Chronic pain is an epidemic that first-world medicine has been unable to ameliorate. The figures can be dramatic: in Europe, one in every four elderly people suffers from chronic muscular or skeletal pain; in the United States, at least 38 million individuals have indicated chronic pain; and in Australia, up to 80% of the nursing home population suffers from persistent pain. Those are huge numbers, and when there is such a large and persistent patient population struggling with pain management, pharmaceutical companies usually invest large and persistent portions of their portfolios towards targeted research and development. Their answer was non-steroidal anti-inflammatories (NSAIDS), steroidal medications such as hydrocortisone, and opioids such as morphine.
Given these options, a patient in pain is stuck choosing between effective and powerful treatment (i.e. what is available from opioids) that could lead to ruinous and fatal addiction problems, or milder, less effective treatment that can still lead to digestive and cardiovascular damage (as is the case with non-steroidal anti-inflammatories such as ibuprofen).
These are afflictions for a demographic beyond the population over 50. Chronic pain management is a concern for cancer patients with intractable pain from their treatments and for patients suffering from multiple sclerosis and other neuropathic diseases and disorders.
Doctors Seeking New Solutions for Pain Management
Pain is a sensation that may begin as a symptom which is downstream of a primary stimulus or cause, but can eventually degenerate into an independent response. Basically, the initial cause of pain can be treated, but the neurological pathways that control our sensations of pain can continue to be triggered long after that original stimulus has been eradicated.
Because the underlying mechanisms of pain can be so complex and even convoluted, physicians and the research community are scrambling to present their patients with a solution for pain management that won’t demand bigger sacrifices from the rest of the body.
Cannabis: An Effective and Safe Therapeutic Alternative
Cannabis is demonstrating again and again that it can be that solution. Clinical trials, animal studies, systematic review, and laboratory science at the bench have been conducted over the last fifty years to try and shed light on the potential of cannabis and its constituents to treat chronic pain.
And statistically significant results keep coming back to suggest time and time again that cannabis seems to act effectively and safely — the two biggest factors in the political, legislative, and clinical community’s determination of a drug’s usefulness to the medical community.
There are different forms of cannabis that have been suggested for clinical use — mainly, the cannabis flowers and cannabis-derived medicine (such as Sativex, an oral spray).
The Cannabinoid Receptors and their Involvement in Pain Management
Though both forms have different properties of metabolism because of their differences in delivery method, the underlying structure of the primary cannabinoids, THC and CBD, remain the same. These molecules are recognized by specific receptors in the brain, known as the CB1 and CB2 receptors (short for Cannabinoid Receptors Type 1 and 2).
The CB1 and CB2 receptors are found in areas of the central nervous system and spinal cord that happen to be associated with many of the consequences people associate with cannabis use (“relax, eat, sleep, forget and protect” (DiMarzo 1998)). But most interesting to the clinical and research community are that these same areas are specifically associated with nociception, or pain perception.
THC and CBD both bind to these cannabinoid receptor types and trigger a cascade of signalling events that result in changes to our physiologies. Both cannabinoids have been shown to stimulate analgesic and anti-inflammatory reactions in the body and brain.
Their demonstrated ability to both relieve pain as it happens (or before it happens) and reduce the redness and inflammation that can infiltrate cellular and muscular systems make cannabis a huge contender in the next wave of therapeutic innovation and hope.
Cannabinoids versus Traditional Pain Medication
In an experiment from the 90s, an investigator in the therapeutic potential of cannabis, Dr. FJ Evans, was able to show that THC has twenty times the anti-inflammatory potency of aspirin, and twice the anti-inflammatory potency of hydrocortisone. Added to the fact that neither THC nor CBD lead to concerns with ulcers, stomach bleeding, and heart problems, cannabis trumps its over-the-counter alternatives easily.
On top of cannabis’s demonstrated pain-relief and anti-inflammatory properties, there are numerous studies which indicate that THC and CBD lead to significant improvements in sleep as a result of symptom reduction, not just sedation. This, combined with the evidence that THC and CBD administration do not lead to any suppressing effects on the immune system only add to the growing body of evidence that cannabis must be taken seriously as a therapy for chronic pain management.
Whether as a therapy administered solely on its own, or used as an adjunct therapy with lower doses of either opioids or other painkillers, cannabinoids should be considered as a novel and promising treatment option for severe pain.
The misuse of prescription medications and the dearth of effective and safe treatments available to patients currently position cannabis to be a viable clinical alternative that can help millions of people.
Marzo, Vincenzo Di, Dominique Melck, Tiziana Bisogno, and Luciano De Petrocellis. “Endocannabinoids: Endogenous Cannabinoid Receptor Ligands with Neuromodulatory Action.” Trends in Neurosciences 21.12 (1998): 521-28.