Experiencing pain is the simplest way to know that something isn’t right with our bodies. However, it isn’t always the easiest condition to diagnose or treat.
In the past few years, cannabis has made headlines as a new potential treatment for chronic pain associated with a large variety of conditions.
Some people use it to treat the chronic pain associated with the inflammation caused by arthritis; others may use it to treat the muscular pain associated with fibromyalgia or even neuropathic pain caused by muscular dystrophy.
Let’s take an in-depth look at pain, what causes it, how we experience it, and how cannabis may help in treating it.
Note: This article is written for informational purposes. Always consult your doctor or medical practitioner before experimenting with a new form of treating any kind of condition.
WHAT IS PAIN AND HOW DOES IT AFFECT US?
While pain may seem like a simple concept, the ways in which medical professionals diagnose it and how we experience is actually quite complex.
In its simplest form, pain is the body’s way of telling us that something isn’t right. Pain is often described as acute or chronic, which can be defined as follows:
Acute pain: Sharp and immediate. Mild acute pain may last only a few moments, while severe acute pain can stick around for weeks or months. Acute pain usually doesn’t last for longer than six months and disappears when the underlying cause of pain has been treated.
Chronic pain: Persistent even after a condition or illness has been treated and can last weeks, months, or even years. Can originate from an untreated injury/infection or can exist in the absence of damage to a certain area of the body. Cannabis is usually used to treat chronic pain.
Pain signals travel to the brain in 3 different ways.
Somatic pain, usually experienced as a persistent, dull ache in an injured area, travels to the brain via peripheral nerves located around the body. An example of somatic pain is the pain you experience for a brief period after you’ve bumped your knee or elbow.
Visceral pain, on the other hand, is a kind of pain caused by disease or damage to an internal organ.
Visceral pain signals are usually received and transmitted to the brain via specific receptors in the body and can cause people to think that the pain is located in a different part of the body than it’s actual source (known as referred pain).
Finally, neuropathic pain is mostly experienced as a burning sensation that can occur even after a gentle touch. It is caused by nerve damage and is usually experienced by AIDS or cancer patients.
Neuropathic pain cannot be treated y narcotic painkillers (such as codeine or methadone) but may occasionally respond to treatment with antidepressants or anticonvulsants.
THE PROBLEM WITH TRADITIONAL PAIN MEDICATIONS
According the National Institute of Health, approximately 50 million Americans suffer from chronic or sever pain. That’s more than the total number of people suffering from diabetes and heart disease combined (21 million and 28 million, respectively).
The most basic form of managing pain most of us are familiar with involve taking non-steroidal anti-inflammatory drugs like ibuprofen or aspirin. Acute and chronic pain is also commonly treated with prescription opiates like codeine or morphine.
Prescription opiates are rapidly becoming one of the most common forms of treating both acute and chronic pain.
In 2012, health care providers wrote 259 million prescriptions for opioid pain medication. That’s enough for every adult American to have a bottle of these pills.
Despite its prevalence, however, treating pain can extremely difficult, and many of the medications currently used to manage pain have a variety of limitations.
Ibuprofen and aspirin are fine for treating isolated cases of simple acute pain, such as headaches, for example. However, they offer little-to-no relief for chronic patients.
Opiate painkillers are also effective at relieving mild or severe acute pain but are not ideal for use in chronic sufferers.
“Unfortunately, patients rapidly develop tolerance to opioids, which significantly reduces their effectiveness for chronic therapy. Because of this as well as their addictive nature, potential for abuse and overdose, and side effects such as constipation, opioids are less than ideal agents for treating chronic pain. It is critical that we find alternatives,” says Professor Caudle.
Addiction and tolerance are two of the most concerning problem with opiate treatment for pain.
The total number of overdose deaths due to prescription opioid pain relievers have more than tripled in the past 20 years.
HOW DOES CANNABIS WORK TO TREAT CHRONIC PAIN?
Medical marijuana, whether smoked/vaporized or ingested, is showing a lot of potential in the treatment of chronic pain as it allows patients to avoid many of the problems associated with opiate medications.
The main cannabinoids associated with pain relief are THC and CBD. When cannabis enters our bodies, these cannabinoids activate various receptors around the body and brain.
These receptors, known as CB1 and CB2 (discovered in 1988 and 1993 respectively) form part of the human endocannabinoid system (ECS). Other mammals also have these systems, which play an important role in mediating a variety of physiological processes, such as appetite, mood, and more.
A 1997 study published in the European Journal of Pharmacology showed that the endocannabinoid system was involved in the control of pain.
Since then, further studies suggest that cannabis may offer effective relief from chronic pain while avoiding the issues of tolerance and addiction associated with opiates.
More recently, a 2016 study from the Clinical Journal of Pain, found that medicinal marijuana improved pain and functional outcomes in over 270 chronic patients. The results suggest that cannabis may have long-term benefits for treating chronic pain.
A 2012 paper published in the Journal of Psychoactive Drugs also found that, when used in conjunction with opiates, cannabinoids produced greater pain relief in patients, which eventually allowed them to decrease their use of opiates.
The paper also claims that cannabinoids can both help to prevent tolerance to opiates and even rekindle their pain-relieving effects once a patient has become tolerant to a previous dosage.
A 2010 paper published in the Canadian Medical Association Journal required adults with post-traumatic or post-surgical neuropathic pain to smoke 25mg doses of cannabis with varying levels of THC (0%, 2.5%, 6% and 9.4%) through a pipe three times a day for five days, followed by a nine-day washout period.
The participants were asked to record the intensity using a numeric rating scale, and researchers also noted the effects the varying strengths of THC had on mood, sleep, and quality of life.
The study found that a single inhalation of 25mg of 9.4% tetrahydrocannabinol cannabis taken three times daily for five days reduced the intensity of pain, improved sleep and was well tolerated by participants.
As always, there are limitations to most of these studies, and there more research is still needed in order to fully understand how the cannabinoids found in medical marijuana can help to manage chronic pain.
However, the studies mentioned above, as well as countless others, show promising results that medical cannabis can work to replace opiates in pain treatment and/or help to minimize their serious side effects.
Apart from THC and CBD, cannabis contains a variety of other cannabinoids and terpenes that may help to treat pain.
Cannabichromene, or CBC, for example, is the second most concentrated compound found in cannabis and has been shown to have clear anti-inflammatory properties, which may help to treat inflammatory pain in conditions such as arthritis.
CBN, or cannabinol, is another cannabinoid believed to have strong sedative effects which may help treat usually treatment-resistant pain in conditions like fibromyalgia.
Terpenes such as beta-myrcene, alpha-pinene, and beta-caryophyllene, have also been shown to have analgesic and anti-inflammatory effects which may also contribute to cannabis’ potential to treat chronic pain
THE PROBLEM WITH CANNABIS MEDICINE
Unfortunately, the cannabis grown both illegal and legally (for recreational and medical markets) is generally only rich in THC and CBD. And while there is plenty of evidence proving the efficiency of these cannabinoids in treating, it’s important that they also create some side effects.
THC, for example, is a psychoactive compound and is what produces the “high” we experience when we consume marijuana. Large doses of CBD and THC can also cause nausea, fatigue and more. This is concerning, especially as medical marijuana is often said to combat some of these symptoms.
The science on what causes these discrepancies isn’t clear. It could be that the studies conducted on cannabis are limited or have been performed incorrectly, or it could come down to something as simple as our individual body chemistries (and reactions to the drug) or even dosing.
Whatever it is, these discrepancies show that we simply don’t understand cannabis enough yet and more research is needed for us to fully comprehend this plant, how it affects our bodies, and how we can manipulate it into a powerful, reliable medicine.