Integrative approach to the therapeutic use of cannabis for orofacial pain
Abordagem integrativa do uso terapêutico da cannabis nas dores orofaciais
Claudia Herrera Tambeli; Guilherme Arthur Martins; Sabrina Legaspe Barbosa; Tassia Tillemont Machado
Abstract
BACKGROUND AND OBJECTIVES: Faced with the difficulty of treating chronic orofacial pain and seeking an approach that aims at the health and well-being of the patient in a broader way, cannabinoid therapy appears as an adjunct to pharmacological approaches.
CONTENTS: Cannabinoid therapy generates analgesia through the activation of the endocannabinoid system, as well as the use of palmitoylethanolamide (PEA), curcumin, grape seed extract, aromatherapy, acupuncture, laser therapy and the practice of physical exercise. In this way, these therapies allow a reduction in the use of analgesic drugs.
CONCLUSION: Cannabinoid therapy is part of this integrative approach and the combination of cannabinoids with other forms of activation of the endocannabinoid system contributes to a better therapeutic outcome and a better quality of life for countless patients suffering from chronic orofacial pain.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: Diante da dificuldade de tratamento das dores orofaciais crônicas e buscando uma abordagem que vise a saúde e o bem-estar do paciente de uma forma mais ampla, surge a terapia canabinoide como coadjuvante nas abordagens farmacológicas.
CONTEÚDO: A terapia canabinoide promove analgesia através da ativação do sistema endocanabinoide, assim como o uso da palmitoiletanolamida (PEA), curcumina, extrato de semente de uva, aromaterapia, acupuntura, laserterapia e a prática de exercício físico. Desta forma, essas terapias permitem redução do uso de fármacos analgésicos.
CONCLUSÃO: A terapia canabinoide faz parte dessa abordagem integrativa e a combinação dos canabinoides com outras formas de ativação do sistema endocanabinoide contribui para melhores resultados terapêuticos e melhor qualidade de vida para inúmeros pacientes que sofrem de dores orofaciais crônicas.
Palavras-chave
Referências
1 Nijs J, Roussel N, Paul van Wilgen C, Köke A, Smeets R. Thinking beyond muscles and joints: therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Man Ther. 2013;18(2):96-102.
2 Graven-Nielsen T, Arendt-Nielsen L. Assessment of mechanisms in localized and widespread musculoskeletal pain. Nat Rev Rheumatol. 2010;6(10):599-606.
3 Türp JC. Failure in chronic pain therapy across the disciplines consequences for the management of orofacial pain. Schmerztherapie. 2017;9(3):197-208.
4 Michelotti A, De Wijer A, Steenks M, Farella M. Home-exercise regimes for the management of non-specific temporomandibular disorders. J Oral Rehabil. 2005;32(11):779-85.
5 Hill KP, Palastro MD. Medical cannabis for the treatment of chronic pain and other disorders: misconceptions and facts. Pol Arch Intern Med. 2017;127(11):785-9.
6 Wong H, Hossain S, Cairns BE. Delta-9-tetrahydrocannabinol decreases masticatory muscle sensitization in female rats through peripheral cannabinoid receptor activation. Eur J Pain. 2017;21(10):1732-42.
7 National Academies of Sciences and Medicine E. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. 2017.
8 Pacher P, Bátkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. 2006;58(3):389-462.
9 Pertwee RG. The therapeutic potential of drugs that target cannabinoid receptors or modulate the tissue levels or actions of endocannabinoids. AAPS J. 2005;7(3):E625-54.
10 Rice AS. Cannabinoids and pain. Curr Opin Investig drugs (London, Engl 2000). 2001;2(3):399-414.
11 Basavarajappa BS. Critical enzymes involved in endocannabinoid metabolism. Protein Pept Lett. 2007;14(3):237-46.
12 Munro S, Tomas KL, Abu-Shaar M. Molecular characterization of a peripheral receptor for cannabinoids. Nature. 1993;365(6441):61-5.
13 Wong H, Cairns BE. Cannabidiol, cannabinol and their combinations act as peripheral analgesics in a rat model of myofascial pain. Arch Oral Biol. 2019;104:33-9.
14 Tsou K, Brown S, Sanudo-Pena MC, Mackie K, Walker JM. Immunohistochemical distribution of cannabinoid CB1 receptors in the rat central nervous system. Neuroscience. 1998;83(2):393-411.
15 Palazzo E, Luongo L, de Novellis V, Rossi F, Maione S. The role of cannabinoid receptors in the descending modulation of pain. Pharmaceuticals. 2010;3(8):2661-73.
16 Woodhams SG, Chapman V, Finn D P, Hohmann AG, Neugebauer V. The cannabinoid system and pain. Neuropharmacology. 2017;124:105-20.
17 Luo Y, Suttle A, Zhang Q, Wang P, Chen Y. Transient receptor potential (TRP) ion channels in orofacial pain. Mol Neurobiol. 2021;58(6):2836-50.
18 Nourbakhsh F, Atabaki R, Roohbakhsh A. The role of orphan G protein-coupled receptors in the modulation of pain: a review. Life Sci. 2018;212:59-69.
19 Kano M, Ohno-Shosaku T, Hashimotodani Y, Uchigashima M, Watanabe M. Endocan-nabinoid-mediated control of synaptic transmission. Physiol Rev. 2009;89(1):309-80.
20 Jansen C, Shimoda LMN, Kawakami JK, Ang L, Bacani AJ, Baker JD, Badowski C, Speck M, Stokes AJ, Small-Howard AL, Turner H. Myrcene and terpene regulation of TRPV1. Channels (Austin). 2019;13(1):344-66.
21 Kozioł A, Stryjewska A, Librowski T, Sałat K, Gaweł M, Moniczewski A, Lochyński S. An overview of the pharmacological properties and potential applications of natural monoterpenes. Mini Rev Med Chem. 2014;14(14):1156-68.
22 De Petrocellis L, Ligresti A, Moriello AS, Allarà M, Bisogno T, Petrosino S, Stott CG, Di Marzo V. Effects of cannabinoids and cannabinoid-enriched Cannabis extracts on TRP channels and endocannabinoid metabolic enzymes. Br J Pharmacol. 2011;163(7):1479-94.
23 Russo EB, Cuttler C, Cooper ZD, Stueber A, Whiteley VL, Sexton M. Survey of patients employing cannabigerol-predominant cannabis preparations: perceived medical effects, adverse events, and withdrawal symptoms. Cannabis Cannabinoid Res. 2021;7(5):706-16.
24 Downer EJ. Anti-inflammatory potential of terpenes present in cannabis sativa L. ACS Chem Neurosci. 2020;11(5):659-62.
25 Russo EB. The case for the entourage effect and conventional breeding of clinical canna-bis: no “strain,” no gain. Front Plant Sci. 2019;9:1969.
26 Ibrahim MM, Deng H, Zvonok A, Cockayne DA, Kwan J, Mata H P, Vanderah T W, Lai J, Porreca F, Makriyannis A, Malan TP Jr. Activation of CB2 cannabinoid receptors by AM1241 inhibits experimental neuropathic pain: pain inhibition by receptors not present in the CNS. Proc Natl Acad Sci. 2003;100(18):10529-33.
27 Piomelli D, Sasso O. Peripheral gating of pain signals by endogenous lipid mediators. Nat Neurosci. 2014;17(2):164-74.
28 Johnson JR, Lossignol D, Burnell-Nugent M, Fallon M T. An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. J Pain Symptom Manage. 2013;46(2):207-18.
29 Sihota A, Smith BK, Ahmed SA, Bell A, Blain A, Clarke H, Cooper ZD, Cyr C, Daeninck P, Deshpande A, Ethans K, Flusk D, Le Foll B, Milloy MJ, Moulin DE, Naidoo V, Ong M, Perez J, Rod K, Sealey R, Sulak D, Walsh Z, O’Connell C. Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control. Int J Clin Pract. 2021;75(8):e13871.
30 Roveroni RC, Parada CA, Cecília M, Veiga FA, Tambeli CH. Development of a behavioral model of TMJ pain in rats: The TMJ formalin test. Pain. 2001;94(2):185-91.
31 Burgos E, Pascual D, Martín MI, Goicoechea C. Antinociceptive effect of the cannabi-noid agonist, WIN 55,212-2, in the orofacial and temporomandibular formalin tests. Eur J Pain. 2010;14(1):40-8.
32 Nitecka-Buchta A, Nowak-Wachol A, Wachol K, Walczyńska-Dragon K, Olczyk P, Batoryna O, Kempa W, Baron S. Myorelaxant effect of transdermal cannabidiol application in patients with TMD: a randomized, double-blind trial. J Clin Med. 2019;8(11):1886.
33 McDonough P, McKenna J P, McCreary C, Downer EJ. Neuropathic orofacial pain: cannabinoids as a therapeutic avenue. Int J Biochem Cell Biol. 2014;55:72-8.
34 Vigil JM, Montera MA, Pentkowski NS, Diviant J P, Orozco J, Ortiz AL, Rael LJ, Westlund KN. The therapeutic effectiveness of full spectrum hemp oil using a chronic neuropathic pain model. Life. 2020;10(5):69.
35 Nutt DJ, Phillips LD, Barnes M P, Brander B, Curran HV, Fayaz A, Finn D P, Horsted T, Moltke J, Sakal C, Sharon H, O’Sullivan SE, Williams T, Zorn G, Schlag AK. A multicriteria decision analysis comparing pharmacotherapy for chronic neuropathic pain, including cannabinoids and cannabis-based medical products. Cannabis Cannabinoid Res. 2022;7(4):482-500.
36 Gajofatto A. Refractory trigeminal neuralgia responsive to nabiximols in a patient with multiple sclerosis. Mult Scler Relat Disord. 2016;8:64-5.
37 Pergam SA, Woodfield MC, Lee CM, Cheng GS, Baker KK, Marquis SR, Fann JR. Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use. Cancer. 2017;123(22):4488-97.
38 Lichtman AH, Lux EA, McQuade R, Rossetti S, Sanchez R, Sun W, Wright S, Kornyeyeva E, Fallon MT. Results of a double-blind, randomized, placebo-controlled study of nabiximols oromucosal spray as an adjunctive therapy in advanced cancer patients with chronic uncontrolled pain. J Pain Symptom Manage. 2018;55(2):179-88.
39 Rocha FCM. Revisão sistemática da literatura sobre o uso terapêutico da cannabis sativa no tratamento dos efeitos colaterais de náusea e vômito em pacientes com câncer submetidos a quimioterapia. 2006.
40 Wong SS, Wilens TE. Medical cannabinoids in children and adolescents: a systematic review. Pediatrics. 2017;140(5):e20171818.
41 Aviram J, Vysotski Y, Berman P, Lewitus GM, Eisenberg E, Meiri D. Migraine frequency decrease following prolonged medical cannabis treatment: A cross-sectional study. Brain Sci. 2020;10(6):360.
42 Calcaterra S, Glanz J, Binswanger IA. National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. Drug Alcohol Depend. 2013;131(3):263-70.
43 Habib G, Artul S. Medical cannabis for the treatment of fibromyalgia. JCR J Clin Rheumatol. 2018;24(5):255-8.
44 Sagy I, Bar-Lev Schleider L, Abu-Shakra M, Novack V. Safety and efficacy of medical cannabis in fibromyalgia. J Clin Med. 2019;8(6):807.
45 Peixoto LSF, Lima IFM, Silva C P, Pimentel LG, Lima VBSR, Santana KR, Paz Júnior FB, Paz ESL. Ansiedade: o uso da Cannabis sativa como terapêutica alternativa frente aos benzodiazepínicos. Braz J Dev. 2020;6(7):50502-9.
46 Clayton P, Hill M, Bogoda N, Subah S, Venkatesh R. Palmitoylethanolamide: a natural compound for health management. Int J Mol Sci. 2021;22(10):5305.
47 Marini I, Lavinia Bartolucci M, Bortolotti F, Rosaria Gatto M, Alessandri Bonetti G. Palmitoylethanolamide versus a nonsteroidal anti-inflammatory drug in the treatment of temporomandibular joint inflammatory pain. J Orofac Pain. 2012;26(2):99.
48 Ottaviani G, Rupel K, Gobbo M, Poropat A, Zoi V, Faraon M, Di Lenarda R, Biasotto M. Efficacy of ultramicronized palmitoylethanolamide in burning mouth syndrome-affected patients: a preliminary randomized double-blind controlled trial. Clin Oral Investig. 2019;23(6):2743-50.
49 Chirchiglia D, Chirchiglia P, Marotta R, Gallelli L. Add-on administration of ultramicronized palmitoylethanolamide in the treatment of new onset burning mouth syndrome. Int Med Case Rep J. 2019;12:39.
50 Mabou Tagne A, Fotio Y, Lin L, Squire E, Ahmed F, Rashid TI, Karimian Azari E, Piomelli D. Palmitoylethanolamide and hemp oil extract exert synergistic anti-nociceptive effects in mouse models of acute and chronic pain. Pharmacol Res. 2021;167:105545.
51 Hewlings SJ, Kalman DS. Curcumin: a review of its effects on human health. Foods. 2017;6(10):92.
52 Sterniczuk B, Rossouw PE, Michelogiannakis D, Javed F. Effectiveness of curcumin in reducing self-rated pain-levels in the orofacial region: a systematic review of randomize-d-controlled trials. Int J Environ Res Public Health. 2022;19(11):6443.
53 Aguiar DD, Gonzaga ACR, Teófilo ALH, Miranda FA, Perez AC, Duarte IDG, Romero TRL. Curcumin induces peripheral antinociception by opioidergic and cannabinoidergic mechanism: pharmacological evidence. Life Sci. 2022;293:120279.
54 Cornelison LE, Chelliboina N, Woodman SE, Durham PL. Dietary supplementation with grape seed extract prevents development of trigeminal sensitization and inhibits pain signaling in a preclinical chronic temporomandibular disorder model. J Oral Pathol Med. 2020;49(6):514-21.
55 Woodman SE, Antonopoulos SR, Durham P. Inhibition of nociception in a preclinical episodic migraine model by dietary supplementation of grape seed extract involves activation of endocannabinoid receptors. Front Pain Res. 2022;3:809352.
56 Yuan R, Zhang D, Yang J, Wu Z, Luo C, Han L, Yang F, Lin J, Yang M. Review of aromatherapy essential oils and their mechanism of action against migraines. J Ethnopharmacol. 2021;265:113326.
57 Benli M, Olson J, Huck O, Özcan M. A novel treatment modality for myogenous temporomandibular disorders using aromatherapy massage with lavender oil: a randomized controlled clinical trial. Cranio. 2020;1-11.
58 Ceccarelli I, Fiorenzani P, Pessina F, Pinassi J, Aglianò M, Miragliotta V, Aloisi AM. The CB2 agonist β-caryophyllene in male and female rats exposed to a model of persistent inflammatory pain. Front Neurosci. 2020;14:850.
59 Donatello NN, Emer AA, Salm DC, Ludtke DD, Bordignon SASR, Ferreira JK, Salgado ASI, Venzke D, Bretanha LC, Micke GA, Martins D F. Lavandula angustifolia essential oil inhalation reduces mechanical hyperalgesia in a model of inflammatory and neuropathic pain: the involvement of opioid and cannabinoid receptors. J Neuroimmunol. 2020;340:577145.
60 Emer AA, Donatello NN, Batisti A P, Belmonte LAO, Santos ARS, Martins D F. The role of the endocannabinoid system in the antihyperalgesic effect of Cedrus atlantica essential oil inhalation in a mouse model of postoperative pain. J Ethnopharmacol. 2018;210:477-84.
61 Lin JG, Kotha P, Chen YH. Understandings of acupuncture application and mechanisms. Am J Transl Res. 2022;14(3):1469.
62 Tobaldini G, Aisengart B, Lima MMS, Tambeli CH, Fischer L. Ascending nociceptive control contributes to the antinociceptive effect of acupuncture in a rat model of acute pain. J Pain. 2014;15(4):422-34.
63 Hu B, Bai F, Xiong L, Wang Q. The endocannabinoid system, a novel and key participant in acupuncture’s multiple beneficial effects. Neurosci Biobehav Rev. 2017;77:340-57.
64 MacDonald IJ, Chen YH. The Endocannabinoid system contributes to electroacupuncture analgesia. Front Neurosci. 2021;14:594219.
65 Sartori CR, Pagliusi Jr M, Bonet IJM, Tambeli CH, Parada CA. Running wheel exercise induces therapeutic and preventive effects on inflammatory stimulus-induced persistent hyperalgesia in mice. PLoS One. 2020;15(10):e0240115.
66 Desai S, Borg B, Cuttler C, Crombie KM, Rabinak CA, Hill MN, Marusak HA. A systematic review and meta-analysis on the effects of exercise on the endocannabinoid system. Cannabis Cannabinoid Res. 2022;7(4):388-408.
67 Khan J, Wang Q, Korczeniewska OA, Eliav R, Ren Y, Eliav E. Exercise-induced hypoalgesia profile in a rat neuropathic pain model predicts pain severity following infraorbital nerve injury and is associated with local cytokine levels, systemic endocannabinoids, and endogenous opioids. J Oral Facial Pain Headache. 2021;35(3):230-40.
Submetido em:
14/07/2022
Aceito em:
06/02/2023
Facebook
Google+
Twitter
LinkedIn
Mendeley
Email