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    Marijuana use prevalent among chronic prostatitis/chronic pelvic pain syndrome patients

    Majority who use it for pain find drug beneficial in treating, relieving symptoms

    Atlanta—It's a topic that's taboo for many urologists, but one that needs to be discussed—medical marijuana.

    With marijuana legalized for medical use in Canada since 2001 and now in 17 U.S. states and the District of Columbia, beginning with California in 1996, urology patients in pain have been turning to marijuana for relief. We need to find out if they're getting it.

    Dean Tripp, PhD, associate professor of psychology at Queen's University in Kingston, Ontario, took a first step to do just that by surveying patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) about their use of marijuana and whether it relieved their pain.

    He and colleagues at Queen's University posted an Internet survey on the topic and invited CP/CPPS patients to participate from the tertiary care urology clinic at Queen's as well as internationally through Web site notices.


    Table 1 Marijuana use in CP/CPPS patients
    In all, 421 patients participated, 206 of whom (49%) had reported previous cannabis use. Of the respondents, 29% (59) said they used it for pain relief. Users of marijuana for any purpose were somewhat younger than never users (mean age, 45 years), but with a mean age of 38 years, the pain users were actually somewhat younger than the recreational users, whose mean age was 45 years.

    Not surprisingly, the mean pain score was higher in the pain users than in the recreational users (13.47 vs. 12.40 on the NIH Chronic Prostatitis Symptom Index), as was the impact of CP/CPPS on quality of life (8.03 in the pain users vs. 7.16 in recreational users on the Short Form Health Survey). Also not surprisingly, suicidal ideation was higher in the pain users than in the recreational users (0.57 vs. 0.38 on the Patient Health Questionnaire for depression).

    Although the survey did not ask questions about degree of pain relief from or access to traditional pain management medications and techniques, it seems likely that many users of marijuana for pain are those who haven't had adequate relief from prescribed medications or other pain therapies. Marijuana can offer added relief, as a study at San Francisco General Hospital showed. Vaporized cannabis was found to augment the analgesic effects of opioids in chronic pain patients without significantly altering plasma opioid levels (Clin Pharmacol Ther 2011; 90:844-51).

    There were no differences between the pain users and recreational users in the degree of side effects, reasons for stopping, use and frequency, or dose smoked. Among those taking in marijuana in food, pain users tended to use more, with 24% reporting consuming more than 1 gram per dose compared with 9% of recreational users consuming this amount.

    Importantly, the survey asked whether the cannabis was of any benefit in treating or relieving symptoms.

    "At this point in time, with the limited data we have on the matter, the answer for the majority of users is 'yes,' " said Dr. Tripp, who worked on the study with the psychology, urology, and anesthesia departments at Queen's University.

    Of the 58 pain users who answered that question, a sizable majority—67%—said that it did indeed offer pain relief. Very few recreational users answered this question, but of the nine who did, three (33%) said it was beneficial for pain, whereas six (67%) said it wasn't. Compared with many treatments tried in the urologic pelvic pain syndromes, effectiveness in 33% isn't bad, and in 67%, it's remarkable.

    Survey studies including more patients would be needed to confirm that figure.

    Type of strain may be important

    Population size isn't the only refinement that would make survey studies more revealing. Where medical use is legal, surveys may also need to ask about the strain of marijuana being used or limit surveys to users of a particular strain. Doing such studies may not be difficult, since staff at a particular medical marijuana dispensary may serve patients with urologic pelvic pain who all use a particular strain.

    In the age of medical use, marijuana is definitely not one thing. Breeders for the medical market have developed strains with lower levels of tetrahydrocannabinol (THC)—the major psychotropic cannabinoid—and higher levels of cannabidiol (CBD), which has anti-inflammatory and other therapeutic effects. Just this July, an Israeli company garnered media attention when it announced it had developed a THC-less strain.

    Marijuana may address more than pain in urologic pelvic pain as well, since marijuana or isolated cannabinoids have demonstrated potential in moderating autoimmune disorders, such as multiple sclerosis, rheumatoid arthritis, and inflammatory bowel disease and neurologic disorders such as Alzheimer's disease, amyotrophic lateral sclerosis, and epilepsy. Research in urologic pelvic pain has pointed to immune dysregulation as well as neuropathies and central sensitization as possible etiologies.

    The survey study was supported by a grant from Valeant Pharmaceuticals International.

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