Painful behavior and medicinal cannabis
Comportamento doloroso e cannabis medicinal
Eduardo Aliende Perin; César Augusto de Paula Santos
Abstract
BACKGKROUND AND OBJECTIVES: Pain is defined as a complex sensory and emotional experience, and it is one of the most common causes for seeking health care, being the chronic pain one of the most prevalent health conditions in the world today, with millions of people debilitated by symptomatic conditions. The discovery of the endocannabinoid system and its organic effects on pain modulation, especially chronic pain, represented an unknown source of possibilities for the production of drugs that, theoretically, would have great potential to improve the quality of life of individuals with chronic pain. Given this, the general objective of this work was to search the literature for studies that investigated the use of medicinal cannabinoids for the treatment of chronic pain and pain behavior.
CONTENTS: This is a narrative review of the literature in which aspects of painful behavior are presented, such as cognitive distortions associated with the experience of pain, and the influence of trauma, stress and psychiatric comorbidities on pain outcomes. The endocannabinoid system influences the modulation of all these points and also the regulation of pain itself.
CONCLUSION: This study provides perspectives on painful behavior and how the endocannabinoid system can interfere with different aspects of pain and with the way the patient perceives pain. Further studies on this issue are extremely important.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: A dor é definida como uma experiência sensitiva e emocional complexa, e está entre as principais causas de busca por atendimento médico, sendo a dor crônica um dos problemas de saúde mais prevalentes no mundo atual, com milhões de pessoas debilitadas por condições sintomáticas. A descoberta do sistema endocanabinoide e seus efeitos orgânicos na modulação da dor, especialmente a crônica, representou uma fonte desconhecida de possibilidades para a produção de fármacos que, teoricamente, possuiriam grande potencial de melhorar a qualidade de vida de indivíduos portadores de dor crônica. Diante disso, o objetivo geral deste trabalho foi buscar na literatura estudos que investigaram o uso de canabinoides medicinais para o tratamento da dor crônica e do comportamento doloroso.
CONTEÚDO: Trata-se de um estudo de revisão narrativa da literatura em que são apresentados aspectos do comportamento doloroso, como as distorções cognitivas associadas à experiência de dor, e a influência do trauma, do estresse e de comorbidades psiquiátricas nos desfechos de dor. O sistema endocanabinoide tem influência na modulação de todos esses pontos e também na própria regulação da dor.
CONCLUSÃO: Este estudo traz perspectivas sobre o comportamento doloroso e de como o sistema endocanabinoide pode interferir em diversos aspectos da dor e da forma como o paciente percebe a dor. Mais estudos sobre o assunto são de extrema relevância.
Palavras-chave
References
1 Bushnell MC, Ceko M, Low LA. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci. 2013;14(7):502-11.
2 Merskey H, Bogduk N. Classification of Chronic Pain. 2nd ed. IASP Task Force on Taxonomy. 1994.
3 Cunningham NR, Kashikar-Zuck S. Nonpharmacological treatment of pain in rheumatic diseases and other musculoskeletal pain conditions. Curr Rheumatol Rep. 2013;15(2):306.
4 Saúde. Protocolo Clínico e Diretrizes Terapêuticas da Dor Crônica. 2012 [Available from:
5 Abrams DI. Integrating cannabis into clinical cancer care. Curr Oncol. 2016;23(2):S8-S14.
6 Bonfá L, Vinagre RCdO, Figueiredo NVd. Uso de canabinóides na dor crônica e em cuidados paliativos. Rev Bras Anestesiol. 2008;58(3):267-79.
7 Bonini SA, Premoli M, Tambaro S, Kumar A, Maccarinelli G, Memo M, Mastinu A. Cannabis sativa: a comprehensive ethnopharmacological review of a medicinal plant with a long history. J Ethnopharmacol. 2018;227:300-15.
8 Robert C. Clarke MDM. Cannabis: Evolution and Ethnobotany. 2013; 434p.
9 Matias GFS, Lima MAC, Costa TA, Faria MS, Nascimento IBO, Debbo A. Use of cannabis for chronic pain treatment: a systematic review.
10 Raichlen DA, Foster AD, Gerdeman GL, Seillier A, Giuffrida A. Wired to run: exercise-induced endocannabinoid signaling in humans and cursorial mammals with implications for the ‘runner’s high’. J Exp Biol. 2012;215(Pt 8):1331-6.
11 Zhang HY, Gao M, Shen H, Bi GH, Yang HJ, Liu QR, Wu J, Gardner EL, Bonci A, Xi ZX. Expression of functional cannabinoid CB2 receptor in VTA dopamine neurons in rats. Addict Biol. 2017;22(3):752-65.
12 Beck AT. Depression: Clinical, Experimental, and Theoretical Aspects. Philadelphia, PA: University of Pennsylvania Press; 1967.
13 Beck A, Rush A, Shaw B, Emergy G. Cognitive therapy of depression: a treatment manual. Philadelphia: AT Beck. 1978.
14 Moss-Morris R, Petrie KJ. Cognitive distortions of somatic experiences: revision and validation of a measure. J Psychosom Res. 1997;43(3):293-306.
15 Corrêa LA, Mathieson S, Meziat-Filho NAM, Reis FJ, Ferreira AS, Nogueira LAC. Which psychosocial factors are related to severe pain and functional limitation in patients with low back pain? Psychosocial factors related to severe low back pain. Braz J Phys Ther. 2022;26(3):100413.
16 Takashima K, Oono Y, Takagi S, Wang K, Arendt-Nielsen L, Kohase H. Acute postoperative pain after orthognathic surgery can be predicted by the preoperative evaluation of conditioned pain modulation and pain catastrophizing. Pain Rep. 2022;7(2):e989.
17 Holt M, Swalwell CL, Silveira GH, Tippett V, Walsh TP, Platt SR. Pain catastrophising, body mass index and depressive symptoms are associated with pain severity in tertiary referral orthopaedic foot/ankle patients. J Foot Ankle Res. 2022;15(1):32.
18 Karshikoff B, Åström J, Holmström L, Lekander M, Kemani MK, Wicksell RK. Baseline pro-inflammatory cytokine levels moderate psychological inflexibility in behavioral treatment for chronic pain. J Clin Med. 2022;11(9):2285.
19 Andrés-Rodríguez L, Borràs X, Feliu-Soler A, Pérez-Aranda A, Rozadilla-Sacanell A, Montero-Marin J, Maes M, Luciano J V. Immune-inflammatory pathways and clinical changes in fibromyalgia patients treated with Mindfulness-Based Stress Reduction (MBSR): a randomized, controlled clinical trial. Brain Behav Immun. 2019;80:109-19.
20 Cuenca-Martínez F, Suso-Martí L, Herranz-Gómez A, Varangot-Reille C, Calatayud J, Romero-Palau M, Blanco-Díaz M, Salar-Andreu C, Casaña J. Effectiveness of telematic behavioral techniques to manage anxiety, stress and depressive symptoms in patients with chronic musculoskeletal pain: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19(6):3231.
21 Campbell J, Jones AS, Dienemann J, Kub J, Schollenberger J, O’Campo P, Gielen AC, Wynne C. Intimate partner violence and physical health consequences. Arch Intern Med. 2002;162(10):1157-63.
22 Loxton D, Dolja-Gore X, Anderson AE, Townsend N. Intimate partner violence adversely impacts health over 16 years and across generations: a longitudinal cohort study. PLoS One. 2017;12(6):e0178138.
23 Bacchus LJ, Ranganathan M, Watts C, Devries K. Recent intimate partner violence against women and health: a systematic review and meta-analysis of cohort studies. BMJ Open. 2018;8(7):e019995.
24 Dillon G, Hussain R, Loxton D, Rahman S. Mental and physical health and intimate partner violence against women: a review of the literature. Int J Family Med. 2013;2013:313909.
25 Rheingold A, Acierno R, Resnick H. Trauma, posttraumatic stress disorder, and health risk behaviors. In P. Schnurr & B. Green (Eds.), Trauma and health: physical health consequences of exposure to extreme stress. American Psychological Association; 2004.
26 Keeshin BR, Cronholm PF, Strawn JR. Physiologic changes associated with violence and abuse exposure: an examination of related medical conditions. Trauma Violence Abuse. 2012;13(1):41-56.
27 McEwen BS, Gianaros PJ. Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease. Ann N Y Acad Sci. 2010;1186:190-222.
28 Hedtke Hedtke KA, Ruggiero KJ, Fitzgerald MM, Zinzow HM, Saunders BE, Resnick HS, Kilpatrick DG. A longitudinal investigation of interpersonal violence in relation to mental health and substance use. J Consult Clin Psychol. 2008;76(4):633-47.
29 Krause ED, Kaltman S, Goodman LA, Dutton MA. Avoidant coping and PTSD symptoms related to domestic violence exposure: a longitudinal study. J Trauma Stress. 2008;21(1):83-90.
30 La Flair LN, Bradshaw CP, Campbell JC. Intimate partner violence/abuse and depressive symptoms among female health care workers: longitudinal findings. Womens Health Issues. 2012;22(1):e53-9.
31 Anderson DK, Saunders DG. Leaving an abusive partner: an empirical review of predictors, the process of leaving, and psychological well-being. Trauma Violence Abuse. 2003;4(2):163-91.
32 Cavanaugh C, Campbell J, Messing JT. A longitudinal study of the impact of cumulative violence victimization on comorbid posttraumatic stress and depression among female nurses and nursing personnel. Workplace Health Saf. 2014;62(6):224-32.
33 Tsai AC, Tomlinson M, Comulada WS, Rotheram-Borus MJ. Intimate partner violence and depression symptom severity among south african women during pregnancy and postpartum: population-based prospective cohort study. PLoS Med. 2016;13(1):e1001943.
34 Blasco-Ros C, Sánchez-Lorente S, Martinez M. Recovery from depressive symptoms, state anxiety and post-traumatic stress disorder in women exposed to physical and psychological, but not to psychological intimate partner violence alone: a longitudinal study. BMC Psychiatry. 2010;10:98.
35 Hill TD, Schroeder RD, Bradley C, Kaplan LM, Angel RJ. The long-term health consequences of relationship violence in adulthood: an examination of low-income women from Boston, Chicago, and San Antonio. Am J Public Health. 2009;99(9):1645-50.
36 Suvak MK, Taft CT, Goodman LA, Dutton MA. Dimensions of functional social support and depressive symptoms: a longitudinal investigation of women seeking help for intimate partner violence. J Consult Clin Psychol. 2013;81(3):455-66.
37 Ford-Gilboe M, Varcoe C, Wuest J, Campbell J, Pajot M, Heslop L, et al. Trajectories of depression, post-traumatic stress, and chronic pain among women who have separated from an abusive partner: a longitudinal analysis. J Interpers Violence. 2022:8862605221090595.
38 International Association for the Study of Pain | IASP: @IASPPAIN; 2017 [Available from:
39 Hilgenberg-Sydney PB, Kowacs PA, Conti PC. Somatosensory evaluation in Dysfunctional Syndrome patients. J Oral Rehabil. 2016;43(2):89-95.
40 Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15.
41 Andias R, Silva AG. Impact of sex, sleep, symptoms of central sensitization and psychosocial factors in adolescents with chronic musculoskeletal pain-an exploratory study. Pain Med. 2022;23(10):1777-92.
42 Young KD. Pediatric procedural pain. Ann Emerg Med. 2005;45(2):160-71.
43 Schlenz AM, McClellan CB, Mark TR, McKelvy AD, Puffer E, Roberts CW, Sweitzer SM, Schatz JC. Sensitization to acute procedural pain in pediatric sickle cell disease: modulation by painful vaso-occlusive episodes, age, and endothelin-1. J Pain. 2012;13(7):656-65.
44 Hedström M, Haglund K, Skolin I, von Essen L. Distressing events for children and adolescents with cancer: child, parent, and nurse perceptions. J Pediatr Oncol Nurs. 2003;20(3):120-32.
45 Vessey JA, Carlson KL, McGill J. Use of distraction with children during an acute pain experience. Nurs Res. 1994;43(6):369-72.
46 Sahiner NC, Bal MD. The effects of three different distraction methods on pain and anxiety in children. J Child Health Care. 2016;20(3):277-85.
47 Hoag JA, Karst J, Bingen K, Palou-Torres A, Yan K. Distracting through procedural pain and distress using virtual reality and guided imagery in pediatric, adolescent, and young adult patients: randomized controlled trial. J Med Internet Res. 2022;24(4):e30260.
Submitted date:
06/20/2022
Accepted date:
02/06/2023