Cannabis and Chronic Pain: a New Hope
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Introduction
The experience of chronic pain is much more than just a physical sensation; it is an emotional, social and psychological burden that can drastically transform the lives of those who suffer from it. This is because chronic pain is not limited to a specific moment in time, but persists for months and years, disrupting a person's routine and diminishing their quality of life.
People living with chronic pain struggle daily with constant fatigue, difficulty sleeping and limited mobility, making it impossible to perform basic tasks and participate in social activities. This has a significant impact on mental health, contributing to stress, anxiety, depression and loss of self-esteem.
In the search for effective solutions to chronic pain, cannabinoids have emerged as a promising option in the medical field.
These substances are classified into three types: endocannabinoids, produced internally by the body; phytocannabinoids, found in plants such as cannabis; and synthetic, artificially manufactured cannabinoids. All of these interact in different ways with the body's endocannabinoid system, making them promising candidates for addressing chronic pain, a condition that affects a significant proportion of the world's population.
Epidemiological data reveal that chronic pain is a major burden on society, with estimates suggesting that 20-40% of the world's population experience it. This is why cannabis has emerged as an interesting alternative in the treatment of pain, especially in patients who do not respond adequately to conventional analgesics and anti-inflammatory drugs.
In this article we will explore in detail the role of cannabis and CBD in the treatment of chronic pain. In addition, we will address different studies that document the analgesic efficacy of cannabis in patients with rheumatic pathologies such as arthritis and osteoarthritis.
Don't miss this opportunity to delve into a topic that is transforming the field of pain management!
The Endocannabinoid System and Pain Perception
In this section we will explore how cannabinoids, specifically THC and CBD, interact with the body's endocannabinoid system to influence the way we perceive pain.
The endocannabinoid system, as we previously discussed in the article "Meet Raphael Mechoulam and the Endocannabinoid System", is an intercellular system that works in conjunction with cannabinoids to maintain the body's homeostasis. Its main objective is to achieve a metabolic balance to optimise the functioning of our body. This signalling system therefore plays a key role in the regulation of various physiological functions, including pain perception.
Exogenous cannabinoids, such as THC (tetrahydrocannabinol) and CBD (cannabidiol), interact with the endocannabinoid system by influencing cannabinoid receptors, in particular CB1 and CB2 receptors.
THC has a considerable affinity for CB1 receptors, which are mostly present in the central nervous system, whereas CBD has a more complex interaction with several receptors and systems, including cannabinoid receptors, serotonin receptors and ion channels.
When cannabinoids bind to cannabinoid receptors in the endocannabinoid system, they trigger a number of cellular responses that can influence the perception of pain.
We could say that THC helps to decrease the amount of pain signals the body sends to the brain, which can result in a reduced sensation of pain, while CBD can help to reduce inflammation and calm the nerves, which can also relieve pain.
Scientific studies
In this section we will discuss key insights from two scientific studies that support the use of cannabis to relieve chronic pain of rheumatic and osteoarticular origin. We certainly encourage you to read them.
Summary Study "Use of cannabis in chronic pain" by reciMundo 2023
This study arises in response to an unmet clinical need, as a possible solution to pain management. It focuses on evaluating the analgesic potential of cannabis, specifically the cannabinoids THC and CBD, in patients with chronic pain of rheumatic origin, such as arthritis and osteoarthritis.
The research seeks to contribute to knowledge about alternative therapies for chronic pain, especially in regions where information about its prevalence and treatment is limited. This is why the use of medicinal plants, including cannabis, has emerged as a possible solution for pain management.
Next, we are going to show you some tables of what we have considered most important in the study; background of the use of cannabis in medicine, results of some systematic reviews on the analgesic properties of cannabinoids and some cannabinoids that have been used for the treatment of pain. Finally, a summary of 4 cases of people with rheumatic pain will be presented.
Relevant Data os the Study
Background on the use of cannabis in medicine
Results of some systematic reviews on the analgesic properties of cannabinoids.
Conclusions and Recommendations from Medical Organisations and Specialist Journals
- The IASP states that cannabinoids are not conclusively effective against chronic neuropathic pain.
- The American Academy of Neurology suggests the use of oral or buccal spray THC or CBD to reduce symptoms of spasticity and pain in multiple sclerosis.
- The National Academies of Sciences, Engineering and Medicine review concluded that cannabis and cannabinoids are effective in the treatment of chronic pain in adults.
- BMJ (2021) recommends the use of non-inhaled medical cannabis and cannabinoids when standard therapy is not sufficient to relieve pain. Furthermore, it suggests starting with low doses of non-inhaled CBD and gradually increasing according to clinical therapeutic response and tolerability.
Clinical Cases and Study Results
Below is a table summarising the 4 clinical cases discussed in the study.
You can see that the results show a considerable improvement in pain and quality of life of the treated patients.
Conclusion of Study
The research highlights the efficacy of cannabinoids in reducing pain and improving the quality of life of patients who did not respond adequately to conventional treatments. Despite the need for further research to determine the optimal dose and possible long-term side effects, the results suggest that medical cannabis may be a promising alternative in the treatment of chronic pain, especially in cases where conventional treatments are insufficient.
Study Link
Link Study: Use of Cannabis in chronic pain (2023)
Study 2: RMU study "Clinical benefit of cannabinoid therapy for non-oncological pain" (2023)
This study arises due to the problem of chronic non-oncological pain, which represents a significant concern in contemporary medicine, affecting medical, social and occupational aspects.
The research mentions how Uruguay has marked an important milestone in the regulation of cannabis use, with the approval of laws that allow its cultivation, sale and medicinal use. This regulation has facilitated access to medical cannabis (MC) products, opening up new therapeutic possibilities for patients with chronic pain. Despite these advances, research on the clinical use of cannabinoids in the treatment of pain remains an area of interest and debate.
The aim of this retrospective exploration is to evaluate the clinical benefit of medicinal Cannabis (MC) preparations in patients with chronic non-cancer pain, with a particular focus on osteoarticular and neuropathic pain.
Through a detailed analysis, we seek to understand the efficacy and safety of cannabinoids in pain management, as well as their impact on patients' quality of life.
Relevant Data os the Study
- Population studied: The sample consisted of 438 Uruguayan patients with chronic non-cancer pain who did not respond to standard treatment.
- Cannabis regulation in Uruguay: Since 2013, Uruguay has progressively regulated the use of medical cannabis, which has expanded access to this therapy for patients with various conditions.
- Aim of the Study: To retrospectively evaluate the effectiveness and safety of medical cannabis in patients with refractory chronic non-cancer pain.
- Methodology: A descriptive, observational and longitudinal design was used, with variable follow-up in each case. Data were collected on the efficacy of the treatment, the presence of adverse effects and the type of pathology that motivated the consultation.
- Variables studied: Included age, sex, schooling, health care coverage, type of pathology that motivated the consultation, accompanying diseases, previous pain medication, indication for medical cannabis, type of chemotype used, indicated dose and effectiveness of the treatment.
- Expected results: We expected to observe a significant reduction in chronic non-cannabinoid-treated non-cannabinoid pain in patients treated with cannabinoids, as measured by the numerical pain scale (NRS). Adverse events associated with cannabinoid treatment were also assessed.
- Statistical analysis: Measures of central tendency and dispersion were used for quantitative variables, and frequencies for categorical variables. Baseline and post-treatment pain levels were compared using appropriate statistical tests.
Results
The study covered the period from September 2016 to March 2020, during which 2,038 patients consulted in CEDU, with 438 of them being for chronic non-oncological pain. Of these patients, 74% were female and 26% male, with an average age of 69 years and more than 84% had secondary or tertiary education. Osteoarticular pain was the most common (71.9%). Standard treatment at baseline was mainly based on NSAIDs (76%) and opioids (34.3%).
Of the 438 patients who started treatment with cannabinoids, the majority (71.7%) received 5% full spectrum CBD. The results showed a statistically significant response at one and three months, with a significant decrease in pain over time. The response to treatment at three months was very good in 42.9% of patients, and 84.2% had no or only mild adverse effects. In addition, there was a reduction in the use of NSAIDs, opioids, corticosteroids and pregabalin as standard pain treatment.
Conclusions
The retrospective study on the use of cannabinoids (CM) in the treatment of chronic non-cancer pain reveals that these compounds may be an effective option for patients who do not respond to standard treatment. Despite the limitations inherent to the retrospective design, a significant reduction in pain was observed in successive controls, showing a positive response to treatment.
The study group, composed mostly of older women with secondary or tertiary education, reflects the local demographic trend. Most patients had osteoarticular pain, for which cannabinoids proved to be effective, although the medical literature tends to focus more on neuropathic pain.
Treatment with cannabinoids, mainly 5% CBD, resulted in a significant decrease in pain and reduced the use of other pain medications, such as opioids and NSAIDs. Tolerability of treatment was good, with mostly mild to moderate adverse effects, supporting the safety of cannabinoid use in this setting.
While acknowledging the need for controlled clinical studies to validate these findings, the evidence obtained supports the integration of cannabinoids in the treatment of chronic non-cancer pain, with the aim of reducing polypharmacy and improving patients' quality of life.
In conclusion, this study underlines the potential benefit of cannabinoid use in the management of chronic non-cancer pain and highlights the importance of making these treatments more accessible to patients in need.
Study Link
Management Options and Practical Tips
The delivery of cannabis as a therapeutic treatment has evolved considerably, offering a variety of forms of consumption to suit individual patient needs and preferences. From traditional methods to innovative delivery techniques, the diversity of administration options allows for greater personalisation of treatment.
If you are interested in learning about the different forms of administration, I encourage you to take a look at the article "What is the best way to take CBD"..
Tips for those considering using cannabis for pain management
- Consultation with a doctor: Before starting any cannabis treatment for pain, it is crucial to talk to a doctor who is familiar with your medical history and can provide guidance on the most appropriate treatment options for you.
- Start with low doses: If you decide to try cannabis, it is advisable to start with low doses and gradually increase as needed. This will allow you to assess your tolerance and response to treatment without experiencing unwanted effects.
- Choose quality products from reliable sources: Be sure to purchase quality cannabis products, preferably from reliable and regulated sources. Look for products that are lab-tested for cannabinoid content to ensure they are safe and effective.
- Consider different forms of administration: Explore different ways to administer cannabis, such as inhalation, ingestion, topicals or edibles. Each delivery method has its own advantages and considerations, so choose the one that best suits your needs and preferences.
- Monitor for side effects: Be aware of any side effects or unwanted reactions you may experience when using cannabis for pain. If you experience negative effects, consult with your doctor to adjust your treatment or consider other options.
- Be aware of local laws and regulations: Familiarise yourself with local laws and regulations regarding the use of medical cannabis in your area. Make sure you comply with all applicable regulations and obtain products legally and safely.
Guides to manage chronic pain
We know that dealing with chronic pain can be challenging. That's why we'd like to recommend some pain management guidelines to help you face the day with more strength.
Link Guide 2: Guide to pain management - Grunenthal
Conclusion
In this article, we have explored the potential benefits of cannabis in the treatment of chronic pain, specifically rheumatic and osteoarticular pain. It has been highlighted that cannabis may be a valid option for patients who do not find relief with standard treatments. Data from retrospective studies suggest that the use of cannabinoids, especially CBD, can significantly reduce the level of pain in patients with chronic non-cancer pain.
In addition, the importance of proper medical care was emphasised when considering the use of cannabis for chronic pain. Patients are advised to start with low doses, consult with a specialised physician and purchase quality products from reliable sources. The need for continued research to better understand the effects of cannabis in pain management and to ensure its safe and effective use has been highlighted.
In summary, cannabis shows promise as a therapeutic option for chronic pain, but individualised assessment and careful medical monitoring are required to maximise its benefits and minimise the risks.
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