Chronic pain is a debilitating condition that affects millions of people worldwide. Traditional treatments often involve the use of over-the-counter or prescription pain medications, including opioids. However, the opioid crisis has highlighted the urgent need for safer alternatives. Medicinal cannabis, specifically its cannabinoids, is emerging as a promising option for chronic pain management.
Cannabinoids are chemical compounds found in the cannabis plant (Cannabis sativa), which has been used medicinally for thousands of years. The two most studied cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD). While THC is responsible for the psychoactive effects of cannabis, CBD does not produce a “high” and has gained attention for its potential therapeutic benefits, including pain relief.
Cannabinoids interact with the body’s endocannabinoid system (ECS), a complex cell-signalling system involved in regulating various physiological processes, such as pain sensation, mood, appetite, and immune response. This system plays a crucial role in maintaining homeostasis, making it a key target for pain management interventions. To understand in detail how the endocannabinoid system works, read our guide here.
Cannabinoids and pain management
Cannabinoids alleviate pain by interacting with the ECS, specifically through cannabinoid receptors, CB1 and CB2, located throughout the body. CB1 receptors are primarily found in the brain and central nervous system, while CB2 receptors are more abundant in the immune system and peripheral tissues.
- THC, by binding to CB1 receptors in the brain, influences pain perception, mood, and other neurological functions. This can help reduce the intensity of chronic pain, particularly neuropathic pain.
- CBD acts on CB2 receptors, which are involved in modulating inflammation. By reducing inflammation, CBD may help alleviate pain caused by inflammatory conditions like arthritis or autoimmune diseases.
The science behind medical cannabis for pain management
Research has shown that cannabis can be effective in treating chronic pain, particularly neuropathic pain, which is often resistant to other types of treatment. A 2018 review of 104 studies published in the journal Pain found that cannabinoids were moderately effective in reducing chronic pain. Another systematic review from JAMA in 2015 concluded that cannabinoids provided modest pain relief in patients with chronic pain conditions such as multiple sclerosis and cancer.
Cannabis-based products, including oral sprays, oils, and topical creams, have been developed to deliver cannabinoids in a controlled manner, allowing patients to tailor their treatment to their specific pain needs.
Chronic pain and the potential of medical cannabis as an alternative
Chronic pain can arise from various causes, including injury, illness, nerve damage, and conditions like fibromyalgia, multiple sclerosis, and arthritis. Unlike acute pain, which is a normal response to injury, chronic pain persists for months or even years, often requiring long-term treatment.
Traditional pain management relies heavily on prescription medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and antidepressants. While these drugs can be effective, they often come with significant risks, including addiction, tolerance, and adverse side effects. The opioid crisis has further complicated the management of chronic pain, leading healthcare professionals and patients to seek safer alternatives.
The importance of medicinal cannabis amid the opioid crisis
The opioid crisis, which has led to over 500,000 overdose deaths in the U.S. alone since 1999, has underscored the need for alternative treatments for chronic pain. Opioids, while effective in the short term, pose substantial risks of addiction, overdose, and death. Medicinal cannabis, with its lower risk profile and potential for effective pain management, offers a viable alternative.
A 2017 report from the National Academies of Sciences, Engineering, and Medicine concluded that there is substantial evidence supporting the use of cannabis for chronic pain management, particularly in patients who do not respond to other treatments. As more states and countries legalise medical cannabis, access to this alternative therapy continues to expand, providing chronic pain patients with a safer, more sustainable option.
Why could cannabis be a safer alternative?
Medicinal cannabis offers a potential alternative for chronic pain sufferers, particularly those who have not found relief from conventional treatments or who are at risk of developing opioid dependence. Unlike opioids, cannabis has a lower risk of overdose and addiction. A 2014 study in JAMA Internal Medicine found that states with medical cannabis laws had a 25% lower rate of opioid overdose deaths compared to states without such laws. This suggests that cannabis could help reduce reliance on opioids and mitigate the risks associated with their use.
Medicinal cannabis also allows for individualised dosing, where patients can find the right balance of THC and CBD to manage their pain effectively without experiencing unwanted side effects. This flexibility makes cannabis an attractive option for patients with chronic pain. Medicinal cannabis is administered in various forms, including:
- Inhalation (smoking or vaporising): Provides rapid relief as cannabinoids are quickly absorbed into the bloodstream via the lungs.
- Oral (oils, tinctures, edibles): Offers a longer-lasting effect but takes longer to onset as it must pass through the digestive system.
- Topical (creams, balms): Targets localised pain by applying cannabinoids directly to the skin, useful for conditions like arthritis.
- Sublingual (under the tongue): A compromise between rapid onset and longer-lasting effects.
- Patients with conditions such as neuropathic pain, arthritis, and multiple sclerosis have reported benefits from medicinal cannabis. A survey published in the Journal of Pain in 2019 found that 62% of medical cannabis users reported using it for chronic pain, with many citing significant improvements in pain relief and quality of life.
Medicinal cannabis is increasingly being recognised as a valuable tool in managing chronic pain, especially in light of the opioid crisis. By leveraging the body’s natural endocannabinoid system, cannabinoids like THC and CBD offer pain relief with fewer risks than traditional pain medications. As research continues to unfold, cannabis may become an even more integral part of chronic pain management, providing hope to millions who struggle with debilitating conditions every day.
