The treatment of chronic pain conditions, especially muscle pain within the medi
ID: 3517414 • Letter: T
Question
The treatment of chronic pain conditions, especially muscle pain within the medical field, presents multiple problems and complications. Studies have placed the prevalence of chronic pain in the United States from 30-33% of the population. Currently, a common medical practice is the prescription of opioid analgesics (painkillers) such as oxycodone, hydrocodone, and codeine to provide pain relief. However, the abuse and addiction to opioid prescriptions has been on the rise.
Conduct some research on the pros and cons of using opioid medications to treat chronic pain. As of early 2018, 23 states and the District of Columbia have passed legislation to legalize medicinal marijuana as a treatment therapy for various issues, including chronic pain conditions. Research the pros and cons of medicinal marijuana to treat chronic pain.
From your research, what do you perceive to be the better option in treating chronic pain -- prescription opioid medications or medicinal marijuana? Make sure you elaborate on your reasoning with your research, opinion(s) and any other comments you have on this topic. Provide appropriate citations for your resources.
Explanation / Answer
ANSWER:
MARIJUANA:
HISTORY:Use of marijuana has been since thousands of years in Eastern countries such as China and India.Since 1960s the rise in marijuana use in the USA.It is estimated that 30-40 million persons in USA have used the drug ,the number of youngsters initiated into use of this drug has declined after a steep rise and an increasingly lowerage of first use.
The botanical name is CANNABIS SATIVA -Marijuana is a mix up of ground-up plant materials that resembles grass clippings.Extraction of the plant provides a more potent product - Hashish.
Pharmacokinetics:The preferred route of administration is by smoking.The high lipid solubility if Tetrahydrocannabinol variant causes it to be readily trapped on the surfactant lining of the lungs.Pharmacokinetic studies indicate that smoking is almost equivalent to intravenous administration except that lower peak plasma concentrations of the tetrahydrocannabinol are attained.
In some eastern countries it is taken orally in the form of various confections and the rate of absorption from this route is slow and highly variable,though the duration of action is longer.
Tetrahydrocannabinol is extensively metabolized and new metabolites are still being discovered.One metabolite 11-hydroxy-Tetrahydrocannabinol is actually more active than the parent compound.The high lipid solubility of the drug leads to extensive sequestration in the lipid compartments of the body,and metabolites may be excreted for as long as week after a single dose.
PHARMACODYNAMICS: A high degree of enantiomer selectivity of both the natural and newer cannabinoids has suggestes a highly selective receptor.A putative endogenous ligand has already been reported .Synthetic cannabinoid agonists with high potency and stereoselectivity in behavioral assays have been used to characterize the cannabinoid binding site,the receptor also mediates the pharmacologic effects.Binding sites are more numerous in the outflow nuclei of the basal ganglia.the substantia nigra pars reticulata,globus pallidus,hippocampus and brainstem.
The receptors has been cloned and is G protein-coupled.PET scan studies have revealed increase in metabolism following THC in the same areas in which receptors are localized.Prostaglandins play a mediator role in its activity.Small doses may be associated with a placebo effect , but larger doses are unequivocal in producing the expected range of effects.Most effects of the drug starts from 20 minutes and lasts till 3 hours,and by this time plasma concentrations are lower.Peak effects after oral administration may be delayed until 3-4 hours after drug ingestion but may last for 6-8 hours.
The early stage is one being high and is characterized by
PHYSICAL SIGNS include-1.Increased pulse rate
2.Reddening of the conjunctiva-It correlates with the presence of detectable plasma concentrations.Pupil size is not changed.
3.The blood pressure may fall in the upright position.
An antiemetic effect may be present.
If the doses are large enough impairment is noted.No distinctive biochemical changes have been noted.Chronic dose leads to mild withdrawl syndrome and tachycardia.
HEALTH HAZARDS:
THERAPEUTIC USES:
Due to the repeated lowering of intraocular pressure following oral administration of tetrahydroxycannabinol has been confirmed.It is now named as DRONABINOL(Marinol)- marked for the indications of nausea,vomiting associated with cancer chemotherapy.
LEVONANTRADOL is another homologue that may have medical use,as an analgesic-as an agent for the relief of muscle spasm,and also as an anticonvulsant.
OPIOIDS:They are obtained from the opium poppy by the incision of the seed pop after the petals of the flower have dropped.The white latex that oozes out turns brown and hardens on standing.This sticky brown gum is opium.
It contains about 20 alkaloids
PHARMACOKINETICS:
Absorption:Most of the analgesics are well absorbed from subcutaneous and intramuscular sites as well as from the mucosal surfaces of the nose or mouth and gastrointestinal tract.In addition transdermal absorption of fentanyl has become an important route of administration.
Distribution:The uptake of opioids by various tissues and organs is function of both physiologic and chemical factors.All opioids bind to plasma proteins with varying degrees of affinity,the compounds leave the blood and localize in highest concentrations in tissues that are highly perfused, such as lungs,liver,kidneys and spleen.
Drug concentrations in skeletal muscles is much lower, this tissue serves as the main reservoir for the drug because of its great bulk.
After frequent high dose accumulation of the drug in the fatty tissue due to administration of high lipophilic opioids which are slowly metabolized,
Brain concentrations of opioids are relatively low because of the blood brain barrier.
The blood brain barrier is traversed more readily by compounds in which the aromatic hydroxyl at C3 is substituted as in Heroin and Codeine.
METABOLISM:The opioids are converted to large parts in polar metabolites which are then readily excreted by the kidneys.Compounds that have free hydroxyl groups are readily conjugated with glucuronic acid.
Heroin is metabolized to monoacetylmorphine and finally to morphine which is then conjugated with glucuronic acid.
The opioids are also N-demethylated by the liver but this is a minor pathway.
EXCRETION:The polar metabolites of the opioids are excreted mainly in the urine.Small amounts of the unchanged drug may also be excreted in the urine.Glucuronide conjugates are also excreted in the bile, but enterohepatic circulation represents only a small portion of the excretory process.
PHARMACODYNAMICS:
Mechanism of action:Morphine and its surrogates bind selectively at many recognition sites throughout the body to produce pharmacologic effects.
Brain loci involved in the transmission of pain and in the alteration of reactivity to nociceptive stimuli appear to be primary but not the only sites at which opioids act.
TOLERENCE:With frequently repeated administration of therapeutic doses of morphine or its surrogates ,there is gradual loss of its effectiveness , to reproduce the original response a larger dose must be administered.With the development of the tolerence , physical dependence occurs. , so the continued administration of the drug becomes necessary to prevent the characteristic withdrawl or abstinence syndrome.
CONTRAINDICATIONS:
Hence most of the time it is usefull to use analgesics rather than marijuana as it is not proved to be or doesnot fit pharmacological classification and must be considered as a separate class.
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