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Pain – Research with cannabinoids

Studies indicate that cannabis reduces pain in patients diagnosed with neuropathic and nociceptive pain, also showing that it is effective in controlling pain resistant to other traditional treatments. Research also suggests that cannabis could mitigate the opioid analgesic crisis, reducing pain and the uncontrolled desire for these substances 17.

Pain is an uncomfortable sensation – pins and needles, tingling, burning, stinging – that occurs after an injury, illness or related to a chronic health problem. Pain can limit productivity and affect an individual’s well-being. The costs associated with treating pain in the United States are between US$560 and US$635 billion per year 16.

Pain is commonly classified as acute or chronic. Acute pain appears as a result of a traumatic event and typically disappears after its cause is identified and treated. Chronic pain is discomfort that develops as a result of a chronic illness, such as arthritis or irritable bowel syndrome. It is common for chronic pain to persist for long periods of time and resist a variety of medical treatments.

Discoveries: effects of cannabis in treating pain

The volume of studies supporting the effectiveness of cannabis as a pain reliever is very large. The main cannabinoids found in the plant have been considered effective in reducing pain levels in a series of clinical conditions 3,6,10,12,17,18,19,21,22,23,24,25,26. Recently, a survey of medical cannabis users found that the plant offers an average of 64% reduction in pain 24.

It is believed that cannabinoids can reduce pain through their interaction with the endocannabinoid system, a regulatory network that keeps vital functions in balance. Cannabinoids interact with the two main cannabinoid receptors (CB1 and CB2) of the endocannabinoid system, which adjusts the release of neurotransmitters in an effort to control pain levels 4,5,8,13,15.

Studies have demonstrated the safety of using cannabis to control pain 23. With the high risk of abuse of analgesic medications, which claim the lives of more than 40 patients per day in the US alone, studies suggest that cannabis could be a non-addictive way to treat chronic pain 1. More recently, researchers found that vaporized cannabis containing THC caused a “significant analgesic response” in a clinical study involving 42 patients who did not have an effective reaction with conventional pain medications of origin. opioid and other non-steroidal anti-inflammatory drugs (NSAID) 26.

References:

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  2. Abrams, D.I., Couey, P., Shade, S.B., Kelly, M.E., and Benowitz, N.L. (2011, December). Cannabinoid–Opioid Interaction in Chronic Pain. Clinical Pharmacology & Therapeutics, 90(6), 844-51. Retrieved from
    http://onlinelibrary.wiley.com/wol1/doi/10.1038/clpt.2011.188/full    .
  3. Borgelt, L.M., Franson, K.L., Nussbaum, A.M., Wang, G.S. (2013, February). The pharmacologic and clinical effects of medical cannabis. Pharmacotherapy, 33(2), 195-209. Retrieved from
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  4. Bosshard, S.C., Grandjean, J., Schroeter, A., Baltes, C., Zeilhofer, H.U., and Rudin, M. (2012, July). Hyperalgesia by low doses of the local anesthetic lidocaine involves cannabinoid signaling: An fMRI study in mice. Pain, 153(7), 1450-8. Retrieved from
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  5. Burston, J.J., Sager, D.R., Shao, P., Bai, M., King, E., Brailsford, L., Turner, J.M., Hathway, G.J., Bennett, A.J., Walsh, D.A., Kendall, D.A., Lichtman, A., and Chapman, V. (2013, November 25). Cannabinoid CB2 Receptors Regulate Central Sensitization and Pain Responses Associated with Osteoarthritis of the Knee Joint. PLOS One, 8(11), e80440. Retrieved from
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  6. Carlini, B.H., Garrett, S.B., and Carter, G.T. (2015, September). Medicinal Cannabis: A Survey Among Health Care Providers in Washington State. The American Journal of Hospice & Palliative Care. Retrieved from
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  9. Emerich, B.L., Ferreira, R.C.M., Cordeiro, M.N., Borges, M.H., Pimenta, A.M.C., Figueiredo, S.G., Duarte, I.D.G., and de Lima, M.E. (2016). δ-Ctenitoxin-Pn1a, a Peptide from Phoneutria nigriventer Spider Venom, Shows Antinociceptive Effect Involving Opioid and Cannabinoid Systems, in Rats. Toxins, 8(4), 106. Retrieved from
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  10. Fine, P.G., and Rosenfeld, M.J. (2014). Cannabinoids for Neuropathic Pain. Current Pain and Headache Reports, 18(10), 451. Retrieved from
    http://link.springer.com/article/10.1007%2Fs11916-014-0451-2.
  11. Gerak, L.R., and France, C.P. (2016, May). Combined treatment with morphine and Δ9-tetrahydrocannibinol (THC) in rhesus monkeys: antinociceptive tolerance and withdrawal. The Journal of Pharmacology and Experimental Therapeutics, 357(2), 357-66. Retrieved from
    http://jpet.aspetjournals.org/content/357/2/357.long.
  12. Hirsh, A.T., Kratz, A.L., Engel, J.M., and Jensen, M.P. (2011). Survey Results of Pain Treatments in Adults with Cerebral Palsy. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists, 90(3), 207–216. Retrieved from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036542/.
  13. Kinsey, S.G., Mahadevan, A., Zhao, B., Sun, H., Naidu, P. S., Razdan, R.K., Selley, D.E., Damaj, M.I., and Lichtman, A.H. (2011). The CB2 cannabinoid receptor-selective agonist O-3223 reduces pain and inflammation without apparent cannabinoid behavioral effects. Neuropharmacology, 60(2-3), 244–251. Retrieved from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021987/    .
  14. Lee, M.C., Ploner, M., Wiech, K., Bingel, Ul, Wanigasekera, V., Brooks, J., Menon, D.K., and Tracey, I. (2013, January). Amygdala activity contributes to the dissociative effect of cannabis on pain perception. Pain, 154(1), 124-134. Retrieved from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549497/    .
  15. Li, M.H., Suchland, K.L., and Ingram, S. (2016, December). Compensatory activation of cannabinoid CB2 receptor inhibition of GABA release in the rostral ventromedial medulla (RVM) in inflammatory pain. Journal of Neuroscience, 1310-16. Retrieved from
    http://www.jneurosci.org/content/early/2016/12/09/JNEUROSCI.1310-16.2016.1    .
  16. Pain: Hope Through Research (2015, September 4). National Institute of Neurological Disorders and Stroke. Retrieved from
    https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Pain-Hope-Through-Research    .
  17. Perron, B.E., Bohnert, K., Perone, A.K., Bonn-Miller, M.O., & Ilgen, M. (2015). Use of Prescription Pain Medications Among Medical Cannabis Patients: Comparisons of Pain Levels, Functioning, and Patterns of Alcohol and Other Drug Use. Journal of Studies on Alcohol and Drugs, 76(3), 406–413. Retrieved fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440298/.
  18. Roberts, J.D., Gennings, C., and Shih, M. (2006, January). Synergistic affective analgesic interaction between delta-9-tetrahydrocannabinol and morphine. European Journal of Pharmacology, 530(1-2), 54-8. Retrieved from
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  19. Russo, E.B., and Hohmann, A.G. (2012, September 22). Role of cannabinoids in pain management. Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches, 181-197. Retrieved from
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  20. Staahl, C., Olesen, A.E., Andresen, T., Arendt-Nielsen, L., and Drewes, A.M. (2009, September). Assessing efficacy of non-opioid analgesics in experimental pain models in healthy volunteers- an updated review. British Pharmacological Society, 68(3), 322-341. Retrieved from
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  21. Wakley, A.A., Wiley, J.L., and Craft, RM. (2014). Sex differences in antinociceptive tolerance to delta-9-tetrahydrocannabinol in the rat. Drug and Alcohol Dependence, 143, 22–28. Retrieved from
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  22. Ware, M.A., Doyle, C.R., Woods, R., Lynch, M.E., and Clark, A.J. (2003, March). Cannabis use for chronic non-cancer pain: results of a prospective survey. Pain, 102(1-2). Retrieved from
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  25. Wilsey, B., Marcotte, T. D., Deutsch, R., Gouaux, B., Sakai, S., & Donaghe, H. (2013). Low Dose Vaporized Cannabis Significantly Improves Neuropathic Pain. The Journal of Pain : Official Journal of the American Pain Society, 14(2), 136–148. Retrieved from
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  26. Wilsey, B., Marcotte, T.D., Deutsch, R., Zhao, H., Prasad, H., and Phan, A. (2016) An Exploratory Human Laboratory Experiment Evaluating Vaporized Cannabis in the Treatment of Neuropathic Pain from Spinal Cord Injury and Disease. Journal of Pain, doi: 10.1016/j.pain.2016.05.010. Retrieved from
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