How Might Medical Cannabis Help?
The most well-known and researched constituents for pain treatment are the cannabinoids (mainly
tetrahydrocannabinol or THC,
cannabidiol or CBD, and
beta-caryophyllene); the cannflavins A, B, and C; and the terpenes (including terpenoids).
When these compounds are taken together, they simultaneously stimulate many systems in the body, including the endocannabinoid system’s receptors
(ECS). In this way, taking medical cannabis can be like taking acetaminophen (Tylenol), ibuprofen, a muscle relaxer, an antidepressant, and a potent analgesic in perfect harmony.
Here are several ways in which medical cannabis may help manage chronic pain.
- Inflammatory pain: Cannabis contains many anti-inflammatory compounds, including tetrahydrocannabinol (THC), cannabidiol (CBD), cannabigerol (CBG), and terpenes like limonene, myrcene, and linalool.
- Neuropathic (nerve) pain: Multiple randomized controlled trials (RCTs) have demonstrated the efficacy of medical cannabis in treating neuropathic pain based on quality of life (QOL) scores.
- Nociceptive pain (pain by damage to body tissue): Beta-caryophyllene, a terpene and atypical cannabinoid found in cannabis, has been shown to attenuate and decrease nociceptive pain in animal studies.
- Functional pain (pain with no obvious point of origin): It is suggested that dysregulation in one’s endocannabinoid system (ECS) is a potential cause of functional pain associated with conditions like IBS and fibromyalgia.
- Reduction in opioid use: Opioids have many adverse side effects, including tolerance, physical dependence, and respiratory depression. States with legal cannabis stores are linked to fewer opioid deaths. Other studies have shown supportive results, with patients using cannabis as medicine (CaM) as a substitute for pain medications (especially opioids), antidepressants, and arthritis medications.
- The endocannabinoid system as a “multi-facet therapeutic target“: As cannabis compounds (cannabinoids, terpenes, flavonoids) can affect multiple receptor systems, such as opioid, serotonin and dopamine receptors, it is theoretically possible that medical cannabis could be used to reduce or replace the need for multiple pills (e.g., cannabis for both depression and physical pain, as opposed to antidepressants for depression and opioids for physical pain).
- Acute pain (sudden, sharp pain that lasts less than six months): Most studies focus on cannabis for chronic pain. One pilot study assessing the effects of dronabinol (synthetic THC) on opioid medication use in patients following physical trauma showed a significant reduction in opioid medication requirements among patients given Dronabinol alongside their regular pain medication regimen. However, reductions in pain were similar between dronabinol-and-opioid and opioid-only cohorts. Although promising, this study does not reach any hard conclusions about THC’s efficacy in treating acute pain.
- Improved function: A recent guideline published by the British Medical Journal (BMJ) shows that cannabis may reduce pain and improve physical function.
Overall, the evidence suggests that medical cannabis may be beneficial in chronic pain management and an alternative to opioids, sedatives, and/or antidepressants that may be prescribed to control various types and causes of chronic pain.