Cannabis and Pain
Pain is the most common condition reported by patients for
using cannabis medicine. In a 2017 National Academies report, Pain was the
primary symptom with evidence supporting the use of cannabis medicines. https://www.nap.edu/resource/24625/Cannabis_committee_conclusions.pdf
The history of cannabis proves it’s use for pain management.
The Chinese found evidence of medical use of cannabis more than four millennia
ago. In the ninth century, the Persian physician Shapur ibn Sahl would pack the
nose of migraine sufferers with juice from cannabis flower to treat their
severe headache pain. Cannabis was widely used in patient medicines for a
variety of symptoms, including pain, as early as the mid 1800s in the United
States.
In 1887, Hobart Amory Hare, a professor of medicine at
Jefferson Medical College Philadelphia, published a long article in the Therapeutic Gazette about the advantage
of cannabis over opium for treating pain. https://www.scribd.com/document/77188793/Hobart-Amory-Hare-Clinical-and-Physiological-Notes-on-the-Action-of-Cannabis-Indica
The types of pain are: neuropathic (originating in nerves),
visceral (originating in an organ), somatic (the skin or musculoskeletal
tissue), and psychogenic (tension headache or panic attack). Unlike other pain
medications, cannabis can treat all of these types of pain.
A University of California San Diego study revealed low
doses of cannabis provide little relief, while moderate doses produce good pain
relief (and large doses may actually increase pain levels). https://www.futuremedicine.com/doi/abs/10.2217/pmt.15.20?journalCode=pmt
Most studies on the use of cannabinoids for treating chronic
pain have been encouraging. Aggarwal found that out of 38 published RCTs
studies (before 2012), 71% of those studies demonstrated significant
pain-relieving effects of medical cannabis. https://www.ncbi.nlm.nih.gov/pubmed/22367503
“With increased use of medical
cannabis as pharmacotherapy for pain comes a need for comprehensive
risk-benefit discussions that take into account cannabis' significant possible
side effects. As cannabis use increases in the context of medical and
recreational cannabis policies, additional research to support or refute the
current evidence base is essential to attempt to answer the questions that so
many healthcare professionals and patients are asking” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549367/
Cannabis has been investigated to treat forms of pain that
does not respond well to opioids. Cannabis may be effective for pain-related
syndromes, such as complex regional pain, reflex sympathetic dustrophy,
neuropathies, and intractable cancer pain, which responds poorly to traditional
analgesics. https://www.ncbi.nlm.nih.gov/pubmed/18403272
https://www.ncbi.nlm.nih.gov/pubmed/23237736
While there are no studies that show how cannabinoids can
treat trigeminal neuralgia, which involves severe facial pain, patients are
claiming that cannabis reduces the extraordinary intensity of the attacks.
A series of reports show that cancer patients who use
cannabis had less anxiety, which can contribute to the intensity of experience
of pain. https://www.ncbi.nlm.nih.gov/pubmed/24937161
Animal studies and anecdotal cases indicate that cannabis is
effective against both neuropathic and visceral (organ) pain in cancer
patients. https://www.ncbi.nlm.nih.gov/pubmed/27863159
Clinical data indicates that cannabis medicines may reduce
the dose of opioid medicines required to treat severe pain. https://www.ncbi.nlm.nih.gov/pubmed/25978826
https://www.ncbi.nlm.nih.gov/pubmed/27001005
Cannabinoids may also reduce the tolerance buildup to opioid
medicines and CBD may even reduce the severity of withdrawal. THC reduces
gastrointestinal bleeding and even hemorrhages caused by nonsteroidal,
anti-inflammatory drugs used to control pain.
Cannabinoids, especially the combination of THC and CBD,
appear particularly effective for intractable pain conditions, including those
associated with multiple sclerosis and cancer. The cannabinoid CBG is a
stronger analgesic.
The Endocannabinoid System interacts with cannabis and helps
to modulate pain signaling throughout the nervous system. Cannabinoids can
relieve pain through a variety of mechanisms, including producing analgesic and
anti-inflammatory effects, through the modulation of neurotransmitter release,
and by stimulating the release of the body’s own natural opioids.
THC was found to displace opioids from the receptor to which
they bind and also allow for reductions in the dose of opioids necessary to
treat high levels of pain. Cannabinoids quell the transmission of ascending
(toward the spine and brain) pain signals. They also modulate pain signaling in
the descending pain pathway from the brain/spine to the affected region.
Endocannabinoids and their deficiency are involved in
painful syndromes, such as fibromyalgia and migraines, which might possibly be
addresses through low-dose cannabis prophylaxis. Cannabinoids reduce
sensitivity to pain.
Medical cannabis augments the effect of opioids, making dose
reduction (or even discontinuation) possible. Any changes to dose or use of
opioid medications should always be undertaken with the supervision of a
trusted physician. Find a trusted
physician who understands cannabis, your personal conditions, and who wants to
help you get off opioids.
To establish the most effective dose of cannabis for pain,
take the least amount of cannabis required to provide the level of effect
needed. Take less, rather than more, and carefully increase the dose only until
optimal effectiveness is reached. Doing this may decrease the possibility of
developing a tolerance to the benefits of cannabis.
Patients report that oral cannabis products work for chronic
pain, but finding the right dose is difficult and requires patience, caution,
and knowledge of potency of the medical cannabis preparations ingested. Oral
cannabis makes restorative sleep possible and reduces the perception of pain
during the night. Patients can achieve pain relief by using very small doses of
an edible in the morning and afternoon – typically, one-fourth of the bedtime
dose. Swallowing cannabis containing THC increases the length of time they are
effective for analgesia and for sleep. Use oral cannabis containing both THC
and CBD. CBD prolongs the effects of THC while reducing some of its side
effects.
Take 2.5 to 7.5 mg THC orally, every three to four hours, to
manage low level to moderate pain. The addition of 2.5 to 10 mg of CBD to the
THC dose can reduce the intensity of THC psychoactivity while providing a
measure of neuroprotection. Oral cannabis may take 30 – 45 minutes for the
effects to be felt. Be careful and use caution not to over medicate and not to
exceed the optimal dose for relief.
Patients report that either inhaled, sublingual tinctures,
or oral spray, medical cannabis removes anticipatory bad pain memories, as it
treats PTSD.
Vaporized or inhaled THC is recommended for faster onset of
pain relief. 2.5 to 7.5 mg of THC is recommended. Cannabis naïve patients
should start with no more than 2.5 mg of THC and wait 45 minutes before taking
more.
Topical applications of cannabis act by stimulating the CB2
receptors in the sensory nerve endings in the skin. A topical application
relieves pain for two or more hours. Topical, high-THC cannabis is useful for
pain-related conditions such as itching, skin inflammation, and dermatitis.
CBD-rich cannabis medicines are also quite effective for skin inflammation. For
topical preparations to work, the pain must be localized (a joint or peripheral
nerve), and the preparation should have high concentrations of THC and CBD. Transdermal Cannabis patches are very helpful for localized pain relief as well as fibromyalgia.
THC is the most important pain-relieving cannabinoid
currently available. CBD and terpenes (such as myrcene and beta-caryophyllene) can also contribute significantly to pain
and anxiety relief. Patients need a more stimulating option for use during the
day (like sativa, or high CBD varieties) and a more sedative variety for sleep
at night (like indica) to assist with recovery and sleep.
Some good books to check out are: Cannabis for Chronic Pain by Dr. Ivker
Information was taken from the fabulous book: Cannabis Pharmacy by Michael Backes
For more research information check out these helpful links:
Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain - https://www.ncbi.nlm.nih.gov/pubmed/17257464
Neuropathic orofacial pain: cannabinoids as a therapeutic avenue - https://www.ncbi.nlm.nih.gov/pubmed/2515083
Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors - https://www.ncbi.nlm.nih.gov/pubmed/22585736
Cannabinoids in the management of difficult to treat pain - https://www.ncbi.nlm.nih.gov/pubmed/18728714
Cannabidiol-Δ9-tetrahydrocannabinol interactions on acute pain and locomotor activity - https://www.ncbi.nlm.nih.gov/pubmed/28445853
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