Cannabis and Cannabinoids in Pain Relief

Cannabis is a term that describes products derived from the Indian hemp, Cannabis sativa. It has its origins probably in India but now grows all over the world. The chemical compounds responsible for intoxication and medicinal effects are found mainly in a sticky golden resin exuded from the flowers of the female plants and surrounding leaves. Cannabis sativa contains a wide range of different chemicals including a family of compounds called “cannabinoids”. Of the cannabinoids delta-9 tetrahydrocannabinol (THC) is probably the main compound responsible for the psychotropic activities. Cannabis has been used as a medicine for thousands of years and is mentioned in a Chinese herbal dating back to 2700 BC. There are records of ’its medicinal use in Egyptian papyri of the sixteenth century BC. Much later, the plant is mentioned in Assyrian texts and in Greek and Roman sources as a medicinal agent. Early Experiences in the 19th Century Cannabis Tincture was used in the nineteenth century as an analgesic, as well as numerous other conditions and was considered milder and less dangerous than opium. W.B.O’Shaughnessy was the first of the western physicians to take an interest in cannabis as a medicine on account Read more […]

Anxiety Disorders: Supplements With Possible Efficacy

In addition to supplements discussed above, a few other compounds may also have some efficacy in treating symptoms of anxiety. However, since the data that supports the use of the following supplements is extremely limited, clinicians should proceed with caution, and consider the use of the compounds discussed in this section as experimental. St. John’s Wort As described in site, St. John’s Wort (Hypericum perforatum) is an herb that exists in many species throughout the world, and it is widely used as an antidepressant. It is available in a variety of preparations, including capsules, liquid, oils, and raw herb to be brewed as tea. St. John’s Wort contains a plethora of active ingredients, including flavonoids, naphthodianthrones, phloroglucinols, phenolic acids, terpenes, and xanthones. These exert a variety of psychoactive effects, and several of these are described below. Of all herbal supplements, St. John’s Wort is the one that has been researched most extensively and there is strong support for its efficacy in reducing depressive symptoms. The use of St. John’s Wort as an anxiolytic is more recent, but a few studies suggest that is may be effective. Davidson and Connor (2001) reported case studies of patients Read more […]

Feverfew (Tanacetum Parthenium)

Clinical Uses Feverfew is used to prevent and treat migraine headaches. Historical Uses Traditionally, feverfew was used to manage labor pains, to reduce fevers, and to repel insects. Growth Feverfew is a member of the daisy family and may be grown in herb gardens in the spring. The plant prefers dry soil and sun. Feverfew: Part Used • Leaves Major Chemical Compounds • Sesquiterpene lactones, primarily parthenolide Feverfew: Clinical Uses Feverfew is used to prevent migraine headaches and also to treat migraine headaches. Mechanism of Action The mechanism by which feverfew works is not fully understood. It may act like non-steroidal anti-inflammatory drugs (NSAIDs) by interfering with the first step of thromboxane synthesis (inhibiting prostaglandin biosynthesis), but it differs from salicylates in that it does not inhibit cyclo-oxygenation by prostaglandin synthase. Feverfew inhibits serotonin release from platelets and polymor-phonuclear leukocyte granules, which benefits patients with migraines or arthritis (The Lawrence Review of Natural Products, 1994). It has shown antinociceptive and anti-inflammatory effects in animals. Feverfew: Dosage To be effective at preventing migraines, the parthenolide Read more […]

Ginger (Zingiber officinale)

Ginger is the underground rhizome of the tropical flowering plant Zingiber officinale. The term officinale in the Latin name of a plant indicates that it was sold by apothecaries in past times and thus has a long history of medicinal use. Zingiber means horn-shaped in Sanskrit and refers to the shape of the ginger rhizome. Ginger has a sharp, sweet flavour and is used to flavour foods and drinks. The oil of ginger root contains the sesquiterpenes zingiberene and ƛ-bisabolene whilst the oleoresin contains a group of pungent phenolic compounds called gingerols and their degradation products. The gingerols are widely regarded as the components of ginger and ginger extracts that are responsible for any pharmacological actions. The gingerols are structurally related to capsaicin in chilli peppers and they bind to the same pain receptors (vanilloid receptor 1, VR1) that are abundant in the mouth and skin. Activation of VR1 receptors is responsible for the searing sensation of eating chilli peppers and also presumably for the pungency of ginger. The chemical structures of capsaicin and several gingerols may be found in Dedov et al. (2002). These same VR1 receptors may also be largely responsible for the chest pain experienced Read more […]

Endometriosis: Conventional Treatment Approaches

Medical treatment of endometriosis includes both pharmaceutical and surgical approaches. Pharmaceutical treatments provide only suppression of the disease; they do not exact a cure. Decisions regarding treatment are based on endometriosis severity and staging, symptom picture, and ultimately, the woman’s needs and goals, for example, desire for children in the future. For women experiencing mild symptoms (or none) and for women who are close to menopause, the appropriate treatment may be to do nothing. For women with mild to moderate symptoms, and those who desire pregnancy, the appropriate pharmacologic therapy should be considered, and if necessary, can be combined with conservative surgery. It should be noted that, in spite of medical treatment, endometriosis has a high recurrence rate of 5% to 20% unless total hysterectomy and bilateral oophorectomy are performed. With pharmacologic interventions, pain typically resumes upon cessation of medications, although initially with pain that is less intense than prior to treatment. Pain relief, pregnancy rates, and recurrence rates are similar with all treatment methods. The goal of pharmaceutical treatment is to interrupt patterns of endometrial stimulation and bleeding. Read more […]

Endometriosis: Anti-Inflammatories and Antioxidants

Inflammation is a hallmark of endometriosis, and as discussed, free radical damage may be part of the etiology of this disorder. It has been suggested that growth factors and inflammatory mediators produced by activated peritoneal leukocytes participate in the pathogenesis of endometriosis by facilitating endometrial cells growth at ectopic sites. Elevated levels of inflammatory cells and mediators such as peritoneal macrophages, prostaglandins, proteolytic enzymes, complement fragments, IL-1, and tumor necrosis factor (TNF) have been identified in the peritoneal fluid of patients with endometriosis. Numerous herbs that have been used traditionally for inflammatory types of conditions demonstrate significant anti-inflammatory and antioxidant effects and should be considered for use in formulations for treatment and symptomatic relief, along with herbs whose use for inflammation is only recently being discovered. These are discussed in the following. Dong Quai Dong quai has antispasmodic, analgesic, and tonic effects, and has demonstrated significant antioxidant and free radical scavenging actions, partially through inhibition of anion radical formation. Limited animal and in vitro studies have reported Read more […]

Fibrocystic Breast

Fibrocystic Breasts And Breast Pain Benign breast conditions are a common finding in clinical practice, with fibrocystic breast changes and fibroadenomas occurring in 60% to 90% of all women. The hallmark of fibrocystic breast changes is that the cysts fluctuate in size and shape, may entirely disappear and reappear cyclically, and are associated with hormonal changes in the menstrual cycle. Women with this condition describe their breasts as feeling lumpy, “ropey,” and tender. The changes occur bilaterally. Fibroadenomas are mobile, solid, firm, rubbery masses that typically occur singly, and are not usually painful. They are second only to fibrocystic changes as the most common of the benign breast conditions, and are commonly found in women in their 20s. Breast tenderness that accompanies the menstrual cycle is known as cystic mastalgia.’ Cyclic mastalgia may be associated with other premenstrual complaints. The terms benign breast disorder and benign breast disease are unfortunate misnomers, as they are neither a disorder nor disease. In only a small percentage of cases are the atypical ductal and lobular hyperplasias associated with increased risk of breast carcinoma. Practitioners consulting with women for Read more […]

CYCLOOXYGENASE INHIBITORS

CYCLOOXYGENASE INHIBITORS bind reversibly or irreversibly to the enzyme cyclooxygenase (originally referred to as the prostaglandin synthase system or ‘prostaglandin H2 synthase'; (PGHS)-l and (PGHS)-2). Members of the prostaglandin family have a number of proinflammatory or hyperalgesic actions, and consequently many cyclooxygenase inhibitors are used as anthnflammatories and ANALGESICS. Prostanoids are members of the eicosanoid family of phospholipid mediators, and are comprised of the thromboxanes and the prostaglandins, both of which are formed by the complex cyclooxygenase system. They share common precursors in the form of a series of unstable cyclic endoperoxides. The first stage of the transformation of arachidonic acid has the enzyme endoperoxide synthase oxygenate arachidonate, followed by cyclization to give a cyclic endoperoxide called PGG2. These reactions are inhibited by cyclooxygenase inhibitors. Subsequently, PGG2 is converted by a peroxidase action to PGH2. This is a common precursor for a number of different pathways, forming prostacyclin (by prostacyclin synthase), the various prostaglandins or thromboxanes (by thromboxane synthase). See THROMBOXANE SYNTHASE INHIBITORS. The conversion depends Read more […]

Herb-Drug Interactions: St John’s wort

Hypericum perforatum L. (Clusiaceae) Synonym(s) and related species Hypericum, Millepertuis. Hypericum noeanum Boiss., Hypericum veronense Schrank. Pharmacopoeias St John’s Wort (British Ph 2009, European Ph 2008, US Ph 32); St John’s Wort Dry Extract, Quantified (British Ph 2009, European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents The main groups of active constituents of St John’s wort are thought to be the anthraquinones, including hypericin, isohypericin, pseudohypericin, protohypericin, protopseudohypericin and cyclopseudohypericin, and the prenylated phloroglucinols, including hyperforin and adhyperforin. Flavonoids, which include kaempferol, quercetin, luteolin, hyperoside, isoquercitrin, quercitrin and rutin; biflavonoids, which include biapigenin and amentoflavone, and catechins are also present. Other polyphenolic constituents include caffeic and chlorogenic acids, and a volatile oil containing methyl-2-octane. Most St John’s wort products are standardised at least for their hypericin content (British Pharmacopoeia 2009), even though hyperforin is known to be a more relevant therapeutic constituent, and some preparations are now standardised for both (The United Read more […]

Herb-Drug Interactions: Ginkgo

Ginkgo biloba L. (Ginkgoaceae) Synonym(s) and related species Fossil tree, Kew tree, Maidenhair tree. Salisburia adiantifolia Sm., Salisburia biloba Hoffmanns. Pharmacopoeias Ginkgo (US Ph 32); Ginkgo capsules (US Ph 32); Ginkgo dry extract, refined and quantified (British Ph 2009, European Ph 2008); Ginkgo leaf (British Ph 2009, European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4); Ginkgo tablets (US Ph 32); Powdered ginkgo extract (The United States Ph 32). Constituents Ginkgo leaves contain numerous flavonoids including the biflavone glycosides such as ginkgetin, isoginkgetin, bilobetin, sciadopitysin, and also some quercetin and kaempferol derivatives. Terpene lactones are the other major component, and these include ginkgolides A, B and C, and bilobalide, Ginkgo extracts may be standardised to contain between 22 and 27% flavonoids (flavone glycosides) and between 5 and 12% terpene lactones, both on the dried basis. The leaves contain only minor amounts of ginkgolic acids, and some pharmacopoeias specify a limit for these. The seeds contain ginkgotoxin (4-O-methylpyridoxine) and ginkgolic acids. Use and indications The leaves of ginkgo are the part usually used. Ginkgo is often used Read more […]