Farmaci cannabinoidi e trattamento sintomatico del dolore e spasticità…

Nessun effetto terapeutico. Sbagliato illudere i malati

http://www.avvenire.it/Cronaca/Pagine/nessuna-effetto-terapeutica.aspx

Ho letto una rivolta tumultuosa online, dopo l’inserimento di questa pagina in internet fatta dall’autore dell’articolo, concordando che sicuramente è vero che non si possono illudere gli ammalati di SM, per una guarigione, ma con questo prodotto usato in pratica medica si possono lenire dolori urenti, continui e devastanti.

E’ vero, non serve illudere le persone con la Sclerosi Multipla, è una patologia con la quale convivo da tanti anni, troppi per continuare a stare male, e sono una fra i tanti in attesa del Sativex e la sua introduzione in Italia a scopo terapeutico, a carico del SSN, perchè non posso permettermi di spendere 680 euro a confezione!

Ho voluto avere informazioni maggiori a livello medico,  e mi sono rivolta, inviandogli l’articolo postato online, ad uno dei tanti amici “angeli custodi medici ” che mi sono trovata dopo la morte di mio fratello che era un chirurgo,  e che ancora in vita mi parlava di questa sostanza cannabinoide, come un domani potesse lenire le sofferenze dolorose dei pazienti con malattie neurodegenerative, tumorali, ecc. utilizzata a scopo farmaceutico. Sono contraria all’uso personale della cannabis e relativa coltivazione, perchè sarebbe incentivare abuso, e creare una sorta di alibi ad utilizzare senza controllo questa sostanza, come molte altre psicotrope senza controllo anche per un banale mal di pancia. Diverrebbe una sorta di autorizzazione al fai da te!

Vorrei invece che il problema venisse affrontato come sta già accadendo in alcune regioni Italiane,  in maniera seria, adottando regole e provvedimenti per favorire questo utilizzo sia di Sativex che Bedrocan, Nabilone ed altri che non sto a citare, presso  i centri di cure per il dolore, e di neurologia ed oncologia,  a regime SSN, non a carico del paziente, seguendo protocolli, e sempre sotto stretto controllo specialistico.

Ecco cosa ho ricevuto, da questa “presenza”, che chiamerò “Herman”  in ricordo di mio fratello Ermanno. Sperando possa aiutare a capire di cosa si parla e perchè si sta lottando per avere questo tipo di farmaci.

“FARMACI CANNABINOIDI E TRATTAMENTO SINTOMATICO DEL DOLORE E DELLA SPASTICITA’ MUSCOLARE”

Da anni sono in uso nel nord America e nel nord d’Europa farmaci cannabinoidi per il trattamento sintomatico di disturbi afferenti per lo più all’area di competenza neurologica.

In Italia è previsto l’uso di sostanza psicotrope ad uso medico con attività terapeutica dimostrata quali barbiturici, benzodiazepine ed oppiacei.

Per quel che riguarda i derivati della cannabis nel 2006 il Ministero della Salute, con un’ordinanza, consentiva la importazione di cannabinoidi a scopo terapeutico.

Attualmente i medesimi non sono presenti su mercato italiano.

Per ordinare all’estero tali specialità medicinali, occorre seguire la procedura richiesta dall’ art. 2 del D.M. 11.02.1997 (Importazione di specialità medicinali registrate all’estero).

A questo ultimo si rimanda.

Il senso ultimo di queste righe vuole essere, nella intenzione di chi scrive, un commento all’articolo apparso su Avvenire del 02.02.2013 dal titolo “Nessun effetto terapeutico. Sbagliato illudere i malati”

Personalmente sono fondamentalmente in accordo con l’autore dell’articolo: sia dove dice che i cannabinoidi non hanno alcun effetto terapeutico sull’andamento della patologia di base sia dove dice che essi agiscono quali sintomatici sulla spasticità muscolare e sul dolore.

La opinione di chi scrive è che si stia facendo un poco edificante uso strumentale circa l’argomento “farmaci cannabinoidi”.
Questo fa male ai pazienti ed allontana la idea dello sdoganamento delle sostanze in questione quali sostanze ad effetto terapeutico/sintomatico.

Non è giusto illudere i pazienti: assolutamente concorde!

Non esiste EBM (“evidence based medicine” ovvero medicina basata sull’evidenza) a favore in un loro effetto terapeutico sulla evoluzione della patologia. Ma è altrettanto vero che esistono evidenze circa l’effetto sintomatico della spasticità e del dolore (non solo nei pazienti affetti Sclerosi Multipla, poiché la spasticità dolorosa ad esempio nello Stroke o Ictus, si giova comunque del cannabinoide ad uso sintomatico). E ciò non è poco!

Il dolore da spasticità muscolare produce sofferenza comunque nei pazienti; non importa (al dolore, alla sofferenza) se chi ne è colpito sia di destra o di sinistra. Il dolore fa solo il suo sporco lavoro: causa sofferenza all’essere umano

I farmaci cannabinoidi sono efficaci nel dolore da spasticità muscolare come “sintomatici” mentre non vi è alcuna evidenza basata sulla medicina che abbiano un qualche effetto sulla evoluzione della patologia di base.

Essi possono essere prescritti dal medico di famiglia o dallo specialista ospedaliero. Pertanto sempre e solo sotto controllo medico.

Poche righe ancora circa il meccanismo d’azione

Il delta-9-tetraidrocannabinolo (THC) agisce a livello del Sistema Nervoso Centrale (SNC) stimolando il rilascio di dopamina dal nucleus accumbens, provocando nella persona reazioni sia fisiche che psichiche (compreso alcuni effetti collaterali). Il legame dei cannabinoidi ai recettori CB1 causa una inibizione presinaptica del rilascio di vari neurotrasmettitori (in particolare dopamina, NMDA e glutammato), ed una stimolazione delle aree della sostanza grigia periacqueduttale (PAG) e del midollo rostrale ventromediale (RVM), che a loro volta inibiscono le vie nervose ascendenti del dolore.

A livello del midollo spinale il legame dei cannabinoidi ai recettori CB1 causa una inibizione delle fibre afferenti a livello del corno dorsale, ed a livello periferico il legame dei cannabinoidi con i recettori CB1 e CB2 causa una riduzione della secrezione di vari prostanoidi e citochine proinfiammatorie, la inibizione del segnale doloroso.

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No therapeutic effect. Wrong to deceive the sick

I read a tumultuous revolt online, after the inclusion of this page on the Internet by the author of the article, agreeing that it is certainly true that you can not deceive the people suffering from MS, for a cure, but with this product used in practice medicine can relieve pain urenti, continuous and devastating.

It ‘s true, no need to deceive people with multiple sclerosis, is a disease in which cohabit for many years, too many to continue to get sick, and are one of the many waiting for Sativex and its introduction in Italy for treatment at the expense of the NHS, because I can not afford to spend 680 euro per pack!

I wanted to have more information on a medical level, and I turned, sending the article posted online, one of the many friends “guardian angels doctors” that I found after the death of my brother who was a surgeon, and that still life was telling me about this cannabinoid substance, such as a painful tomorrow could alleviate the suffering of patients with neurodegenerative diseases, cancer, etc.. used for pharmaceutical purposes. I am against the personal use of cannabis and its cultivation, because it would encourage abuse, and create a sort of excuse to use this control without substance, like many other psychotropic without control even for a simple stomach ache. Become a kind of permission to do it yourself!

I would rather that the problem was dealt with as is already happening in some Italian regions, in a serious way, adopting rules and measures to promote this use of Sativex is that Bedrocan, Nabilone and others that I will not mention, at care centers for pain, neurology and oncology, at full SSN, not the patient, using protocols, and always under strict control specialist.

Here’s what I got from this “presence”, which I call “Herman” in memory of my brother Herman. Hoping to help you understand what they are about and why you are struggling to have this type of medication.

“DRUGS AND CANNABINOIDS symptomatic relief of pain and spasticity ‘MUSCLE”

For years I have used in North America and northern Europe cannabinoid drugs for the symptomatic treatment of disorders related to the area covered mostly neurological.

In Italy it is expected the use of psychotropic substances for medical use with demonstrated therapeutic activity such as barbiturates, benzodiazepines and opiates.

With regard to cannabis derivatives in 2006 the Ministry of Health, by order, allow the import of cannabis for therapeutic purposes.

Currently, the same are not present on the Italian market.

To order such products abroad, you must follow the procedure required by ‘art. 2 of Ministerial Decree 11/02/1997 (Importing medicines that are registered abroad).

In this last reference is made.

The ultimate meaning of these lines want to be, in the intention of the writer, a review article published in Avvenire of 02.02.2013 entitled “No therapeutic effect. Wrong to deceive the sick ”

Personally, I am basically in agreement with the author of the article: it is where it says that cannabinoids have no therapeutic effect on the progress of the underlying disease is where it says that they act as symptomatic on muscle spasticity and pain.

The writer’s opinion is that it is doing a little uplifting instrumental use about the topic “cannabinoid drugs.”
This is bad for patients and away the idea of ​​customs clearance of these substances as substances having therapeutic / symptomatic.

It is not right to deceive patients: absolutely agree!

There EBM (“evidence based medicine” or evidence-based medicine) for a therapeutic effect on the evolution of the disease. But it is equally true that there is evidence for the symptomatic effect of spasticity and pain (not only in patients with multiple sclerosis, for example painful spasticity in stroke or stroke, however, takes advantage of the cannabinoid use symptomatic). And this is no small feat!

The pain from muscle spasticity leads to suffering patients, however, do not care (pain and suffering) if those affected either the right or left. The pain is only his dirty work: causes suffering to the human

The cannabinoid drugs are effective in pain from muscle spasticity as “symptomatic” while there is no evidence-based medicine that has some effect on the evolution of the underlying disease.

They may be prescribed by the family doctor or specialist hospital. Therefore always and only under medical supervision.

A few lines still about the mechanism of action

The delta-9-tetrahydrocannabinol (THC) acts in the central nervous system (CNS) stimulating the release of dopamine from the nucleus accumbens, in the person causing both physical and psychological reactions (including some side effects). The binding of the cannabinoid receptor CB1 causes a presynaptic inhibition of the release of various neurotransmitters (in particular dopamine, glutamate and NMDA), and a stimulation of areas in the periaqueductal gray (PAG) and the rostral ventromedial medulla (RVM), which in their Once inhibit ascending pain pathways.

At the level of the spinal cord to the binding of the cannabinoid CB1 receptors cause an inhibition of the afferent fibers at the level of the dorsal horn, and at the peripheral level of the link with the cannabinoid receptors CB1 and CB2 receptors causes a reduction of the secretion of various prostanoids and proinflammatory cytokines, the inhibition of the pain signal.

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Aucun effet thérapeutique. Tort de tromper les malades

J’ai lu une ligne révolte tumultueuse, après l’inclusion de cette page sur Internet par l’auteur de l’article, en convenant qu’il est vrai que vous ne pouvez pas tromper les gens atteints de SEP, pour une cure, mais avec ce produit utilisé dans la pratique médicament peut soulager la douleur, urenti continue et dévastatrice.

C’est vrai, pas besoin de tromper les gens avec la sclérose en plaques est une maladie dans laquelle cohabitent depuis de nombreuses années, trop nombreux pour continuer à tomber malade, et sont l’une de l’attente beaucoup pour le Sativex et son introduction en Italie pour traitement à la charge du NHS, parce que je ne peux pas se permettre de dépenser € 680 par pack!

Je voulais avoir plus d’informations sur le plan médical, et je me suis tourné, l’envoi de l’article publié en ligne, l’un des nombreux amis “tuteur médecins anges” que j’ai trouvé après la mort de mon frère qui était un chirurgien, et qu’il est encore la vie m’a parlé de cette substance cannabinoïde, comme une douloureuse demain pourrait alléger les souffrances des patients atteints de maladies neurodégénératives, cancers, etc. utilisé à des fins pharmaceutiques. Je suis contre l’usage personnel de cannabis et sa culture, car cela encouragerait les abus, et de créer une sorte d’excuse pour utiliser ce contrôle sans substance, comme beaucoup d’autres psychotropes sans contrôle, même pour un mal d’estomac simple. Devenir une sorte de permission de le faire vous-même!

Je préférerais que le problème a été traitée comme c’est déjà le cas dans certaines régions italiennes, d’une manière sérieuse, en adoptant des règles et des mesures visant à promouvoir l’utilisation de cette Sativex est que Bedrocan, nabilone et d’autres que je ne citerai pas, dans les centres de soins pour les la douleur, de la neurologie et en oncologie, au SSN complet, et non le patient, en utilisant des protocoles, et toujours sous un contrôle strict spécialiste.

Voici ce que j’ai reçu de cette «présence», que j’appelle «Herman» dans la mémoire de mon frère Herman. Dans l’espoir de vous aider à comprendre ce qu’ils sont et pourquoi vous avez du mal à avoir ce type de médicament.

«Les drogues et de secours CANNABINOÏDES symptomatique de la douleur et de la spasticité MUSCLE ‘”

Pendant des années j’ai utilisé en Amérique du Nord et Europe du Nord médicaments cannabinoïdes dans le traitement symptomatique des troubles liés à la zone couverte essentiellement neurologique.

En Italie, il est prévu l’utilisation de substances psychotropes à des fins médicales ayant une activité thérapeutique démontré, comme les barbituriques, les benzodiazépines et les opiacés.

En ce qui concerne les dérivés du cannabis en 2006, le ministère de la Santé, par arrêté, autoriser l’importation de cannabis à des fins thérapeutiques.

À l’heure actuelle, les mêmes ne sont pas présents sur le marché italien.

Pour commander ces produits à l’étranger, vous devez suivre la procédure prévue par l’art. 2 du décret ministériel 02/11/1997 (Importation de médicaments qui sont immatriculés à l’étranger).

Dans cette dernière référence est faite.

Le sens ultime de ces lignes voulons être, dans l’intention de l’auteur, un article de synthèse publié en Avvenire du 02.02.2013 intitulé «Pas d’effet thérapeutique. Tort de tromper les malades ”

Personnellement, je suis fondamentalement d’accord avec l’auteur de l’article: il est où il est dit que les cannabinoïdes n’ont aucun effet thérapeutique sur la progression de la maladie sous-jacente est où il est dit qu’ils agissent comme symptomatique de la spasticité musculaire et la douleur.

Avis de l’auteur, c’est qu’il fait un peu édifiante utilisation instrumentale sur le sujet des «médicaments cannabinoïdes.”
Ce n’est pas bon pour les patients et loin l’idée de dédouanement de ces substances comme des substances dont thérapeutique / symptomatique.

Il n’est pas juste pour tromper les patients: absolument d’accord!

Il EBM (“evidence based medicine” ou de la médecine fondée sur les preuves) pour un effet thérapeutique sur l’évolution de la maladie. Mais il est également vrai qu’il existe des preuves de l’effet symptomatique de la spasticité et de la douleur (et pas seulement chez les patients atteints de sclérose en plaques, par exemple la spasticité douloureuse accident vasculaire cérébral ou accident vasculaire cérébral, cependant, prend avantage de l’utilisation des cannabinoïdes symptomatique). Et ce n’est pas un mince exploit!

La douleur de spasticité musculaire conduit à la souffrance des patients, cependant, ne se soucient pas (douleur et souffrance) si les personnes touchées, soit l’. Droite ou à gauche La douleur n’est que son sale boulot: cause de la souffrance de l’humain

Les médicaments cannabinoïdes sont efficaces dans la douleur de spasticité musculaire comme «symptomatiques» alors qu’il n’y a pas de médecine factuelle qui a un effet sur l’évolution de la maladie sous-jacente.

Ils peuvent être prescrits par le médecin de famille ou un hôpital spécialisé. Il faut donc toujours et uniquement sous surveillance médicale.

Quelques lignes encore sur le mécanisme d’action

Le delta-9-tétrahydrocannabinol (THC) agit dans le système nerveux central (SNC) la stimulation de la libération de dopamine par le noyau accumbens, en la personne de provoquer des réactions physiques et psychologiques (y compris certains effets secondaires). La liaison du récepteur cannabinoïde CB1 entraîne une inhibition présynaptique de la libération de divers neurotransmetteurs (la dopamine particulier, le glutamate et NMDA), et une stimulation des zones dans la grise périaqueducale (PAG) et le rostrale rachidien ventromédian (RVM), qui, dans leur Une fois inhiber voies de la douleur ascendants.

Au niveau de la moelle épinière à la liaison des récepteurs CB1 des cannabinoïdes récepteurs provoquer une inhibition des fibres afférentes au niveau de la corne dorsale, et au niveau périphérique de la liaison avec les récepteurs cannabinoïdes CB1 et CB2 provoque une diminution de la sécrétion de prostanoïdes diverses et des cytokines pro-inflammatoires, l’inhibition du signal de la douleur.

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