What is Palliative Care
Palliative care is the treatment, care, and support of people with an untreatable, progressive, and/or advanced illness that is life-limiting, life-threatening, and/or terminal. Examples of life-limiting illnesses include advanced cancer, motor neuron disease (MND), and dementia. However, palliative care can also extend to helping family and friends cope with their emotions and needs in their day-to-day lives.
The principal aim of palliative care is to support, improve and maintain a good quality of life, including being as well and as active as is possible in the time patients have left. This includes:
- Managing physical symptoms such as pain
- Providing emotional, spiritual, and psychological support
- Social care, including helping with things like washing, dressing, and eating
- Supporting family and friends
Palliative care can be provided at any stage of illness and receiving it does not necessarily mean that death is imminent. Instead, palliative care can be provided for many years alongside other treatments, therapies, and medicines aimed at controlling the illness.
What is End of Life Care
One specific and very important form of palliative care is end-of-life care that involves the treatment, care, and support for people who are nearing the end of their life. Unlike palliative care that can be helpful at any stage of a life-limiting illness, end-of-life care is generally limited to the last year of projected life. However, this timeframe can be difficult to predict, as some people might only receive it in their last weeks, or days.
End-of-life care’s main aims are to help terminal patients live as comfortably as possible in the time they have left, with patients often requiring more care than patients in palliative care. End-of-life care is especially focused on the management of physical symptoms while also providing emotional support for both patients and their loved ones. Conversations often involving talking about the needs and wishes of the patient (including support with practical things like making a will or getting financial support) as well as everyone can expect towards the end of the patient’s life.
Palliative Care Medications & Treatments
Palliative and end-of-life care usually combine medical treatments and medicines with therapies and care from various professionals. The type of medicines and professionals involved largely depend on that sort of care and support the patient needs as well as where care is provided (e.g., at home, care home, nursing home, or hospice).
Medical treatments and pharmaceutical interventions are aimed at controlling the illness the patient is suffering from, but also additional medication that can help with controlling symptoms and side-effects. These often include things like pain medications, sedatives, antidepressants, anxiolytics, and anti-emetics.
Because palliative and end of life care is focused on providing comfort and maintaining the quality of life, non-pharmaceutical interventions tend to be provided by teams made up of general as well as specialist care professions.
- General health and social care professionals give day-to-day palliative care to people as part of their roles and can include the patient’s GP, district or community nurses, social workers, care workers, and spiritual care professionals.
- Specialist palliative care professionals will have training and experience in providing palliative care. They might be involved in managing more complex care problems, usually work in teams to provide cohesive and complementary care. Specialist teams include palliative care doctors, nurse specialists, psychological and spiritual counselors as well as specialist health professionals, such as physiotherapists, occupational therapists, dieticians, and social workers.
Cannabinoids for Palliative Care & End of Life Care
Research & Scientific Evidence
There is an increased interest in the use of cannabinoids in the treatment of symptoms in palliative care patients. This is primarily due to their multimodal action and favorable adverse side effect profile, making them an attractive alternative, particularly in patients with multiple concomitant symptoms of mild and moderate intensity. Especially cannabidiol (CBD) in combination with tetrahydrocannabinol (THC) is becoming increasingly popular in the treatment of pain, sleep disorders, nausea, and vomiting.
Palliative Care with CBD in Combination with THC
Medical cannabis that contains both CBD and THC is increasingly being used in the treatment of terminal patients. Treatment specific disease settings include Alzheimer’s disease, cancer (including pain, nausea, vomiting, and tumor control), HIV, spasticity, depression, and PTSD.
However, research seems to underscore the importance of the CBD to THC ratio being a vital consideration in efficacy as this ratio seems to explain considerable variance in perceived effectiveness, which will, in turn, the ratio also determine treatment decisions.
To illustrate, in a 2019 study published in the Journal of Palliative Medicine, researchers showed that in 26,150 observations monitoring pain, anorexia, anxiety, depressive, insomnia, and post-traumatic stress symptoms, positive responses were associated with increased THC to CBD ratios for pain, insomnia, and depressive symptoms. However, increasing THC ratios had no measurable positive effect for post-traumatic stress disorder (PTSD)-related flashbacks or anorexia.
Clinical trials that combine THC with CBD also suggest that the role of formulation and delivery system is critical in establishing and optimizing the risk-benefit profile of cannabinoid medicines. Synergies between cannabinoids have the potential to treat pain, sleep disorders, appetite loss, muscle spasm as well as a wide range of other palliative and end-of-life conditions and symptoms effectively, often being more beneficial than their isolates.
What this developing body of literature is suggesting is that, when medical cannabis is administered using the right formulations, the right ratios, and in the correct dosages, the combination of CBD and THC can help with the treatment of symptoms in a variety of terminal conditions. Their synergistic effects therefore not only contributing to improved palliative and end-of-life patient care but potentially also as first-line interventions.
CBD in Palliative Care
However, many people do not have legal access to medical cannabis or find its intoxicating effects undesirable. For those palliative and end-of-life care patients, CBD on its own can also be beneficial, showing promise in helping relieve various symptoms, particularly for the treatment of pain, anxiety, depression, sleep disorders, muscle spasms, convulsions, and seizures.
The use of CBD for pain is popular, with scientific data showing that it has the ability to mediate both neuropathic and inflammatory pain. For example, repeated oral treatments with CBD reverses increased sensitivity to pain via two mechanisms. The first is by inhibiting the uptake of anandamide which is involved in pain control through activation of cannabinoid CB1 and CB2 receptors. The second mechanism is by acting as an agonist that desensitizes the vanilloid TRPV1 receptors implicated in pain.
CBD also shows significant anti-allodynic effects in chronic pain. Scientists evaluated the pain-blocking potential of CBD and found that the mechanism by which CBD does this via the activation of the serotonergic system, blocking pain signals via the 5-HT1A receptors thought to be involved in the sensation of pain.
Moreover, several studies have investigated the role of, and mechanisms by which, CBD can play a role in successfully treating anxiety and depression. Researchers have found that CBD proved to be a useful, versatile, and safe substance in the treatment of depression with no adverse effects on cognitive functioning or mobility.
Similarly, CBD has the ability to regulate emotion and emotional memory processing via the same serotonin subtype 5-HT1A receptors targeted by anxiolytic, antidepressant, and antipsychotic medications. In addition, CBD is also effective in relieving symptoms of anhedonia as well as hopelessness and helplessness and helplessness, thought to be due to its polypharmacological profile that results in multiple mechanisms of action.
In addition, CBD shows promise for having the potential to help treat a variety of issues palliative and end-of-life care patients struggle with, including dementia, seizures and convulsions, spasticity, neurodegeneration, and related disorders as well as PTSD and stress.
Treatment & Product Considerations
There is enough data that indicates that CBD has an exceedingly safe and favorable side effect profile, making it suitable for use in palliative care patients. However, before integrating CBD into a palliative care routine, there are certain considerations that should be kept in mind. These include:
- Strength and potency: Try to purchase the strongest CBD products possible. More severe illnesses often require more CBD to be effective and restore homeostasis.
- Product types: Consider using a multifaceted approach that incorporates different product types for different circumstances. For example, full-spectrum CBD oils are great for daily symptom relief and control, while products such as vaporizers and topicals can provide relief if and when needed.
- Contraindications: Despite CBD being safe, even at high dosages, CBD can interact with pharmaceutical drugs. It is important to always speak to the treating physician before using medical cannabis or CBD.
- Legalities: The legality surrounding medical cannabis and CBD varies greatly from state to state and country to country. Ensure that all cannabinoid-based products, whether extracted from cannabis or hemp, comply with local and country laws.
From the scientific evidence, it is clear that the polypharmacological profile and multiple mechanisms of action of CBD can help palliative and end-of-life care patients in multiple ways. In addition, early data suggests that CBD can also play a role in the primary treatment of various terminal conditions as well. However, research is in the early stages and very few human trials have been completed that investigates the use of CBD in palliative care treatment, making it of vital importance to consult the treating physician or other medical practitioner as they can monitor and advise on dosage, symptom severity, drug interactions, and other clinical parameters.