of serratiopeptidase in the resolution of inflammation. Asian Journal of Pharmaceutical Sciences (May 2017); 12(3): 209-215.

https://www.sciencedirect.com/science/article/pii/S181808761630160X

(2) Al-Khateeb and Nusair. Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars. Int J Oral Maxillofac Surg. (March 2008); 37(3): 264-8.

https://www.ncbi.nlm.nih.gov/pubmed/18272344

GENERAL INFORMATION

(1) Serrapeptase.org

http://www.serrapeptase.org/serrapeptase-research/what-is-serrapeptase/

http://www.serrapeptase.org/serrapeptase-research/serrapeptase-medical-research/

http://www.serrapeptase.org/references/

(2) https://serrapeptase.info

Many science papers are provided in this link.

PATIENT STORIES

(1) Amba Carrington – Lower Back Pain Patient 

Stephens, Anastasia. How silkworms can end back pain. Daily Mail. 

http://www.dailymail.co.uk/health/article-84202/How-silkworms-end-pain.html

(2) Jann Barry – Back Pain Patient 

http://www.serrapeptase.org/serrapeptase-research/what-is-serrapeptase/

(3) Lea Verity – Tempero-Mandibular Joint Patient (not described in blog) 

Hilary Freeman speaks to Lea Verity whose life has been transformed by Serrapeptase. Daily Express (5 February 2002 – extracts).

https://silkwormbutterflyenzyme.com/hilary-freeman-speaks-to-lea-verity-whose-life-has-been-transformed-by-serrapeptase/

MEDIA – IN GERMAN

(1) Tehrani, Mona. Das Schmetterlings-Enzym: So gut ist Serrapeptase für deine Gesundheit. Elle ().

https://www.elle.de/serrapeptase

(2)  Serrapeptase

http://cleanquell.com/serrapeptase/

 

 

‘The Biggest Health Scandal Affecting Women Since Thalidomide’ – Can Surgery to Remove Vaginal Mesh Reduce Severe Pain Following Failed Mesh Implants?

Feature Image of an assortment of implantable pelvic mesh devices sourced from:

http://www.theherald.com.au/story/4547363/its-so-awful-and-so-private-photos-video/?cs=5507

Dear Pain Matters blog readers,

This blog post aims to offer hope, inspiration and courage to those women who suffer from severe and ongoing pelvic pain due to failed vaginal mesh implant surgery.

Pelvic mesh implant surgery was often recommended when conservative treatments for prolapse, incontinence and other pelvic conditions failed.

58f73dba1b0000330016c490.jpeg

Source:  Stocktrek images via Getty Images

https://www.huffingtonpost.co.uk/entry/what-is-vaginal-mesh-incontinence-treatment-risks_uk_58f71cdde4b05b9d613e6bda

Many women were ill-advised of the high risks associated with mesh implant surgery including severe and disabling pelvic pain.

In November 2017, the Therapeutic Goods Administration (TGA) in Australia finally banned 45 pelvic mesh devices including vaginally-implantable prolapse mesh devices and certain mesh slings following the international pelvic mesh fiasco (McCarthy, 2017).

THE GOOD NEWS FOR SOME FAILED MESH IMPLANT PATIENTS   

Patients suffering from severe pain and other serious complications due to failed mesh implants may explore whether mesh removal surgery (i.e. mesh excision) is a viable option to remove all or part of the mesh implant. 

http://www.med.umich.edu/1libr/Gyn/ExcisionOfMesh.pdf

https://urogyn.coloradowomenshealth.com/patients/library/transvaginal-mesh-removal

A French Mesh Removal Study

A French mesh removal study revealed that mesh can be removed both safely and efficiently in many patients, with operating times averaging only 21 minutes.  (NB Some mesh removal operations may require several hours to perform.)

Specifically, 61 of 83 mesh patients underwent complete mesh removal.  Fifty-eight (58) mesh excisions were done more than 2 years after the mesh was implanted in the first place (Marcus-Braun and von Theobald, 2010).

A Dutch Mesh Excision Study

A Dutch study analysed 73 patients who underwent partial or complete mesh excision.  Seventy-seven percent (77%) suffered severe pain including vaginal pain, pain during intercourse and abdominal, back, buttock and/or leg pain prior to mesh removal.

Thirty (30) patients had complete mesh removal while the remaining 43 patients underwent 51 partial mesh operations.

Positive outcomes were achieved for most of the 73 patients.

Specifically, 70% of the patients who underwent complete mesh excision and 60% of those who had partial mesh excision enjoyed COMPLETE RELIEF from mesh-related symptoms (Tijdink et al, 2011).

Catie’s Story

The following is a story about Catie in New Zealand who underwent 3 operations in an effort to remove all mesh.

Catie’s pelvic mesh was initially implanted without incident.  However, 2 years later, (quoting Catie) ‘[the mesh] was rotting and eroding inside …’, causing pain and discharge.  At first, Catie was treated for a potential STD (which wasn’t the case at all) via ‘many courses of metronidazole’, an antibiotic with terrible side effects.

Several years later in March 2011, Catie finally underwent her first mesh removal surgery.  The partial mesh excision took 5 hours because (in Catie’s words) ‘[the mesh] was so ‘stuck’ on in bits and the surgeon had a lot of difficulty getting it out’.

By August 2012, Catie had 2 more excision surgeries.

After her third (and hopefully final) excision surgery that involved ‘a good clean out’ and a D&C, (quoting Catie) ‘there [was] no revolting discharge and … no pain’.

In Catie’s view, it may be another year or more before she will have fully recovered.  She credits her mesh removal surgeon for being wonderful.

Formerly a triathlete, Catie is struggling to become active again.  Nonetheless she is grateful for feeling better after a very long and painful journey.

Catie’s Story:

http://meshdownunder.co.nz/kiwi-stories

WARNING – DO NOT UNDERGO RISKY MESH IMPLANT SURGERY

ALL WOMEN, both young and young-at-heart, should be DISCOURAGED from undergoing surgical mesh implants in the first place.  Full stop.  End of story.

The high risks and serious complications can be catastrophic, post-mesh implant surgery.  Mesh implants can cause permanent, disabling and incapacitating pelvic injuries as well as severe, intractable pelvic pain.

Quoting Jan Wise (who now suffers from back and leg pain thanks to a botched implant surgery involving a pig intestine pelvic mesh device in 2012):

‘[I am] rotting from the inside … shooting electrical shock pain from my lower body up through to my head … hoping the thoughts of the nightmare won’t take up too much of [every] day. I allow myself only one period of sadness and crying per day’ (McCarthy, 2017).

Post-implant, in addition to severe pain, Jan suffers ongoing incontinence, a collapsed vagina, (quoting Jan) ‘putrid seroma discharge’ and ‘pelvic discharge with a foul smell’ as well as loss of intimacy with her husband.  In her words, It’s a dreadful mess down there.’

Some women require pain killers and benzodiazepines as well as regular catheterisation (due to a lost ability to urinate following a failed implant).  Many suffer chronic incontinence together with ongoing urinary tract and vaginal infections, discharge and granulomas.  Others require enemas for chronic bowel problems.  Punctures or lacerations of vessels, nerves, bladder, urethra, bowel, organs and other structures may occur.  Mesh implants often erode into the vagina rendering sex impossible with their husbands or partners.  

In some instances, exposed mesh may even cause pain and injury to the male partner during intercourse (McCarthy, 2017; Stern, 2017 – in German).

Sadly, the list of mesh-related severe complications seems to never end.

One Canadian mother of two young children has died at only 42 due to complications including heart failure and sepsis following pelvic mesh surgery to treat childbirth-induced incontinence (McCarthy, 2017).  

screen-shot-2017-12-04-at-15.30.11-0.png

Chrissy Brajcic (deceased at only 42 following mesh implant complications)

Source:  https://www.independent.co.uk/news/uk/transvaginal-vaginal-mesh-surgery-stress-urinary-incontinence-sui-uti-tvt-antiobiotic-resistance-a8092006.html

Believing to be too great a burden to their family and friends and after giving up hope altogether, other patients commit suicide to end it all (McCarthy, 2017).

If chronic pelvic pain prevails, the only effective treatment may be surgery to remove the implanted mesh (see above).  Unfortunately, it may not always be possible to remove all of the mesh without damaging nearby organs and tissues.  In other words, there may be residual mesh that is too risky to remove.

OTHER OPTIONS

Options to try before even thinking about the unthinkable vaginal mesh implant surgery include:

Non Invasive Options

  • Pelvic floor exercises, also known as Kegel exercises (named after Arnold Kegel, a US gynaecologist).  Kegel exercise can be taught and supervised by a physiotherapist, and done daily at home (Ward, 2018);
  • Yoga and pilates that aim to strengthen the pelvic regions.
  • Incontinence pads (many women opt for this non-invasive option);
  • Substitute action sports (e.g. soccer, tennis) for gentler physical activities that may lead to less ‘leakage’ … and don’t stress if there is residual ‘leakage’.  After all, that is what incontinence pads and showers are for; and
  • Maintain a healthy diet and ensure good quality of sleep.  This is important for optimum autonomic nervous system function including high vagal output throughout the body including in the pelvic region.

Surgery Without Mesh Implant

  • Surgery that does not involve mesh implants.

In conclusion, please avoid vaginal mesh implants altogether.  The risk is too high that severe pelvic pain and other serious injuries may result, post-mesh implant.

SUMMARY

An Australian Senator, Derryn Hinch, stated that ‘Transvaginal mesh is one of Australia’s  greatest medical scandals’ (Marwick, 2017).  

Others call it ‘the new thalidomide’.

Legal class action suits all around the world including more than 100,000 American women clearly demonstrate the unacceptable risks of vaginal mesh implants, with legal bills expected to exceed $20 billion.

The risks of mesh surgery including disabling pelvic pain, compromised or non-existent sex life, loss of enjoyment of life, suicide and death certainly outweigh any possible benefits.

To protect all women in the future, mesh implant operations should be banned altogether (McCarthy, 2017).

Finally, women currently affected by pelvic pain caused by mesh implants should be considered for mesh reversal surgery (assuming this is in the best interest of the patient).

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS If you believe that this information may help someone, please share this blog post via Facebook, etc.

And please tell this person to never, ever give up!

REFERENCES

Hope for Mesh Patients

Medical Papers and Articles – Corrective Surgery to (Partly or Fully) Reverse Failed Vaginal Mesh Implants

(1) Marcus-Braun, N and von Theobald, P. Mesh removal following transvaginal mesh placement: a case series of 104 operations. Int Urogynecol J. (April 2010); 21(4): 423-30.

doi:10.1007/s00192-009-1050-3.

https://www.ncbi.nlm.nih.gov/pubmed/19936589

(2) Tijdink et al. Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh. Int Urogynecol J. (Nov 2011); 22(11): 1395-404.

doi:10.1007/s00192-011-1476-2.

https://www.ncbi.nlm.nih.gov/pubmed/21681595

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3187855/

(3) Stetson, Diana. Vaginal Mesh Excision. Department of Obstetrics and Gynecology, von Voigtlander Women’s Hospital, Michigan Medicine (May 2018).

http://www.med.umich.edu/1libr/Gyn/ExcisionOfMesh.pdf

(4) Transvaginal Mesh Removal. Colorado Women’s Health, University of Colorado Hospital.

https://urogyn.coloradowomenshealth.com/patients/library/transvaginal-mesh-removal

A Patient Who Underwent Several Excision Surgeries to Remove All Mesh 

(5) Catie’s Story:

Real Kiwis, Real Stories. New Zealand – Mesh Down Under 

http://meshdownunder.co.nz/kiwi-stories

Media – Failed Vaginal Mesh Implant Stories  

Alison Blake (Suicided Following Botched Mesh Implant) 

(1) McCarthy, Joanne.’There was a look in her eyes’: Mother’s emotional torment at surgery nightmare. Sydney Morning Herald (20 December 2017).

http://www.smh.com.au/nsw/there-was-a-look-in-her-eyes-mothers-emotional-torment-at-surgery-nightmare-20171220-h080e0.html

Chrissy Brajcic (Deceased At Only 42 Following Failed Mesh Implant) 

(2A) McCarthy, Joanne. Canadian woman Christina Lynn Brajcic dies after receiving pelvic mesh implant. Sydney Morning Herald (4 December 2017).

http://www.smh.com.au/national/health/canadian-woman-christina-lynn-brajcic-dies-after-receiving-pelvic-mesh-implant-20171203-gzxsl1.html

Please watch 2-minute video of Chrissy’s sad surgical mesh story (now deceased at only 42 following mesh-related complications).

(2B) Marsden, Harriet. Vaginal mesh campaigner ‘dies of sepsis after antibiotic-resistant infection’. Independent (4 December 2017).

https://www.independent.co.uk/news/uk/transvaginal-vaginal-mesh-surgery-stress-urinary-incontinence-sui-uti-tvt-antiobiotic-resistance-a8092006.html

Jan Wise, A Mesh Implant Pain Sufferer  

(3A) McCarthy, Joanne. Pelvic mesh victim speaks out about ‘one of the greatest medical scandals in Australian history’. The Herald (23 March 2017).

http://www.theherald.com.au/story/4547363/its-so-awful-and-so-private-photos-video/?cs=5507

Please watch 3-minute video of Jan’s tragic surgical mesh story.

(3B) McCarthy, Joanne. Pelvic mesh victim speaks out about ‘one of the greatest medical scandals in Australian history’. The Herald (23 March 2017).

https://www.theherald.com.au/story/4547363/its-so-awful-and-so-private-photos-video/

Other Articles and Stories from Media

(4) Marwick, Jane. Why aren’t we talking more about one of Australia’s greatest medical scandals? The Daily Telegraph (29 August 2017).

https://www.dailytelegraph.com.au/rendezview/why-arent-we-talking-more-about-one-of-australias-greatest-medical-scandals/news-story/92f4cb833ba105f6e86eefd82404afe1

(5A) Marsden, Harriet. The biggest NHS scandal you’ve never heard of only affects women, but men should be just as concerned. Independent (5 August 2017).

https://www.independent.co.uk/voices/trans-vaginal-mesh-scandal-thalidomide-tvt-gynaecology-vaginal-procedure-womens-health-feminism-a7878136.html

(5B) Marsden, Harriet. Panorama investigation reveals medical company failed to fully inform doctors of vaginal mesh risks. Independent (11 December 2017).

https://www.independent.co.uk/news/uk/home-news/vaginal-mesh-scandal-tvt-transvaginal-sling-implant-risks-thalidomide-device-bbc-panorama-a8102726.html

(6) Moss, Rachel. What is A vaginal mesh implant? Government to launch audit into complications. Huffington Post (30/1/2018).

https://www.huffingtonpost.co.uk/entry/what-is-vaginal-mesh-incontinence-treatment-risks_uk_58f71cdde4b05b9d613e6bda

(7) McCarthy, Joanne. Pelvic mesh left a man ‘stabbed’ during sex, regulator warned. The Herald (17 March 2017).

http://www.theherald.com.au/story/4535453/mesh-in-stabbing-incident/?cs=5507

(8) McCarthy, Joanne. Australian pelvic mesh victims launch their case against Johnson & Johnson. The Herald (4 July 2017).

http://www.theherald.com.au/story/4769450/pelvic-mesh-victims-in-landmark-action/?cs=2452

(9) Moodie, Claire. Vaginal mesh implants: Gynaecologist urges proactive response to health concerns. ABC News (4 July 2017).

http://www.abc.net.au/news/2017-07-04/vaginal-mesh-implants-surgeon-urges-proactive-response/8677488

(10) McCarthy, Joanne. Johnson & Johnson pelvic mesh doctor said he would not want his wife to undergo procedure, Federal Court told. Sydney Morning Herald (5 July 2017).

http://www.smh.com.au/national/johnson–johnson-pelvic-mesh-doctor-said-he-would-not-want-his-wife-to-undergo-procedure-federal-court-told-20170704-gx4i27.html

(11) Sansom, Kath. Vaginal mesh left me in agony. When will women’s health be taken seriously? The Guardian (27 April 2017).

https://www.theguardian.com/commentisfree/2017/apr/27/vaginal-mesh-women-health-bladders-bowels-sex-lives-nhs-operations

(12) Pelvic implant lawsuit underway in Sydney. 9 News (4 July 2017).

http://www.9news.com.au/national/2017/07/04/08/57/vaginal-mesh-lawsuit-to-commence

(13) Smith, Leesa. ‘Vaginal mesh implant has destroyed my life — it’s just so hard to go on’. News (11 May 2017).

http://www.news.com.au/lifestyle/parenting/kids/vaginal-mesh-implant-has-destroyed-my-life-its-just-so-hard-to-go-on/news-story/c9a78c04bbbaf0c32689ab2d0108658d

(14) For Donna’s, Catie’s, Helen’s and other mesh victim’s stories, please see:

Real Kiwis, Real Stories. New Zealand – Mesh Down Under 

http://meshdownunder.co.nz/kiwi-stories

Please note:  Catie’s story involving complete mesh removal may offer hope to other mesh patients.

Pelvic Mesh Support Groups

(1) Australia – Mesh Down Under 

https://www.facebook.com/MeshDownUnder/

(2) New Zealand – Mesh Down Under 

http://meshdownunder.co.nz

Kegel Exercises For Weak Pelvic Floor Muscles

(1) Ward, Mary. A weak pelvic floor can mean more than a little leakage. Sydney Morning  Herald (18 June 2018).

https://www.google.com.au/amp/s/amp.smh.com.au/lifestyle/health-and-wellness/a-weak-pelvic-floor-can-mean-more-than-a-little-leakage-20180605-p4zjje.html

In German

(1) Wenn die Vagina plötzlich zubeißt. Stern (21 March 2017).

http://www.stern.de/familie/beziehung/stressinkontinenz–wenn-die-vagina-ploetzlich-zubeisst–7377994.html

 

 

 

 

 

 

The Colour of Pain

Feature Image sourced from:

https://www.pinterest.com.au/pin/440367669785694940/?lp=true

Dear Pain Matters blog readers,

Here is some exciting news:

Neuroscientist Professor Mark Hutchinson at The University of Adelaide in Australia recently revealed that a novel blood test can diagnose chronic pain within minutes.

CNBP-Director-Prof-Mark-Hutchinson_lab.jpg

Professor Mark Hutchinson, The University of Adelaide

http://cnbp.org.au/our-research

Called the ‘painHS’ test and available in 18 months, this novel blood test relies on hyperspectral imaging analysis (light measurement tools) to identify certain molecular structures and colour ‘biomarkers’ associated with ongoing pain.  Mark and his team observed that immune cells give off a different natural colour in the presence of chronic pain, compared to in its absence.

chronic-pain-blood-test-1.jpg

Credit: Haridy, 2018

https://newatlas.com/blood-test-chronic-pain/54507/

Patients suffering from persistent pain and unable to communicate their level of pain (e.g. babies, dementia patients and severely disabled patients) may be amongst those who will benefit from this blood test.

Quoting Mark,

‘This gives us a brand new window into patients’ pain because we have created a new tool that not only allows for greater certainty of diagnosis but also can guide better drug treatment options.’

‘We are literally quantifying the colour of pain.’

Whilst this blood test will never replace valuable information obtained from pain questionnaires, self-resports and patient discussions, it will likely be a useful adjunct for pain diagnosis and treatment (ANZCA, 2018).

What an exciting development!!

Sabina Walker

Blogger, Pain Matters (in WordPress)

REFERENCES

(1) Breakthrough Blood Test Reveals Colour of Chronic Pain. ANZCA (6 May 2018).

http://www.anzca.edu.au/breakthrough-blood-test-reveals-colour-of-chronic

(2) Haridy, Rich. Revolutionary New Blood Test Can Instantly Identify Chronic Pain. New Atlas (7 May 2018).

https://newatlas.com/blood-test-chronic-pain/54507/

(3) Snook, Julie. Breakthrough blood test reveals chronic pain in colour. 9news (6 May 2018).

(Includes a 2-minute video)

http://www.adelaidenow.com.au/news/national/breakthrough-blood-test-reveals-chronic-pain-in-colour-9news/video/679b3f3bb53699b21d8dffd3bef70a98

 

 

‘Poking Long Pointy Needles’ – Needling Including Ultrasound-Guided Needling of Myofascial Trigger Points for Pain Relief

Feature Image Credit: Studio Musculoskeletal

https://studioms.com.au/pages/dry-needling

Dear Pain Matters blog readers,

Recently, I had the honour and pleasure of meeting one of Vancouver’s most respected pain clinicians, Dr Gillian Lauder, Pediatric Anesthesiologist, Director of Acute Pain Service (BC Children’s Hospital).  I first heard about Dr Lauder’s work after reading an inspirational story about a young girl named Anaïs Poirier whom Dr Lauder had successfully treated for CRPS.  After a full recovery from CRPS, and in response to a question about who her hero was, Anaïs replied:

‘That’s an easy one! Dr. Lauder, because she saved my life. I know pain doesn’t kill you, but it takes everything away from you.’

Giving a Voice to Children who Suffer from Chronic Pain

https://www.theglobeandmail.com/life/giving/giving-a-voice-to-children-who-suffer-from-chronic-pain/article4400974/

Dr Lauder has also published a book called Complex Regional Pain Syndrome (CRPS) Explained – For Teenagers, By Teenagers (available in Amazon).

Over coffee, Dr Lauder and I discussed various topics including dry needling of myofascial trigger points for pain relief.  Gillian added that 2 – 3 webinars will be available soon that will offer further insight into this promising treatment.  Stay tuned for a follow-up blog post!

Inspired by Gillian’s comments, today’s blog post is dedicated to needling of myofascial trigger points – with or without medication injections – for pain relief.

INTRODUCTION

First, some definitions:

Dry needling (aka nonacupoint needling) means that needles without medication (eg anaesthetics) are used to stimulate myofascial trigger points.

Myofascial active trigger points are sore, hypersensitive/hyperirritable, palpable hard nodules (‘tender points’, or ‘knots’) located within the myofascia that surrounds a taut band of skeletal muscle.  Compression of these trigger points may result in pain as well as motor and autonomic dysfunction.  Local pressure or stretch of tissue may also activate trigger points.

Referred pain is pain that may radiate from trigger points into larger areas that may even be remote to trigger points.

What exactly is dry needling of myofascial trigger points?:

Insertion of needles into palpable nodules (ie rapid, brief mechanical stimulation of active trigger points) in the myofascia results in an involuntary spinal reflex.  Specifically, trigger point needling elicits a sudden involuntary muscle contraction (‘local twitch response’) in the taut band.

Local twitch responses in superficial trigger points can easily be seen while twitch responses occurring more deeply may only be visible via real-time ultrasonography.

Once a local twitch response is elicited, deactivation of the trigger point occurs and myofascial tension relief, reduced pain and improved musculoskeletal function result.  

Twitch responses may also be achieved during non invasive treatments including transcutaneous electrical stimulation, manual compression of trigger points and massage.

NB Twitch responses are not the same as muscle spasms.  Whilst the entire muscle is involved in both cases, the twitch response refers to a small spontaneous twitch only, and not an entire muscle contraction (as in muscle spasms).    

CASE STUDIES

(1) Ultrasound-Guided Trigger Point Needling for Myofascial Pain  

A Ukrainian study involving 133 myofascial pain patients compared ultrasound-guided versus non-ultrasound-guided trigger point needling.  Average pain levels were 7.2 and 7.4, respectively, prior to dry needling treatment.

Ultrasound scanning was done to precisely identify myofascial trigger points.

Dry needling was performed over 2 – 4 session to inactivate all trigger points.  Steel acupuncture needles (28 gauge) were used during dry needling treatments.

This study found that ultrasound-guided trigger point needling led to enhanced pain relief by evoking a greater number of local twitch responses.  Specifically, pain levels dropped from an average of 7.2 to 1.1 within 24 hours following ultrasound-guided trigger point needling.  This compares to average pain level decreases from 7.4 to 2.7 in the non-ultrasound-guided dry needling group (Bubnov and Wang, 2013).

(2) Ultrasound-Guided Trigger Point Needling (Including Medication Injection) in Patients with Chronic Chest Wall Pain Following Surgery    

Eight patients (7 women and 1 man; mean age = 56; 47 to 74) suffered severe chest wall pain (serratus anterior muscle pain syndrome) for 1 to 3 years, with pain levels ranging from 7 to 10.  The chest wall pain had started after surgery for lung cancer (n=2), cardiac surgery (n=2) and total mastectomy (n=4).

Once the trigger points in the serratus anterior muscle were identified, all 8 patients were offered 1 – 3 injections over 3 months.

Ultrasound-guided injection of medicine into the infiltration sites was performed to deactivate the trigger points.  Medication comprised lidocaine, bupivacaine and triamcinolone.

Ultrasound-guided trigger point injection treatment resulted in reduced pain levels (down to 3 or 4) in all 8 patients shortly after the first injection as well as 55% less pain (on average) after 3 months.   

(3) A 29 Year Old Female with Myofascial Pain Syndrome

A 29 year old female patient (let’s call her ‘Annie’) suffered myofascial pain syndrome in her left orofacial region for 3 months (pain rating up to 9).  Annie’s pain was dull, diffuse and ongoing.  Her pain affected her left ear and pre-auricular region, extended to her left temporal area and was accompanied by a headache.  Annie’s pain increased while chewing food and she was unable to open her mouth widely.  Her quality of sleep was also affected.

Following palpation, myofascial trigger points over her masticatory and suboccipital muscles were identified as well as referred pain to her left ear and a taut muscle band.  

Annie was offered 3 deep dry needling sessions over a week to deactivate the myofascial trigger points in the orofacial muscles.  

During Annie’s 1st appointment, the exact locations of her myofascial trigger points were identified via palpation of the affected muscles.  Thereafter, dry needling of her sternocleidomastoid and masseter using a 25 mm stainless steel needle was done.  The needle was positioned perpendicular to the trigger points before performing the ‘lift and thrust’ maneuver to evoke the local twitch response.  

During her 2nd appointment, Annie stated that half of her pain was gone and that her headache was now significantly reduced!  She was also able to open her mouth wider.  Dry needling of her lateral pterygoid (via a 40 mm needle), temporalis (via a 13 mm needle) and deep masseter muscles was performed resulting in a local twitch response in the masseter.

On her 3rd visit (on the 7th day), Annie finally had NIL pain!  There was no pain following palpation of the sternocleidomastoid, masseter, digastric and suboccipital muscles and her myofascial trigger points were no longer tender.  Her headache had disappeared shortly after her 2nd session and she was now able to open her mouth widely. 

Complete resolution of Annie’s myofascial pain syndrome via needling demonstrates the benefits of dry needling in patients with non-dental orofacial pain (Asha et al, 2015).

(4) A 40 Year Old Male with Myofascial Pain Syndrome

A 40 year old man suffered posterior thigh pain despite massage therapy, chiropractic adjustments and physical therapy.  Myofascial pain syndrome in the quadratus femoris was diagnosed following palpation.  Dry needling (based on a grading system) was offered.

The patient enjoyed immediate benefits following dry needling treatment.  Furthermore, he was completely pain free at the 4-month follow-up consultation (Anandkumar, 2017).

(5) An Iranian Clinical Trial Involving Dry Needling of Myofascial Trigger Points for Heel Pain  

A single-blinded clinical trial involving 20 patients with chronic heel pain due to plantar fasciitis revealed that a weekly session of dry needling of myofascial trigger points for 4 consecutive weeks can reduce the severity of heel pain (Eftekharsadat et al, 2016).

(6) A 53 Year Old Male with Painful Plantar Fasciitis

A 53 year old Iranian man suffered bilateral plantar heel pain that involved sharp, stabbing pain and accumulation of fluid beneath the metatarsal heads.  Pain levels were 8 in the right foot and 6 in the left foot and he was unable to stand for more than 20 minutes at a time.  

Dry needling of myofascial trigger points was offered twice a week for 2 weeks.

The man enjoyed a 60-70% decrease in pain levels (ie his pain levels dropped from 8 to 3 in his right foot and from 6 to 2 in his left foot), and he was able to return to his normal daily activities.   

THE SCIENCE BEHIND DRY NEEDLING OF MYOFASCIAL TRIGGER POINTS FOR PAIN RELIEF 

What do trigger points look like?

An Indian ultrasound study found that trigger points appear as echogenic structures under the surface of the trapezius muscle (and not inside the muscle mass).  These echogenic structures do not appear in or around unaffected, healthy skeletal muscle.

Here is an example of an echogenic structure (i.e. trigger point):

Credit for above image of a trigger point: Parthasarathy et al, 2017.

An American paper called Dry Needling for Myofascial Trigger Point Pain included 2 ultrasound images (A and B, below).  In A, a trigger point appears as a focal hypoechoic nodule in the upper trapezius.  In B, four (4) hypoechoic myofascia trigger points are visible.

An external file that holds a picture, illustration, etc. Object name is ijspt-06-402-F001.jpg

Credit for above ultrasound images: Unverzagt et al, 2015.

Many ultrasound images of trigger points are available in literature (Wong, 2017; Mayoral et al, 2013; other papers).

Benefits of Ultrasound Imaging of Trigger Points

Ultrasound-guided needling of trigger points can enhance the accuracy of needle placement in deeper musculature and intraarticular regions hence reducing the risk of pneumothorax, needling damage to organs and tissue (eg kidneys, lungs, salivary glands, adipose) as well as other complications (Botwin et al, 2008).    

Is dry needling of trigger points similar to acupuncture?

Researchers have suggested that the entire fascia network may be the physical substrate of all acupuncture-related meridians (the latter having been part of Traditional Chinese Medicine for 1,000’s of years).  Peter Dorsher noted an 89% overlap in myofascial meridians and the acupuncture principal meridian (Behnam et al, 2015).  Dorsher also found that 92% of all 255 trigger points correlated with acupuncture points.  The local twitch response can be compared to acupuncture’s ‘de qi’ sensation (Bai et al, 2011; Dorsher, 2006; Dorsher, 2009).

These observations suggest a positive correlation between the anatomy-based dry needling of trigger points and acupuncture.  

SUMMARY

The science behind dry needling (and injection) of trigger points is incomplete.  Many medical professionals are still sceptical about this procedure.  Quoting from a paper offering a critical view (see Abstract):

‘…the theory of MPS [myofascial pain syndrome] caused by TrPs [trigger points] has been refuted…’ (Quintner et al, 2015).

Ongoing research that includes imaging (e.g. real-time ultrasonography) to specifically locate and identify the trigger points during dry needling (puncture) will enhance the underlying science and credibility for this technique.

Real-time ultrasound imaging can also enhance the accuracy of trigger point needling, particularly when targeting hyperactive trigger points located within the deeper fascia and musculature layers, intraarticular regions and other areas that cannot be palpated.  This reduces the risk of pneumothorax and other complications that may otherwise result from ‘blind methods’ (Mayoral et al, 2013).  

Dry needling of myofascial trigger points may offer effective and long-lasting pain relief, reduced focal inflammation, regeneration, increased mobility and enhanced autonomic function for patients suffering from musculoskeletal pain and/or myofascial pain syndromes.

Note: For patients who have a fear of needles (i.e. needle phobia), hypnotherapy may be beneficial.  For further information, please refer to my blog post called ‘Chronic Pain and Hypnotherapy’.

Sabina Walker

Blogger, Pain Matters (in WordPress)

REFERENCES

Case Studies

(1) Ultrasound-Guided Trigger Point Needling for Myofascial Pain  

Bubnov and Wang. Clinical Comparative Study for Ultrasound-Guided Trigger-Point Needling for Myofascial Pain. Medical Acupuncture (17 Dec 2013); 25(6): 437-443.

https://www.researchgate.net/publication/259189884_Clinical_Comparative_Study_for_Ultrasound-Guided_Trigger-Point_Needling_for_Myofascial_Pain

(2) Ultrasound-Guided Trigger Point Needling (Including Medication Injection) in Patients with Chronic Chest Wall Pain Following Surgery  

Vargas-Schaffer et al. Ultrasound-Guided Trigger Point Injection for Serratus Anterior Muscle Pain Syndrome: Description of Technique and Case Series. A&A Case Reports (15 Sept 2015): 5(6); 99-102.

https://journals.lww.com/aacr/Fulltext/2015/09150/Ultrasound_Guided_Trigger_Point_Injection_for.4.aspx

(3) A 29 Year Old Female with Myofascial Pain Syndrome

Asha et al. A Novel Case of Orofacial Pain Treated by Dry Needling Technique – A Case Report. Dentistry (2015); 5: 319.

http://www.academia.edu/25006600/Open_Access_Case_Report_A_Novel_Case_of_Orofacial_Pain_Treated_by_Dry_Needling_Technique_-A_Case_Report

(4) A 40 Year Old Male with Myofascial Pain Syndrome

Anandkumar, S. Effect of Dry Needling on Myofascial Pain Syndrome of the Quadratus Femoris: A Case Report. Physiotherapy Theory and Practice (Feb 2018); 34(2): 157-164. 

https://www.ncbi.nlm.nih.gov/pubmed/28922048

(5) An Iranian Clinical Trial Involving Dry Needling of Myofascial Trigger Points for Heel Pain  

Eftekharsadat et al. Dry Needling in Patients with Chronic Heel Pain Due to Plantar Fasciitis: A Single-Blinded Randomized Clinical Trial. Medical Journal of the Islamic Republic of Iran (2016); 30: 401.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5038993/

(6) A 53 Year Old Male with Painful Plantar Fasciitis

Behnam et al. The Use of Dry Needling and Myofascial Meridians in a Case of Plantar Fasciitis. J Chiropr Med. (March 2014); 13(1): 43–48.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976498/?report=reader#__ffn_sectitle

Other Academic References

(1) Mayoral et al. Myofascial Trigger Points: New Insights in Ultrasound Imaging. Techniques in Regional Anesthesia and Pain Management (July 2013); 17(3): 150–154.  

http://www.asociacionandaluzadeldolor.es/wp-content/uploads/2017/02/US-miofascial.pdf

(2) Mayo Clinic. Acupuncture And Myofascial Trigger Therapy Treat Same Pain Areas. ScienceDaily (14 May 2008).

http://www.sciencedaily.com/releases/2008/05/080513101614.htm>

(3) Dorsher PT. Trigger Points and Acupuncture Points: Anatomic and Clinical Correlations. Medical Acupuncture (May 2006); 17.

(4) Dorsher PT. Myofascial Referred-Pain Data Provide Physiologic Evidence of Acupuncture Meridians. J Pain (July 2009); 10 (7): 723–31.

doi:10.1016/j.jpain.2008.12.010

(5) Liu et al. Traditional Chinese Medicine Acupuncture and Myofascial Trigger Needling: The Same Stimulation Points? Complementary Therapies in Medicine (2016); 26: 28-32.

doi:10.1016/j.ctim.2016.02.013.

(6) Bai et al. Review of Evidence Suggesting That the Fascia Network Could Be the Anatomical Basis for Acupoints and Meridians in the Human Body (2011). Evidence-Based Complementary and Alternative Medicine (2011); Article ID 260510, 6 pages.

http://dx.doi.org/10.1155/2011/260510

https://www.hindawi.com/journals/ecam/2011/260510/

(7) Unverzagt et al. Dry Needling for Myofascial Trigger Point Pain: A Clinical Commentary. International Journal of Sports Physical Therapy. 2015;10(3):402-418.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458928/pdf/ijspt-06-402.pdf

(8) Wong YM. Developments of Nonacupoint Needling in Japan. Medical Acupuncture (2017); 29(6): 349-351.

doi:10.1089/acu.2017.1247.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733641/

(9) Botwin et al. Ultrasound-Guided Trigger Point Injections in the Cervicothoracic Musculature: A New and Unreported Technique. Pain Physician (Nov/Dec 2008); 11(6): 885-9.

https://www.ncbi.nlm.nih.gov/pubmed/19057634

(10) Parthasarathy S, John Charles S A. Analgesic Efficacy of Ultrasound Identified Trigger Point Injection in Myofascial Pain Syndrome: A Pilot Study in Indian Patients. Indian J Pain (2016); 30: 162-5.

(11) Wong YM. Developments of Nonacupoint Needling in Japan. Medical Acupuncture (2017) ;29(6): 349-351.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733641/

(12) Myofascial Trigger Point

https://en.wikipedia.org/wiki/Myofascial_trigger_point

(13) Quintner, Bove and Cohen. A Critical Evaluation of the Trigger Point Phenomenon, Rheumatology (1 March 2015); 54(3): 392–399.

https://academic.oup.com/rheumatology/article/54/3/392/1796114

 

Cannabidiol (CBD) – ‘Cannabis With the Fun Bit Taken Out’ – For Severe Chronic Pain

Feature Image sourced from:  https://www.cannadish.net/cbd-oil-benefits

Dear Pain Matters blog readers,

Today’s blog post will focus on a particular cannibinoid molecule called cannabidiol (CBD).

Cannabidiol offers many medicinal benefits including pain relieving, mild anti-inflammatory, antioxidant and neuroprotective benefits.

Contrary to widespread belief, cannabidiol (CBD) treatment results in NIL psychoactive effects.  Hence it is impossible to get ‘high’ on cannabidiol (CBD) alone.  Some people even jokingly refer to cannabidiol (CBD) as ‘cannabis with the fun bit taken out’.

Introduction

The cannabis plant species (that includes marijuana and hemp plants) comprise up to 144 different phytocannabinoids (ie cannabinoids).  Different plant strains contain different combinations of cannabinoids.  These cannabinoids act on cannabinoid receptors throughout the body and brain.  These cannabinoids include a non-psychoactive molecule, cannabidiol (CBD), as well as a psychoactive component, tetrahydrocannabinol (THC).  

Different cannabis plant species (ie marijuana and hemp plant strains) offer different CBD:THC ratios.  For example, industrial hemp contains less than 0.3% THC levels.

It is important to note that when isolated, the CBD molecule is the same, regardless whether it is isolated from marijuana or female hemp.  As such, CBD (in its purest molecular form) does not exert any hallucinogenic effects, regardless of its source.   

Quoting Franjo Grotenhermen, International Association of Cannabinoid Medicines:

“CBD is CBD. The human body does not care where the molecule comes from.

Screen-Shot-2017-05-09-at-8.00.19-PM.png

Diagram of the CBD molecule is sourced from:

https://www.thecbdistillery.com/hemp-cbd-versus-marijuana-cbd/

Cannibidiol use does not lead to addiction and there is virtually nil toxicity (hence minimal side effects).  Cannabidiol is well tolerated and can be taken alone or with other medications (with nil CBD-attributable side effects).  Inclusion of CBD in pain management can lead to reduced intake or complete cessation of other pain medications (hence reducing or eliminating all of their adverse effects).

Cannabidiol can reduce ongoing pain in arthritis, rheumatoid arthritis, nerve pain, cancer pain, back pain, knee pain, fibromyalgia and other debilitating chronic pain conditions via its strong anti-inflammatory and other biological effects.  

Not only does cannabidiol promote relaxation and calmness, but it may also alleviate certain symptoms of insomnia, menstrual pain, depression, mood problems, anxiety, fear, post traumatic stress syndrome (PTSD) and Parkinson’s disease (including significant reduction of tremors as well as improved swallowing and talking) (Barton, 2017).  Cannabidiol may ameliorate chemotherapy-induced nausea and vomiting, spasticity, epileptic seizures as well as certain symptoms of multiple sclerosis (MS) and Alzheimer’s.  Cannabidiol may be a useful adjunct to palliative care.  

Cannabidiol’s neuroprotective and other biological effects are invaluable following a stroke (Hayakawa et al, 2010), bone fracture (Kogan et al, 2015) or against Paclitaxel-induced neurotoxicity (Likar and Nahler, 2017).  A CBD-based study is currently underway to investigate CBD’s potential effects on malignant brain tumours in children.  This study was inspired by a 4-year old boy whose potentially fatal brain tumour shrunk by 66% after being given CBD and going on a low carbohydrate (ketogenic) diet (Grundy, 2017; Marsh, 2017; Waugh, 2017).   

Hops-Derived CBD (vs Cannabis- or Hemp-Derived CBD)

Researchers are now able to isolate CBD from hops.  Given that hops is not associated with the same stigma that cannabis- or hemp-derived CBD may still have, doctors may be more willing to prescribe hops-derived CBD for pain (in countries where CBD is legal).

https://isodiol.com/isodiol-news/civilized-life-reports-scientists-develop-non-cannabis-cbd-hops/

https://www.civilized.life/articles/scientists-have-developed-a-non-cannabis-cbd-product-made-out-of-hops/

Given that CBD in its purest form is ‘only’ a molecule , it is irrelevant whether CBD is derived from hemp, cannabis, hops or otherwise.  As stated above,  

“CBD is CBD. The human body does not care where the molecule comes from.” 

Nano-Amplified Cannabidiol (CBD)

Researchers are now able to reduce the size of CBD molecules by 100 times (down from their original size of 2,000 nanometers) via a process called ‘Nano-Amplification’ (ie nano-emulsification of CBD).  Being as small as 16-20 nanometers across, these Nano-Amplified CBD particles may be more easily be absorbed by human cells than unaltered large, fat-soluble CBD molecules, leading to greater bio-availability of CBD.  

https://isodiol.com/isodiol-news/cbd-isolate/

Adult-Onset Still’s Disease (AOSD)

Excess levels of the pro-inflammatory cytokine IL-1β play a major role in Adult-Onset Still’s Disease (AOSD), a systemic autoimmune disease that often presents with persistent high spiking fevers, joint pain and salmon-colored bumpy skin rashes.  Recent treatments of AOSD include Canakinumab and Rilonacept (ie IL-1β blockers) (Giampietro and Fautrel, 2012).  

A study showed that when mice with MS-like symptoms were treated with CBD, they had decreased IL-1β and other pro-inflammatories (compared to mice who did not receive CBD treatment) (Mecha et al, 2013).

A question: Would CBD treatment that strongly inhibits IL-1β and other pro-inflammatory cytokines in mice similarly benefit AOSD patients (where excess IL-1β levels also appear to be a problem)?  If yes, what CBD dosage would be effective?  Investigation may be warranted.    

How to Use Cannabidiol (CBD)

Cannabidiol products are available as capsules, tinctures, infused edibles, syrups, teas, chewing gum, extracts, isolate and topical creams and ointments (that allow CBD to be directly absorbed through the skin).  Each product has its own method of dispensing (eg. via ingestion, inhalation via vapourizer or e-cigarette).  To obtain the full benefits of CBD, one should always read the instructions.  

Cannabidiol is also available as CBD oil that can be sublingually applied.  Sublingual application of CBD involves the placement of multiple drops of CBD oil under the tongue.  This allows CBD to be quickly absorbed into the bloodstream via the mucous membrane in the mouth, thus bypassing the digestive system and liver.

Some CBD products are more effective than others, depending on CBD purity (see next section involving the Austrian study for a discussion on CBD purity).  Extraction methods, plant strains and application methods may also influence CBD’s effectiveness.  

Correct dosages are important.  Dosages may have to be titrated until therapeutic benefits including pain relief are achieved.    

The application of CBD oil is somewhat similar to that of cannabis-derived Sativex (Nabiximols), although the latter is sublingually applied via mouth spray.  There is one crucial difference between CBD and Sativex, being that Sativex comprises both CBD and THC, roughly on a 1:1 ratio, while CBD oil comprises negligible amounts of THC.

Note: Sativex was also discussed in 2 earlier blog posts: 

https://painmatters.wordpress.com/2017/04/10/lets-talk-to-an-inspirational-young-woman-paula-orecklin-about-crps-sativex-physiotherapy-and-neuroplasticity

and here:

https://painmatters.wordpress.com/2016/09/22/medical-cannabis-medical-marijuana-and-nerve-pain

A CBD-Based Medical Study in Austria

The Study

Prof Dr Rudolf Likar, MSC, performed a study involving 9 severe pain patients in Austria.  Four patients were unable to complete this study for various reasons, while the remaining 5 patients completed the study. 

28661442_1889922131026173_8826567756498337792_n.jpg

Prof Dr Rudolf Likar, MSC

Head of Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt, Austria

General Secretary of Österreichischen Schmerzgesellschaft (ÖSG; Austrian Pain Society)

Photo sourced from:   https://www.facebook.com/Dr.Likar/

The severe pain patients in Dr Likar’s study were offered 2 ‘200 mg CBD’ capsules, twice a day after meals (one in the morning and one at night, totalling 400 mg CBD daily), in addition to their usual medications.  

Made by a pharmacist in Velden, Austria, the CBD capsules contain CBD in its purest form (purity exceeding 99.5%) that has been isolated from industry hemp grown in the UK.  Pure CBD, in its crystalline (powder) form, is dissolved in hemp oil and heated up to temperatures not exceeding 50 degrees C (to preserve CBD’s bioactivity) (Likar, 2016; also see the excellent video in German, below, from 2:30 minutes on).    

The 5 patients including 3 males were aged 49 to 79.  Three patients had cancer (multiple myeloma, urothelial carcinoma and breast cancer), one patient (49) had fibromyalgia and one patient (52) suffered various painful conditions including brachialgia, cervico-cephalgia, thalamic pain and dental pain.

After 1 month of CBD treatment, the urothelial carcinoma patient (53) no longer suffered any pain.  Post-CBD, he stopped taking Fentanyl patches, Neodolpasse, Vendal and Lidocaine infusions.  His pain was completely managed via CBD and 150 mg Lyrica/day (down from 300 mg Lyrica/day).

After 4 months of CBD treatment, the fibromyalgia patient (49) enjoyed significantly less pain (from VAS = 8 to VAS = 3).  She was able to reduce her Oxygerolan medication by 33% as well as stop all her other pain medications.  

After 6 weeks of CBD treatment, the breast cancer patient (74) no longer had nausea and was, for the most part, pain-free.  Her Hydal intake was reduced by 33% daily and all her other pain medications were stopped.

After only 1 week of CBD treatment, the multiple myeloma patient (79) enjoyed pain reduction from 9 to 6 (VAS) and was consequently able to reduce his Lyrica intake.  His quality of sleep also improved.

After 2 months of CBD treatment, the patient with several painful conditions (52) had reduced pain levels and better quality of sleep.  She was able to reduce some of her medications. 

In summary, there were no psychoactive effects nor side effects resulting from the CBD treatment.  There was no risk of addiction and the CBD treatment was well tolerated as a co-medication (Likar, 2016).     

Dosing

In order to derive optimal medicinal benefits from CBD treatment, it is perimount that CBD (in its purest form) be offered on a 20:1 ratio (or greater) with THC.  Otherwise, there is a risk that CBD’s unique effects including pain relief may not occur (due to ‘CBD underdosage’) (Likar, 2016).

In comparison (as noted in the Introduction), Sativex comprises relatively equal amounts of CBD and THC on a ~1:1 ratio.  Precisely, each 100 microlitre spray contains 2.5 mg CBD and 2.7 mg THC (ie CBD and THC on a 1.00:1.08 ratio) (plus up to 0.04 g alcohol).

Dr Likar noted that in the presence of an equal amount of THC, CBD underdosing may result – that may lead to reduced and/or nil CBD-induced pain relief.  Thus, a significantly higher CBD to THC ratio (for eg, 20:1, or greater) is a prerequisite before CBD’s unique medicinal benefits can be optimally achieved (Likar, 2016).

The following YouTube (in German) includes interviews with Prof Dr Rudolf Likar and several pain patients:

Here in this video, Dr Likar noted that some pain patients may require daily CBD dosages up to 400 mg – 600 mg (half in morning and half at night) to derive optimal pain relief (refer to 2:25 minutes), while others may not benefit from CBD treatment.

Anecdotal Case Studies   

(1) Laura Bryant of Australia – Cannabidiol (CBD) Oil for Severe Arthritis Pain Including Ankylosing Spondylitis 

Laura Bryant (20) from Canberra, Australia, suffers from severe arthritis including painful ankylosing spondylitis.  Stress (eg due to university studies) and cold weather are enough to bring on flares, painful joints, aching hands and feet as well as skin blotches.  At times her pain is so bad that she relies on an elbow crutch for mobility.  

IMG_5230-1.jpg

Laura Bryant (20) at home in Canberra, Australia (2015) 

Credit: Jay Cronan, Fairfax Media/The Canberra Times

Prior to discovering the pain-relieving benefits of CBD oil for her painful ankylosing spondylitis, Laura used to ingest a fistful of pills, crawl into the bathroom and soak in a hot bath for 2 hours while waiting for the stabbing, knife-like, pain in her back and hips to finally ease up just a bit.  On a good day, she would finally be able to leave her room just in time for a 20-30 minute lunch (assuming that she could eat in the first place due to all the pain pills that messed with her appetite).  After lunch, her mother had to help her back into bed where she had to lie horizontal due to excessive pain.  Laura spent entire days and weeks watching television.  It was simply too difficult to read given all the pills that she was taking.  This routine continued for 3 years as her ankylosing spondylitis worsened.

One day, she counted 28 daily pills including Oxycontin!  ‘Wow, 28 pills every day?’, she thought to herself.  There were pills for breakfast, lunch and dinner.  In fact, there were so many pills that they made her sweat turn orange.  Her appetite suffered drastically.  The worst part of this story was that her daily cocktail of 28 pills did not even effectively manage her severe pain!

Laura endured more than 10 hospitalizations due to excessive pain.  Laura even fainted on the hospital floor due to excessive painful stabbing in her vertebra.  Despite this, she would rate her pain as ‘only a 7’.  This is because she feared that if she rated her pain levels any higher, they might accidentally overdose her on morphine again.  She feared being in a wheelchair again with tubes coming out of her nose.

Laura tried many pain treatments including a treatment involving a 30 cm-long spinal needle with a 45 degree bend.

One day, her specialist said to her (after discussing her ongoing cortisone and biological injection treatment protocol):

“If this doesn’t work, I’m afraid this is pretty much it … You’re on everything we can give you.  There are no more treatment options … I’m afraid, I’ve run out of options … This is going to be your life.”

Laura sobbed after hearing her hopelessly grim, long-term prognosis from her specialist while her dedicated parents looked on helplessly.

Depression soon set in.  She would stare at her Oxycontin pills and think:

“Why not just take a couple of extra and be done with it?”

One sad day, Laura begged her mother, Bernadette, to ‘put her out of her misery’ and ‘help her end it all’.

On another day while driving to Sydney with her family, doubled up in pain in the back seat of the SUV, Laura wailed out in pain,

“I don’t want to do this anymore.  I can’t do this.  I can’t do this!”

Laura’s 16-year old brother tried to comfort her in the back of the SUV by saying, “It’s going to be OK.”  But even he could not stop his own tears from streaming down his face.  Bernadette quickly stopped the vehicle to a safe side of the road.  It was pouring rain and dark outside.  Regardless, Bernadette hurried outside to the back of the SUV to locate the Valium that would sedate Laura as quickly as possible, all the while listening to her daughter scream out, “Just give them to me!”  

Seeing her daughter in so much pain, suffering and agony was almost too much for Bernadette to handle…

Warning:  Under-treatment of severe chronic pain often leads to thoughts of suicide, and Laura was certainly no exception.  Sadly, many who despair due to excess pain actually do go through with suicide.  Clearly, timely access to effective pain treatment options (whether this is CBD or another pain treatment option) is paramount.   

Finally, A Trickle of Hope Turns Into A Tsunami of Pain Relief

One day while lying in bed, a television show appeared about a Colorado-based company called Charlotte’s Web.  This company offered a strain of cannabis that promised low-psychoactive effects.  The show added that some arthritis sufferers were now obtaining relief from this strain of cannabis.

Wasting no time, Laura immediately emailed the company, Charlotte’s Web:

“… I’m in Australia … can you give me any advice or put me in touch with people here? I’m desperate.”

Several weeks later, Laura received her first supply of CBD oil.  Laura’s daily pill intake was reduced shortly afterward, as was her time spent in bed and in the hot bath.  Within 2 weeks, her pelvis became less stiff.  Consequently, she no longer needed her long, hot baths and she removed her shower chair and toilet aids from the bathroom.  She also started eating breakfast at a normal time.

Laura started working out with a personal trainer each week.  One day, she started playing Oztag.  Another day, she was finally strong enough to take her nephew to the park to play … and her sister was so overwhelmed that she cried with joy.  Laura even started dreaming about her life goals and travel plans again.

Laura now uses several drops of CBD oil under her tongue every morning to manage her painful ankylosing spondylitis.  Laura states,

 “[Medicinal cannabis] has given me my life back [after years of severe pain] and doctors aren’t recognising it” (Hannaford, 2015; Brown, 2016).

For more details, please read:

http://www.canberratimes.com.au/interactive/2015/cannabis-and-pain/

This article also includes an excellent 4-minute video called ‘Forbidden Healing’ (Credit: Jay Cronan, Fairfax Media, 2015).

(2) Hope Bobowski of Canada – Cannabidiol (CBD) Oil for Severe Osteoarthritis Pain in Back  

Hope Bobowski (79) of Keremeos, BC, Canada, is spreading her own very special message of hope and joy around.  Until June 2016, Hope suffered from severe osteoarthritis pain in her back.  Her pain was so severe that her husband had to assist her to and from bed, dress her and take over the cooking.  In her words,

“I was going downhill fast.”

Hope was taking 4 – 6 ‘Tylenol 3’ codeine-containing pills daily for her intense osteoarthritis pain.  When her GP suggested trying opioid painkillers, she was worried about becoming addicted.

In June 2016, after her husband located CBD oil from an unlicensed producer, Hope tried her very first spoonful of CBD oil.  Guess what happened next??  Only one day after taking 10 drops of CBD oil, she had nil pain in her back!  In her own words,

“There was no pain.”

Since taking her daily spoon of CBD oil just before going to sleep, Hope was able to cease taking all pharmaceutical painkillers.  Hope has nil psychotic effects from the CBD oil due to its virtual absence of THC.  Best of all, Hope no longer suffers from back pain and is now able to sleep without leg cramps.   

Thanks to her daily dose of CBD, Hope was able to return to gardening, card games and cooking for her beloved great-grandchildren.  Life could not be better for Hope (Barton, 2017)!   

image.jpg

Image of Hope Bobowski with her beloved grandchildren

Credit: Jeff Bassett, The Globe and Mail

GM_Bobowski_JCB_005.JPG

Image of Hope Bobowski at home in Keremeos, BC, Canada, on April 2017

Credit: Jeff Bassett, The Globe and Mail

(3) Deryn Blackwell of the UK – Cannabis Tincture for Severe Cancer Pain 

deryn-ii.jpg

Image of Deryn Blackwell with his devoted mother, Callie  

Credit: This Morning/Youtube  

Deryn Blackwell underwent chemo- and radiation therapy following his diagnosis of leukemia in 2010 (when he was only 10).

Two years later, Deryn (by then, aged 12) was also diagnosed with Langerhans cell sarcoma, a very rare form of cancer with very poor prognosis.  Deryn’s treatment for Langerhans cell sarcoma included countless additional chemo- and radiation therapies, 3 failed bone marrow transplants plus a 4th (and final) bone marrow transplant. 

On Day 46, post-4th transplant, and believing that he was terminally ill anyway, Deryn decided that he no longer wanted to live anymore.  After all, he had already undergone 4 years of treatment, he was very sick and in a lot of pain (despite painkillers including morphine and fentanyl), he hadn’t been able to eat for 7 months, his mouth was covered in blisters, he could not swallow and his body had wounds that were simply not healing.

Deryn even went so far as to plan his own funeral.  However, Deryn’s mother, Callie, was not ready to give up on her son yet …    

While his cancer was successfully eradicated, his immune system was now severely compromised.  According to his mother, without antibiotics, morphine and fentanyl, Deryn would only be able to survive 3 – 7 days at best unless Deryn’s 4th bone marrow transplant finally succeeded.  Unfortunately on Day 70, his blood tests still showed ‘nothing in his bone marrow’, indicating that his 4th transplant was failing.  Deryn was running out of options and his prognosis did not look good.  

Enter Cannabis Tincture …

By  now, Callie had read a lot about the medicinal benefits of cannabis oil.  She asked the doctor to add Bedrocan, a cannabis-based pain reliever, to Deryn’s hospital medication.  The doctor said that she was unable to do this as Bedrocan was not licenced for children in the UK.

Desperate and completely out of (legal) options, Callie gave a cannabis tincture under the tongue (sublingually) to Deryn for the first time at the end of Day 70 (with Deryn’s consent, but without the doctor’s knowledge).  After all, Callie thought, what did she have left to lose?  Her son was dying anyway.

Guess what happened next??

Within only 30 – 60 minutes of his first cannabis oil treatment, Deryn felt completely relaxed for the first time in a long time.  His anxiety had stopped.  Five (5) days later on Day 75, his overall health and well-being had improved significantly including his wounds on his injured fingers that had disappeared altogether within a mere 5 days.  The now-healed wounds on his fingers had been bandaged only 5 days earlier, on Day 70 – the same day when his blood tests still showed absolutely ‘nothing in his bone marrow’.

In her opinion, Callie’s decision to secretly add cannabis tincture to Deryn’s treatment protocol on Day 70 was the key turning point for Deryn.  It was the cannabis tincture that had (somehow) stimulated the 4th failing bone marrow transplant into finally becoming a success. 

And now, thanks to the cannabis tincture, Deryn is finally 100% painfree and healthy.

To celebrate this significant milestone, Callie wrote a book called ‘The Boy in 7 Billion’ (available in Amazon).

Here’s the video link dated 27 March 2017:

Credit: This Morning/Youtube

(4) Other Comments and Testimonials About CBD 

Phil Schwarz 

Born in Scotland, Phil Schwarz (82) suffered painful rheumatoid arthritis (pain levels up to 7) for many years.  One day a family member encouraged her to try CBD (nicknamed ‘cannabis with the fun bit taken out’) for her severe pain.  Phil started taking two 15% raw hemp oil drops, three times a day (without changing her other medication).  Quoting Phil:

“So the first time I took some was at night time before I went to sleep. The next day I was out of bed like a spring chicken and I’ve been pain free ever since’  ‘I’ve just been out and I’ve walked about ¾ of a mile’ … ‘before I couldn’t do about a hundred yards. It’s like a miracle worker, and I don’t care if it’s in my head or in a bottle, whatever it is, it’s doing it”.

For the story, please click:

CBD Made Me Pain Free, Now I’ll Have to Break the Law to Get It

https://www.endoca.com/blog/cbd-made-pain-free-now-ill-break-law/

Wendy Primeau

Wendy Primeau suffered fibromyalgia, Lupus, rheumatoid arthritis and a painful and deteriorating spine.  She took Hydrocodone for almost 5 years, and occasionally, she also took Vicodin, Roxicet and Perkicet.  Only 6 hours after trying a high dose of CBD oil, she was pain-free.  Quoting her:

“My husband was worried, and asked me said what was wrong. I just kept crying because I was so happy, I couldn’t believe it, but I was pain free for the first time in YEARS.

https://www.endoca.com/blog/community-stories-wendy-primeau-part-1/

David Wells

David Wells, a former pitcher in Major League Baseball, has endured many painful episodes over his career.  He tells his story here:

Other Stories

For more stories, see:

https://www.marijuanabreak.com/best-cbd-oils-pain-relief

Quoting ‘Peter’ on 9 February 2018:

Buy it over the internet. I had 7 vertebrae fused in my neck 3.5 years ago, which popped up as a problem when my lower back was so bad that after 20 years of drugs, injections, and booze I was ready to get that operated on. Was in agonizing lower back pain in addition to the post-cervical operation pain. Two sprays under the tongue and 5 minutes later [pain] was gone. Haven’t even taken an Advil since, stopped drinking too. I spray twice a day, and when I don’t, pain comes back after a couple days, so I know it is working. No side effects whatsoever!”

Here is another link describing many pain patients’ experiences with CBD (in German only, for German readers):

CBD-Erfahrungsberichte

http://cbd360.de/erfahrungen/

Peer-Reviewed Science Papers

So what does the science say about CBD for pain and inflammation?

A study found that decreased leukocyte (white blood cell) migration was observed in the injured lungs of CBD-treated mice for up to 4 days following lung injury.  A reduction in leukocyte migration into these lung regions resulted in less leukocyte activation as well as reduced pro-inflammatory mediators including TNF and IL-6 in CBD-treated mice.  This can lead to lower tissue damage and enhanced tissue regeneration.  It is likely that CBD’s anti-inflammatory effects occur via enhanced adenosine release as well as increased signaling via the adenosine A2A receptor (and other biological mechanisms).  Other studies showed that CBD can decrease the production and release of IL-1β and IL-6, together with other anti-inflammatory effects (Ribeiro et al, 2012; Pisanti et al, 2017).

Mice with MS-like symptoms that underwent CBD treatment had reduced IL-1β and other immunoregulatory actions, and that this likely occurred via increased A2A adenosine receptor signalling (Mecha et al, 2013; Pisanti et al, 2017).

Another animal study found that transdermal CBD decreased inflammation and pain behaviours in rats with arthritic-like symptoms.  Specifically, there was a dose-dependent reduction in pro-inflammatory cytokines including TNF (up to an optimal dose of 6.2 mg CBD/day for 4 days).  The rats did not display any psychoactive effects.  The results of this study suggest that topical (skin) applications of CBD may offer localized pain relief and reduced inflammation with minimal side effects in arthritis patients  (Hammell et al, 2016).

Further details pertaining to medicinal cannabis including CBD are available in many papers (Likar and Nahler, 2017, and other science papers).

Many videos on CBD also exist including this YouTube link (in English, with German subtitles):

Is Cannibidiol (CBD) Oil Legal in Australia?  

A friend with back pain just asked me where he could legally buy CBD oil in Australia.  This section tries to answer his question as best as possible:

First, the good news:

Yes, in theory, CBD oil is now legal in Australia.  Cannabidiol is now listed as a ‘Prescription Only Medicine’ in Australia.

Specifically, after 1 October 2017, CBD Oil (Full Spectrum CBD Oil Extract) was classified as a ‘Schedule 4 – Prescription Only Medicine OR Prescription Animal Remedy’.  Thus, assuming you can find a doctor who will prescribe CBD oil, it is now legal.  

And now, the bad news:

There may only be 23 Paediatric Neurologists in all of Australia who are actually authorised to prescribe to children with neurological conditions.  (Don’t quote me on this one though.) 

https://eternalplants.com.au/is-cbd-oil-legal-australia/

If this is true, what can the adult chronic pain patients in Australia do if they would like to legally obtain the non-pyschoactive and non-addictive CBD oil for pain relief??

Chronic pain is a serious issue.  It is one thing to legalize CBD oil.  It is another thing to then unnecessarily delay legal access to it, for whatever reasons.  The current situation is simply unacceptable.  More has to be done to ensure that chronic pain patients in Australia can obtain a prescription for CBD from their doctor, should they wish to do so.  For the sake of chronic pain patients all across Australia, this issue needs to be sorted out as a matter of highest priority.  

For more information, please refer to these articles:

(1) Medical Cannabis Process Still “Heavily Laden With Red Tape” and Hard to Navigate: AMA (1 March 2017)

http://www.abc.net.au/triplej/programs/hack/medical-cannabis-doctors-respond/8314222

(2) Is Cannabidiol (CBD) Oil Legal in Australia? (updated Feb 2018)

https://eternalplants.com.au/is-cbd-oil-legal-australia/

Please read the following section for Switzerland’s more enlightened approach to CBD:

Switzerland and Cannabidiol (CBD)

In Switzerland, chronic pain patients no longer have to obtain a medical prescription to buy CBD as long as it contains less than 1% THC.  After all, the Swiss authorities acknowledge that psychoactive effects can not arise in the first place if THC content is less than 1%.  Furthermore, because CBD does not compromise mental clarity, it does not increase the risk of falls in seniors.  Equally important, the Swiss authorities accept that (unlike opioids), CBD is not addictive. 

Cannabidiol legalization helps to remove the stigma and adverse social consequences related to its use.  People who use CBD for medicinal purposes only are often mistakenly accused of simply wanting ‘an excuse to get high’.  In actual fact (as already stated), CBD has nil psychoactive effects.    

By allowing CBD containing less than 1% THC to be legally available without a prescription, greater pain treatment options are now available in Switzerland. 

A question:

Why are there so many diverse approaches to the legalization of CBD between different countries?  Can we learn anything from Switzerland, Austria and other countries whose pain patients are able to legally access CBD, with or without a prescription, more easily than in Australia?  Finally, are we doing the best that we can for pain patients in Australia?  If not, why not??  

Summary

Some doctors believe that CBD’s medical benefits are ‘purely anecdotal in nature’ and that more CBD research is needed.

However, there is a growing number of medical practitioners that recognize CBD’s medicinal benefits including pain relief.  Daily CBD use does not result in any psychoactive effects (given its virtual absence of THC), tolerance nor other adverse effects.

Many patients including Laura Bryant, Hope Bobowski and Deryn Blackwell say that, based on their own personal experiences, they have all the evidence they will ever need that CBD offers effective pain relief for their chronic pain.  

In Hope Bobowski’s words,  

“I’m spreading the word.”

In Laura Bryant’s words (quoting),

“The medical system failed me.  The hospitals failed me.  There are medical journals out there supporting the use of medical cannabis.  Why did I have to get to the point where my mother had to sedate me on the side of the road and my little brother had to go through that?  Why did I have to get to the point where I didn’t want to live anymore when there is a medication out there that has changed my life but I’m not supposed to have it? … 

I want to show the sceptics that I am not some 20-year-old stoner with no job.  [CBD oil has] given me my independence back.  I didn’t have to go through that guilt!”

” … this is a medicine and … it has given me my life back.  I want them to know that without it, I will go back to the way I was, and even if my condition isn’t life-threatening, the side effects of it are.

While CBD (containing less than 1% THC) may not work for everyone, the first and foremost step is to allow legal access to CBD in the most acceptable, practical and expedient manner possible.  Switzerland, Austria and other countries have paved the way for pain patients to legally access CBD (with negligible THC content) via prescription or otherwise.  It is hoped that many more countries will find a humane and compassionate way to help ease the pain and suffering of its patients by offering as many pain treatment options as possible including CBD.

NB Please obtain proper medical advice and ensure compliance with local laws before using medicinal cannabis including CBD oil.

 

Here’s to Laura, Hope, Deryn and many other patients for sharing their inspiring stories that offer hope to other pain patients.

In Laura’s words, 

“…there is hope.  I want them to know not to stop trying.”

Thank you, Laura, Hope and Deryn for spreading hope!

Sabina Walker

Blogger, Pain Matters (in WordPress)

If you find this blog post helpful, please share this link via social media including Facebook.

REFERENCES

In English

Media

(1) Hoffman, Andy. A Swiss Startup Is Pumping Out Legal Hashish. Bloomberg (8 December 2017).

https://www.bloomberg.com/news/features/2017-12-08/a-swiss-startup-is-pumping-out-legal-hashish

(2) Swiss Oasis for Legal Cannabis, Without the High. The Local (14 April 2017).

https://www.thelocal.ch/20170414/swiss-oasis-for-legal-cannabis-without-the-high

(3) Killalea, Debra. AAP (22 February 2017).

Medical Marijuana Legal in Australia: What It Means for You

http://www.news.com.au/lifestyle/health/medical-marijuana-legal-in-australia-what-it-means-for-you/news-story/b61f0238f84be843855c20605bc17ed1

(4) Calvo, Amberley. How Does Cannabidiol (CBD) Work? Elixinol (19 August 2015).

https://elixinol.com/blog/how-does-cannabidiol-cbd-work/

(5A) Marsh, Sarah. Study Looks at Cannabis Ingredient’s Ability to Help Children’s Tumours.   UK Research into Cannabidiol (CBD) Comes After Surge in Parents Administering it to Children Without Medical Advice. The Guardian (3 May 2017).

https://www.theguardian.com/society/2017/may/02/study-cannabis-cannabidiol-cbd-ability-to-help-children-brain-tumours

(5B) Waugh, R. Four-Year-Old Brain Cancer Patient Sees Tumour Shrink – Thanks to Cannabis Oil. Metro News (3 May 2017). 

Four-year-old brain cancer patient sees tumour shrink – thanks to cannabis oil

(6) Isodiol – The World Leader in CBD

https://isodiol.com

Anecdotal Case Studies

(7) Barton, Adriana. Seniors turning to cannabis for relief – and businesses are all in. The Globe and Mail (20 April 2017).

https://beta.theglobeandmail.com/life/health-and-fitness/health/seniors-turning-to-cannabis-for-relief-and-businesses-are-all-in/article34760076/?ref=http://www.theglobeandmail.com&service=mobile

(8A) Hannaford, Scott. The Canberra Times (2015).

Pain, and a Future on Hold

http://www.canberratimes.com.au/interactive/2015/cannabis-and-pain/

(8B) Brown, Andrew. The Canberra Times (29 October 2016).

Medicinal Cannabis Now Legal After Law Change Comes Into Effect

http://www.canberratimes.com.au/act-news/medicinal-cannabis-now-legal-after-law-change-comes-into-effect-20161029-gsdmto.html

(9) Hussain, Danyal. Mother Who Gave Her Dying Son Cannabis to Ease His Cancer Symptoms Says It’s Saved His life And HERS After She Used It To Treat Her Depression. Daily Mail (4 February 2018).

http://www.dailymail.co.uk/news/article-5349749/Mother-gave-dying-son-cannabis-said-saved-lives.html

Medical and Science Papers

(10) Hammell DC, Zhang LP, Ma F, et al. Transdermal Cannabidiol Reduces Inflammation and Pain-Related Behaviours in a Rat Model of Arthritis. European Journal of Pain (2016); 20(6): 936-948.

doi:10.1002/ejp.818.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/pdf/nihms737474.pdf

(11) Mecha, M et al. Cannabidiol Provides Long-Lasting Protection Against the Deleterious Effects of Inflammation in a Viral Model of Multiple Sclerosis: A Role for A2A Receptors. Neurobiology of Disease (11 July 2013); 59: 141–150.

https://ac.els-cdn.com/S0969996113001939/1-s2.0-S0969996113001939-main.pdf?_tid=112c4b30-0439-452d-b7f4-ccbb039a1689&acdnat=1522893833_6b9a541d2bf01af00090396fad8b5d5f

(12) Ribeiro et al. Cannabidiol, A Non-Psychotropic Plant-Derived Cannabinoid, Decreases Inflammation in a Murine Model of Acute Lung Injury: Role for the Adenosine A2A Receptor. European Journal of Pharmacology (12 January 2012); 678: 78–85.

https://ac.els-cdn.com/S0014299912000052/1-s2.0-S0014299912000052-main.pdf?_tid=f06b8205-b148-4724-ac0c-a5e7af7e8644&acdnat=1522896643_83233be18ca5782f59dc71b757083571

(13) Pisanti et al. Cannabidiol: State of the art and new challenges for therapeutic applications. Pharmacol Ther. (July 2017); 175: 133-150.

doi: 10.1016/j.pharmthera.2017.02.041.

https://www.ncbi.nlm.nih.gov/pubmed/28232276

(14) Giampietro, C and Fautrel, B. Anti-Interleukin-1 Agents in Adult Onset Still’s Disease. International Journal of Inflammation (2012), Vol. 2012, Article ID 317820, 6 pages. doi:10.1155/2012/317820

https://www.hindawi.com/journals/iji/2012/317820/abs/

(15) Likar, R, Nahler, G. The Use of Cannabis in Supportive Care and Treatment of Brain Tumor. Neuro-Oncology Practice (1 September 2017); 4(3): 151–160.

(16) Hayakawa K, Mishima K, Fujiwara M. Therapeutic Potential of Non-Psychotropic Cannabidiol in Ischemic Stroke. Pharmaceuticals (2010); 3(7): 2197-2212. doi:10.3390/ph3072197.

https://doi.org/10.1093/nop/npw027

(17) Kogan et al. Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts. J Bone Miner Res. (30 Oct 2015); (10):1905-13.

doi: 10.1002/jbmr.2513.  

https://www.ncbi.nlm.nih.gov/pubmed/25801536

(18) Grundy, R. New Research to Test Effect of Cannabidiol on Child Brain Tumours. Children’s Brain Tumour Research Centre, University of Nottingham, UK (2 May 2017).

http://www.cbtrc.org/newsandevents/news/2017/new-research-to-test-effect-of-cannabidiol-on-child-brain-tumours.aspx

(19) A Safety Study of Sativex Compared With Placebo (Both With Dose-intense Temozolomide) in Recurrent Glioblastoma Patients. ClinicalTrials.gov Identifier: NCT01812616.

https://clinicaltrials.gov/ct2/show/NCT01812616

 

In German

Media

(1) Die Schweiz im Cannabis-Light-Rausch: So Professionell Läuft das CBD-Geschäft. Watson (26 November 2017)

https://www.watson.ch/Schweiz/Drogen/462446747-Die-Schweiz-im-Cannabis-light-Rausch–So-professionell-laeuft-das-CBD-Geschaeft

(2A) Likar, Rudolf.  Cannabidiol: Schmerzreduktion bei Therapieresistenten Fällen.  Universum Innere Medizin (2016); 08/16: 96-97.

(2B) Cannabis-Inhaltsstoff CBD Hilft Bei Schmerzen. Kaernten News (20 January 2017).

http://kaernten.orf.at/news/stories/2821011/

(2C) Kofler, B. Hanf-Inhaltsstoff Cannabidiol Dämpft Schmerzen Ohne Effekt Auf Gehirn – Hinweise Auch Auf Entzündungshemmende Wirkung. B&K (20 January 2017).

http://www.bkkommunikation.com/de/journalistenservice/aktuell/hanf-inhaltsstoff-cannabidiol-daempft-schmerzen-ohne-effekt-auf-gehirn-hinweise-auch-auf-entzuen/

(2D) Cannabidiol: Schmerzlindernd ohne Nebenwirkungen. Der Standard (20 Jänner 2017).

https://derstandard.at/2000051213430/Cannabis-Inhaltsstoff-koennte-auch-entzuendungshemmend-wirken

Medical Paper

(3) Likar Rudolf. Cannabidiol: Schmerzreduktion bei Therapieresistenten Fällen. Universum Innere Medizin (2016); 08/16: 96-97.

Anecdotal Case Studies

(4) rpw. Weil Nichts Mehr Half – Mutter Verabreichte Ihrem Krebskranken Sohn Heimlich Cannabis. Stern (28 March 2017)

http://www.stern.de/familie/kinder/mutter-verabreichte-ihrem-krebskranken-sohn-deryn-heimlich-cannabis-7388940.html