Schrader, N.H.B.(Nicholas) (2016) Prevalence and Characterisation of Cannabis-use to Treat Pain and Itch inEpidermolysis Bullosa. thesis, Medicine.
Full text available on request.Abstract
Epidermolysis bullosa (EB) is a severely debilitating inherited disease caused by mutations on genes encoding essential intercellular adhesion proteins in the skin, mucosal membranes, urinary tract, respiratory tract, and gastro-intestinal tract, amongst others. As a result, patients suffer from chronic pain and itch caused by lowfriction threshold blister formation and the prolonged healing of wounds. Pain and itch are listed as the most debilitating problems in both children and adults with EB. In severe cases of EB, pain caused by everyday activities cannot be managed without inducing an inappropriate level of sedation, such as through the use of opioid based drugs. Itch occurring as a result of hypersensitivity to pruritogens (many of which the role is unknown) during wound healing, remains complex and problematic in EB, and is inadequately controlled. Patients with EB, for over a decade (reported verbally to clinicians), have been using cannabis as a method of symptom alleviation, with specific regard to pain and itch. A formal assessment of the effects has not yet been completed by clinicians. The aim of this study was to establish the prevalence and motivations behind the use of cannabis in EB in the Dutch population, as well as characterize the reported effects on pain and itch, refractory to or untreatable by conventional medicines. This study comprised a cross-sectional observational method addressing patients with EB registered at the University Medical Center of Groningen (UMCG) in the Netherlands. Patients fulfilling the inclusion criteria (diagnosis of EB; 18 years of age or older), were sent three surveys assessing their: current state of itch, current state of pain, and use of- cannabis in relation to their therapeutic management of pain and itch. Reported levels of pain and itch in cannabis-users and non-users were compared by way of independent sample t-testing. Descriptive data was also collected adding supplementary information about pain, itch, and symptom alleviation through the use of cannabis. Fourty-four patients responded to the survey (response rate of 33%) of which 7 (16%) currently use or have used cannabis. Within this group, 4 of 5 (80%) patients reported a successful alleviation of pain, and 2 of 3 (66%) patients reported a successful alleviation of itch owing to the therapeutic use of cannabis. Patients reported tolerable minor side effects including, nausea, a delayed reaction time and an increased appetite. This study also produced similar results to previous studies that described itch in the EB subtypes (EBS, JEB, DDEB & RDEB). The pain survey also allowed us to describe the levels of 20 clinically relevant qualities of pain in EB which was never done before. The beneficial effects of cannabis reported by patients with EB relay the therapeutic potential that has yet to be investigated. This study has laid a cornerstone for future investigations in EB regarding novel methods of symptom alleviation, encouraging research and development of cannabis based medicines in relation to pain and itch.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisors: and Jonkman, Prof. dr. M.F. Department Head (Dermatology) and Yuen, Dr. W.Y. Dermatologist and UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1305 |
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