Pain Management

Posted on Pain Management

CBD products don’t ease pain and are potentially harmful – new study finds

There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, new research finds
There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, new research finds

There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, according to new research led by the University of Bath in the UK.

CBD (short for cannabidiol) is one of many chemicals found naturally in the cannabis plant. It’s a popular alternative medicine to treat pain and is readily available in shops and online in the form of oils, tinctures, vapes, topical creams, edibles (such as gummy bears) and soft drinks.

However, consumers would do well to steer clear of these products, according to the new study.

“CBD presents consumers with a big problem,” said Professor Chris Eccleston, who led the research from the Centre for Pain Research at Bath. “It’s touted as a cure for all pain but there’s a complete lack of quality evidence that it has any positive effects.”

He added: “It’s almost as if chronic pain patients don’t matter, and that we’re happy for people to trade on hope and despair.”

For their study, published this week in The Journal of Pain, the team – which included researchers from the Universities of Bath, Oxford and Alberta in Canada – examined research relevant to using CBD to treat pain and published in scientific journals up to late 2023.

They found:

  • CBD products sold direct to consumers contain varying amounts of CBD, from none to much more than advertised.
  • CBD products sold direct to consumers may contain chemicals other than CBD, some of which may be harmful and some illegal in some jurisdictions. Such chemicals include THC (tetrahydrocannabinol), the main psychoactive component of the cannabis plant.
  • Of the 16 randomised controlled trials that have explored the link between pain and pharmaceutical-grade CBD, 15 have shown no positive results, with CBD being no better than placebo at relieving pain.
  • A meta-analysis (which combines data from multiple studies and plays a fundamental role in evidence-based healthcare) links CBD to increased rates of serious adverse events, including liver toxicity.

Medical vs non-medical CBD

In the UK, medical cannabis is the only CBD product that is subject to regulatory approval. It’s occasionally prescribed for people with severe forms of epilepsy, adults with chemotherapy-related nausea and people with multiple sclerosis.

Non-medical CBD is freely available in the UK (as well as in the US and many European countries) so long as it contains negligible quantities of THC or none at all. However, CBD products sold on the retail market are not covered by trade standards, meaning there is no requirement for them to be consistent in content or quality.

Most CBD products bought online – including popular CBD oils – are known to contain very small amounts of CBD. Moreover, any given product may be illegal to possess or supply, as there’s a good chance it will contain forbidden quantities of THC.

Chronic pain

An estimated 20% of the adult population lives with chronic pain, and sufferers are often desperate for help to alleviate their symptoms. It’s no surprise then that many people reach for CBD products, despite their high price tag and the lack of evidence of their effectiveness or safety.

Dr Andrew Moore, study co-author and former senior pain researcher in the Nuffield Division of Anaesthetics at the University of Oxford, said: “For too many people with chronic pain, there’s no medicine that manages their pain. Chronic pain can be awful, so people are very motivated to find pain relief by any means. This makes them vulnerable to the wild promises made about CBD.”

He added that healthcare regulators appear reluctant to act against the spurious claims made by some manufacturers of CBD products, possibly because they don’t want to interfere in a booming market (the global CBD product market was estimated at US$3 billion in 2021 or £2.4 billion and is anticipated to reach US$60 billion by 2030 or £48 billion) especially when the product on sale is widely regarded as harmless.

“What this means is that there are no consumer protections,” said Dr Moore. “And without a countervailing body to keep the CBD sellers in check, it’s unlikely that the false promises being made about the analgesic effects of CBD will slow down in the years ahead.”

The study’s authors are calling for chronic pain to be taken more seriously, with consumer protection becoming a priority.

“Untreated chronic pain is known to seriously damage quality of life, and many people live with pain every day and for the rest of their lives,” said Professor Eccleston. “Pain deserves investment in serious science to find serious solutions.”

Posted on Pain Management

Did you know that physical activity can protect you from chronic pain? One of the reasons is that it increases your pain tolerance

Kayakers in northern Norway

UiT researchers have found that physically active people have a lower risk of experiencing chronic pain several years later. “This suggests that physical activity increases our ability to tolerate pain and may be one of how activity helps to reduce the risk of developing severe chronic pain,” says doctoral fellow Anders Årnes. David Jensen/UiT The Arctic University of Norway

In 2023, researchers from UiT The Arctic University of Norway, the University Hospital of North Norway (UNN), and the Norwegian Institute of Public Health found that among more than 10,000 adults, those who were physically active had a higher pain tolerance than those who were sedentary; and the higher the activity level, the higher the pain tolerance.

After this finding, the researchers wanted to understand how physical activity could affect the chances of experiencing chronic pain several years later. And they wondered if this was related to how physical activity affects our ability to tolerate pain.

“We found that people who were more active in their free time had a lower chance of having various types of chronic pain 7-8 years later. For example, being just a little more active, such as going from light to moderate activity, was associated with a 5% lower risk of reporting some form of chronic pain later,” says doctoral fellow Anders Årnes at UiT and UNN.

He is one of the researchers behind the study.

He adds that for severe chronic pain in several places in the body, higher activity was associated with a 16% reduced risk.

Measured cold pain tolerance

The researchers found that the ability to tolerate pain played a role in this apparent protective effect. That explains why being active could lower the risk of having severe chronic pain, whether or not it was widespread throughout the body.

“This suggests that physical activity increases our ability to tolerate pain and may be one of the ways in which activity helps to reduce the risk of severe chronic pain,” says Årnes.

The researchers included almost 7,000 people in their study, recruited from the large Tromsø survey, which has collected data on people’s health and lifestyle over decades.

After obtaining information about the participants’ exercise habits during their free time, the researchers examined how well the same people handled cold pain in a laboratory. Later, they checked whether the participants experienced pain that lasted for 3 months or more, including pain that was located in several parts of the body or pain that was experienced as more severe.

Among the participants, 60% reported some form of chronic pain, but only 5% had severe pain in multiple parts of the body. Few people experienced more serious pain conditions.

The research was recently published in the journal PAIN – Journal of the International Association for the Study of Pain.

Pain and exercise

When it comes to exercising if you already have chronic pain, the researcher says:

“Physical activity is not dangerous in the first place, but people with chronic pain can benefit greatly from having an exercise program adapted to help them balance their effort so that it is not too much or too little. Healthcare professionals experienced in treating chronic pain conditions can often help with this. A rule of thumb is that there should be no worsening that persists over an extended period of time, but that certain reactions in the time after training can be expected.”

Posted on Autism, Pain Management

Empowering autistic teens: New advice for navigating chronic pain

Empowering autistic teens: New clinician advice for navigating chronic pain

When you’re an autistic teenager living with chronic pain, getting treatment for your pain can be a challenging experience. According to a group of young people who’ve spoken to Dr Abbie Jordan of the Department of Psychology and Centre for Pain Research at The University of Bath about their experiences. Teenagers mention sensory issues, a lack of autism awareness among staff, or feeling “doubly different” compared to their peers, making receiving “one-size-fits-all” psychologically focused treatment for their chronic pain particularly challenging.

Improving treatment for autistic adolescents matters because there are widespread reports that autistic people have shorter life expectancies and poorer health than their non-autistic peers and report receiving lower-quality healthcare.

Now, her team have come up with a new set of clinical guidelines they hope will make things easier for pain clinicians working with autistic adolescents.

The recommendations published in The Journal of Pediatric Psychology are:

  1. Provide written/visual information to take home: Consider providing written and/or visual information for the adolescent to take home. Ask about the type of format the autistic individual will find most useful to enable them to follow the information provided. Use pictures and colours if these work for the individual.
  2. Ensure that information is individualised: Avoid using a standard form for all adolescents. Include key points and make sure they are pertinent to the adolescent. Adopt language used by the adolescent too answer the questions. Use individualised information to validate the autistic adolescent’s experiences and explain how pain and autism may present together.
  3. Take your time: If an adolescent has autism diagnosis in their clinical notes, plan to go more slowly, take more time with the clinical work and pause.
  4. Include parents and caregivers: Ask and include parents and caregivers, they know their adolescent best. Shape what the parent/caregiver says outside of the clinic, they can reinforce the clinical work outside of clinical settings.

These recommendations are based on the findings from a study conducted by Dr. Jordan and pain research and clinical colleagues in which they interviewed 10 autistic teenagers and their mothers who had engaged with a pain treatment in a pain clinic.  The authors asked the adolescents and their mothers about the adolescents’ experiences of living with chronic pain and being autistic.  

A mother of a 15 year boy with hypermobility spectrum disorder described how for her son,

“It’s so tiring and exhausting being in pain, and then it’s even more so by having autism and then by having it suddenly pointed out that you are so completely different. I think it can be quite isolating.”

Regarding psychological treatment for her chronic pain, such as cognitive-behavioural therapy (CBT) or acceptance and commitment therapy (ACT), 18-year-old “Chloe” said:

“Some of the mindfulness ones [activities] are like “imagine you’re up a mountain” and things like that, and I’m just like, I know I’m not up a mountain… I was just thinking, I can’t imagine being anywhere other than where I am.”

Chloe’s mother went on to explain:

“The clinicians say, ‘imagine that your toes are dipping into the water and how cold it is,’ and I can imagine an experience, but Chloe is like ‘oh no they’re not so they’re not.’ So, most of the techniques around anxiety…they’re blocked by the ASD [Autism Spectrum Disorder], so Chloe doesn’t get the benefit of a drop in anxiety. And therefore, the drop in pain doesn’t come because the anxiety threshold is still there.”

The teenagers also spoke about how they communicate their chronic pain differently compared with their neurotypical peers. For 15-year-old “Jack,” that’s by laughing, but it took a few years for this to be picked up by medical staff. His mother explains:

“We had a little bit of a problem with physios or doctors not understanding that when he’s laughing, he’s in pain, so we were almost sort of brushed off, so I think maybe not being taken seriously or understanding quite the level of pain he was in.”

It’s hoped that Dr. Jordan and teams’ new guidelines will help clinicians better understand the experiences of autistic adolescents living with chronic pain and, in turn, improve their ability to manage their pain and its impact on their life.

Dr Jordan explained “We hope that these simple guidelines will be widely adopted by pain clinicians working with autistic adolescents and that they will enable autistic adolescents living with chronic pain to receive more targeted treatment that better meets the specific needs of autistic adolescents. A one size fits all approach does not work for pain treatment and that is even more so the case when working with autistic adolescents who live with chronic pain. We hope that these guidelines will encourage the development of more individualised pain treatments”.

Posted on Pain Management

Additional study shows promise for low-intensity ultrasound as a non-invasive approach to alleviate pain.

Low intensity focused ultrasound

Wynn Legon (left), the faculty director of the transcranial MR-guided focused ultrasound facilities at the Fralin Biomedical Research Institute, and Andrew Strohman, an M.D.-Ph.D. student at Virginia Tech, were among researchers reporting that application of low-intensity focused ultrasound to an area deep within the brain may potentially help people cope with chronic pain. The research was published in the Journal of Neuroscience. Photo by Clayton Metz for Virginia Tech.

Virginia Tech researchers at the Fralin Biomedical Research Institute at VTC report that applying low-intensity focused ultrasound to an area deep within the brain may point to new ways to help people cope with chronic pain.

In a study showing published in the Journal of Neuroscience, scientists demonstrated the effectiveness of using low-intensity focused ultrasound to modulate the activity in a critical region in the brain that processes and regulates pain signals. 

Researchers, including first author Andrew Strohman, a Virginia Tech M.D.+Ph.D student at the Fralin Biomedical Research Institute, found the application of low-intensity ultrasound to a structure known as the dorsal anterior cingulate cortex reduced pain, diminished bodily responses to pain, and decreased pain-related brain activity without the need for invasive procedures, researchers said.

“This study points to a non-invasive and effective way to modulate a critical region of the brain involved in pain processing, while eliminating many of the risks associated with surgeries,” said Wynn Legon, assistant professor at the Fralin Biomedical Research Institute and senior author of the study. “It provides a potential new means to modulate the brain activity in response to pain that may serve to better understand the mechanisms of chronic pain to provide a new, innovative therapeutic option that could change how we approach and treat pain in the future.”

In a study with 16 healthy volunteers, researchers focused ultrasound energy on the dorsal anterior cingulate cortex to see if it could change how people feel pain. To test whether it changed someone’s perception of pain, they applied brief heat to the skin and measured pain perception, heart rate variability, skin responses, and brain electrical signals.

Data were collected in three sessions on three separate days along with an imaging visit consisting of an anatomical computerized tomography (CT) and structural magnetic resonance imaging (MRI) to accurately and reliably target this hard-to-reach area in each individual.

The results showed that the ultrasound made people feel less pain, and it also altered how the brain and heart communicate. Overall, the heart did not respond as strongly to pain, and certain brain signals changed. 

“Chronic pain patients often experience cardiovascular issues, which may either be at the root of their chronic pain or play a role in contributing to it,” said Legon, who is also an assistant professor of the School of Neuroscience of the College of Science and in the VTC School of Medicine Department of Neurosurgery. “Understanding this intricate relationship is crucial, because it enhances our comprehension of pain mechanisms and suggests the importance of addressing both pain perception and cardiovascular health.”

The results suggest that using ultrasound applied to this specific region of the brain may help reduce pain and change how the body reacts to pain. 

More recently, in a study published in the journal PAIN on Feb. 5, the researchers found soundwaves from low-intensity focused ultrasound aimed at a brain region called the insula can also reduce the perception of pain and other effects.

“This study provides some of the first evidence we can change three major areas of activity, those being pain perception, brain activity, and cardiac activity,” Strohman said. “The next steps are to look at how these metrics relate to each other and explore how these findings can be applied to improve the lives of patients suffering from chronic pain.”

“While there has been tremendous progress in recent years in the use of high intensity focused ultrasound for creating small lesions in patients’ brain to treat disorders such as essential tremor and for tumor ablation, we are at the very beginning of exploration of the use of low intensity focused ultrasound to mildly modulate brain activity and affect perception and behavior,” said Michael Friedlander, executive director of the Fralin Biomedical Research Institute, who was not involved with the study. 

“The new work by Strohman and Legon and their pioneering team represents some of the most exciting new advances of this approach,” added Friedlander, who is also Virginia Tech’s vice president for health sciences and technology.  

“The fact that it is addressing one of the most debilitating diseases, chronic pain, represents a major step in this important emerging field of biomedical research and provides hope for better treatments that may avoid the untoward effects of many drugs used for treating pain,” Friedlander said. 

Research Assistant Brighton Payne, medical student Alexander In, and M.D.+Ph.D. student Katelyn Stebbins of the Legon lab at the Fralin Biomedical Research Institute contributed to the study.

Posted on Pain Management

More on the relationship between pain and weather

Study shows desire for new forecasts, potentially altered behavior when risk is high
Study shows desire for new forecasts, potentially altered behavior when risk is high

For individuals who experience chronic pain, weather can be a significant factor in their day-to-day plans. In a recent study from the University of Georgia, about 70% of respondents said they would alter their behavior based on weather-based pain forecasts.

“We’re finding more consistent relationships between weather patterns and pain, so it seems more possible to make weather-based pain forecasts,” said lead author and geography/atmospheric sciences lecturer Christopher Elcik. “This study was to survey and see what the audience was for this type of forecast.”

The study surveyed more than 4,600 individuals, and among migraine sufferers, 89% identified weather as something that impacts their pain level, and 79% saw weather as a trigger for pain. Among individuals with other conditions, 64% said weather patterns could trigger pain and 94% identified weather as a factor that impacts pain.

Elcik built on previous research regarding specific weather patterns and pain-related conditions to gauge public interest in a weather-based pain forecast, which could indicate high or moderate risk for migraines or chronic pain.

“I see how much people can be affected by these types of pain, so if I can provide someone with insight into the level of risk for a day, maybe people can take steps to prevent the pain from happening,” Elcik said. “There are preventative measures people can take if risks are higher.”

If the hypothetical risk was high, more than half of respondents said they were likely to take preventive measures, such as medication, resting or avoiding compounding triggers, and about 47% of respondents with migraines and 46% with pain-related conditions were “extremely likely” to take such measures.

Desire for a forecasting tool was quite high, Elcik said, with 72% of those living with migraine and 66% with pain-related conditions saying they would alter their behavior by canceling plans or taking preventive measures in response to a weather-based pain forecast. Some respondents reported already using web-based tools, such as AccuWeather’s arthritis or migraine forecast, which predicts low-to-high risk according to atmospheric conditions. With existing tools, however, there is little available information about the variables considered or how the predictions are made.

Likelihood to continue with plans also depended on the length of the activity. If plans were about 30 minutes long, 57% of respondents with migraines and 52% with pain-related conditions said they were “extremely likely” to continue plans despite a moderate risk of pain, and about 43% from each group would continue with a highest risk forecast.

With an activity lasting more than three hours, however, that number dropped to around 23% for moderate risk and 18% for high risk with migraines and 21% or 23%, respectively, for other pain-related conditions. As level for risk increased, so did the likelihood to alter plans.

“This was across the board,” Elcik said. “Everyone was more likely to cancel plans if the forecast risk was higher.”

While additional research and studies are needed to create a reliable pain-based weather forecast, Elcik said this study highlights the importance of developing such a resource.

“This publication shows there’s an audience that’s willing and eager to try something new, and there are probably many more people who would benefit—more than we even thought,” he said. “I think these results can push other researchers to also look at similar, larger-scale weather phenomena and help the community better understand how the atmosphere does impact pain.”