Speaker: João Gustavo dos Anjos Morais Oliveira, Escola Bahiana de Medicina e Saúde Pública (grid.414171.6)
Title: Endocannabinoid System as an alternative way for neuropathic pain treatment
Emcee: Srikanth Ramaswamy
Backend host: Gelana Tostaeva
Presented during Neuromatch Conference 3.0, Oct 26-30, 2020.
Summary: Neuropathic pain is a debilitating condition, which can occur in both the central and peripheral nervous system lesions. Its cost could amount to as much as $160 billion annually in the United States. The magnitude of the cost is associated with scarce effective treatment for this condition. Research made with the Endocannabinoid System are raising its potentiality to be an alternative way for the treatment of this condition. That fact based the production of this review, with systematic reviews and reviews searched via PubMed.
Clinical evidence has suggested cannabis-based medical extracts may be helpful as an adjuvant treatment for some patients with neuropathic pain symptoms, especially the activation of CB1 receptors by Δ9-Tetrahydrocannabinol (THC). However, side effects related to the activation of CB1 receptors could be harmful, as CB1 is expressed in higher function areas in the central nervous system, representing a threat specially for individuals with a history of neuropsychiatric conditions. Local injection of cannabinoids has shown effectiveness as CB1 receptors are present in peripheral tissue. It has been demonstr ated that oromucosal spray containing equal mixture of THC and Cannabidiol (CBD) induced significant antinociceptive effects in patients with peripheral neuropathic pain and has also suggested the capacity of CDB to reduce THC’s psychotic effects. Furthermore, smoked cannabis has presented better results as a second-line treatment, as it has presented a dose-dependent anti-nociceptive effect capable of attenuating neuropathic pain. The inhibition of endocannabinoids degrading enzymes can lead up to elevated levels of these substances where their actions can produce analgesia. This strategy represents an alternative to the global activation of CB1 receptors, which is associated with adverse effects. Even though the results are promising, the evidence is not strong enough for its disseminated use. There are gaps to be filled, for example the lack of natural versus synthetic compounds comparison.