Not all pain is equal
Pain relief can be tricky, since not all pain is the same. Pain can be cancer-related or neuropathic. It can be central pain (related to multiple sclerosis) or it can be visceral (related to the gut). Pain can also be acute and short-lived or chronic, lasting for months or years. Normally for acute pain, such as the kind you may experience after an injury or an operation, or neuropathic pain which is related to a whole host of diseases such as diabetes or cancer, doctors will prescribe opiates or NSAIDS (non-steroidal anti-inflammatory drugs).
However, opiates and NSAIDS are less effective in treating chronic pain. Both have adverse side-effects, including nausea, stroke, erectile dysfunction, heart-attack, hepatoxicity. Opiates often cause sedation that make long-term opiate use burdensome to the user. Plus, long-term use of traditional pain relievers builds tolerance, meaning that for these analgesics to continue to be effective, users must consistently increase their dosage. This can also lead to accidental overdose.
However, there is a light at the end of the tunnel. Research has proven time and time again that cannabis can be employed to relieve pain without the adverse side-effects that come from synthetic analgesics.
A 2008 double-blind, randomized clinical trial at the University of California Davis found that both high and low doses of inhaled cannabis reduced neuropathic pain of various causes. The subjects who participated in the study were chosen for their unresponsiveness to standard pain therapies.
In another clinical trial conducted in 2013, researchers reported that both inhaled and oral THC decreased pain significantly. The trial exposed healthy subjects to painful stimuli and discovered that the subjects had decreased pain sensitivity and increased pain tolerance with the use of either smoked or orally-administered THC.
Also in 2013, a clinical trial provided evidence that vaporized cannabis had a strong impact on neuropathic pain. Low doses of vaporized THC (1.29%) “provided statistically significant 30% reductions in pain intensity when compared to placebo.”
There is also strong evidence that the compound THCa is highly effective in treating pain. THCa is the more commonly known compound THC before it’s dried and burned. In this raw state, THCa is non-psychoactive and has anti-proliferative, anti-spasmodic, and anti-inflammatory properties. It’s anti-inflammatory properties are responsible for reducing the pain of ailments from arthritis to endometriosis and even menstrual cramps.
Dr. William Courtney of Mendocino County is leading a growing number of patients and caregivers who believe that THCa has numerous medicinal qualities that are lost when cannabis is dried. He is a proponent of juicing raw cannabis for its many health benefits from THCa, including the relief his wife, Kristen Peskuski, experiences from her chronic Lupus.
While more studies need to be conducted, there is plenty of evidence that cannabis is highly effective in moderating pain. These studies have shown that smoking, vaporizing, and taking administering oral cannabis can all reduce various kinds of pain.
Not all strains are equal
But just like there are many different varieties of pain, the varieties of cannabis strains are vast. With over 400 active pharmacological compounds found in cannabis that can be used to treat a range of ailments, there are countless ways to mix and match components and create specific strains to treat an array of ailments, and of course, all kinds of pain.
I mentioned earlier that cannabis is almost too good to be true, and this becomes even more apparent when you see how many of the compounds in cannabis can be used to treat various ailments. Active components such as cannabinoids work alongside terpenoids (also known as terpenes) and flavonoids to offer a multiplicity of benefits for the human body. Some of the active compounds that work to fight pain are CBC, CBD, CBG4, D9-THC, THCA-C4, THCYA, CBLA, CBNA, Linalool, and Myrcene. By combining a number of these cannabinoids, terpenes, and flavonoids, you can create the perfect pain relief solution in your own backyard. Or, of course you can go down to your friendly neighborhood dispensary (if you reside in a legalized state) and purchase one of these pain-fighting strains:
Strains that fight pain
For wounds, muscle, and back pain, try Afghan Kush. This strain is nearly all indica, which means its effects will mostly be physical. It has a high dosage of THC which is notorious for pain relief as well as a number of analgesic terpenes such as Humulene, Caryophyllene, and Terpinoline.
If you’re experiencing neuropathic chronic pain due to either tissue damage or damage to the central nervous system, then the strain Jack Herer might be a good option for you. This strain is mostly sativa and has an energizing effect. Like Afghan Kush, Jack Herer also features high levels of THC, but has a host of other compounds and terpenes that make this strain specifically beneficial for treating neuropathic pain such as Pinene, Myrcene, Caryophyllene, and Humulene.
If arthritis and inflammation is what’s getting you down, try Harlequin. Harlequin is very high in CBD which interacts with the CB2 receptors in our bodies. In one study, it was found that mice who didn’t have CB2 receptors have weaker bones. From this it was determined that CBD is very beneficial in treating symptoms of arthritis, particularly the inflammatory and pain parts. Harlequin features a 5 to 2 ratio of CBD to THC as well as other anti-inflammatory, pain-relieving compounds and terpenes, including CBC, CBG, Myrcene, and Pinene. It’s also interesting to note that CBD is not a psychoactive component like THC is, which means that you won’t get the trippy effects of the other two.
It is becoming more and more evident that cannabis is a natural pain reliever that doesn’t have any of the nasty effects of traditional pain medications. With more research and more push back against the federal ban on marijuana, we may soon see a day when prescribing various strains of cannabis is the norm for treating all varieties of pain.
Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State.
- University of Washington, Seattle, Washington, USA.
This study was conducted to better understand the characteristics of chronic pain patients seeking treatment with medicinal cannabis (MC).
Retrospective chart reviews of 139 patients (87 males, median age 47 years; 52 females, median age 48 years); all were legally qualified for MC use in Washington State.
Regional pain clinic staffed by university faculty.
age 18 years and older; having legally accessed MC treatment, with valid documentation in their medical records. All data were de-identified.
MAIN OUTCOME MEASURES:
Records were scored for multiple indicators, including time since initial MC authorization, qualifying condition(s), McGill Pain score, functional status, use of other analgesic modalities, including opioids, and patterns of use over time.
Of 139 patients, 15 (11 percent) had prior authorizations for MC before seeking care in this clinic. The sample contained 236.4 patient-years of authorized MC use. Time of authorized use ranged from 11 days to 8.31 years (median of 1.12 years). Most patients were male (63 percent) yet female patients averaged 0.18 years longer authorized use. There were no other gender-specific trends or factors. Most patients (n = 123, 88 percent) had more than one pain syndrome present. Myofascial pain syndrome was the most common diagnosis (n = 114, 82 percent), followed by neuropathic pain (n = 89, 64 percent), discogenic back pain (n = 72, 51.7 percent), and osteoarthritis (n = 37, 26.6 percent). Other diagnoses included diabetic neuropathy, central pain syndrome, phantom pain, spinal cord injury, fibromyalgia, rheumatoid arthritis, HIV neuropathy, visceral pain, and malignant pain. In 51 (37 percent) patients, there were documented instances of major hurdles related to accessing MC, including prior physicians unwilling to authorize use, legal problems related to MC use, and difficulties in finding an affordable and consistent supply of MC.
Data indicate that males and females access MC at approximately the same rate, with similar median authorization times. Although the majority of patient records documented significant symptom alleviation with MC, major treatment access and delivery barriers remain.
The role of the endocannabinoid system in pain.
- Momentum Laboratory of Molecular Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, 1083, Hungary.
Preparations of the Cannabis sativa plant have been used to analgesic effect for millenia, but only in recent decades has the endogenous system responsible for these effects been described. The endocannabinoid (EC) system is now known to be one of the key endogenous systems regulating pain sensation, with modulatory actions at all stages of pain processing pathways. The EC system is composed of two main cannabinoid receptors (CB1 and CB2) and two main classes of endogenous ligands or endocannabinoids (ECs). The receptors have distinct expression profiles, with CB1 receptors found at presynaptic sites throughout the peripheral and central nervous systems (PNS and CNS, respectively), whilst CB2 receptor is found principally (but not exclusively) on immune cells. The endocannabinoid ligands are lipid neurotransmitters belonging to either the N-acyl ethanolamine (NAEs) class, e.g. anandamide (AEA), or the monoacylglycerol class, e.g. 2-arachidonoyl glycerol (2-AG). Both classes are short-acting transmitter substances, being synthesised on demand and with signalling rapidly terminated by specific enzymes. ECs acting at CB1 negatively regulate neurotransmission throughout the nervous system, whilst those acting at CB2 regulate the activity of CNS immune cells. Signalling through both of these receptor subtypes has a role in normal nociceptive processing and also in the development resolution of acute pain states. In this chapter, we describe the general features of the EC system as related to pain and nociception and discuss the wealth of preclinical and clinical data involving targeting the EC system with focus on two areas of particular promise: modulation of 2-AG signalling via specific enzyme inhibitors and the role of spinal CB2 in chronic pain states.
The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study.
- *Pain Relief Unit ‡Department of Anesthesia and Critical Care Medicine, Hadassah-Hebrew University Medical Center §Hadassah School of Dental Medicine, Hebrew University, Jerusalem, Israel †Department of Anesthesiology, Division of Clinical and Translational Research, Washington University School of Medicine, Saint Louis, MO.
The objective of this prospective, open-label study was to determine the long-term effect of medicinal cannabis treatment on pain and functional outcomes in participants with treatment-resistant chronic pain.
PATIENTS AND METHODS:
The primary outcome was the change in the pain symptom score on the S-TOPS (Treatment Outcomes in Pain Survey-Short Form) questionnaire at the 6-month follow-up in an intent-to-treat population. Secondary outcomes included the change in S-TOPS physical, social, and emotional disability scales, the pain severity, and pain interference on the Brief Pain Inventory, sleep problems, and the change in opioid consumption.
A total of 274 participants were approved for treatment; complete baseline data were available for 206 (intent-to-treat), and complete follow-up data for 176 participants. At follow-up, the pain symptom score improved from median 83.3 (95% confidence interval [CI], 79.2-87.5) to 75.0 (95% CI, 70.8-79.2) (P<0.001). The pain severity score (7.50 [95% CI, 6.75-7.75] to 6.25 [95% CI, 5.75-6.75]) and the pain interference score (8.14 [95% CI, 7.28-8.43] to 6.71 [95% CI, 6.14-7.14]) improved (both P<0.001), together with most social and emotional disability scores. Opioid consumption at follow-up decreased by 44% (P<0.001). Serious adverse effects led to treatment discontinuation in 2 participants.
The treatment of chronic pain with medicinal cannabis in this open-label, prospective cohort resulted in improved pain and functional outcomes, and a significant reduction in opioid use. Results suggest long-term benefit of cannabis treatment in this group of patients, but the study’s noncontrolled nature should be considered when extrapolating the results.
Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence.
- Center for Pain Medicine, University of California San Diego, 9300 Campus Point Drive, Mail Code 7651, La Jolla, CA, 92037, USA, firstname.lastname@example.org.
Cannabinoid compounds include phytocannabinoids, endocannabinoids, and synthetics. The two primary phytocannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), with CB1 receptors in the brain and peripheral tissue and CB2 receptors in the immune and hematopoietic systems. The route of delivery of cannabis is important as the bioavailability and metabolism are very different for smoking versus oral/sublingual routes. Gold standard clinical trials are limited; however, some studies have thus far shown evidence to support the use of cannabinoids for some cancer, neuropathic, spasticity, acute pain, and chronic pain conditions.
The endocannabinoid system as a potential therapeutic target for pain modulation.
- Department of Medical Pharmacology, Trakya University Faculty of Medicine, Edirne, Turkey.
Although cannabis has been used for pain management for millennia, very few approved cannabinoids are indicated for the treatment of pain and other medical symptoms. Cannabinoid therapy re-gained attention only after the discovery of endocannabinoids and fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL), the enzymes playing a role in endocannabinoid metabolism. Nowadays, research has focused on the inhibition of these degradative enzymes and the elevation of endocannabinoid tonus locally; special emphasis is given on multi-target analgesia compounds, where one of the targets is the endocannabinoid degrading enzyme. In this review, I provide an overview of the current understanding about the processes accounting for the biosynthesis, transport and metabolism of endocannabinoids, and pharmacological approaches and potential therapeutic applications in this area, regarding the use of drugs elevating endocannabinoid levels in pain conditions.
2-AG; FAAH; MAGL; anandamide; endocannabinoids; pain