In North America, medical marijuana is a popular alternative to traditional medication for pain relief, including opioids. Marijuana (also known as cannabis) eases various types of chronic pain, including nerve pains, multiple sclerosis, Fibromyalgia and pains related to inflammation.
Currently, not all cannabis-based products are approved by the U.S. Food and Drug Administration (FDA), and more evidence is required to confirm its safety and effectiveness.
However, preclinical studies have found modest evidence that cannabis and its compounds may help relieve some types of pain. A highly promising area of research is the use of cannabis for PTSD in war veterans returning from combat. Many veterans and therapists report radical improvement, and have requested less governmental restrictions on studies. Medical marijuana is also reported to help patients suffering from pain associated with HIV, as well as irritable bowel syndrome and Crohn’s disease.
How does cannabis work for pain?
Cannabis contains compounds that are said to relieve pain, anxiety, nausea, and other symptoms. The two most commonly studied compounds for pain relief are cannabidiol (CBD) and tetrahydrocannabinol (THC).
In a study published on the Journal of Clinical Pharmacology, cancer patients who received the highest doses of THC pills reported significant pain relief. This is one of the most encouraging clinical studies on cannabinoids and marijuana.
THC vs. CBD
THC is the chemical that is responsible for most of marijuana’s psychological effects. According to NIDA, it resembles cannabinoid chemicals that occur naturally in the body. When ingested or inhaled, THC stimulates your brain’s cannabinoid receptors. Specifically, it activates your brain’s “reward system” and relieves pain. In other words, THC works with your brain’s receptors to produce an “elevated state of mind”, known as a high.
CBD, however, does not cause a high despite interacting with the brain’s pain receptors to produce pain relieving and anti-inflammatory effects.
Does research support cannabis for pain?
In recent times, many organizations have studied the effects of cannabis for chronic pain. Some studies only used parts of the natural plant (like CBD or THC oil) while others used the whole plant. Using parts of the cannabis plant helps study specific actions related to that ingredient. However, using the whole plant results in an “entourage effect” whereby various parts of the plant work together to produce a greater effect. Since there is no industry-wide standard for clinical studies, more research is required for cannabis to gain greater acceptance for pain treatment.
A 2015 review of existing research on the use of medical marijuana for chronic pain conditions reported several trials with positive results. Researchers suggest that cannabis may be an effective treatment for certain types of chronic pain such as neuropathy (nerve pain).
A 2016 research paper found that marijuana used for cancer treatment led to a 64% reduction in opioid usage, improved quality of life, and fewer medicinal side effects.
Similar studies have also reported benefits with chronic pain management:
- Of about 17,000 cancer patients, 70% reportedly experienced an improvement in pain and general well-being after using marijuana.
- In a specialty clinic in Colorado, patients with chronic migraines experienced a reduction in migraine episodes.
More research into cannabis for chronic pain treatment is required, especially regarding the effects of different strains, dosages, and delivery methods.
Synthetic and medicinal marijuana
Medical cannabis, also known as medical marijuana, are cannabis or CBDs that are prescribed by physicians. It most commonly refers to unprocessed cannabis plant and extracts.
Medical marijuana only has approval from the U.S. FDA for treatment of two rare forms of epilepsy that involve seizures. Interestingly enough, no other drugs have been able to control these cases of epilepsy aside from marijuana.
The name of the FDA-approved CBD drug is Epidiolex. It contains a purified form of CBD, and received approval in June 2018.
With synthetic products, however, the FDA has approved two medications containing THC cannabinoids: dronabinol (Marinol) and nabilone (Cesamet). Both the drugs reduce chemotherapy-induced nausea and vomiting and increase the appetite of HIV patients with anorexia.
As of 2019, the FDA has not yet approved any marijuana drugs for pain treatment.
Risks and side effects
Cannabis consumption can cause side effects, such as:
- Difficulty breathing
- Impaired reaction times
- Negative interactions with other medication
- Loss of focus
- Poor memory
- Mental health issues
- Rapid heart rates
- Withdrawal symptoms
Different forms of Cannabis
The use of cannabis, or marijuana, is becoming increasingly popular among people with chronic pain. The use of this plant is available in various forms, including:
- Dried mixture
- Shredded leaves
- Pills or tablets
- Oils or extracts (CBD or THC)
- Topical treatments (creams, lotions, balms and salves)
- Edibles (cookies, brownies, candies infused with cannabis)
- Sublingual cannabis
Cannabis vs. opioids for pain relief
Opioids are powerful medications that act on opioid receptors to produce morphine-like effects. They are used medically for pain relief purposes, including anesthesia. Opioids are extremely addictive, and can trigger withdrawal symptoms.
Reports in 2017 show that approximately 130 people died from opioid-related drug overdoses per day in the U.S, and 11.4 million people misused prescription opioids per year.
Is marijuana better than opioids?
Medical marijuana is a good alternative to addictive opioids. In a 2015 study of marijuana patients with chronic pain, participants reported a 45% increase in quality of life with marijuana compared to opioid treatment.
Among study participants, medical marijuana use was associated with a 64% decrease in opioid use, and decreased in the number and side effects of medications.
Many studies report that use of cannabis is beneficial for chronic pain.
In fact, some studies claimed that cannabis is as effective as opioids. In other words, this natural plant is among the most potent pain-relieving options.
Chronic pain patients should be aware of the downsides and side effects to cannabis. These side effects are usually minimal, especially when compared to the side effects of opioid usage. In addition, due to lack of regulation for marijuana-based therapies, treatment quality cannot always be guaranteed.
As with any type of herbal plant, there are many strains of cannabis available. Therefore, even if one strain doesn’t reduce symptoms, another one may. Patients who are new to cannabis are advised to keep their dosage low, to prevent adverse side effects. Also, prior discussion with a medical professional about the risks and benefits of cannabis is recommended.
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