Chronic Pain

BY KATIE WEITMAN

Cannabis has been used to treat pain for hundreds of years. In fact, there is reference to the use of cannabis for pain management in all major ancient cultures from China to the Middle East, from Africa to Europe and the Americas. The earliest references to cannabis as medicine are believed to have come from the Pen Ts’ao, a medical text compiled by Chinese emperor ShenNung—known as the father of Chinese medicine. In 200 CE, Hua T’ao, a Chinese surgeon who reportedly pioneered complex surgeries such as organ grafts and intestinal resections, was said to use a preparation of wine and cannabis resin called ma-yo as an incredibly effective anesthetic that rendered his complex surgeries painless.

The Scythians (a group of tribes living on the borders of what are now Asia and Russia) are said to have been the first to bring cannabis from the Orient to the western world. The Mesopotamians in the Middle East and the Egyptians in North Africa both benefited from this migration and used cannabis topicals to treat inflammation. It is even supposed by some that references in the New Testament regarding Jesus’s healing powers are references to cannabis—for instance, the line in Acts of Thomas, “Thou holy oil given unto us for sanctification […] thou art the straightener of the crooked limbs.” Cannabis continued its westward march up into the common era, and as late as the early 19th century, it was used by most cultures—including our own—for various types of pain, including, but not limited to, headaches, inflammation/arthritis, neuropathic pain, menstrual cramps, and labor pains. In 1859, Sir John Russell Reynolds, physician to Queen Victoria, wrote that, “For the relief of certain kinds of pain […] there is no more useful medicine than cannabis within our reach.”

Today chronic pain—defined as pain which occurs 100+ days a year—is the most common diagnosis cannabis is used to treat. Since its popularity and availability in modern western medicine have grown over the past 10+ years, many who suffer pain of all types have begun using CBD and/or THC or whole plant medicines to try and experience relief without the heinous side effects that come along with other treatments.

‘Pain’ can be broken down into two categories: ‘nociceptive’ pain and ‘neuropathic’ pain. ‘Nociceptive’ pain is defined as pain signaling impending or actual tissue damage. ‘Neuropathic’ pain refers to pain caused by the nervous system itself. Because of its antiinflammatory, neuroprotective, and muscle relaxant qualities, cannabis shows promise for the treatment of

most kinds of pain. Today it is commonly recommended for neuropathic pain (such as with diabetic neuropathy or MS), migraines and cluster headaches, cancer and HIV-related pain, and some kinds of muscle pain. A study done on 96 MS patients by researchers at the Rocky Mountain MS Center at the University of Colorado found that 32% use CBD and 52% use THC for pain.

In an article published by the Journal of the International Association for the Study of Pain, “Chronic Pain Patients’ Perspectives of Medical Cannabis,” the authors detail ‘a developing basic science evidence base linking the cannabinoid neurotransmitter system to [nociceptive pain].’ They point out that high concentrations of CB1 receptors are found in many of the brain’s pain centers (the periaqueductal gray, spinal trigeminal nucleus, amygdala, and the basal ganglia, for instance), and that CB2 receptors found outside of the central nervous system are also thought to play a contributing role in pain management. The authors also note that the endogenous cannabinoids (that is, cannabinoids created by the body, as opposed to ‘phyto-cannabinoids,’ which are produced by cannabis plants)—anandamide and 2-arachidonlyglycerol (2AG)— also work to reduce pain by binding to presynaptic receptors and blocking neurons transmitted in response to painful stimuli.

Because the endocannabinoid system is both centrally and peripherally involved in the processing of pain signals, cannabinoid-based treatments may be especially effective at treating neuropathic and nociceptive pain. Additionally, cannabis is not a single medicine but is composed of numerous medicinal compounds that offer multiple mechanisms of action to combat pain.

While THC and CBD have analgesic properties all by themselves, several other molecular compounds found in cannabis (cannabinoids such as CBC, CBG, THC-A, and THC-V and terpenes like Beta Caryophyllene, Myrcene, and Linalool, to name a few) also work to treat pain, making whole plant medicine more effective than THC or CBD on their own. On top of that, new cannabinoids and their therapeutic properties are being discovered all the time, so it is reasonable to assume that cannabis works to kill pain in a whole lot of ways we don’t even know about yet.

Multiple studies have come out in the last few years showing that patients with access to medical cannabis use fewer opiates, and states that have made medical cannabis available generally have lower rates of drug addiction and overdose. A survey done in 2017 even reported that 97%(!) of patients ‘strongly agreed/

agreed’ that they are able to reduce their opioid consumption when also using cannabis. But, as with most conditions cannabis appears to treat, there is still limited empirical research to back up patients’ anecdotal evidence.

The CDC published a report in 2018 stating that in 2016, 20.4% of medical cannabis patients (or around 50 million people) were using marijuana to treat chronic pain. Many of these patients were looking to avoid or decrease opiate use. According to the CDC, over the last 20 years the opioid epidemic has killed almost a half a million Americans, with almost 50,000 in 2018 alone.

The majority of these deaths weren’t ‘junkies’ buying drugs off the street; they were average, everyday Americans prescribed legal pharmaceuticals by boardcertified medical providers. Between 2017 and 2018, prescription opioid overdoses increased by 13.5%, while over that same time period of time heroin-related overdoses decreased by 4%. Deaths are no longer caused primarily by dirty drugs distributed by cartels; they are the result of the over-prescribing of perfectly legal synthetic substances. There are no reported cases of death related to cannabis overdose.

There are many patients who are simply opposed to any psychoactive substances that lead to altered consciousness. These patients look for alternatives to synthetic opioids, but often overlook cannabis because of false information promoted by anticannabis institutions. A common misconception is that cannabis always has psychoactive properties, and that these psychoactive properties are a major part of its therapeutic effects when treating pain. This is not the case. There are many ways to benefit from cannabis without the ‘high,’ and it is a much safer option than most other pain treatments.

The stigma attached to cannabis use has prevented providers from considering it as an alternative pain management option. Some hospital systems—most notably the VA—bar doctors from even discussing marijuana as medicine. This only causes patients in pain more undue suffering. Physicians need to be educated and free to discuss cannabis as an option with their patients so that they can make an informed decision regarding their treatment plan.

Cannabis can be an excellent alternative to traditional pain treatments. It helps not only with pain caused by injury and inflammation, but also with muscle spasticity (as with MS) and neuropathic pain (such as diabetic neuropathy). So, if you suffer from any kind of pain, start experimenting, and chances are you’ll be able to find a cannabis treatment method that works for you.

(Note: Patients should be careful about dosage because cannabis is biphasic, meaning that while small doses may have positive outcomes, higher doses can have the opposite effect. If you’re not opposed to inhalation options, they are a good way of starting out because they work quickly and are therefore easier to manage dose-wise.)