Brief Commentary: Cannabinoid Dosing for Chronic Pain Management
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Ideas and Opinions15 January 2019Brief Commentary: Cannabinoid Dosing for Chronic Pain ManagementKevin F. Boehnke, PhD and Daniel J. Clauw, MDKevin F. Boehnke, PhDUniversity of Michigan Medical School, Ann Arbor, Michigan (K.F.B., D.J.C.) and Daniel J. Clauw, MDUniversity of Michigan Medical School, Ann Arbor, Michigan (K.F.B., D.J.C.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2972 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editors' Note: This commentary was selected for publication from among 100 submitted manuscripts in response to a call for readers' perspectives on prescribing or recommending marijuana.As pain researchers, we are underwhelmed by systematic reviews of clinical trials of cannabinoids, which report modest effect sizes for chronic neuropathic pain but limited or insufficient efficacy in other pain conditions (1). These reviews also report substantial adverse events (1). Nevertheless, we cannot ignore the reality of cannabis's growing use as medicine, especially for chronic pain. As such, we believe that appropriately contextualizing cannabinoids is critical so that physicians and patients can navigate ...References1. Nugent SM, Morasco BJ, O'Neil ME, Freeman M, Low A, Kondo K; et al;. The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. Ann Intern Med. 2017;167:319-31. [PMID: 28806817]. doi:10.7326/M17-0155 LinkGoogle Scholar2. MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12-9. [PMID: 29307505] doi:10.1016/j.ejim.2018.01.004 CrossrefMedlineGoogle Scholar3. Malfait AM, Gallily R, Sumariwalla PF, Malik AS, Andreakos E, Mechoulam R, et al. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proc Natl Acad Sci U S A. 2000;97:9561-6. [PMID: 10920191] CrossrefMedlineGoogle Scholar4. Steigerwald S, Wong PO, Khorasani A, Keyhani S. The form and content of cannabis products in the United States [Letter]. J Gen Intern Med. 2018;33:1426-8. [PMID: 29770952] doi:10.1007/s11606-018-4480-0 CrossrefMedlineGoogle Scholar5. Ballantyne JC, Sullivan MD. Discovery of endogenous opioid systems: what it has meant for the clinician's understanding of pain and its treatment. Pain. 2017;158:2290-300. [PMID: 28832397] doi:10.1097/j.pain.0000000000001043 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Michigan Medical School, Ann Arbor, Michigan (K.F.B., D.J.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2972.Corresponding Author: Kevin F. Boehnke, PhD, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106; e-mail, [email protected]umich.edu.Current Author Addresses: Drs. Boehnke and Clauw: 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106.Author Contributions: Conception and design: K.F. Boehnke, D.J. Clauw.Analysis and interpretation of the data: K.F. Boehnke.Drafting of the article: K.F. Boehnke.Critical revision of the article for important intellectual content: K.F. Boehnke.Final approval of the article: K.F. Boehnke, D.J. Clauw.Administrative, technical, or logistic support: K.F. Boehnke, D.J. Clauw.Collection and assembly of data: K.F. Boehnke.This article was published at Annals.org on 8 January 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBrief Commentary: Marijuana and Cardiovascular Disease—What Should We Tell Patients? Tina M. Kaufman , Sergio Fazio , and Michael D. Shapiro Brief Commentary: Advocating for Blunt Policy Jan K. 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Hoyte Metrics Cited byHealthcare provider and medical cannabis patient communication regarding referral and medication substitution: the Canadian contextCannabidiol (CBD) in Rheumatic Diseases (Musculoskeletal Pain)Potency and Therapeutic THC and CBD Ratios: U.S. Cannabis Markets OvershootSex-Dependent Prescription Patterns and Clinical Outcomes Associated With the Use of Two Oral Cannabis Formulations in the Multimodal Management of Chronic Pain Patients in ColombiaTackling the taboo: a sensible prescription for appropriate cannabis use in fibromyalgiaCommunication between healthcare providers and medical cannabis patients regarding referral and medication substitutionConsensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi processConsensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain controlPost Herpetic Neuralgia: Recent AdvancementsHigh-Frequency Medical Cannabis Use Is Associated With Worse Pain Among Individuals With Chronic PainCannabis use in active athletes: Behaviors related to subjective effects 15 January 2019Volume 170, Issue 2Page: 118KeywordsCannabinoidsCannabisDisclosureDrug administrationExercise therapyMarijuanaNeuropathic painOpioidsPainPain management ePublished: 8 January 2019 Issue Published: 15 January 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. 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Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,017 | 0,109 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,004 |
| Bibliométrie | 0,003 | 0,002 |
| Études des sciences et des technologies | 0,006 | 0,007 |
| Communication savante | 0,006 | 0,008 |
| Science ouverte | 0,007 | 0,003 |
| Intégrité de la recherche | 0,068 | 0,057 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,025 | 0,017 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».