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1.
Environ Sci Process Impacts ; 26(5): 928-941, 2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38635247

RESUMO

Motor vehicles are among the major sources of pollutants and greenhouse gases in urban areas and a transition to "zero emission vehicles" is underway worldwide. However, emissions associated with brake and tire wear will remain. We show here that previously unrecognized volatile and semi-volatile organic compounds, which have a similarity to biomass burning emissions are emitted during braking. These include greenhouse gases or, these classified as Hazardous Air Pollutants, as well as nitrogen-containing organics, nitrogen oxides and ammonia. The distribution and reactivity of these gaseous emissions are such that they can react in air to form ozone and other secondary pollutants with adverse health and climate consequences. Some of the compounds may prove to be unique markers of brake emissions. At higher temperatures, nucleation and growth of nanoparticles is also observed. Regions with high traffic, which are often disadvantaged communities, as well as commuters can be impacted by these emissions even after combustion-powered vehicles are phased out.


Assuntos
Poluentes Atmosféricos , Monitoramento Ambiental , Emissões de Veículos , Compostos Orgânicos Voláteis , Compostos Orgânicos Voláteis/análise , Poluentes Atmosféricos/análise , Emissões de Veículos/análise , Monitoramento Ambiental/métodos , Poluição do Ar/estatística & dados numéricos , Veículos Automotores
2.
J Geophys Res Atmos ; 124(2): 1148-1169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32832312

RESUMO

Emissions of C2-C5 alkanes from the U.S. oil and gas sector have changed rapidly over the last decade. We use a nested GEOS-Chem simulation driven by updated 2011NEI emissions with aircraft, surface and column observations to 1) examine spatial patterns in the emissions and observed atmospheric abundances of C2-C5 alkanes over the U.S., and 2) estimate the contribution of emissions from the U.S. oil and gas industry to these patterns. The oil and gas sector in the updated 2011NEI contributes over 80% of the total U.S. emissions of ethane (C2H6) and propane (C3H8), and emissions of these species are largest in the central U.S. Observed mixing ratios of C2-C5 alkanes show enhancements over the central U.S. below 2 km. A nested GEOS-Chem simulation underpredicts observed C3H8 mixing ratios in the boundary layer over several U.S. regions and the relative underprediction is not consistent, suggesting C3H8 emissions should receive more attention moving forward. Our decision to consider only C4-C5 alkane emissions as a single lumped species produces a geographic distribution similar to observations. Due to the increasing importance of oil and gas emissions in the U.S., we recommend continued support of existing long-term measurements of C2-C5 alkanes. We suggest additional monitoring of C2-C5 alkanes downwind of northeastern Colorado, Wyoming and western North Dakota to capture changes in these regions. The atmospheric chemistry modeling community should also evaluate whether chemical mechanisms that lump larger alkanes are sufficient to understand air quality issues in regions with large emissions of these species.

3.
Geophys Res Lett ; 45(20): 11423-11430, 2018 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33005064

RESUMO

Carbon tetrachloride (CCl4) is an ozone-depleting substance, accounting for about 10% of the chlorine in the troposphere. Under the terms of the Montreal Protocol, its production for dispersive uses was banned from 2010. In this work we show that, despite the controls on production being introduced, CCl4 emissions from the eastern part of China did not decline between 2009 and 2016. This finding is in contrast to a recent bottom-up estimate, which predicted a significant decrease in emissions after the introduction of production controls. We find eastern Asian emissions of CCl4 to be 16 (9-24) Gg/year on average between 2009 and 2016, with the primary source regions being in eastern China. The spatial distribution of emissions that we derive suggests that the source distribution of CCl4 in China changed during the 8-year study period, indicating a new source or sources of emissions from China's Shandong province after 2012.

4.
Sci Total Environ ; 574: 1021-1043, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27668854

RESUMO

Photochemical smog, characterized by high concentrations of ozone (O3) and fine particles (PM2.5) in the atmosphere, has become one of the top environmental concerns in China. Volatile organic compounds (VOCs), one of the key precursors of O3 and secondary organic aerosol (SOA) (an important component of PM2.5), have a critical influence on atmospheric chemistry and subsequently affect regional and global climate. Thus, VOCs have been extensively studied in many cities and regions in China, especially in the North China Plain, the Yangtze River Delta and the Pearl River Delta regions where photochemical smog pollution has become increasingly worse over recent decades. This paper reviews the main studies conducted in China on the characteristics and sources of VOCs, their relationship with O3 and SOA, and their removal technology. This paper also provides an integrated literature review on the formulation and implementation of effective control strategies of VOCs and photochemical smog, as well as suggestions for future directions of VOCs study in China.

5.
Environ Pollut ; 220(Pt A): 87-94, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27634000

RESUMO

From 2005 to 2013, volatile organic compounds (VOCs) and other trace gases were continuously measured at a suburban site in Hong Kong. The measurement data showed that the concentrations of most air pollutants decreased during these years. However, ozone (O3) and total non-methane hydrocarbon levels increased with the rate of 0.23 ± 0.03 and 0.34 ± 0.02 ppbv/year, respectively, pointing to the increasing severity of photochemical pollution in Hong Kong. The Hong Kong government has ongoing programs to improve air quality in Hong Kong, including a solvent program implemented during 2007-2011, and a diesel commercial vehicle (DCV) program since 2007. From before to after the solvent program, the sum of toluene, ethylbenzene and xylene isomers decreased continuously with an average rate of -99.1 ± 6.9 pptv/year, whereas the sum of ethene and propene increased by 48.2 ± 2.0 pptv/year from before to during the DCV program. Despite this, source apportionment results showed that VOCs emitted from diesel exhaust decreased at a rate of -304.5 ± 17.7 pptv/year, while solvent related VOCs decreased at a rate of -204.7 ± 39.7 pptv/year. The gasoline and liquefied petroleum gas vehicle emissions elevated by 1086 ± 34 pptv/year, and were responsible for the increases of ethene and propene. Overall, the simulated O3 rate of increase was lowered from 0.39 ± 0.03 to 0.16 ± 0.05 ppbv/year by the solvent and DCV programs, because O3 produced by solvent usage and diesel exhaust related VOCs decreased (p < 0.05) by 0.16 ± 0.01 and 0.05 ± 0.01 ppbv/year between 2005 and 2013, respectively. However, enhanced VOC emissions from gasoline and LPG vehicles accounted for most of the O3 increment (0.09 ± 0.01 out of 0.16 ± 0.05 ppbv/year) in these years. To maintain a zero O3 increment in 2020 relative to 2010, the lowest reduction ratio of VOCs/NOx was ∼1.5 under the NOx reduction of 20-30% which was based on the emission reduction plan for Pearl River Delta region in 2020.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/prevenção & controle , Monitoramento Ambiental , Política Ambiental , Poluição do Ar/legislação & jurisprudência , Alcenos , Derivados de Benzeno , Hong Kong , Hidrocarbonetos/análise , Ozônio/análise , Rios , Solventes , Tolueno/análise , Emissões de Veículos/análise , Compostos Orgânicos Voláteis/análise
6.
Science ; 351(6279): 1317-20, 2016 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-26917596

RESUMO

Single-point failures of natural gas infrastructure can hamper methane emission control strategies designed to mitigate climate change. The 23 October 2015 blowout of a well connected to the Aliso Canyon underground storage facility in California resulted in a massive release of natural gas. Analysis of methane and ethane data from dozens of plume transects, collected during 13 research-aircraft flights between 7 November 2015 and 13 February 2016, shows atmospheric leak rates of up to 60 metric tons of methane and 4.5 metric tons of ethane per hour. At its peak, this blowout effectively doubled the methane emission rate of the entire Los Angeles basin and, in total, released 97,100 metric tons of methane to the atmosphere.

7.
Atmos Chem Phys ; 16(9): 5969-5991, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29681921

RESUMO

Formation of organic nitrates (RONO2) during oxidation of biogenic volatile organic compounds (BVOCs: isoprene, monoterpenes) is a significant loss pathway for atmospheric nitrogen oxide radicals (NOx), but the chemistry of RONO2 formation and degradation remains uncertain. Here we implement a new BVOC oxidation mechanism (including updated isoprene chemistry, new monoterpene chemistry, and particle uptake of RONO2) in the GEOS-Chem global chemical transport model with ∼25 × 25 km2 resolution over North America. We evaluate the model using aircraft (SEAC4RS) and ground-based (SOAS) observations of NOx, BVOCs, and RONO2 from the Southeast US in summer 2013. The updated simulation successfully reproduces the concentrations of individual gas- and particle-phase RONO2 species measured during the campaigns. Gas-phase isoprene nitrates account for 25-50% of observed RONO2 in surface air, and we find that another 10% is contributed by gas-phase monoterpene nitrates. Observations in the free troposphere show an important contribution from long-lived nitrates derived from anthropogenic VOCs. During both campaigns, at least 10% of observed boundary layer RONO2 were in the particle phase. We find that aerosol uptake followed by hydrolysis to HNO3 accounts for 60% of simulated gas-phase RONO2 loss in the boundary layer. Other losses are 20% by photolysis to recycle NOx and 15% by dry deposition. RONO2 production accounts for 20% of the net regional NOx sink in the Southeast US in summer, limited by the spatial segregation between BVOC and NOx emissions. This segregation implies that RONO2 production will remain a minor sink for NOx in the Southeast US in the future even as NOx emissions continue to decline.

8.
Eur J Pain ; 17(4): 527-38, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23132624

RESUMO

BACKGROUND: Unusual symptoms such as digit misidentification and neglect-like phenomena have been reported in complex regional pain syndrome (CRPS), which we hypothesized could be explained by parietal lobe dysfunction. METHODS: Twenty-two patients with chronic CRPS attending an in-patient rehabilitation programme underwent standard neurological examination followed by clinical assessment of parietal lobe function and detailed sensory testing. RESULTS: Fifteen (68%) patients had evidence of parietal lobe dysfunction. Six (27%) subjects failed six or more test categories and demonstrated new clinical signs consistent with their parietal testing impairments, which were impacting significantly on activities of daily living. A higher incidence was noted in subjects with >1 limb involvement, CRPS affecting the dominant side and in left-handed subjects. Eighteen patients (82%) had mechanical allodynia covering 3-57.5% of the body surface area. Allochiria (unilateral tactile stimulation perceived only in the analogous location on the opposite limb), sensory extinction (concurrent bilateral tactile stimulation perceived only in one limb), referred sensations (unilateral tactile stimulation perceived concurrently in another discrete body area) and dysynchiria (unilateral non-noxious tactile stimulation perceived bilaterally as noxious) were present in some patients. Greater extent of body surface allodynia was correlated with worse parietal function (Spearman's rho = -0.674, p = 0.001). CONCLUSION: In patients with chronic CRPS, detailed clinical examination may reveal parietal dysfunction, with severity relating to the extent of allodynia.


Assuntos
Hiperalgesia/fisiopatologia , Lobo Parietal/fisiopatologia , Distrofia Simpática Reflexa/fisiopatologia , Atividades Cotidianas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Testes Neuropsicológicos , Medição da Dor , Estimulação Física
9.
Eur J Pain ; 16(2): 182-95, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22323371

RESUMO

Cortical reorganisation of sensory, motor and autonomic systems can lead to dysfunctional central integrative control. This may contribute to signs and symptoms of Complex Regional Pain Syndrome (CRPS), including pain. It has been hypothesised that central neuroplastic changes may cause afferent sensory feedback conflicts and produce pain. We investigated autonomic responses produced by ambiguous visual stimuli (AVS) in CRPS, and their relationship to pain. Thirty CRPS patients with upper limb involvement and 30 age and sex matched healthy controls had sympathetic autonomic function assessed using laser Doppler flowmetry of the finger pulp at baseline and while viewing a control figure or AVS. Compared to controls, there were diminished vasoconstrictor responses and a significant difference in the ratio of response between affected and unaffected limbs (symmetry ratio) to a deep breath and viewing AVS. While viewing visual stimuli, 33.5% of patients had asymmetric vasomotor responses and all healthy controls had a homologous symmetric pattern of response. Nineteen (61%) CRPS patients had enhanced pain within seconds of viewing the AVS. All the asymmetric vasomotor responses were in this group, and were not predictable from baseline autonomic function. Ten patients had accompanying dystonic reactions in their affected limb: 50% were in the asymmetric sub-group. In conclusion, there is a group of CRPS patients that demonstrate abnormal pain networks interacting with central somatomotor and autonomic integrational pathways.


Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Dor Crônica/fisiopatologia , Distrofia Simpática Reflexa/fisiopatologia , Percepção Visual/fisiologia , Adulto , Idoso , Doenças do Sistema Nervoso Autônomo/diagnóstico , Dor Crônica/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Estimulação Luminosa/métodos , Adulto Jovem
10.
Science ; 331(6022): 1295-9, 2011 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-21393539

RESUMO

A large fraction of atmospheric aerosols are derived from organic compounds with various volatilities. A National Oceanic and Atmospheric Administration (NOAA) WP-3D research aircraft made airborne measurements of the gaseous and aerosol composition of air over the Deepwater Horizon (DWH) oil spill in the Gulf of Mexico that occurred from April to August 2010. A narrow plume of hydrocarbons was observed downwind of DWH that is attributed to the evaporation of fresh oil on the sea surface. A much wider plume with high concentrations of organic aerosol (>25 micrograms per cubic meter) was attributed to the formation of secondary organic aerosol (SOA) from unmeasured, less volatile hydrocarbons that were emitted from a wider area around DWH. These observations provide direct and compelling evidence for the importance of formation of SOA from less volatile hydrocarbons.

11.
Environ Sci Technol ; 43(4): 1067-70, 2009 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-19320159

RESUMO

Sulfuryl fluoride (SO2F2) is a radiatively active industrial chemical released into the atmosphere in significant (ktonne/ year) quantities. The potential for SO2F2 to contribute to radiative forcing of climate change needs to be assessed. Long path length FTIR/smog chamber techniques were used to investigate the kinetics of the gas-phase reactions of Cl atoms, OH radicals, and O3 with SO2F2, in 700 Torr total pressure of air or N2 at 296 +/- 1 K. Upper limits of k(Cl + SO2F2) < 9 x 10(-19), k(OH + SO2F2) < 1.7 x 10(-14) and k(O3 + SO2F2) < 5.5 x 10(-24) cm3 molecule(-1) s(-1) were determined. Reaction with Cl atoms, OH radicals, or O3 does not provide an efficient removal mechanism for SO2F2. The infrared spectrum of SO2F2 is reported and a radiative efficiency of 0.196 W m(-2) ppbv(-1) was calculated. Historic production data estimates are presented which provide an upper limit for expected atmospheric concentrations. The radiative forcing of climate change associated with emissions of SO2F2 depends critically on the atmospheric lifetime of SO2F2. Further research is urgently needed to define the magnitude of potential nonatmospheric sinks.


Assuntos
Atmosfera/química , Cloretos/química , Efeito Estufa , Radical Hidroxila/química , Ozônio/química , Ácidos Sulfínicos/química , Ar/análise , Meio Ambiente , Cinética , Espectrofotometria Infravermelho , Fatores de Tempo
12.
Science ; 322(5904): 1085-8, 2008 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-19008442

RESUMO

Climate models incorporate photosynthesis-climate feedbacks, yet we lack robust tools for large-scale assessments of these processes. Recent work suggests that carbonyl sulfide (COS), a trace gas consumed by plants, could provide a valuable constraint on photosynthesis. Here we analyze airborne observations of COS and carbon dioxide concentrations during the growing season over North America with a three-dimensional atmospheric transport model. We successfully modeled the persistent vertical drawdown of atmospheric COS using the quantitative relation between COS and photosynthesis that has been measured in plant chamber experiments. Furthermore, this drawdown is driven by plant uptake rather than other continental and oceanic fluxes in the model. These results provide quantitative evidence that COS gradients in the continental growing season may have broad use as a measurement-based photosynthesis tracer.


Assuntos
Atmosfera/química , Fotossíntese , Plantas/metabolismo , Óxidos de Enxofre/análise , Dióxido de Carbono/análise , Dióxido de Carbono/metabolismo , América do Norte , Desenvolvimento Vegetal , Estações do Ano , Óxidos de Enxofre/metabolismo
13.
Rheumatology (Oxford) ; 47(9): 1417-21, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18632788

RESUMO

OBJECTIVES: Contralateral responses to unilateral stimuli have been well described in animal models. These range from central sensitization to peripheral inflammatory responses. Our aim was to test for contralateral responses following unilateral intradermal capsaicin injection in man. METHODS: Three groups were investigated. A healthy volunteer group (1) was injected with capsaicin into the volar aspect of one forearm. A group of patients with RA (2) was also injected with capsaicin. A control group of healthy volunteers (3) was not injected with capsaicin. All groups were tested for hyperalgesia and allodynia every 10 min for 1 h following the injection using quantitative sensory testing. RESULTS: A total of 9/14 healthy volunteers (Group 1) and 10/14 patients with RA (Group 2) demonstrated contralateral sensitization that subsided within 1 h following intradermal capsaicin injection. A total of 2/23 control subjects (Group 3) demonstrated positive responses with the monofilaments. The frequency of the contralateral responses in the experimental groups compared with the control group is significant (P < 0.05). The peak hyperalgesia was relatively delayed contralaterally compared with the ipsilateral side (35 min vs 15 min). The area of sensitization, where present, was reduced compared with the ipsilateral side (5-50%). CONCLUSIONS: This is the first demonstration of a contralateral response following a unilateral stimulus in man. Bilateral neural pathways mediating contralateral responses may have a role in the pathophysiology of chronically painful or inflammatory diseases and a confounding influence on using the contralateral limb as a control experimentally. We did not find that a systemic inflammatory disease sensitized for this phenomenon.


Assuntos
Artrite Reumatoide/complicações , Hiperalgesia/induzido quimicamente , Dor Referida/induzido quimicamente , Adulto , Idoso , Capsaicina , Feminino , Humanos , Hiperalgesia/etiologia , Injeções Intradérmicas , Masculino , Pessoa de Meia-Idade , Vias Neurais/fisiopatologia , Medição da Dor/métodos , Dor Referida/etiologia
14.
Rheumatology (Oxford) ; 47(11): 1612-6, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18625661

RESUMO

Complex regional pain syndrome (CRPS), a fairly common problem in rheumatological and orthopaedic practice, is an allodynic pain state of uncertain pathology often variably and unpredictably responsive to treatments. Although published diagnostic criteria are available, in the reality of clinical practice these do not appear to encompass the wide variety of symptoms that a patient may present with. This leads to scepticism on the part of the clinician and confusion for the sufferer. This article aims to provide some explanations for an often bewildering clinical picture. We provide a construct for the plethora of symptoms that we have entitled 'the embarrassment of pain perceptions'. With the aid of a case report we examine recent research that suggests how peripherally based symptoms and signs arise from changes within the central nervous system, with particular attention given to the control function of the motor-proprioceptive integrative system. We speculate how these changes within the central nervous system may provide the patient with CRPS the ability to access complex layers of lower level perceptions that are normally suppressed. We propose that such a system may explain some of the clinical puzzlements seen in this condition and suggest that the complexities of CRPS may provide an insight into brain development through evolution, which is a fruitful area for interdisciplinary clinical and scientific research.


Assuntos
Doenças do Sistema Nervoso Autônomo/etiologia , Síndromes da Dor Regional Complexa/etiologia , Adulto , Doenças do Sistema Nervoso Autônomo/psicologia , Encéfalo/fisiopatologia , Síndromes da Dor Regional Complexa/psicologia , Retroalimentação Psicológica , Feminino , Humanos , Masculino , Nociceptores/fisiologia , Limiar Sensorial/fisiologia
16.
Rheumatology (Oxford) ; 46(10): 1587-92, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17767000

RESUMO

OBJECTIVES: Conflict between sensory-motor central nervous processing generates somaesthetic disturbances, including pain, in healthy volunteers (HVs). Such conflict has been proposed as a potential cause of pain that occurs in the absence of injury or when the pain response is disproportionate to the injury. Fibromyalgia (FMS) exemplifies the former state. We hypothesized that the artificial generation of such conflict would exacerbate somaesthetic perceptions including pain in FMS greater than in HVs. METHODS: Twenty-nine adults with FMS took part in an established task that generates varied degrees of sensory-motor conflict during congruent/incongruent limb movements. A qualitative methodology recorded any changes in sensory experience. Data generated were compared with age and gender-matched HV data. RESULTS: Twenty-six subjects (89.7%) with FMS reported changes in sensory perception at some stage in the protocol in addition to, or worse than, baseline compared with 14 (48%) of HVs. All stages of the protocol generated a higher frequency of report in the FMS population than that of the maximum report in the HVs population. New perceptions included disorientation, pain, perceived changes in temperature, limb weight or body image. CONCLUSIONS: Our findings support the hypothesis that motor-sensory conflict can exacerbate pain and sensory perceptions in those with FMS to a greater extent than in HVs.


Assuntos
Fibromialgia/psicologia , Dor/etiologia , Transtornos de Sensação/etiologia , Adulto , Idoso , Doença Crônica , Extremidades/fisiopatologia , Fadiga/etiologia , Feminino , Fibromialgia/complicações , Fibromialgia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Dor/fisiopatologia , Dor/psicologia , Medição da Dor/métodos , Desempenho Psicomotor , Transtornos de Sensação/fisiopatologia
17.
Proc Natl Acad Sci U S A ; 104(40): 15613-8, 2007 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-17895380

RESUMO

Recent technical advances allow detection of several hundred volatile organic compounds (VOCs) in human exhaled air, many of which reflect unidentified endogenous pathways. Our group has previously estimated plasma glucose levels in healthy adults during a standard oral glucose tolerance test via exhaled VOC analysis. As a result of the metabolic characteristics of hyperglycemia in the diabetic (low insulin and increased free fatty acids and ketones), we hypothesized that different exhaled VOC profiles may be present in children with type 1 diabetes mellitus (T1DM) during spontaneous hyperglycemia. Exhaled methyl nitrate strongly correlated specifically with the acute, spontaneous hyperglycemia of T1DM children. Eighteen experiments were conducted among 10 T1DM children. Plasma glucose and exhaled gases were monitored during either constant euglycemia (n = 5) or initial hyperglycemia with gradual correction (n = 13); all subjects received i.v. insulin and glucose as needed. Gas analysis was performed on 1.9-liter breath samples via gas chromatography using electron capture, flame ionization, and mass selective detection. Among the approximately 100 measured exhaled gases, the kinetic profile of exhaled methyl nitrate, commonly present in room air in the range of 5-10 parts per trillion, was most strongly statistically correlated with that of plasma glucose (P = 0.003-0.001). Indeed, the kinetic profiles of the two variables paralleled each other in 16 of 18 experiments, including repeat subjects who at different times displayed either euglycemia or hyperglycemia.


Assuntos
Testes Respiratórios , Diabetes Mellitus Tipo 1/sangue , Hiperglicemia/diagnóstico , Nitratos/análise , Biomarcadores/análise , Glicemia/análise , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Criança , Diabetes Mellitus Tipo 1/tratamento farmacológico , Expiração , Gases/análise , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Valores de Referência
20.
Rheumatology (Oxford) ; 45(1): 50-2, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16282192

RESUMO

OBJECTIVES: To assess the efficacy of a cannabis-based medicine (CBM) in the treatment of pain due to rheumatoid arthritis (RA). METHODS: We compared a CBM (Sativex) with placebo in a randomized, double-blind, parallel group study in 58 patients over 5 weeks of treatment. The CBM was administered by oromucosal spray in the evening and assessments were made the following morning. Efficacy outcomes assessed were pain on movement, pain at rest, morning stiffness and sleep quality measured by a numerical rating scale, the Short-Form McGill Pain Questionnaire (SF-MPQ) and the DAS28 measure of disease activity. RESULTS: Seventy-five patients were screened and 58 met the eligibility criteria. Thirty-one were randomized to the CBM and 27 to placebo. Mean (S.D.) daily dose achieved in the final treatment week was 5.4 (0.84) actuations for the CBM and 5.3 (1.18) for placebo. In comparison with placebo, the CBM produced statistically significant improvements in pain on movement, pain at rest, quality of sleep, DAS28 and the SF-MPQ pain at present component. There was no effect on morning stiffness but baseline scores were low. The large majority of adverse effects were mild or moderate, and there were no adverse effect-related withdrawals or serious adverse effects in the active treatment group. CONCLUSIONS: In the first ever controlled trial of a CBM in RA, a significant analgesic effect was observed and disease activity was significantly suppressed following Sativex treatment. Whilst the differences are small and variable across the population, they represent benefits of clinical relevance and show the need for more detailed investigation in this indication.


Assuntos
Analgésicos/uso terapêutico , Artrite Reumatoide/complicações , Dor/prevenção & controle , Extratos Vegetais/uso terapêutico , Administração Oral , Canabidiol , Método Duplo-Cego , Dronabinol , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Extratos Vegetais/efeitos adversos , Resultado do Tratamento
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