Chronic Pain and Medical Cannabis Treatment
There are a variety of types of cannabis products available for use for chronic pain, including the cannabis plant, tinctures, edibles, oils, and topical products. Many topical products exclusively contain cannabidiol (CBD) that touts healing benefits without the psychoactive effects of using cannabis. Many patients find partial relief from CBD lotions and patches.
During a task force meeting for PAINWeek 2020, doctors and researchers met to provide prescribing guidelines to doctors. PAINWeek serves as the most recognized pain management meeting for medical professionals in the United States. The task force recommended the following prescribing guidelines:
- Patients should begin with 5mg of CBD twice daily. Tetrahydrocannabinol (THC) should only be used if there is no improvement with up to 40 mg of CBD alone (1).
- 2.5mg of THC should be introduced with CBD and gradually increased to a maximum of 40mg of THC a day (1).
- Frail or elderly patients should begin with 1mg of THC per dose and increase slowly (1).
- The rapid protocol for patients with severe pain or who have had significant cannabis consumption in the past, is to begin with 2.5mg doses of CBD & THC (1:1 ratio) once or twice daily (1).
It is important to keep in mind that everyone responds differently to medications in general. A coach in the Veriheal network may be able to help you figure out dosages to control your pain as well as address any concerns you may have regarding the psychoactive properties of cannabis.
Considerations to Keep in Mind
Many chronic pain patients using medical cannabis and CBD experience the following (2):
- Improved pain management
- Improved ability to fall asleep
- Improved ability to stay asleep through the night
- Reduced nightmares
- Improved quality of life
- Increased focus and relaxation due to lack of pain
- Reduction in opioid use
- Decreased anxiety and depression associated with chronic pain
- Increased appetite
Alternatively, the downside of using cannabis for chronic pain includes the following:
- Coughing and breathing issues from smoking
- Strong smell of cannabis
- Increased appetite
- Cannabis pricing
- Fear of social stigma
- Brain fog
Using THC and CBD for Chronic Pain
THC and CBD are the two main cannabinoids (chemical compounds found in cannabis) that produce health benefits for chronic pain patients. Both cannabinoids interact with the cannabinoid receptors of the endocannabinoid system of the human body and work together to provide relief for ailments like pain, anxiety, depression, etc.
A 2006 review article in the journal of Current Neuropharmacology investigates how cannabinoid receptors influence chronic pain. Research has shown that cannabinoid receptor agonists reduce inflammation and “display synergistic effects with other systems that influence analgesia, especially the endogenous opioid system (3).” They have also shown therapeutic value against neuropathic pains.
According to cannabinoidologist E. Ayako Monsell:
“When it comes to pain management and cannabis, it’s not all about the highest percent of THC. With over 400 known compounds in the cannabis plant – and more unknown – it truly is that this whole can be greater than the sum of its parts. Other popular or up and coming cannabinoids like CBD, THCa, CBN, THCV, CBG, and CBC each play important roles.
As patients incorporate more of the entire plant with cannabinoids, terpenoids, and flavonoids, each adding to the entourage effect, they are often able to mitigate symptoms of chronic pain. It’s like a chemical domino effect. CBD has been shown to promote endocannabinoid production within the body while its role in controlling stress can lead to the control of stress responses like inflammation which supports pain management,” said E. Ayako Monsell.
Understanding The Different Types of Chronic Pain
When it comes to chronic pain, there are three main types that people experience. The first type of pain that patients use medical cannabis for is nociceptive pain. Nociceptive pain is pain caused by tissue damage (4). This pain type is the most common type of chronic pain and includes damage to bones, organs, and other soft tissue. It can also include other types of chronic pain such as migraines and arthritis. Specific types of nociceptive pain include broken bones, cancer, back pain, and more.
The second type of pain that people are familiar with is neuropathic pain, or rather, pain that comes from nerve damage (4). Nerve damage can be caused by accidental injuries, limbs being crushed or emergency amputations. It can also be caused by diabetes, HIV infections, or stroke.
The final pain category is psychogenic pain (4). Psychogenic pain usually begins with nerve pain or tissue pain, but then results in additional pain that is exacerbated by anxiety, depression, stress or mental illness.
What Does the Science Say?
According to a scientific study published in The Journal of Pain, using medical cannabis for chronic pain resulted in a 64% decrease in patient use of opioids and other prescription pain medications (2). In addition, those patients saw a great improvement in their quality of life and experienced fewer side effects from prescription medication.
“Patients are essentially substituting medical cannabis for opioids and other medications for CP [chronic pain] treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications (2).”
Note: Veriheal does not intend to give this as professional medical advice. Do not attempt to self-diagnose or prescribe treatment based on the information provided on this page. Always consult a physician before making any decision on the treatment of a medical condition.
1. Basen, R. (2020, September 13). New Guidelines Issued on Medical Cannabis for Chronic Pain. Medical News and Free CME Online. https://www.medpagetoday.com/meetingcoverage/painweek/88593
2. Boehnke, K. F., Litinas, E., & Clauw, D. J. (2016). Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. The Journal of Pain, 17(6), 739–744. https://www.jpain.org/article/S1526-5900(16)00567-8/fulltexthttps://doi.org/10.1016/j.jpain.2016.03.002
3. Piper, B. J., Beals, M. L., Abess, A. T., Nichols, S. D., Martin, M. W., Cobb, C. M., & DeKeuster, R. M. (2017). Chronic pain patients’ perspectives of medical cannabis. Pain, 158(7), 1373–1379. https://journals.lww.com/pain/Abstract/2017/07000/Chronic_pain_patients__perspectives_of_medical.23.aspx
4. Wheeler, T. (2019, August 16). Pain Classifications and Causes: Nerve Pain, Muscle Pain, and More. WebMD. https://www.webmd.com/pain-management/guide/pain-types-and-classifications