Is marijuana good for pain relief?
There is mounting interest among patients and healthcare professionals about the clinical benefits of medical cannabis for various ailments, most commonly for pain relief. Some studies have concluded that medical cannabis may be an alternative for opioids in certain patient populations, while other studies concluded there is insufficient evidence. Medical cannabis is believed to be useful for treating several medical conditions and symptoms, and there is great debate about the safety and efficacy of cannabis for medicinal purposes. It is estimated that 2.1 million Americans use medical cannabis. The legalization and expansion of medical cannabis have created a great debate within the medical community. As the majority of states now allow medical cannabis use, pharmacists must be prepared to provide pharmaceutical care for patients who use medical cannabis, while practicing within the boundaries of the law.
While life-altering, medical professionals are now equipped with the knowledge — and medication — necessary to treat chronic pain issues in patients. But before you decide to explore cannabis or select a treatment plan, you should know more about the symptoms and various forms that define chronic pain first. Below, we’ll explore this condition in greater depth so that you can pursue your wellness plan with an informed mindset.
What Is Chronic Pain?
Chronic pain is a state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years. Research has shown that medical cannabis for pain can be an effective method of treatment that is far safer than many other options.
Chronic pain is an often-incapacitating condition that affects every aspect of your life. It can make the simplest of activities, such as buttoning your shirt or tying your shoes, a struggle. Over time, the condition takes its toll, and you can find yourself becoming down and depressed due to your constant struggle with your pain. Unlike temporary pain which often resolves within days or weeks, chronic pain is often much more impactful due to its long-lasting nature.
How does marijuana work for pain?
Marijuana, or cannabis, contains compounds that may relieve pain, nausea, and other symptoms. The components of marijuana that most studies focus on for pain relief are cannabidiol (CBD) and tetrahydrocannabinol (THC).
THC vs. CBD
THC resembles the cannabinoid chemicals that occur naturally in the body. When people ingest or inhale THC, it stimulates the brain’s cannabinoid receptors.
This activates the brain’s reward system and reduces pain levels. THC is a psychoactive compound as it binds to cannabinoid receptors and produces an elevated state of mind, known as a high.
CBD does not cause a high, although it does interact with pain receptors in the brain to exert pain-relieving and anti-inflammatory effects.
Types of Chronic Pain
Unlike other health complications which may afflict certain portions of the body, chronic pain can be widespread and is likely to influence patients differently.
However, there are three primary forms of chronic pain that impact patients the most. Common types of chronic pain include the following:
- Neuropathic pain: Neuropathic pain results from any damage to the nerves. Rather than an injury provoking pain, neuropathic pain may manifest from irregular signals to the brain that create unwarranted aches.
- Visceral pain: Visceral pain stems from a disturbance in the organs. Because not every organ has the capacity to signal pain, discomfort that is difficult to pinpoint should be reported to your primary care physician for further evaluation.
- Somatic pain: Somatic pain occurs when an individual experiences pain due to an external factor. Chronic pain stemming from somatic pain can include damage from broken bones, joint injury, arthritis or general injuries.
How Is Medical Marijuana an Effective Pain Treatment?
Years worth of anecdotal evidence points to the efficacy of marijuana to treat chronic pain conditions. Nowadays, medical and scientific communities are catching up with what many marijuana advocates have known for years.
So, what do the studies say? According to a Harvard-led review of 28 studies of cannabinoids to treat medical and pain issues published in the Journal of the American Medical Association, the use of marijuana for chronic pain is supported by quality evidence.
Of the studies reviewed, all six generalized chronic pain studies found a substantial improvement through using cannabis.
Furthermore, a study from the University of Michigan from March 2016 and published in the Journal of Pain showed that marijuana:
- Improved quality of life.
- Reduced opioid usage by an average of 64 percent.
- Decreased side effects of other medications.
Your body creates its own cannabis-like chemicals that affect various processes like inflammation and pain. It’s thought that cannabis works well to treat chronic discomfort due to these natural cannabinoid receptors we all have within our bodies, although more research needs to be done to ascertain exactly how marijuana works to relieve pain
Cannabidiol (CBD) is a type of cannabinoid, a chemical found naturally in cannabis (marijuana and hemp) plants. CBD doesn’t cause the “high” feeling often associated with cannabis. That feeling is caused by tetrahydrocannabinol (THC), a different type of cannabinoid.
Some people with chronic pain use topical CBD products, in particular CBD oil, to manage their symptoms. CBD oil may reduce:
- overall discomfort related to a variety of health conditions
The research on CBD products and pain management has been promising.
CBD can offer an alternative for people who have chronic pain and rely on medications, such as opioids, that can be habit-forming and cause more side effects. However, more research is needed to verify the pain-relieving benefits of CBD oil and other products.
Epidiolex, a drug prescribed for epilepsy, is the only CBD product on the market that the Food and Drug Administration (FDA) has approved.
There aren’t any FDA-approved, nonprescription CBD products. They aren’t regulated for purity and dosage like other medications.
Keep reading to learn more about the potential benefits of CBD use for pain. You can also talk with your doctor to see if it’s an option for your condition.
CBD for chronic pain relief
Everyone has a cell-signaling system known as the endocannabinoid system (ECS).
Some researchers think that CBD interacts with a core component of the ECS — endocannabinoid receptors in your brain and immune system.
Receptors are tiny proteins attached to your cells. They receive signals, mostly chemical ones, from different stimuli and help your cells respond.
This response creates anti-inflammatory and pain-relieving effects that help with pain management. This means that CBD oil and other products may benefit people with chronic pain, such as chronic back pain.
One 2018 review assessed how well CBD works to relieve chronic pain. The review looked at studies conducted between 1975 and March 2018. These studies examined various types of pain, including:
- cancer pain
- neuropathic pain
Based on these studies, researchers concluded that CBD was effective in overall pain management and didn’t cause negative side effects.
CBD for arthritis pain relief
A 2016 studyTrusted Source looked at CBD use in rats with arthritis.
Researchers applied CBD gel to rats for four days in a row. The rats received either 0.6, 3.1, 6.2, or 62.3 milligrams (mg) per day. The researchers noted reduced inflammation and overall pain in the rats’ affected joints. There were no obvious side effects.
Rats who received low doses of 0.6 or 3.1 mg didn’t improve their pain scores. The researchers found that 6.2 mg/day was a high enough dose to reduce the rats’ pain and swelling.
In addition, rats who received 62.3 mg/day had similar outcomes to the rats that received 6.2 mg/day. Receiving a substantially larger dosage didn’t result in them having less pain.
The anti-inflammatory and pain-relieving effects of CBD gel could potentially help people with arthritis. However, more human studies are needed.
CBD for cancer treatment relief
Some people with cancer also use CBD. Research on mice has shown that CBD can lead to the shrinking of cancerous tumors. However, most studies in humans have investigated the role of CBD in managing pain related to cancer and cancer treatment.
The National Cancer Institute (NCI)Trusted Source has pointed to CBD as a possible option for reducing chemotherapy side effects, such as:
- lack of appetite
In a 2010 study on cancer-related pain, study subjects received oral sprays of a combination THC-CBD extract. The THC-CBD extract was used in conjunction with opioids. This study revealed that using the extract provided more effective pain relief than using the opioids alone.
A 2013 study on THC and THC-CBD oral sprays had a similar finding. Many researchers from the 2010 study worked on this study as well. More evidence is still needed.
CBD for migraine pain relief
Studies on CBD and migraine are limited. The studies that currently exist also look at CBD when it’s paired with THC, not when it’s used alone.
However, results from a 2017 study indicate that CBD and THC can lead to less acute pain and less intense pain for people with migraine.
In this two-phase study, some participants took a combination of two compounds. One compound contained 9 percent CBD and almost no THC. The other compound contained 19 percent THC. Doses were taken orally.
In phase I, there was no effect on pain when the doses were under 100 mg. When the doses were increased to 200 mg, acute pain fell by 55 percent.
In phase II, participants who received the combination of CBD and THC compounds saw the frequency of their migraine attacks fall by 40.4 percent. The daily dose was 200 mg.
The combination of compounds was slightly more effective than 25 mg of amitriptyline, a tricyclic antidepressant. Amitriptyline reduced migraine attacks by 40.1 percent in study participants.
Participants with cluster headaches also found pain relief with the combination of CBD and THC compounds, but only if they’d had a childhood history of migraine.
CBD side effects
CBD doesn’t pose significant risks for users, and most topical CBD products don’t enter the bloodstream.
However, certain side effects are possible, such as:
- changes in appetite
- changes in weight
CBD may interact with:
- certain over-the-counter (OTC) drugs
- prescription medications
- dietary supplements
Proceed with caution if any of your medications or supplements contain a “grapefruit warning.” Grapefruit and CBD both interfere with enzymes that are crucial to drug metabolism.
Like other drugs and supplements, CBD may also increase your risk of liver toxicity.
One study on mice concluded that CBD-rich cannabis extract increased their risk of liver toxicity. However, some of the mice had been force-fed very large amounts of the CBD-rich cannabis extract.
Side Effects of Marijuana for Chronic Pain
It’s imperative that you start off with the lowest dose possible when you’re beginning to take medical pot. You’ll soon find out via a trial and error process what works best for you.
If you do have any side effects of ingesting medical marijuana, they won’t last long and may include:
- Dry mouth and thirst
- Short-term memory loss
- Increased appetite
- Red eyes
- Anxiety or uneasiness
Medical marijuana affects everyone differently, but overall the marijuana side effects are more manageable and milder than those that come with traditional medicines like opioids.
HOW TO GET – AND USE – MEDICAL MARIJUANA FOR PAIN AND RELATED SYMPTOMS
Step 1: Get a Doctor’s Order
The first step in consuming medical marijuana (legally speaking) will be getting a recommendation from your doctor. Because marijuana is still illegal at the federal level, doctors give recommendations or orders but are not legally permitted to give prescriptions. You can find state-by-state information regarding what conditions qualify for medical marijuana.
Step 2: Pick Your Passion
Next, you’ll need to decide what form you want to use – each type will dictate your experience with it.10 Consumption methods can change the percentage of active compounds your body absorbs, the time it takes to feel the effects of marijuana, and the duration of those effects. There are three main ways to consume cannabis:
- inhalation – vaping with a vaporizer or smoking (think a “joint”)
- edibles – gummies, brownies, and other “snacks”; tinctures and oils that dissolve under the tongue fall into this category too
- topicals – creams, ointments, salves applied directly to your skin
Below is a quick overview of each.
Inhalation marijuana allows the active components to readily cross the blood-brain barrier and may be an effective way to decrease the CNS response to pain sensations. This can be especially useful for difficult to treat neuropathic pain or centralized pain conditions, such as fibromyalgia. When people smoke marijuana, they typically begin feeling effects after 2 minutes, with that feeling peaking after 30 minutes. When smoking, people tend to feel the influence of marijuana for 2 to 4 hours and the body typically absorbs about 25% of the active compounds.
When people inhale cannabis via vaporization, they absorb more of the active compounds than when smoking. This is an important consideration, especially for first-time users. Vaporization typically results in a 33% absorption of cannabinoids so you may want to consume less if vaping than when smoking.
Taking medical marijuana by mouth has similar effects to inhalation, but with a slower and less predictable uptake. There are different forms of edibles on the market. When you eat a marijuana-containing product, it must travel through the digestive tract just like any other food or beverage, so you will not feel the effects right away – a couple of hours is typical. This is one reason why people are more likely to over-consume edibles, so be careful. If you do not feel the effects immediately, do not take more. Some studies suggest that the digestion of marijuana may have increased beneficial effects on the digestive system, due to the direct interaction with the gut microbiota.11
Dispensaries often consider between 1 and 5 milligrams of THC to be a micro-dose, and often a recommended place to begin. The effects of ingesting edibles containing marijuana can be stronger and longer lasting than inhaling cannabis.
Walk into a medical marijuana dispensary and you are likely to see an array of edibles, including:
Tinctures and Oils
Tinctures and oils are sometimes thought of as edibles because you take them by mouth, but they are more readily absorbed by the body. Tinctures and oils can be taken under the tongue, where they are rapidly absorbed into the bloodstream and cross the blood-brain barrier. Tinctures may be a good option for people who want greater control over their dose, because they are easier to measure precisely.
Topical application is best used to decrease localized pain and inflammation, should not result in systemic absorption, and should not give you a high (like consuming and inhaling marijuana will). If you have joint pain and apply a topical lotion to the source, it can have a pain-relieving effect. Marijuana-infused topicals include:
Just like any medicine, the dose of marijuana you use will be a decisive factor in its effect on your body. Dosage can be more difficult to predict and control because the effects will vary based on the strain, method of consumption, your unique body chemistry, and even your history with marijuana (you may find that you need more as time goes on).
Some things to keep in mind:
- Your body absorbs more cannabinoids when vaping than when smoking.
- You will not feel the effects of edibles right away. Start small and go slow.
- Dosage listings for retail products (especially edibles) may be inexact and it often only takes a small percentage of the product to feel the effects.
- Tinctures (liquid edibles taken under the tongue) usually allow for the most accurate and measurable dosage.
- The experience you have with one strain may not be the experience you have with another; doses and brands will vary.
Step 3: Get Into the Science to Stay Safe
Just as the cannabinoids produced by your body interact with a variety of other natural components, the cannabinoids produced by the marijuana plant interact with their own variety of elements. Both are affected by their surroundings.
For us, our specific type of pain, our weight, and our daily habits (what we eat, how much we sleep, and how much stress we’re under) can impact how marijuana affects our bodies. For marijuana plants, the sun, soil, and humidity can impact how they grow. And just like a wine grape, the same marijuana strand may differ from harvest to harvest.
So in addition to selecting the basic form you want to try, you need to look at the product from the inside out. Here’s how.
Best Strains of Marijuana for Chronic Pain
Whether you use edible forms of medical cannabis for pain, roll it into a joint or use a vaporizer, there are many different strains of the plant that can substantially reduce discomfort. Perhaps you feel better when you smoke the drug, whereas someone else may find that taking low-dose edibles works for them.
Of course, the chemical composition of the strain you choose as well as your method of ingestion may affect your painkilling outcome. Keep in mind that it’s likely you might need to take a trial and error approach before you hit on the right strain and dosage for you.
Generally speaking, less is more when it comes to treating this type of pain. Many people find that sativa strains higher in THC — the primary psychoactive substance that gives you a “high” — work better for them than hybrid or indica strains. These also work most effectively in doses that are low to moderate and can potentially make your pain worse in higher doses.
No matter how you plan to ingest medical cannabis, there are various strains that can help reduce your discomfort. These include:
Although it can be difficult to find, ACDC contains high levels of the cannabinoids CBD and THC. Advocates of this strain indicate that the benefits are numerous.
2. Afghan Kush
A potent general pain reliever, Afghan Kush is almost 100 percent indica. Its effects are felt mostly physically which is why it works so well regarding pain relief. Afghan Kush contains anti-inflammatory and painkilling terpenes.
This strain also contains caryophyllene, which is known to work against cancer. Therefore, if your pain is cancer-related, this could offer you relief. Other useful strains high in caryophyllene include Super Sour Diesel, Maui Waui and Hash Plant.
3. Blue Dream
Blue Dream is a hybrid sativa that was first grown in California. It provides not only relaxation throughout the entire body, but many users also find it to be invigorating. This strain produces a mellow euphoria that yields a calming effect and also has an aroma similar to berries. Since it doesn’t result in the sedative effects of other strains, Blue Dream is well-suited for daytime use.
4. Granddaddy Purple
Another Californian type, Granddaddy Purple has been in existence for approximately 15 years. This strain can be potent, so don’t use it if you plan to go out during the day or the evening. Patients use Granddaddy Purple to relieve symptoms from pain, muscle spasms, stress, insomnia and more.
5. Girl Scout Cookies
This is another hybrid with a sweet aroma that’s very easy to spot, thanks to its orange hairs and purple leaves. This strain is well-known for producing a feeling of relaxation throughout the body and is popular among people who suffer from not only severe pain but also nausea and loss of appetite. The Girl Scout Cookies strain is best taken in small doses until you’re certain of how much you can handle at one time.
6. Jack Herer
A well-known strain for easing nerve pain, Jack Herer, named after the author and activist, is high in sativa. Filled with natural painkillers, Jack Herer contains pinene that has anti-tumor properties.
7. White Widow
A half-and-half cross between a pure indica and a pure sativa, this is a well-balanced strain that makes you feel uplifted while tackling your pain. White Widow also contains linalool, an anti-inflammatory and pain reliever that’s also found in lavender.
Always speak to your doctor about which medical marijuana strain is anticipated to work best for your type of pain.
Clearly, the debate regarding the pros and cons associated with the use of medical cannabis will persist due to continuing legalization and research efforts. Therefore, it is imperative that pharmacists are knowledgeable about this issue and are prepared to answer clinician and patient questions. As one of the most accessible healthcare providers, pharmacists have a pivotal role in educating patients and prescribers about medical cannabis, including the current regulations and clinical studies exploring the potential uses of medical cannabis in chronic pain. There is ongoing research about the ECS and the role of cannabinoid compounds in various medical conditions. While various clinical studies have been conducted regarding the clinical benefits of medical cannabis, more research is required to better understand effective pain-management regimens for medical cannabis users.