CC#7: The Use of Cannabis Products for the Management of Pain Associated With Gynecologic Conditions

Question 1

Cannabinoid w/ contrasting MoA and therapeutic indications to delta-9-THC; as an isolated substance, CBD is considered a psychoactive substance but does not cause intoxication

Answer 1

Cannabidiol (CBD)

Question 2

Any of a group of closely-related compounds that include cannabinol and active constituents of cannabis

Answer 2

Cannabinoid

Question 3

Broad term that can be used to describe various products and chemical compounds derived from Cannabis sativa or Cannabis indica species; typically, Cannabis sativa has higher THC:CBD ratio compared to Cannabis indica

Answer 3

Cannabis

Question 4

problem-causing pattern of cannabis use leading to clinically significant impairment/distress, as manifested by >2 distinguishing sxs (ie cannabis is taken in larger amounts or for longer periods than intended, experience of craving, continued cannabis use despite experience of physical/social/interpersonal problems cause by cannabis use) occurring within 12-month period

Answer 4

Cannabis use disorder

Question 5

medicinal products containing cannabis or cannabinoids derived from cannabis plant (ie THC and/or CBD)

Answer 5

Cannabis-based products for medicinal use

Question 6

cannabinoid derived from hemp used as an herbal remedy; has moderately intoxicating effects

Answer 6

Delta-8-tetrahydrocannabinol (THC)

Question 7

Cannabinoid used for medicinal purposes and nonmedicinally for its intoxicating effects

Answer 7

Delta-9-tetrahydrocannabinol (THC)

Question 8

synthetic delta-9-THC that is FDA-approved for tx of anorexia, for those w/ AIDS, and for N/V for those receiving chemotx for cancer

Answer 8

Dronabinol

Question 9

Cannabis resin, compressed trichomes (resin) from buds

Answer 9

Hash/Hashish

Question 10

Resin extracted in purest form (oil-like) w/ >50% THC

Answer 10

Hash oil

Question 11

Cannabis plants w/ very low levels of THC (<0.3%) that are not considered marijuana, but instead hemp

Answer 11

Hemp

Question 12

Use of “slang” term is controversial because it is associated w/ 1930s US campaigns to demonize the plant by associating it with/ immigrants from Mexico

Answer 12

Marijuana

Question 13

Has chemical structure similar to THC and synthetically derived; FDA-approved for tx of chemotx-induced N/V

Answer 13

Nabilone

Question 14

Material from cannabis plant that is not regulated as a medicinal product; widely used for intoxicating effects

Answer 14

Nonmedicinal cannabis

Question 15

Products containing CBD that are widely sold as herbal remedies but are not regulated as medicinal products

Answer 15

Nonmedicinal CBD products

Question 16

synthetic cannabinoids that are not structurally related to naturally occurring cannabinoids and are not currently recognized for medicinal use (ie synthetic cannabinoid receptor agonists, found in products such as “Spice”)

Answer 16

Nonmedicinal synthetic cannabinoids

Question 17

Endocannabinoid-like lipid mediator w/ documented anti-inflammatory/analgesic/antimicrobial/immunomodulatory/neuroprotective effects

Answer 17

Palmitoylethanolamide (PEA)

Question 18

Medicinal products containing synthetically produced cannabinoids that typically mimic the effects of THC (ie rabinol, nabilone)

Answer 18

Synthetic cannabinoids for medicinal use

Question 19

For pulmonary (smoking/vaporizing/dabbing) cannabis consumption, onset; duration; bioavailability for inhaled CBD; bioavailability for inhaled THC

Answer 19

5-10 mins; 2-4 hours; 11-45%; 2-56%

Question 20

For GI (edible/candy/drinks/capsules/baked goods/”cannabutter”) cannabis consumption, onset; duration; bioavailability for oral CBD; bioavailability for oral THC

Answer 20

30-180 mins; 6-8 hours; 6-33%; 4-20%

Question 21

Topical cannabis formulations w/ variable onset/duration and unknown bioavailability (6)

Answer 21

Balms, lotions, salves, bath soak, sprays, creams

Question 22

Transdermal cannabis formulations w/ variable onset/duration and unknown bioavailability (2)

Answer 22

Patches, gels

Question 23

Oral cannabis formulations w/ variable onset/duration and unknown bioavailability (6)

Answer 23

Drops, tinctures, sprays, lollipops, chewing gum, strips

Question 24

Vaginal cannabis formulations w/ variable onset/duration and unknown bioavailability (3)

Answer 24

Suppository, oil, wax

Question 25

Rectal cannabis formulations w/ variable onset/duration and unknown bioavailability (3)

Answer 25

Suppository, oil, wax

Question 26

THC concentration of CBD products below which they are classified as hemp, effectively legalized, and allowed for commercial sale

Answer 26

<0.3%

Question 27

THC concentration of CBD products above which they are classified as Schedule 1 drug under Controlled Substances Act

Answer 27

>0.3%

Question 28

Percent improvement seen in pain severity and response when using synthetic products w/ high THC:CBD ratios (>98% THC) for chronic pain pts; possible side effects associated w/ use of synthetic products w/ high THC:CBD ratios (2)

Answer 28

>30%; dizziness, sedation

Question 29

Sxs that showed very small-to-small improvements w/ noninhaled medical cannabis/cannabinoids among pts w/ chronic pain (3); side effects associated w/ such products (4)

Answer 29

Pain relief, physical functioning, sleep quality; transient cognitive impairment, N/V, drowsiness, impaired attention

Question 30

Was there a difference noted between neuropathic vs nonneuropathic pain in subgroup analysis of pain relief; was there a difference noted between chronic noncancer-related pain vs chronic cancer-related pain in subgroup analysis of pain relief?

Answer 30

No; no

Question 31

Is there conclusive/substantial evidence that cannabis/cannabinoids are effective for tx of chronic pain in adults?

Answer 31

Yes

Question 32

Percentage of pts who reported never using cannabis who were willing to use cannabis to treat gyn pain; percentage of ever users who were willing to use cannabis to treat gyn pain

Answer 32

61.2%; 90.0%

Question 33

Two main types of cannabinoid receptors; receptor most closely linked w/ THC

Answer 33

CB1 and CB2; CB1

Question 34

Responsibility of cannabinoid receptors and endocannabinoid system re endogenous cannabinoids

Answer 34

Maintaining homeostasis within body and respond to endogenous cannabinoids (naturally produced by body)

Question 35

Primary locations of CB1 receptors (3)

Answer 35

Brain/spinal cord, uterus, ovaries

Question 36

Responsibility of CB1 receptors (4)

Answer 36

"High" associated w/ cannabis use, impaired cognition and anxiety, regulation of mood/memory/appetite/pain perception/coordination, therapeutic effects w/ pain relief and appetite stimulation

Question 37

Primary locations of CB2 receptors (4)

Answer 37

Immune cells, uterus, spleen, GI tract

Question 38

Responsibility of CB2 receptors (4)

Answer 38

Less associated w/ "high" (ie disinhibition, hallucinations), modulate immune responses/inflammation/pain perception, therapeutic effects w/ reducing inflammation/autoimmune disorders/ neurodegenerative diseases

Question 39

By how much are Black individuals more likely to be arrested for cannabis possession?

Answer 39

3.73x (despite similar rates of cannabis use among White and Black individuals)

Question 40

Characteristics of pts who used cannabis (2)

Answer 40

Higher rates of anxiety/depression/catastrophizing, worse functional QoL

Question 41

Percentage of pts w/ chronic pelvic pain who reported using cannabis products

Answer 41

23%

Question 42

Among chronic pelvic pain pts who reported using cannabis products, percentage of those who used CBD; percentage of those who used THC, percentage of those who used combo CBD+THC

Answer 42

24%; 12%; 60%

Question 43

Percentage of chronic pelvic pain pts who used cannabis who reported a reduction in use of opioids 2/2 cannabis use

Answer 43

Nearly 33%

Question 44

Most common method of reported cannabis use among chronic pelvic pain pts

Answer 44

Inhalation

Question 45

Percentage of pts who use PEA-transpolydatin who reported improvement in pain

Answer 45

98.18%

Question 46

Percentage of pts w/ endo or chronic pelvic pain who reported improvement in dysmenorrhea and dyspareunia w/ taking PEA combined w/ alpha-lipoic acid or polydatin

Answer 46

>70%

Question 47

Common doses of PEA studied for management of chronic pelvic pain

Answer 47

300mg-600mg BID

Question 48

At what age does the prefrontal cortex complete development?

Answer 48

Mid-20s

Question 49

Brain areas that have shown structural alterations among adolescent cannabis users (2)

Answer 49

Hippocampus, prefrontal cortex

Question 50

Characteristics associated w/ cannabis use in adolescence (5)

Answer 50

Decrease in verbal memory, decrease in IQ, increase in ADHD sxs that may affect academic function (including lower rates of high school completion), higher rates of cannabis use disorder (most commonly developed a few years after first use of cannabis), higher rates of adult mental health disorders (ie depression, schizophrenia)

Question 51

Adverse cognitive effects associated w/ cannabis (particularly substances w/ higher concentrations of THC) (7)

Answer 51

Intoxication, decreased short-term memory, impaired perception, impaired motor skills, somnolence, insomnia, increased suicidality (among adolescents)

Question 52

Adverse bodily effects associated w/ cannabis (5)

Answer 52

Dry mouth, respiratory effects from inhaled products, transaminase elevation, N/V/D, rashes from ingested/topical routes