The use of cannabis and cannabinoid products for the treatment of neuropathic pain is a growing area of research. This type of pain has a high prevalence, limited response to available therapies and high social and economic costs. Systemic cannabinoid-based therapies have shown some unwanted side effects. Alternative routes of administration in the treatment of neuropathic pain may provide better acceptance for the treatment of multiple pathologies associated with neuropathic pain. To examine the efficacy, tolerability, and safety of cannabinoids (individualized formulations, phytocannabinoids, and synthetics) administered by routes other than oral or inhalation compared to placebo and/or conventional medications in the management of neuropathic pain. This systematic review of the literature reveals a lack of clinical research investigating cannabis by routes other than oral and inhalation as a potential treatment for neuropathic pain and highlights the need for further investigation with well-designed clinical trials. There is a significant lack of evidence indicating that cannabinoids administered by routes other than oral or inhaled may be an effective alternative, with better tolerance and safety in the treatment of neuropathic pain. Higher quality, long-term, randomized controlled trials are needed to examine whether cannabinoids administered by routes other than inhalation and oral routes may have a role in the treatment of neuropathic pain.

Background Neuroinflammation plays a critical role in the progression of neurological disorders such as Alzheimer’s and Parkinson’s diseases, as well as chronic pain. It is characterized by elevated production of pro-inflammatory cytokines, including IL-6, and TNF-α, by microglia, the resident immune cells of the central nervous system. Emerging research highlights the involvement of the endocannabinoid system (ECS) in neuroinflammation, proposing cannabinoids as potential therapeutic agents owing to their immunosuppressive and anti-inflammatory properties. Methods This study used an in vitro model, specifically the BV-2 murine microglial cell line, to assess neuroinflammation. Cell viability was measured using the MTT assay, and cytokine production was quantified using advanced nanobiosensor technologies, including Surface Plasmon Resonance (SPR). Immunocytochemistry (ICC) was used to evaluate protein expression. Microglial cells were treated with varying concentrations of dexamethasone sodium phosphate (Dex-SP), cannabidiol (CBD), a full-spectrum tetrahydrocannabinol (FSE-THC) extract (70% THC), or a combination of the two at a 1:1 ratio (FSE-THC/CBD). Results The treatments did not affect BV-2 microglial cell viability. Nitric oxide (NO) production remained unaltered following treatment with Dex-SP, CBD, FSE-THC 70%, or FSE-THC:CBD in LPS-stimulated BV-2 microglia. However, CBD and FSE-THC:CBD significantly reduced TNF-α levels, whereas Dex-SP and CBD decreased IL-6 expression. Furthermore, Dex-SP, CBD, FSE-THC (70%), and FSE-THC:CBD modulated the activation of Bcl-2, Bax, TNF-α, IFN-γ, NF-κB, and iNOS in concentration- and treatment-specific manners. Conclusions Dex-SPs demonstrate acute anti-inflammatory effects in LPS-stimulated BV2 microglial cells. Specific cannabinoids at particular concentrations exhibit comparable or superior efficacy in modulating key inflammatory mediators. These findings suggest the therapeutic potential of cannabinoids in neuroinflammation, and emphasize the need for further investigation to optimize their application.

Introduction: The pain prevalence in hospitalized infants and preschool children has not been accurately identified in high-income countries, and in low and medium-income countries it has not been extensively studied. The assessment instruments are limited. Objective: To describe the prevalence and management of pain in infants and preschool children during the first 24 hours of hospitalization in a third level institution in Colombia, using the CRIES scale. Methods: An observational study was conducted during the first 24 hours of hospitalization. Demographic information was recorded, pain was assessed at admission, after 4, and 24 hours using the CRIES scale. Pharmacological therapy was also documented. Results: 250 children between one month and 5 years old were studied. The pain prevalence at admission was 12 %. The pain prevalence per subgroups was higher among the surgical patients, as compared to the clinical patients (35.9 % vs. 7.6 %). The pharmacological analysis revealed that 70.8 % of patients received treatment; the most widely used medications were oral acetaminophen and intravenous dipyrone. Conclusions: Pain prevalence was lower than the levels described for the general pediatric population. This result may be due to the sensitivity of the CRIES instrument, or to a particular pain behavior. Further studies are needed to identify the sensitivity of the assessment instruments in early life and to accurately investigate any associated phenomena.

Letter to the Editor Carta al Editor