Compassionate use of medicinal Cannabis for pain treatment in children with Klippel-Trenaunay Syndrome. Case report
Uso compassivo de Cannabis medicinal para tratamento de dor em criança com Síndrome de Klippel-Trenaunay. Relato de caso
Michelle dos Santos Severino Costa; Caroline Carvalho Mageste; Flavio Henrique Esteves Guedes; Leticia Pontes Reis; Luisa Hermetrio Lazzarini; Ariel de Freitas Quintão Américo
Abstract
The multimodal approach, which included the use of tetrahydrocannabinol, led to a reduction in pain and an improvement in the patient’s quality of life. Medical cannabis therapy proved to be an effective option, especially in cases of pain refractory to other interventions.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: A síndrome de Klippel-Trenaunay (KTS) é uma doença congênita rara que se manifesta no nascimento ou na infância e apresenta etiologia desconhecida, sem predileção étnica ou de gênero. O manejo da dor, comum em muitos casos, é desafiador devido à complexidade dos fatores envolvidos. O objetivo deste relato foi demonstrar o uso eficaz de uma abordagem multimodal, incluindo cannabis medicinal, no tratamento da dor em uma criança com KTS.
RELATO DO CASO: Trata-se do caso de uma criança portadora de KTS que apresentava dor crônica intensa, comprometendo significativamente sua qualidade de vida. A dor foi manejada com terapias farmacológicas, incluindo uso de cannabis medicinal como alternativa terapêutica, quando os tratamentos convencionais se mostraram insuficientes. A abordagem multimodal, que incluiu o uso de tetraidrocanabinol, levou à redução da dor e à melhora na qualidade de vida do paciente. A terapia com cannabis medicinal demonstrou ser uma opção eficaz, especialmente em casos de dor refratária a outras intervenções.
CONCLUSÃO: O tratamento da dor em pacientes com KTS deve ser multimodal, com ênfase em abordagens não invasivas. O uso de cannabis medicinal é uma alternativa viáve
Palavras-chave
References
1
2 Sharma D, Lamba S, Pandita A, Shastri S. Klippel-Trénaunay Syndrome - a very rare and interesting syndrome. Clin Med Insights Circ Respir Pulm Med. 2015;9:1-4
3 Obara P, McCool J, Kalva SP, Majdalany BS, Collins JD, Eldrup-Jorgensen J, et al. ACR Appropriateness Criteria® Clinically Suspected Vascular Malformation of the Extremities. J Am Col Radiol. 2019;16(11):S340-7.
4 Garzon MC, Huang JT, Enjolras O, Frieden IJ. Vascular malformations. J Am Acad Dermatol. 2007;56(4):541-64.
5 Jacob AG, Driscoll DJ, Shaughnessy WJ, Stanson AW, Clay RP, Gloviczki P. Klippel-Trénaunay Syndrome: Spectrum and Management. Mayo Clin Proc. 1998;73(1):28-36.
6 Dispenza K. Severe Pain Related to Klippel-Trénaunay-Weber syndrome: a case study. Pain Manag Nurs. 2011;12(2):112-4.
7 Lee A, Driscoll D, Gloviczki P, Clay R, Shaughnessy W, Stans A. Evaluation and management of pain in patients with Klippel-Trenaunay Syndrome: a review. Pediatrics. 2005;115(3):744-9.
8 Samimi M, Lorette G. Syndrome de Klippel-Trenaunay. Presse Med. 2010;39(4):487-94.
9 Asghar F, Aqeel R, Farooque U, Haq A, Taimur M. Presentation and management of Klippel-Trenaunay Syndrome: a review of available data. Cureus. 2020;12(5):e8023.
10 Bakır M, Rumeli Ş, Pire A. Multimodal analgesia in pediatric cancer pain management: a retrospective single-center study. Cureus. 2023;15(9):e45223
11 Guay J. The benefits of adding epidural analgesia to general anesthesia: a metaanalysis. J Anesth. 2006;20(4):335-40.
12 De Rosa F, Giannatiempo B, Charlier B, Coglianese A, Mensitieri F, Gaudino G, Cozzolino A, Filippelli A, Piazza O, Dal Piaz F, Izzo V. Pharmacological treatments and therapeutic drug monitoring in patients with chronic pain. Pharmaceutics. 2023;15(8):2088.
13 Yaster M, McNaull PP, Davis PJ. The opioid epidemic in pediatrics: a 2020 update. Curr Opin Anaesthesiol. 2020;33(3):327-34.
14 Mion G. History of anaesthesia. Eur J Anaesthesiol. 2017;34(9):571-5.
15 Di Mascio A, Bossini B, Barbi E, Benini F, Cozzi G. Use of ketamine by paediatricians in Italian paediatric emergency departments: a missed opportunity? Eur J Pediatr. 2019;178(4):587-91.
16 Splinter W. Novel approaches for treating pain in children. Curr Oncol Rep. 2019;21(2):11.
17 Courade M, Bertrand A, Guerrini-Rousseau L, Pagnier A, Levy D, Lervat C, Cojean N, Ribrault A, Dugue S, Thouvenin S, Piguet C, Schmitt C, Marec-Berard P. Low-dose ketamine adjuvant treatment for refractory pain in children, adolescents and young adults with cancer: a pilot study. BMJ Support Palliat Care. 2022;12(e5):e656-e663.
18 Guerrero-Alba R, Barragán-Iglesias P, González-Hernández A, Valdez-Moráles EE, Granados-Soto V, Condés-Lara M, Rodríguez MG, Marichal-Cancino BA. Some Prospective alternatives for treating pain: the endocannabinoid system and its putative receptors GPR18 and GPR55. Front Pharmacol. 2019;9:1496.
19 Zuardi AW. History of cannabis as a medicine: a review. Rev Bras Psiqu. 2006;28(2):153-7.
20 Zuardi AW, Crippa JAS, Hallak JEC, Moreira FA, Guimarães FS. Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. Br J Med Biol Res. 2006;39(4):421-9.
21 Qian L, Beers JL, Jackson KD, Zhou Z. CBD and THC in special populations: pharmacokinetics and drug-drug interactions. Pharmaceutics. 2024;16(4):484.
22 Jensen B, Chen J, Furnish T, Wallace M. Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence. Curr Pain Headache Rep. 2015;19(10):50.
23 Aran A, Cayam-Rand D. Medical Cannabis in Children. Rambam Maimonides Med J. 2020;11(1):e0003.
24 Campbell CT, Phillips MS, Manasco K. Cannabinoids in Pediatrics. J Pediatr Pharmacol Ther. 2017;22(3):176-85.
25 Divisic A, Avagnina I, De Tommasi V, Santini A, Brogelli L, Giacomelli L, Benini F. The use of medical cannabis in pediatric palliative care: a case series. Ital J Pediatr. 2021;47(1):229.
26 Doherty M, Power L, Attala M, Vadeboncoeur C. Use of oral cannabis extracts in the pediatric palliative care setting: A retrospective chart review. Palliat Med. 2020;34(3):435-7.
Submitted date:
05/21/2024
Accepted date:
09/30/2024