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| Name | Class |
|---|---|
| University of Colorado, Denver | OTHER |
| Colorado State University | OTHER |
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This study tests the effects of cannabinoid levels in blood on pain relief, inflammation, and cognitive dysfunction in chronic pain patients who choose to use edible cannabis. Over a two-week period, participants use an edible product of their choice. Blood levels of 9-delta-tetrahydrocannabinol (THC) and cannabidiol (CBD) will be measured before, during, and after the two-week exposure period to determine whether there are associations with pain, inflammation, sleep, physical activity, anxiety/depression, and cognitive dysfunction. After the two-week self-administration period, participants will be followed for six months to collect self-report data on cannabis use, pain levels, sleep quality, and mental health symptoms.
The National Center for Health Statistics reports that approximately 76 million Americans suffer from chronic pain, affecting the lives of more Americans than cancer, diabetes, and heart disease combined. Perhaps because of its ubiquity and the challenge to its treatment, relief from chronic pain is by far the most commonly cited condition by patients for use of marijuana, with 87%-94% of medical marijuana users reporting using for relief of a pain condition.
Although the mechanisms are still unclear, marijuana and its constituent cannabinoids, including 9-delta-tetrahydrocannabinol (THC), are thought to be involved in reducing pain and associated inflammation. However, THC is also associated with harm in the form of cognitive dysfunction. Synergistic interactions of multiple cannabinoids are believed to produce different effects on both pain relief and cognitive function as compared to THC alone. For example, cannabidiol (CBD) is another primary cannabinoid that may work synergistically with THC in a multi-target analgesic approach.
This study examines the effects of cannabinoids in edible form on pain relief, inflammation, and cognitive dysfunction in chronic pain patients who choose to use marijuana in the context of a short-term (2 weeks), patient-oriented, observational design and a mobile pharmacology and phlebotomy lab.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cannabis Edible | Drug | Self-Directed Use (ad-libitum) |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Interference: Roland Morris Disability Questionnaire (RMDQ) | The Roland Morris Disability Questionnaire assesses self-rated physical disability caused by low back pain. Scores range from 0 to 24, with higher scores indicating more pain interference. | Change over two time points over 2 weeks: Baseline (before 2 weeks of edible use), Pre-Administration (after 2 weeks of use and before acute administration) using the total RMDQ score (0-24). |
| Inflammation: Circulating Levels of Cytokines | Tests levels of recent inflammation (panel of inflammatory markers) before and after cannabis use. Higher numbers indicate higher levels of circulating pro-inflammatory cytokines. Results are in pg/mL and are separated by the three cytokines: IL-1b, IL-6, and IL-10. | Change over two time points over 2 weeks: Baseline (before 2 weeks of edible use) and Pre-Administration (after 2 weeks of use and before acute administration). |
| Flanker Inhibitory Control Attention Task (FICA) & International Shopping List Task (ISLT) | Co-outcomes testing cognitive impairment in the domains of immediate and delayed recall (ISLT) and attention and inhibitory control (FICA). Cognitive outcomes are measured in standard scores (e.g. Range of >70 to >140 (Mean of 100 and SD of 15) with higher scores indicating better performance) and can be averaged to reflect a Standard score of overall cognitive function. | Change over two time points over 2 weeks: Baseline (before 2 weeks of edible use), Pre-Administration (after 2 weeks of use and before acute administration). |
| Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog) | Subjective report of cognitive function using the Perceived Cognitive Impairments subscale of the Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog). Possible scores range from 0-80 where higher scores are associated with higher levels of perceived impairment. | Change over two time points over 2 weeks: Baseline (before 2 weeks of edible use), Pre-Administration (after 2 weeks of use and before acute administration). |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Intensity: Current Pain Using NIH Pain Intensity Scale. | Test effects of cannabinoids on pain using the NIH Pain intensity scale for "current pain" (on a scale from 0-10 with 10 being the worst). | Change over 2 weeks |
| Health & Wellbeing |
| Measure | Description | Time Frame |
|---|---|---|
| Exploratory: Daily Follow-up Messages | Brief self-report from participants on pain and sleep in the past 24 hours. These are 1-item novel questions in a daily, text based survey. Pain and sleep are on a scale of 1-10, with higher numbers being more pain or better sleep. Score is an average rating over 14 days. | 2 weeks (daily) |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Cinnamon Bidwell, PhD | Institute of Cognitive Science, University of Colorado, Boulder | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Center for Innovation and Creativity | Boulder | Colorado | 80304 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39380911 | Derived | Melendez SN, Ortiz Torres M, Lisano JK, Giordano G, Skrzynski C, Hutchison KE, Bryan AD, Bidwell LC. Edible cannabis for chronic low back pain: associations with pain, mood, and intoxication. Front Pharmacol. 2024 Sep 24;15:1464005. doi: 10.3389/fphar.2024.1464005. eCollection 2024. |
| Label | URL |
|---|---|
| CUChange Lab, University of Colorado, Boulder | View source |
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Note: 268 participants were consented for the study. Among those, 253 submitted photos of their experimental product and were thus assigned to product groups. It is not possible to "group" the 15 participants lost to attrition at that point in the study flow.
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| ID | Title | Description |
|---|---|---|
| FG000 | THC Group | Participants used THC dominant products |
| FG001 | CBD Group | Participants used CBD dominant products |
| FG002 | THC+CBD Group | Participants used products with roughly equivalent proportions of THC and CBD |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | THC Group | Participants used THC dominant products |
| BG001 | CBD Group | Participants used CBD dominant products |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Pain Interference: Roland Morris Disability Questionnaire (RMDQ) | The Roland Morris Disability Questionnaire assesses self-rated physical disability caused by low back pain. Scores range from 0 to 24, with higher scores indicating more pain interference. | Posted | Mean | Standard Deviation | score on a scale | Change over two time points over 2 weeks: Baseline (before 2 weeks of edible use), Pre-Administration (after 2 weeks of use and before acute administration) using the total RMDQ score (0-24). |
|
2 weeks
This study was quasi-observational and minimally invasive.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | THC Group | Participants used THC dominant products | 0 |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. L. Cinnamon Bidwell | University of Colorado Boulder | 3037355180 | lcb@colorado.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jan 24, 2023 | Jan 23, 2025 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D059350 | Chronic Pain |
| D002189 | Marijuana Abuse |
| D010146 | Pain |
| D007249 | Inflammation |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D019966 | Substance-Related Disorders |
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Blood samples collected for cytokine and cannabinoid quantitation.
Self-report measure across primary domains of diet, assessment of sleep quality, and health-related well-being. Each domain was assessed with the following single items:
Diet: "In general, how healthy is your overall diet? Would you say" (response options 0- excellent; 1- very good; 2- good; 3- fair; 4- poor) Sleep Quality: "During the past 2 weeks, how would you rate your sleep quality overall?" (response options 0- very good; 1- fairly good; 2- fairly bad; 3- very bad") Health Related Wellbeing: "In general, how would you describe your health?" (response options 0- excellent; 1- very good; 2- good; 3- fair; 4- poor)
| Change over 2 weeks |
| Pittsburgh Sleep Quality Assessment (PSQI) | The Pittsburgh Sleep Quality Assessment (PSQI) is a self-report assessment of sleep quality.9 self-reported items belongs to one of seven subcategories: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Scores for each question range from 0 to 3, with higher scores indicating more acute sleep disturbances (Scores range from 0 to 21 overall, with scores greater than 5 suggesting significant sleep difficulties). | Change over 4 weeks |
| Motor Function | Motor control assessed via dynamic sway and proprioception. Motor outcomes were aggregated to reflect a Z-score of overall motor function. Scores reported below are sum of Motor Battery Balance z-scores (Eyes Open, Eyes Closed, and Head Back). Higher scores correspond to worse balance- there is not a maximum score. | Change over 2 weeks |
| Depression and Stress | The DASS21 is a 21-item scale that measures self-reported change in anxiety, depression, and stress symptoms. Participants are asked to use 4-point severity/frequency scales (higher values indicate greater severity) to rate the extent to which they have experienced each state. For this aim, the Depression and Stress subscales were used. Depression subscale score range 0-21 Normal (0 to 4), Mild (5 to 6), Moderate, (7 to 10), Severe (11 to 13), Extremely Severe (14 and above) Stress subscale score range 0-33 Normal (0 to 14), Mild (15 to 18), Moderate, (19 to 25), Severe (26 to 33) | Change over 2 weeks |
| Acute Cognitive Impairment: Flanker Inhibitory Control Attention Task (FICA) and International Shopping List Task (ISLT). | Co-outcomes testing cognitive impairment after acute use of cannabis in the domains of immediate and delayed recall (ISLT) and and attention and inhibitory control (FICA). Cognitive outcomes are measured in standard scores (e.g. Range of <70 to >140 (Mean of 100 and SD of 15) with higher scores indicating better performance) and can be averaged to reflect a Standard score of overall cognitive function. | 2 Weeks |
| Patient Global Impression of Change: Global Impression of Change Scale (PGIC). | Patient Global Impression of Change Scale (PGIC) measures self-reported change on a 1-7 scale (i.e. from 1 (very much worse) to 7 (very much improved) in pain. Changes in this measure will be tested in relation to THC and CBD blood levels. Scale possible score range 1-7, with higher scores indicating the largest amount of possible change. Importantly, it is a subjective self-assessment of change and is only measured at the 2 week timepoint. | Change over 2 week primary exposure period. |
| Exploratory: Monthly Follow-up Surveys |
Self-report from participants on pain levels (0-10 with 10 being worst pain), sleep quality (0-10 with 10 being best sleep), perceived cognitive ability (0 - 27 with 27 being the best), perceived cognitive impairments (0-72 with 72 being the worst), and general health (0-4 with 4 being best). Scores are reported as average scores reported once a month over six months. |
| 6 months (monthly) |
| Objective Physical Activity/Exercise | Physical activity via objective daily data on wearable watch as measured by average minutes of moderate to vigorous physical activity (MVPA). | 2 weeks |
| Physical Activity/Exercise | Physical activity via subjective self-report data using the Stanford Leisure-Time Activity Categorical item with 6 item responses (L-CAT; 1-6). Scores are reported as a mean between 1 and 6, larger numbers correspond to higher levels of activity. | 2 weeks |
| BG002 |
| THC+CBD Group |
Participants used products with roughly equivalent proportions of THC and CBD |
| BG003 | Total | Total of all reporting groups |
| years |
|
| Sex/Gender, Customized | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Pain Intensity | Participants' current pain intensity was measured via a single item from the Pain Intensity Short Form 3a which asked, "What is your level of lower back pain currently?" and was rated on a scale of 0 = "no pain" to 10 = "worst imaginable pain" | Mean | Standard Deviation | units on a scale |
|
| OG002 |
| THC+CBD Group |
Participants used products with roughly equivalent proportions of THC and CBD |
|
|
| Primary | Inflammation: Circulating Levels of Cytokines | Tests levels of recent inflammation (panel of inflammatory markers) before and after cannabis use. Higher numbers indicate higher levels of circulating pro-inflammatory cytokines. Results are in pg/mL and are separated by the three cytokines: IL-1b, IL-6, and IL-10. | Posted | Mean | Standard Deviation | pg/mL | Change over two time points over 2 weeks: Baseline (before 2 weeks of edible use) and Pre-Administration (after 2 weeks of use and before acute administration). |
|
|
|
| Primary | Flanker Inhibitory Control Attention Task (FICA) & International Shopping List Task (ISLT) | Co-outcomes testing cognitive impairment in the domains of immediate and delayed recall (ISLT) and attention and inhibitory control (FICA). Cognitive outcomes are measured in standard scores (e.g. Range of >70 to >140 (Mean of 100 and SD of 15) with higher scores indicating better performance) and can be averaged to reflect a Standard score of overall cognitive function. | Posted | Mean | Standard Deviation | score on a scale | Change over two time points over 2 weeks: Baseline (before 2 weeks of edible use), Pre-Administration (after 2 weeks of use and before acute administration). |
|
|
|
| Primary | Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog) | Subjective report of cognitive function using the Perceived Cognitive Impairments subscale of the Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog). Possible scores range from 0-80 where higher scores are associated with higher levels of perceived impairment. | Posted | Mean | Standard Deviation | score on a scale | Change over two time points over 2 weeks: Baseline (before 2 weeks of edible use), Pre-Administration (after 2 weeks of use and before acute administration). |
|
|
|
| Secondary | Pain Intensity: Current Pain Using NIH Pain Intensity Scale. | Test effects of cannabinoids on pain using the NIH Pain intensity scale for "current pain" (on a scale from 0-10 with 10 being the worst). | Posted | Mean | Standard Deviation | score on a scale | Change over 2 weeks |
|
|
|
| Secondary | Health & Wellbeing | Self-report measure across primary domains of diet, assessment of sleep quality, and health-related well-being. Each domain was assessed with the following single items: Diet: "In general, how healthy is your overall diet? Would you say" (response options 0- excellent; 1- very good; 2- good; 3- fair; 4- poor) Sleep Quality: "During the past 2 weeks, how would you rate your sleep quality overall?" (response options 0- very good; 1- fairly good; 2- fairly bad; 3- very bad") Health Related Wellbeing: "In general, how would you describe your health?" (response options 0- excellent; 1- very good; 2- good; 3- fair; 4- poor) | Posted | Mean | Standard Deviation | units on a scale | Change over 2 weeks |
|
|
|
| Secondary | Pittsburgh Sleep Quality Assessment (PSQI) | The Pittsburgh Sleep Quality Assessment (PSQI) is a self-report assessment of sleep quality.9 self-reported items belongs to one of seven subcategories: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Scores for each question range from 0 to 3, with higher scores indicating more acute sleep disturbances (Scores range from 0 to 21 overall, with scores greater than 5 suggesting significant sleep difficulties). | Posted | Mean | Standard Deviation | score on a scale | Change over 4 weeks |
|
|
|
| Secondary | Motor Function | Motor control assessed via dynamic sway and proprioception. Motor outcomes were aggregated to reflect a Z-score of overall motor function. Scores reported below are sum of Motor Battery Balance z-scores (Eyes Open, Eyes Closed, and Head Back). Higher scores correspond to worse balance- there is not a maximum score. | Posted | Mean | Standard Deviation | z-score | Change over 2 weeks |
|
|
|
| Secondary | Depression and Stress | The DASS21 is a 21-item scale that measures self-reported change in anxiety, depression, and stress symptoms. Participants are asked to use 4-point severity/frequency scales (higher values indicate greater severity) to rate the extent to which they have experienced each state. For this aim, the Depression and Stress subscales were used. Depression subscale score range 0-21 Normal (0 to 4), Mild (5 to 6), Moderate, (7 to 10), Severe (11 to 13), Extremely Severe (14 and above) Stress subscale score range 0-33 Normal (0 to 14), Mild (15 to 18), Moderate, (19 to 25), Severe (26 to 33) | Posted | Mean | Standard Deviation | score on a scale | Change over 2 weeks |
|
|
|
| Secondary | Acute Cognitive Impairment: Flanker Inhibitory Control Attention Task (FICA) and International Shopping List Task (ISLT). | Co-outcomes testing cognitive impairment after acute use of cannabis in the domains of immediate and delayed recall (ISLT) and and attention and inhibitory control (FICA). Cognitive outcomes are measured in standard scores (e.g. Range of <70 to >140 (Mean of 100 and SD of 15) with higher scores indicating better performance) and can be averaged to reflect a Standard score of overall cognitive function. | Posted | Mean | Standard Deviation | standard score | 2 Weeks |
|
|
|
| Secondary | Patient Global Impression of Change: Global Impression of Change Scale (PGIC). | Patient Global Impression of Change Scale (PGIC) measures self-reported change on a 1-7 scale (i.e. from 1 (very much worse) to 7 (very much improved) in pain. Changes in this measure will be tested in relation to THC and CBD blood levels. Scale possible score range 1-7, with higher scores indicating the largest amount of possible change. Importantly, it is a subjective self-assessment of change and is only measured at the 2 week timepoint. | Posted | Mean | Standard Deviation | score on a scale | Change over 2 week primary exposure period. |
|
|
|
| Other Pre-specified | Exploratory: Daily Follow-up Messages | Brief self-report from participants on pain and sleep in the past 24 hours. These are 1-item novel questions in a daily, text based survey. Pain and sleep are on a scale of 1-10, with higher numbers being more pain or better sleep. Score is an average rating over 14 days. | Posted | Mean | Standard Deviation | units on a scale | 2 weeks (daily) |
|
|
|
| Other Pre-specified | Exploratory: Monthly Follow-up Surveys | Self-report from participants on pain levels (0-10 with 10 being worst pain), sleep quality (0-10 with 10 being best sleep), perceived cognitive ability (0 - 27 with 27 being the best), perceived cognitive impairments (0-72 with 72 being the worst), and general health (0-4 with 4 being best). Scores are reported as average scores reported once a month over six months. | Posted | Mean | Standard Deviation | units on a scale | 6 months (monthly) |
|
|
|
| Other Pre-specified | Objective Physical Activity/Exercise | Physical activity via objective daily data on wearable watch as measured by average minutes of moderate to vigorous physical activity (MVPA). | Posted | Mean | Standard Deviation | minutes | 2 weeks |
|
|
|
| Other Pre-specified | Physical Activity/Exercise | Physical activity via subjective self-report data using the Stanford Leisure-Time Activity Categorical item with 6 item responses (L-CAT; 1-6). Scores are reported as a mean between 1 and 6, larger numbers correspond to higher levels of activity. | Posted | Mean | Standard Deviation | score on a scale | 2 weeks |
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| 36 |
| 0 |
| 36 |
| 0 |
| 36 |
| EG001 | CBD Group | Participants used CBD dominant products | 0 | 95 | 0 | 95 | 0 | 95 |
| EG002 | THC+CBD Group | Participants used products with roughly equivalent proportions of THC and CBD | 0 | 117 | 0 | 117 | 0 | 117 |
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| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
| D010335 | Pathologic Processes |
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| Baseline IL-6 Blood Levels |
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| IL-6 Blood Levels at 2 Weeks |
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| Baseline IL-10 Blood Levels |
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| IL-10 Blood Levels at 2 Weeks |
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| Baseline ISLT Scores |
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| 2 Week ISLT Scores |
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| Baseline Sleep Quality |
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| 2 Week Sleep Quality |
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| Baseline Health-Related Wellbeing |
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| 2 Week Health-Related Wellbeing |
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| Baseline Stress Score |
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| 2 Week Stress Score |
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| Monthly Perceived Cognitive Ability |
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| Monthly Perceived Cognitive Impairments |
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| Monthly General Health Rating |
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