The Effects of Cannabinoids on Individuals with Chronic Pain: A Critically Appraised Topic

Context: As of 2020, cannabis has been legalized for medicinal purposes in 33 states and the District of Columbia1. The most common reason for the use of medicinal cannabis treatments is chronic pain1,2. Within the cannabis plant there are two main components; delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Because of the analgesic and anti-inflammatory effects of cannabinoids and the fight against the opioid epidemic, there has been an increase in research of the effects of THC and CBD on patients experiencing chronic pain1,2,3. Objective: As the growth of this treatment method continues to increase, the need for more data and research becomes more crucial. Therefore, there was a need to critically appraise the literature regarding the effects of cannabinoids and/or cannabis on chronic pain. In doing this, important insight into the use of this treatment in clinical practice for patients suffering from chronic pain may be found. Results: Although high-quality studies, there was no conclusive evidence to show that cannabinoids and/or cannabis are effective in producing analgesic effects in individuals suffering from chronic pain. Three of the studies concluded that there was no significant difference between the cannabis treatment group(s) and the placebo group1,2,4. The fourth study concluded that using a Syqe inhaler with low doses of cannabis showed pain relief, indicating that this form of administration of the drug could be beneficial3. Conclusion: Based on the inconclusiveness of the selected studies, determining the effectiveness of cannabis and/or cannabinoids on chronic pain cannot be achieved. Further studies involving larger patient populations over a longer period of time need to be performed

The Assessment of Quad to Quad and Hamstring to Quad Ratios in Patients Twelve to Twenty-Four Months Post Completion of a Supervised Anterior Cruciate Ligament Reconstruction Rehabilitation Program

Context: The assessment of quadriceps to quadriceps (Q-Q) and hamstring to quadriceps (H-Q) ratios following anterior cruciate ligament (ACL) reconstruction is an important factor for returning to sport. Significant differences in these ratios can result in reinjury. Objective: The purpose of this study is to assess Q-Q and H-Q ratios in collegiate athletes who have undergone ACL reconstruction and have successfully completed a supervised physical therapy program in the last 12-24 months and compare the results to established normative return to play guidelines (Q-Q = 90% and H-Q = 60%). Design: Cross-sectional study. Setting: Midwest outpatient physical therapy clinic. Patients or Other Participants: Four collegiate athletes (2 females and 2 males; age range = 19-21). Inclusion criteria included a previous ACL reconstruction using a bone-patellar tendon-bone graft and completion of a supervised physical therapy program in the past 12-24 months. Methods: Isokinetic strength measurement and peak torque values of knee flexion and extension between injured and uninjured legs using the Humac Norm Isokinetic Dynamometer by CSMI. The Q-Q and H-Q ratios were calculated using raw data. Main Outcome Measures: Q-Q and H-Q Ratios Results: Subject 1: Q-Q = 97%, H-Q = 62%; Subject 2: Q-Q = 109%, H-Q = 65%; Subject 3: Q-Q = 110%, H-Q = 61%; Subject 4: Q-Q = 113%, H-Q = 77%. Conclusions: Results indicate that each of the subjects met return to play normative values. Due to the small number of participants, further research is needed to discover any true discrepancies