PhysioUpdate 9th May 2023
Teenager Wil Ritchie is harbouring ambitions to become a physiotherapist as a result of the inspirational support he has received from a team based at Ninewells Hospital in Dundee. Wil, 17 and from Forfar, was involved in mountain biking accident in 2020 which left him with a serious brain injury and a hospital stay lasting more than nine months.
His rehab programme received a recent fillip when he started running again, using a Matrix treadmill with his body weight being supported by a new hoist. He now runs for about 15 minutes during a typical physiotherapy session, covering up to 1.5 km – five times longer than he could manage without the hoist.
Clinical specialist physiotherapist Carol Greig said: ‘The body weight support treadmill is a welcome addition to our rehabilitation equipment and seeing Wil’s progress in such a short space of time shows what a difference it will make to so many of our patients. It means the patient is fully supported by the harness and the amount of weight taken through their body can be reduced to make walking feel safer, easier and more secure.
Carol added: ‘So far patients with conditions including stroke, traumatic brain injury/major trauma and functional neurological disorder have all used the equipment and the patient feedback has been very positive.’
Fast forward
Wil said: ‘I always like to run as fast as I can. I can see the hoist benefiting so many people who are making progress just like me and also those who were just like me when I first started rehab. It will really help people.'
The body weight support treadmill is a welcome addition to our rehabilitation equipment and seeing Wil’s progress in such a short space of time shows what a difference it will make to so many of our patients [Carol Greig]
His mother Karen Ritchie is thrilled by his progress: ‘This new machine is amazing. We are so proud of him, he’s a very positive person and he never gives up. He has just worked so hard every day, supported by the physio team.’
The specialist treadmill and walking hoist is sited at the East of Scotland Major Trauma Centre at Ninewells Hospital, which provides dedicated trauma services – including rehabilitation support – to help patients with significant injuries recover more quickly. Being portable, the hoist can be used at a patient’s bedside if required.
The machine also provides members of the physiotherapy team with data, meaning they monitor each patient's progress, and log information about speed, stride lengths and distances.
'Incredible piece of equipment'
Fiona Hutcheson, who manages the East of Scotland Major Trauma Network, said: ‘The walking hoist is an incredible piece of equipment that enables patients to walk at an earlier stage of their rehabilitation.
Fiona added: 'It enhances patient independence and functional ability throughout their rehab journey. The staff have been very enthusiastic about the new hoist and seeing the difference it is making to patients.’
Prescribing medicinal cannabis to relieve cancer pain appears to be a safe option, the results of a multicentre registry study that was published online in BMJ Supportive & Palliative Care today (3 May) suggest.
Medicinal cannabis also helps to reduce the total number of medication and opioids taken by patients, according to a research team that included Antonio Vigano, from the Supportive and Palliative Care Division at the McGill University Health Centre in Montreal, Quebec.
Products with an equal balance of the active ingredients tetrahydrocannabinol (THC) and cannabidiol (CBD) – rather than a dominance of either one – seem to be particularly effective, Dr Vigano and his colleagues note. They suggest that medicinal cannabis is a safe and complementary treatment when conventional drugs fail to touch cancer-related pain.
Patients’ pain intensity and other factors monitored
The research team studied the treatment responses of 358 adults with cancer whose details were submitted to a multicentre registry – the Quebec Cannabis Registry in Canada – over a period lasting three and a half years (May 2015-October 2018).
The patients’ average age was 57; nearly half (48 per cent) were men; and the three most common cancer diagnoses were genitourinary, breast, and bowel. Pain was the most frequently reported (72.5 per cent) symptom that prompted a prescription of medicinal cannabis. THC-dominant, THC:CBD-balanced, and CBD-dominant products were authorised in 24.5 per cent, 38 per cent, and 16.5 per cent of patients, respectively. Taking the product by mouth was the most frequently recommended route (59 per cent).
Our data suggest a role for [medicinal cannabis] as a safe and complementary treatment option in patients with cancer failing to reach adequate pain relief through conventional analgesics, such as opioids [Saro Aprikian et al]
Pain intensity
Patients’ pain intensity, symptoms, total number of drugs taken, and daily morphine consumption were monitored quarterly for one year. Pain intensity was rated, using validated measures, on a sliding scale from none (zero) to the worst possible (10), and pain relief from none (0 per cent) to complete (100 per cent), with two summary measures of overall pain severity and pain interference over the preceding 24 hours.
Medicinal cannabis seemed to be safe and well tolerated, with only 15 side effects (rated as moderate to severe) reported by 11 patients, 13 of which were regarded as minor. The two most common side effects were sleepiness, reported by three patients, and fatigue, reported by two.
Close supervision of patients was helpful
Two serious side effects (pneumonia and a cardiovascular event) were deemed unlikely to have been linked to medicinal cannabis. Only five patients stopped taking medicinal cannabis because of side effects. ‘The particularly good safety profile of [medicinal cannabis] found in this study can be partly attributed to the close supervision by healthcare professionals who authorised, directed, and monitored [the] treatment,’ Dr Vigano and his colleagues state.
Statistically significant decreases were observed at three, six and nine months for worst and average pain intensity, overall pain severity, and pain interference [with daily life] Overall, THC:CBD balanced products were associated with better pain relief than either THC-dominant or CBD-dominant products. The total number of drugs taken also fell consistently at all the subsequent quarterly check-ups, while opioid use fell over the first three check-ups.
Conclusion
As this study was observational in nature, cause cannot be established, the researchers acknowledge. Moreover, a significant number of patients was lost to follow-up over the course of the 12 months, while information on the use of other prescribed medication was limited to addition or discontinuation, the authors note.
They conclude: ‘Our data suggest a role for [medicinal cannabis] as a safe and complementary treatment option in patients with cancer failing to reach adequate pain relief through conventional analgesics, such as opioids.’
Factfile
More than half of patients undergoing anti-cancer treatment and two thirds of those with advanced or terminal disease experience pain, the researchers state.
Powerful opioids along with other medication – such as anti-inflammatory and anticonvulsant drugs – are usually prescribed for pain relief.
But one patient in three will still experience pain, while the side effects of opioids include nausea, sleepiness, constipation, and respiratory depression.
To see the full version of the paper – titled Medical cannabis is effective for cancer-related pain: Quebec Cannabis Registry results doi 10.1136/spcare-2022-004003 – click
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