An observational study of the effects of edible cannabis and its constituent cannabinoids on pain, inflammation, and cognition

慢性疼痛影响着7600万美国人，也是使用医用大麻最常被引用的原因。 大麻及其组成的大麻素，包括9-三角洲-四氢大麻酚(THC)，被认为是 参与减轻疼痛和相关的炎症。然而，THC也与有害的 认知副作用。大麻素的协同作用被认为对疼痛产生不同的影响 和炎症，以及与单独使用THC相比，对认知功能的影响。例如，大麻二酚(CBD) 是另一种主要的大麻素，可能与THC在多靶点止痛和抗炎方面有协同作用 接近。此外，CBD不具有精神活性，被认为具有减重作用 THC的负面认知副作用。尽管关于它们的影响的数据有限，但有大量广泛的 美国各地的药房都可以买到用于疼痛治疗的二手大麻产品。这些大麻 产品含有一系列大麻素的效力和比例，这可能会对它们的效果产生很大影响 慢性疼痛患者，包括认知副作用。我们建议进行一项观察性研究，以检验 血液中大麻素水平对慢性腰痛缓解、炎症和认知功能障碍的影响 选择使用可食用大麻的疼痛患者在短期(2周)机制研究的背景下 使用以病人为中心的方法和流动的药理实验室，解决了许多后勤问题 进行大麻研究。我们的全球假设是，我们对自我报告和客观的观察 选择使用大麻食用产品的疼痛患者对大麻食用产品的影响的措施 根据血液中THC与CBD的比例，产品会有所不同。此外，我们假设 观察到的认知影响将因血液中THC/CBD比率的不同而不同。为此，我们将衡量 疼痛、炎症和认知损害与血液中THC和CBD水平的关系 希望使用可食用大麻来治疗疼痛的疼痛患者。这种方法在生态上是有效的和及时的。 鉴于大麻的各种效力和比例的食用大麻被患者广泛用于医学 在我们州和整个美国，到目前为止，绝对没有对这些产品进行任何研究。血样 THC和CBD水平将在暴露期间之前、期间和之后进行测量(当参与者在 观察性研究摄取他们已购买产品并选择摄取)以确定 这与疼痛、炎症和认知功能障碍有关。这项研究的结果将提供 向公众和卫生专业人员提供有关自导大麻影响的关键和及时的数据 使用，包括各种大麻素的联系，对疼痛和相关过程。

Chronic pain effects 76 million Americans and is the most commonly cited reason for use of medical marijuana. Marijuana and its constituent cannabinoids, including 9-delta-tetrahydrocannabinol (THC), are thought to be involved in reducing pain and associated inflammation. However, THC also is associated with harmful cognitive side effects. Synergistic interactions of cannabinoids are believed to produce different effects on pain and inflammation, as well as on cognitive function as compared to THC alone. For example, cannabidiol (CBD) is another primary cannabinoid that may work synergistically with THC in a multi-target analgesic and antiinflammatory approach. In addition, CBD does not have psychoactive properties and is thought to attenuate the negative cognitive side effects of THC. Despite limited data on their effects, there is a vast array of widely used marijuana products available for pain treatment across dispensaries throughout the US. These marijuana products contain a range cannabinoid potencies and ratios, which may have a large impact on their effects in chronic pain patients, including cognitive side effects. We propose an observational study to examine the effects of cannabinoid levels in blood on pain relief, inflammation, and cognitive dysfunction in chronic low back pain patients who choose to use edible cannabis in the context of a short-term (2 weeks) mechanistic study using a patient-oriented approach and a mobile pharmacology lab that solves many of the logistical problems with marijuana research. Our global hypothesis is that our observations of self-report and objective measures of the effects of marijuana edible products by pain patients who choose to use these products will vary as a function of the ratio of THC to CBD in their blood. Further, we hypothesize that cognitive impacts observed will differ by the THC/CBD ratio in blood. To that end, we will measure the association of pain, inflammation, and cognitive impairment with the levels of THC and CBD in the blood of pain patients who wish to use edible cannabis to treat their pain. This approach is ecologically valid and timely given that marijuana edibles of various cannabinoid potencies and ratios are widely used medically by patients in our state and across the US, yet absolutely no research has been done on these products to date. Blood levels of THC and CBD will be measured before, during, and after the exposure period (when participants in the observational study ingest a product they have purchased and choose to ingest) to determine whether there are associations with pain, inflammation, and cognitive dysfunction. Results from this study will provide critical and timely data to the public and health professionals regarding the effects of self-directed marijuana use, including the associations of various cannabinoids, on pain and related processes.