Can Cannabis Help With Chronic Pain?
Chronic pain is the most common reason people turn to medical marijuana. According to a 2019 study, two-thirds of medical cannabis patients in the US listed pain as their qualifying condition.
Thanks to the lifting of cannabis prohibitions and advances in medical research, we now have a solid body of clinical evidence that medical marijuana preparations work for various types of chronic pain.
That research is welcome news for sufferers for several reasons. Firstly, chronic pain conditions don’t always respond to standard treatment. Secondly, marijuana has less serious side effects than many prescription pain medications, including a much lower risk of addiction and almost zero risk of fatal overdose.
How Cannabis Works on Chronic Pain
Scientists and doctors only really started to understand how cannabis interacts with the human body in the 1990s.
It was then that researchers discovered that cannabinoids, chemical compounds like THC and CBD found in the cannabis plant, are also produced naturally by the human body.
Soon thereafter, scientists mapped out an entire system of receptors in the body (the endocannabinoid system) that reacts only to cannabinoids, both those produced by the plant (phytocannabinoids) and those produced by the body (endocannabinoids).
In the years since, medical researchers discovered that the endocannabinoid system plays a major role in regulating key functions of the body, including mood, metabolism, learning and memory, sleep, immunity — and pain.
Today, we know that endocannabinoid receptors are involved in regulating two of the major types of pain, and how our bodies perceive them: nociceptive pain (caused by actual harm to the body, such as a burn) and neuropathic pain (caused by damage to nerves that relay pain signals).
Endocannabinoid receptors have been discovered in various parts of the peripheral and central nervous system, and in almost every aspect of the pain pathway. Other endocannabinoid receptors have been found to play a role in reducing and regulating inflammatory pain.
Medical Studies on Chronic Pain and Cannabis
Dozens of studies have been conducted on how, and whether cannabis and cannabinoids is an effective treatment for pain, including chronic pain.
- A 2015 systematic review of 28 such studies concluded that “there was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain.”
- A 2010 study on cancer pain that wasn’t responding to regular opioid medications, found that a treatment which combined CBD and THC resulted in a significant reduction of pain. In that study, 43% of subjects reported a 30% or greater improvement. This is an especially notable finding because it indicates that drugs containing multiple cannabinoids may be more effective than isolated active ingredients.
- Another highly-cited study from 2008, examining the effects of smoking cannabis for neuropathic pain, found that using resulted in significant pain relief.
- A 2006 study by British researchers examining the effects of Sativex, a cannabis-based drug, found that it led to significant improvement on pain associated with rheumatoid arthritis.
- Another highly cited study from 2008 examined the effect of Nabilone, a THC-based drug, on fibromyalgia patients. It found that the treatment resulted in significant improvements in pain and quality of life.
- A 2016 study looked at the benefits of medical cannabis in people with various kinds of treatment-resistant chronic pain. Researchers found that marijuana not only reduced pain but also significantly reduced the use of prescription opioid medications.
- Another 2016 study looked at the use of medically prescribed cannabis in patients with chronic migraine headaches. Over 85% of the patients reported having fewer migraines per month (average of 10.4 down to 4.6).
In conclusion, more clinical trials should still be done but there is solid scientific evidence that cannabis is effective in the treatment of chronic pain. Its low side-effect profile makes it an attractive option.
While cannabis has been found to be an effective treatment option for chronic pain, especially in cases that don’t respond to conventional medicine, it’s not without downsides.
Most notably, THC, one of the active therapeutic ingredients, is psychotropic and can lead to cognitive side effects such as impaired memory, anxiety, and euphoria. It can also trigger psychosis in some individuals. CBD-rich preparations, such as CBD oil, however, are not intoxicating.
Cannabis-based treatments can also cause other side effects including drowsiness, fatigue, dry mouth, and changes in appetite.
All in all, however, these side effects are minor and marijuana is a remarkably safe substance, especially when compared to the pharmaceutical drugs normally prescribed to treat pain. There have been no verified cases of death caused by cannabis.
When considering the use of cannabis for chronic pain, or any other medical condition, it is important to consult with your doctor before initiating therapy.
About Chronic Pain
It is estimated that chronic pain affects as many as 100 million people across Europe. In the UK, an estimated 28 million people in the UK alone suffer from chronic pain, and among those aged over 75, that jumps as high as 62%.
While acute pain comes and goes over the course of seconds, minutes, hours, or days, chronic pain is a condition that remains over a long period of time. As a result, it can have a tremendous impact on quality of life and impact practically every aspect of life.
It’s often connected to long-term disorders such as arthritis and fibromyalgia, but it can also develop after an injury or medical condition—even those that have been treated. Chronic pain can come on suddenly, or develop gradually over time. It can be present practically anywhere in the body.
It’s important to note that chronic pain and chronic pain syndrome (CPS) are real and cause real distress. While others may not be able to actually “see” the pain, it can be ever present, and shouldn’t be dismissed as something that is “all in your head.”
The main symptom of chronic pain is ongoing pain or discomfort that lasts for three to six months or longer. When the cause of the pain is unclear in origin, it is known as chronic pain syndrome (CPS).
Chronic pain syndrome can be accompanied by secondary symptoms as well as the unexplained pain. These usually include but are not limited to:
- Anxiety and depression, due to fear of pain or the consequences of pain
- Insomnia, because the pain keeps you from sleeping well
- Stress and irritability
- Feelings of guilt about unexplained pain preventing you from living your ideal life
- Loss of interest in sex
When to see a doctor
If you’ve been in pain for 12 weeks or more, the pain isn’t getting any less, and there’s no apparent reason for the pain, you should consult with your doctor. In addition to exploring the cause of the pain and seeking out a solution, they can also help provide much needed pain relief and resources for coping with chronic pain.
A doctor will conduct a formal evaluation for your pain which will often start with a history and a comprehensive physical exam, pinpointing where the pain is and what may be causing it. In addition, he/she may order blood tests and imaging for further evaluation. Often, a specific cause for the pain will be found. Sometimes that isn’t the case, as in common conditions such as chronic pain syndrome, fibromyalgia, IBS, and other potentially disabling pain conditions.
Researchers are still uncertain about what causes chronic pain. It’s possible that it’s a “learned response.” This means that your pain was originally caused by a certain medical or physical issue, but your brain continued to send the same pain signals even after the cause of the pain was removed. It’s also thought that people with chronic pain syndrome might have a different set of reactions to stress that makes them feel pain.
There are also certain conditions or incidents that seem to provoke chronic pain. These include:
- Strained or sprained muscles and broken bones that continue to cause pain even once they have healed
- Back pain and headaches
- Infectious etiologies such as herpes infections and Lyme disease
- Nerve damage
- Inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS)
- Acid reflux and stomach ulcers
Women are more likely to get chronic pain syndrome than men, and it is more commonly found in sufferers of mood disorders such as anxiety and depression. Those suffering from chronic pain may also suffer from sleep problems, and chronic pain, unfortunately, correlates with onset of other chronic conditions such as diabetes, hypertension, heart disease, and cerebrovascular disease.
Given the disabling symptoms chronic pain causes and its impact on quality of life along with its correlation with other troubling conditions, treatment of chronic pain is of paramount importance.
Chronic pain is very difficult to cure entirely, but it can be managed and treated. There is no perfect treatment. Different techniques and treatments are effective for different people and often an integrative approach, combining several therapies, works best. Treatment should be personalized for the specific type of pain and sufferer. Many people have to try many different therapies before finding adequate pain relief, and often treatments have side effects which can be intolerable or harmful. Therefore, the goal is not necessarily pain relief but improving quality of life.
Most people with chronic pain begin by taking pain medication, but that is not always the ideal solution. There’s a risk that you’ll become dependent on and/or addicted to your pain medication, and that you’ll be led towards stronger, more addictive painkillers. Furthermore, it often does not tackle the actual cause of the pain, which is critical with chronic pain.
Sometimes, antidepressants, antiseizure drugs, and muscle relaxants can help control chronic pain better than painkillers.
- Antidepressants can increase certain neurotransmitters such as serotonin, dopamine, and norepinephrine, which help regulate pain, thereby potentially decreasing pain and improving mood. There are multiple types of antidepressants including SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin norepinephrine reuptake inhibitors), and tricyclic antidepressants with the tricyclics and SNRIs used more for pain. Side effects can include insomnia, weight gain, and nausea.
- Antiseizure drugs used for conditions including epilepsy and bipolar disorder are often used in chronic pain. By blocking transmission between nerve cells, they can often be an effective way to reduce pain. The side effects of anti-epileptic drugs can include fatigue and drowsiness, increased clumsiness, and nausea. They can also affect your emotions and make you more irritable.
- Anti-anxiety drugs. While not directly reducing pain, anti-anxiety drugs can make dealing with pain more manageable by improving relaxation and sleep. The side effects can include insomnia, restlessness, nausea, and headaches.
- Muscle relaxants help relieve tight muscles that have gone into spasm and are causing muscle pain, but they can also cause confusion, dizziness, headaches, and depression.
Although chronic pain can make ambulating and moving in general a nightmare and cause more pain, exercise is actually the best thing you can do to combat chronic pain. Exercise releases endorphins, which are the body’s natural pain relievers and help lift your mood, whereas staying in bed just makes your body weaker and leads to more pain. Exercise also reduces stress, which tends to play a big part in chronic pain. Besides that, it also improves sleep, and increases the same neurotransmitters that antidepressants do.
Yoga can be particularly useful, since it combines stretching that improves your body’s strength with mind-body balance, which can also be effective at combating chronic pain.
Physical therapy and massage can also help to ease the pain from tight muscles that have gone into spasm. Strength training builds muscle strength, helping your muscles to stretch and relax and eases pain from arthritis and back pain.
There are a number of alternative therapies that help reduce chronic pain. These include:
- TENS therapy. A TENS machine sends a low electric current through your body to disrupt pain signals. They are inexpensive to buy online or in stores.
- Acupuncture can help to increase your pain threshold, helping you to cope with the pain, relax your muscles, and encourage your body to release natural painkillers.
- Deep breathing exercises that train your muscles to relax, releasing endorphins in your brain and soothing tight muscle pain.
- Meditation helps many people to relax and let go of stress, which is important because stress makes your muscles more tense, adding to muscle and joint pain, and increases pain in general.
- Biofeedback is a way of learning how to control your involuntary physical processes, like heart rate and your pain responses. You’ll be attached to a computer with body sensors, which guides you to relax your muscles, let go of tension, and reduce your pain.
- Mindfulness. Multiple studies have shown that practicing mindfulness can reduce chronic pain scores and improve mood and sleep.
Many people find that certain foods make their pain worse, while other vitamins, supplements, and foods can ease their symptoms. Red wine and cheese are common culprits for migraines and severe headaches. You might need to keep a food diary to see if there’s any connection between your symptoms and what you eat.
Supplements and natural remedies
Although there’s no scientific proof, many people find that some herbal and natural remedies help relieve chronic pain. Some of the most popular products include:
- Omega-3 and omega-6 fish oil supplements can be particularly helpful against joint pain like arthritis.
- Glucosamine has been found to relieve joint and muscle pain in many people with chronic pain.
- Chondroitin sulfate occurs naturally in the cartilage and tissues around your joints. It’s often effective for chronic pain from aching muscles and joints, and pain from osteoarthritis.
The burden of chronic pain on individuals and society as a whole is huge. Partly as a result of doctors prescribing opioid pain treatments for chronic pain, an opioid epidemic has killed tens of thousands of people in the US. Opioid painkillers can also lead to other forms of substance abuse.
As a result of chronic pain, people are not the husbands/wives, mothers/daughters, fathers/sons workers and friends they’d like to be. Mood and sleep are affected, and down the line, a host of other dangerous chronic conditions can follow.