Chronic Pain and Medical Marijuana/Cannabis

Chronic Pain, Muscle Pain & Other Types of Pain and Medical Cannabis

Definition

There are various types of pain, including physical, mental, emotional and spiritual. It is not uncommon for a person who is in persistent pain to start suffering from other kinds of pain, as being in pain all day can wear one thin very quickly. Moreover, pain is a symptom of pretty much every condition on this list, so it is worth looking at for the treatment of other conditions on this list.

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Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Chronic Pain, Muscle Pain and Other Types of Pain (e.g. Joint Pain)

High, particularly for physical pain. Some types and sources of pain may not respond to cannabinoids as well. For those who may wish to reduce their opioid intake, we also recommend checking out the Leafwell Addiction Treatment page.

Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help

Both THC and CBD are of use.

CBC also has significant anti-inflammatory properties. CBDA also has anti-inflammatory properties, and THCA may help as well. Linalool, myrcene, pinene and beta-caryophyllene could be useful.

THC has analgesic, pain-distracting & anti-inflammatory effects as well.

CBD:THC 20:1; CBD:THC 18:1; CBD:THC 5:2; CBD:THC 1:1.

High THC may also help for pain, in particular physical pain (although high doses may worsen anxiety).

Medical Cannabis Pros

The cannabis plant contains many anti-inflammatory compounds, including THC, CBD, linalool, myrcene and beta-caryophyllene.

THC and beta-caryophyllene have analgesic effects.

CBD can also act as an allosteric modulator of the mu- and delta- opioid receptors, meaning it can help change the way pain signals are processed. CBD can help “turn down the volume” of pain signals.

Can be used for various kinds of pain, including neuropathic, emotional and even spiritual pain, as well as physical. This is due to cannabis’ “entourage effect” and the fact that several different receptor systems are being affected by the endocannabinoid system (ECS), whether directly or indirectly.

There is a substantial amount of evidence suggesting that increased levels of anandamide in the body via suppressed fatty acid amide hydrolase (FAAH) inhibition can suppress pain.

Medical Cannabis Cons

Cannabinoids may not be useful for some of the more extreme levels of pain.

Does cannabis kill or just distract from the pain? Most evidence suggests a little of both, but there could be a placebo effect.

There is some suggestion that THC may increase sensitivity to pain in some.

One four-year study shows that cannabis is not necessarily effective for chronic pain.

More About the Condition

We have a look at neuropathic pain under peripheral neuropathy (PN) and neuropathy, but we will look at chronic pain a bit more generally here. As the detection of pain sensation follows a similar pathway regardless of the type of pain (not entirely true or accurate, but somewhat true enough), it is worth looking at more broadly before going into specifics. Muscle pain is also sometimes referred to as “myalgia”.

Pain is deemed “chronic” if a person is suffering for 12 weeks or more. Those who suffer from pain in “waves” (i.e. a few days a week, or peaking to a crescendo) are also said to be suffering from chronic pain. Physical pain increases mental and emotional pain, and chronic pain sufferers often have permanent or semi-permanent alterations in their body’s level of the serotonin type 5-hydroxytryptophan (5-HT). For this reason, antidepressants are often one of the first ports of call for chronic pain sufferers, alongside analgesics and NSAIDs such as ibuprofen.

Sadly, such medications don’t always prove effective, or are only partially effective. For some conditions, only stronger medications such as opioids and benzodiazepines will help. Unfortunately, these drugs can be highly addictive, and can cause a different type of pain all on their own. Opioid overdoses increased by almost 6 times between 1999 and 2017, and an average of 130 Americans die everyday due to an opioid overdose. There is certainly a demand for alternatives for pain management in the long-term.

Cannabis could help reduce or replace the need for many types of pain medications (and may even reduce the number of opioid prescriptions in states with legalized medical cannabis), as it has many different compounds that work on multiple types of receptor sites, from opioid receptors to serotonin receptors.

Cannabinoids could also help with pain and swelling associated with reflex sympathetic dystrophy syndrome (RSD), which is a disorder that causes lasting pain, usually in an arm or leg, after suffering from a stroke, heart attack, traumatic brain injury (TBI), or type-1 complex regional pain syndrome (CRPS). Cannabinoids may also be useful for treating residual limb pain and phantom pain.

Quotes from Experts

“The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The paradoxical superiority of the cannabis plant over cannabinoid molecules represents a challenge for the medical community and the established processes that define modern pharmacy.” Source: Romero-Sandoval EA, Fincham JE, Kolano AL, Sharpe BN, Alvarado-Vázquez PA. ‘Cannabis for Chronic Pain: Challenges and Considerations‘ Pharmacotherapy. 2018 Jun;38(6):651-662. doi: 10.1002/phar.2115. Epub 2018 May 16. PMID: 29637590.