Setting the Stage

Cannabis refers to a group of plants in the family Cannabaceae that contain compounds called cannabinoids. There are over 100 different cannabinoids, but the two most well-known are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the compound that is responsible for the psychoactive effects of cannabis, while CBD is non-psychoactive.

When we consume cannabis, the cannabinoids in the plant interact with our body’s endocannabinoid system (ECS). The ECS is a complex system of receptors and neurotransmitters that are involved in regulating many different bodily functions, including pain, mood, appetite, and sleep.

When THC interacts with the ECS, it activates the CB1 receptors, which are primarily located in the brain and central nervous system. This activation leads to the release of neurotransmitters like dopamine and serotonin, which can help to reduce pain and improve mood. THC can also interact with the CB2 receptors, which are primarily located in the immune system and can help to reduce inflammation.

CBD, on the other hand, does not directly activate the CB1 or CB2 receptors but can interact with other receptors in the body, including the serotonin and vanilloid receptors [2]. This can lead to reduced pain and inflammation, as well as improved mood and sleep.

The evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS — or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day.

Dr. Joycelyn Elders, Public Health Administrator [Sep. 8, 1993 – Dec. 31, 1994]

Cannabis has been used for a variety of different types of pain, including:

1. Neuropathic pain: This type of pain is caused by damage to the nerves and can be chronic and difficult to treat with traditional pain medications. Cannabis has been shown to be effective in reducing neuropathic pain, particularly when it contains high levels of THC [4].
2. Inflammatory pain: Inflammation is a natural response of the immune system to injury or infection, but it can also cause pain and discomfort. Cannabis has been shown to have anti-inflammatory properties and can be effective in reducing pain associated with inflammation [6].
3. Cancer-related pain: Cancer and its treatments can cause a range of different types of pain, including neuropathic pain, inflammatory pain, and pain caused by muscle spasms. Cannabis, particularly with high levels of THC, has been shown to be effective in reducing cancer-related pain[3].
4. Chronic pain: Chronic pain is defined as pain that persists for more than three months and can be difficult to treat with traditional pain medications. High-THC varieties of Cannabis have also proved effective in reducing chronic pain [5].

According to a recent study by researchers from Harvard Medical School, the long-term use of medical cannabis may be able to reduce chronic pain, especially pain from arthritis and swollen joints [7]. Both THC and CBD may help with the short-term mitigation of chronic pain [6]. Multiple patient surveys indicate that cannabis helps with their experience of chronic pain.

Source: https://www.liebertpub.com/doi/10.1089/can.2021.0088

While cannabis has been shown to be effective in managing pain, it is important to note that its effectiveness can vary depending on the individual and the type of pain they are experiencing. People have reported different levels of relief after taking cannabis to ease their pain; for some there’s an immediate and noticeable difference and for others it makes no difference.

While cannabis can be an effective treatment for pain, it is not without risks. Some of the risks associated with cannabis use, whether medicinal or recreational, include:

• Cardiac and lung effects: Cannabis use can cause rapid heart rate and bronchitis when inhaled [1].
• Addiction: Cannabis use can be addictive, especially when used regularly over a long period of time [1].
• Drug interactions: Cannabis, particularly CBD, can interact with other medications[1].
• Anxiety and panic attacks: Cannabis can cause or worsen anxiety, especially at high dosages, even leading to panic attacks [1].
• Impaired driving and heavy machinery operation: Cannabis use can impair driving and the operation of heavy machinery [1].
• Teenagers: Cannabis use can be especially dangerous for teenagers, as it can interfere with brain development and lead to long-term cognitive impairments [1].
• Pregnancy: Smoking cannabis during pregnancy has been linked to lower birth weight [4].

Forms of Cannabis for Pain Relief

Cannabis can be used in many different forms for pain relief. Especially if people are only familiar with smoking cannabis, it is important to be aware that there are alternative ways to ingest it that avoid the health consequences of smoking. Here are some of the most common forms:

1. Flower: This is the dried, cured, and ground form of the cannabis plant that is smoked or vaporized. It is the most common form of cannabis used for pain relief.
2. Edibles: These are food products that contain cannabis. They come in many different forms, such as gummies, chocolates, and baked goods. Edibles take longer to take effect than smoking or vaporizing, but their effects last longer.
3. Tinctures: These are liquid extracts of cannabis that are taken orally. They are usually administered using a dropper and are absorbed through the mucous membranes under the tongue.
4. Topicals: These are creams, balms, and lotions that contain cannabis. They are applied to the skin and can provide localized pain relief.
5. Concentrates: These are highly potent forms of cannabis that are extracted from the plant. They come in many different forms, such as wax, shatter, and oil. Concentrates are usually vaporized or dabbed and are not recommended for beginners.

The effectiveness of cannabis for pain relief can vary depending on the form it is taken in. Here is a breakdown of how each form varies in effectiveness:

THC and CBD are two of the most commonly consumed cannabinoids and they have different effects on the body. THC is the primary psychoactive compound in cannabis, responsible for the “high” feeling that people experience. CBD, on the other hand, is not psychoactive and does not produce a high.

When it comes to pain relief, both THC and CBD have shown promise, but they have different effects on the body. THC has been found to be more effective for pain relief than CBD, but it also comes with more side effects and a higher risk of addiction. CBD, on the other hand, has fewer side effects and a lower risk of addiction, but it may not be as effective as THC for pain relief.

Studies indicate that for many patients, cannabis with higher percentages of THC, and to a lesser extent CBD, are more effective in treating pain.

Here are some of the key differences between THC and CBD:

• Psychoactive effects: THC produces a high, while CBD does not.
• Pain relief: THC has been found to be more effective for pain relief than CBD, but CBD may still have some pain-relieving effects.
• Side effects: THC can cause side effects like dry mouth, red eyes, increased heart rate, and impaired coordination. CBD, on the other hand, has fewer side effects, but it can cause drowsiness, dry mouth, and changes in appetite.
• Addiction risk: THC has a higher risk of addiction than CBD, and long-term use can lead to withdrawal symptoms when use is stopped.
• Legal status: THC is still illegal at the federal level in the United States, while CBD is legal as long as it is derived from hemp and contains less than 0.3% THC.

Scientists are still researching the exact mechanisms by which both THC and CBD, as well as their combined use, may work with the ECS to reduce pain. For example, some research has suggested that THC might not actively reduce the pain itself, but act on the brain’s amygdala to affect the perception of pain [4]. Once again, it’s important to note that the effectiveness of THC and CBD for pain relief can vary depending on the individual and the type of pain they are experiencing.

Overall, both THC and CBD have therapeutic potential for pain relief, but they have different effects on the body and come with different risks and benefits. The best approach for pain relief will depend on the individual and their specific needs. Be sure to talk to a healthcare professional before using cannabis for pain relief, as there can be potential interactions with other medications and side effects to consider.

Comparing Methods of Using Cannabis for Pain Relief

The dosage of cannabis that a person should take can vary depending on several factors, such as their age, weight, and medical condition. Additionally, the method of consumption can also affect the dosage that is appropriate. Here are some ways that dosages can vary based on the method of consumption:

• 1

  Inhalation: When cannabis is inhaled, it can take effect quickly, usually within a few minutes. However, the effects can wear off relatively quickly as well, usually within a few hours. The dosage that is appropriate for inhalation mostly varies based on the potency of the cannabis being used, as well as the person's tolerance level. Generally, it is recommended that people start with a low dosage and gradually increase it as needed.

• 2

  Edibles: When cannabis is consumed in the form of an edible, it can take much longer to take effect, usually anywhere from 30 minutes to two hours, and effects typically last longer than when cannabis is inhaled. Because of the delayed onset and longer-lasting effects, it can be more difficult to determine the appropriate dosage for edibles. It is recommended that people start with a low dosage (5-10mg) and wait at least 2 hours before taking more.

• 3

  Topicals: When cannabis is applied topically, such as in the form of a cream or lotion, it is absorbed through the skin and can provide localized relief without producing psychoactive effects. Dosages can vary based on the potency of the product and the area of the body where it is being applied.

• 4

  Sublingual: When cannabis is consumed sublingually, placed under the tongue, it can take effect relatively quickly, usually within 15-45 minutes. Dosages can vary based on the potency of the product and the person's tolerance level.

Conditions Treated with Cannabis for Pain Relief

Over 200 separate indications or uses for medical cannabis have been identified [3]. The most common conditions that cannabis is used to treat for pain relief include:

• 1

  Neuropathic pain: This is a type of chronic pain caused by damaged nerves; sometimes it is a side-effect of chemotherapy. Studies have found that marijuana can be helpful in treating neuropathic pain [5].

• 2

  Muscular pain: Topical cannabis can be effective in providing pain relief without the side effects of pharmaceutical painkillers [7].

• 3

  Fibromyalgia: Medical marijuana can be effective in reducing pain and improving sleep quality in patients with fibromyalgia [6].

• 4

  Inflammatory conditions: Cannabis has anti-inflammatory properties and can be helpful in treating conditions such as arthritis [3].

• 5

  Migraines: Medical marijuana has been found to reduce the frequency and intensity of migraines [6].

Cannabis is one of the best medicines for migraines. It's so effective - it works rapidly, and it has limited toxicity, although lung damage from smoking is a concern.

Dr. Phillip Denney, M.D. (University of Southern California)

The success rates for treating the above conditions with cannabis vary and depend on several factors, including the individual’s health status, the method of consumption, and the dosage and quality of the cannabis product used. Additionally, since the use of cannabis for medicinal purposes is a relatively new field of study, there is still a need for more research to establish the long-term effectiveness of cannabis in treating these conditions.

Side Effects of Using Cannabis to Treat these Conditions:

Like any medication, cannabis can have side effects. According to the Mayo Clinic [1], some potential side effects of using cannabis include:

• Dizziness
• Drowsiness
• Impaired memory and concentration
• Increased heart rate
• Dry mouth and eyes
• Psychosis, especially in people with a history of mental illness

It’s also essential to be aware that smoking cannabis can have negative effects on lung health, as shared above. In some cases, cannabis can worsen anxiety or even trigger panic attacks. People who have a history of mental illness, including anxiety and depression, should be cautious when using cannabis for pain relief. According to Harvard Health Publishing [2], people who use cannabis with high levels of THC, may be more likely to experience anxiety and other mental health side effects.

Safety and Legal Considerations

Like any medication, cannabis has potential risks that should be considered before use. Here are some important safety considerations to keep in mind when using cannabis for pain relief:

• Inflammation: Smoking cannabis can inflame the lungs and cause bronchitis, making it an unsafe option for people with respiratory conditions. Instead, consider using alternatives like tinctures, edibles, topicals, or dry herb vaporizers [1].
• Addiction: Cannabis can be addictive, and some people may develop a dependence on it [2].
• Interactions: Cannabis can interact with other medications, especially those that contain CBD. It’s important to consult with a healthcare provider before using cannabis if you are taking other medications [2].
• Impairment: Cannabis can impair driving and the operation of heavy machinery, so it’s important to avoid these activities while under the influence of cannabis [2].

Overall, cannabis can be a safe and effective option for pain relief when used responsibly and under the guidance of a healthcare provider.

Before using cannabis for pain relief, it is essential to be aware of the legal considerations that come with its use. In many countries, including the United States, cannabis remains illegal under federal law. However, many states have legalized cannabis for medical or recreational purposes, and it is important to understand the legal framework in your state or country.

In addition to checking the basic legal status of cannabis in your area, here are some legal considerations to keep in mind when using cannabis for pain relief:

1. Medical vs. recreational use: In states where cannabis is legal for both medical and recreational use, it is important to understand the difference between the two. Medical use typically requires a doctor’s recommendation and is subject to different regulations than recreational use.
2. Possession and consumption limits: Even in states where cannabis is legal, there are often limits on how much you can possess and consume. It is important to understand these limits and abide by them to avoid legal trouble.
3. Age restrictions: In most states, you must be at least 21 years old to purchase and consume cannabis for recreational purposes. Medical cannabis may be available to minors in some states, but it is subject to additional restrictions.
4. Workplace drug testing: While cannabis may be legal in your state, it is important to understand how it may impact your employment. Many employers may have policies, or be subject to federal regulations, prohibiting cannabis use by employees.
5. Federal law: It is important to understand that cannabis remains illegal under federal law, regardless of its legal status in your state. This means that you may still be subject to federal prosecution, even if you are abiding by state law.

Comparison with Other Pain Relief Methods

Chronic pain affects millions of people and finding effective pain relief methods can be a challenge. While traditional pharmaceutical pain relievers can be effective, they also come with a host of potential side effects and risks, such as opioid addiction . As a result, many people have turned to alternative methods, including cannabis, for pain relief.

Here, we’ll explore how cannabis compares to other pain relief methods in terms of effectiveness, the advantages and disadvantages of using cannabis compared to other pain relief methods, and potential risks of using other pain relief methods.

Research suggests that the cannabinoids found in cannabis can help to relieve pain by interacting with the body’s endocannabinoid system, which plays a role in regulating pain, inflammation, and other physiological processes.

Medical cannabis replaced my need for oxycodone. Now I don't need them at all.

Patient response from study conducted on Medical Cannabis users in Hawai’i

Several studies have compared the effectiveness of cannabis to other pain relief methods, including traditional pharmaceuticals. Here are a few key findings:

• A 2015 systematic review found that cannabis was effective in treating chronic pain in adults. The review analyzed 28 randomized, controlled trials and found that cannabis was associated with a statistically significant reduction in chronic pain compared to a placebo [1].
• A 2018 meta-analysis of 16 studies found that cannabis-based treatments were more effective than placebo in reducing chronic neuropathic pain [2].
• A 2019 study compared the effectiveness of cannabis to opioids in treating chronic pain. The study found that cannabis was associated with a similar level of pain relief as opioids, but with fewer side effects and a lower risk of addiction [3].

Overall, the evidence suggests that cannabis can be an effective treatment option for chronic pain, and may be a safer alternative to traditional pharmaceuticals in light of the crippling effects of opioid addiction.

In one study of people who switched from managing pain with prescription opioids to medical cannabis, many reported better quality of life and less negative impacts [7].

Traditional pharmaceutical pain relievers come with a host of potential risks and side effects, the most serious of which are addiction and overdose. Especially when taken in high doses or for a prolonged period of time, these risks increase.

The risks associated with opioids include:

• Addiction: Opioids are highly addictive and can cause physical dependence [5].
• Withdrawal: When someone decides to cease opioid use after a prolonged period or who is physically dependent, withdrawal symptoms can be severe.

Overdose: Overdose is a serious risk associated with opioid use. In 2020, over 68,000 people died from opioid overdoses in the United States alone [5].

Opioid misuse has become a major public health issue, and it is important to consider alternative pain management options whenever possible.

Non-opioid pain relievers like acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin are commonly used to manage pain. These drugs can be effective in reducing pain, but they also carry the following risks:

When considering different pain relief methods, it is important to weigh the potential benefits and risks of each option. Cannabis may offer a safer alternative for some people, particularly those who cannot tolerate or do not want to use opioids or NSAIDs.

As mentioned earlier, opioids and non-opioid pain relievers carry a number of risks, including addiction, overdose, and side effects like stomach ulcers and liver damage. In addition, some other pain management methods may carry their own risks:

• Surgery: Surgery carries a risk of complications, including infection, bleeding, and nerve damage. It may also require a lengthy recovery period and can be prohibitively expensive for people who are under-insured.
• Injections: Injected medications can cause side effects like allergic reactions and infections. In addition, injections may not be effective for all types of pain.
• Physical therapy: Physical therapy can be effective in reducing pain and improving function, but it may be costly and time-consuming. It may also require ongoing maintenance to maintain the benefits.
• Alternative therapies: Alternative therapies like acupuncture, massage, and chiropractic care may offer some pain relief, but their effectiveness is not well-established. In addition, these therapies may not be covered by insurance and can be expensive.

Recommendations for use

Dosages can vary depending on the individual’s needs and the product being used. It is recommended to start with a low dose and gradually increase until the desired effect is achieved. Pay attention to any changes in mood or behavior as the effects of cannabis can be highly individualized.

The following are some general dosage guidelines:

• For smoking or vaporizing cannabis flower, start with 1-2 inhalations and wait at least 15 minutes before deciding if another dose is needed.
• For edibles, begin with a low dose of 5-10mg of THC and wait at least 2 hours before deciding if you should take any more. Edibles can take longer to take effect and the effects can last longer than other methods of consumption.
• For tinctures or oils, start with a low dose of 2.5-5mg of THC and wait at least 2 hours before deciding if another dose is needed.

It is important to note that the effectiveness of each method can vary depending on the individual and the type of pain being experienced. Experimenting with different methods and dosages can help individuals find what works best for them.

Top Online resources

• 
  Americans for Safe Access

  This organization is dedicated to ensuring safe and legal access to medical cannabis for therapeutic use and research. They provide educational resources, legal support, and advocacy for patients and medical professionals.

• 
  International Association for Cannabinoid Medicines

  This association focuses on the use of cannabinoids for medical purposes, including pain management. They provide resources for patients and medical professionals, as well as advocacy for cannabis research and access.

• 
  Marijuana Policy Project

  This organization works to change cannabis laws and policies to increase access for patients and reduce harm. They provide information on state laws, advocacy resources, and support for cannabis reform.

• 
  National Organization for the Reform of Marijuana Laws (NORML)

  NORML advocates for the legalization of marijuana for adults, as well as legal access for medical patients. They provide educational resources, legal support, and advocacy for cannabis reform.

• 
  Patients Out of Time

  This organization provides education and advocacy for the therapeutic use of cannabis, including pain management. They offer resources for patients, medical professionals, and policymakers, and promote research into cannabis as medicine.

• 
  Society of Cannabis Clinicians

  This association is dedicated to promoting the safe and effective use of cannabis for medical purposes, including pain management. They provide educational resources, networking opportunities, and advocacy for cannabis research and access.

• 
  Veterans Cannabis Project

  This organization advocates for the use of cannabis for military veterans, including pain management. They provide resources for veterans, promote research into cannabis as medicine, and advocate for legal access to cannabis for veterans.

• 
  The Cannabis Alliance

  This organization promotes safe and legal access to cannabis for medical purposes, including pain management. They offer educational resources, advocacy for cannabis reform, and support for research into cannabis as medicine.

Conclusion

Living in constant pain is a distressing reality for millions of people. In an effort to ease that pain, the pharmaceutical industry inadvertently created an opioid crisis that has claimed hundreds of thousands of lives. Now more than ever, an alternative form of pain management with less severe side effects such as cannabis, should be seriously considered by doctors and patients alike.

Research on the efficacy of cannabinoids like THC and CBD to alleviate pain continues to shed light of which kinds of pain, such as neuropathic pain, cannabis seems to be most effective for. The increasing scope for legal medicinal cannabis use makes this treatment a viable option for more people than ever. If you or a loved one is dealing with long-term pain, consider talking to a medical professional to see if cannabis can be the means to relieve it.

Sources

1. Research Gate. “Vijaya (Cannabis sativa Linn. ) and its therapeutic importance in Ayurveda; a review.” Accessed on April 26, 2023.
2. Frontiers in Pharmacology. “Cannabinoids and Pain: New Insights From Old Molecules.” Accessed on April 26, 2023.
3. CDC. “Marijuana and Public Health: Pain.” Accessed on April 26, 2023.
4. Medical News Today. “What are the best cannabis strains for chronic pain?” Accessed on April 26, 2023.
5. Harvard Health Publishing. “Does cannabis actually relieve pain — or is something else going on?” Accessed on April 26, 2023.
6. Harvard Health Publishing. “Can cannabis help relieve pain?” Accessed on April 26, 2023.
7. Pain News Network. “Harvard Study Finds Cannabis Effective for Chronic Pain.” Accessed on April 26, 2023.
8. Harvard Health Publishing. “Common questions about medical cannabis.” Accessed on April 26, 2023.
9. NIH. “Cannabis (Marijuana) and Cannabinoids: What You Need To Know.” Accessed on April 26, 2023.
10. International Association for the Study of Pain. “Distilling the highs of cannabis-based pain relief.” Accessed on April 26, 2023.
11. VerywellHealth. “Health Conditions Medical Marijuana Can Treat.” Accessed on April 26, 2023.
12. Cannabis.net .“10 Conditions That Topical Cannabis Can Treat.” Accessed on April 26, 2023.
13. AARP. “What Medical Marijuana Works For.” Accessed on April 26, 2023.
14. Mayo Clinic. “Medical marijuana.” Accessed on April 26, 2023.
15. U.S. News. “Where Is Marijuana Legal? A Guide to Marijuana Legalization.” Accessed on April 26, 2023.
16. JAMA. “Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review.” Accessed on April 26, 2023.
17. NIH. “Cannabis-based medicines for chronic neuropathic pain in adults.” Accessed on April 26, 2023.
18. Science Direct. “Pills to Pot: Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain.” Accessed on April 26, 2023.
19. CDC. “Death Rate Maps & Graphs.” Accessed on April 26, 2023.
20. NIH. “Drug Overdose Death Rates.” Accessed on April 26, 2023.
21. PLOSOne. “Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study.” Accessed on April 26, 2023.
22. NIH. “Therapeutic Benefits of Cannabis: A Patient Survey.” Accessed on April 26, 2023.
23. Nature. “The Association between Cannabis Product Characteristics and Symptom Relief.” Accessed on April 26, 2023.

Cannabis and Cannabinoid Research. “Perceived Efficacy, Reduced Prescription Drug Use, and Minimal Side Effects of Cannabis in Patients with Chronic Orthopedic Pain .” Accessed on April 26, 2023.