A whopping 64.2 percent of those polled for a recent survey say they are using cannabis for pain. An excellent overview can be found in “Role of Cannabinoids in Pain Management” by Ethan Russo and Andrea G. Hohmann. This is a chapter from the 2013 textbook issued by the American Academy of Pain entitled “Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches.” Russo is an ardent cannabis scholar and acknowledges in the article that documenting cannabis research “has been a major preoccupation.” The chapter offers a balanced, comprehensive and sometimes guarded review of literally dozens of cannabis studies conducted in the past 30 years. With predictable reserve, Russo concludes, “Basic science and clinical trials support the theoretical and practical basis of cannabinoid agents as analgesics for chronic pain.”
Another excellent Russo article is “Cannabinoids in the Management of Difficult to Treat Pain.” Originally part of “Therapeutics and Clinical Risk Management” the article is available at researchgate.net.
A leaner compilation of the research can be found in “Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence,” by Bjorn Jensen, et.al. published in “Current Pain and Headache Report.” This report provides links to more than 80 studies, most published in the past 20 years. The authors draw no conclusions, but do offer a short cut for those readers who prefer not to cull through hundreds of internet listings, but are seeking scientific information about cannabis and pain.
As medical cannabis is also legalized in other countries larger studies have gotten underway that will aid tremendously in understanding long-term effects of cannabis. In Canada, a multi-center cohort study was conducted over four years evaluating safety issues in more than 400 patients using cannabis for chronic pain against a non-cannabis using a control group. The study was primarily looking at safety issues which for cannabis were found to be “modest” but they also reached a conclusion regarding cannabis “Compared with baseline, a significant reduction in average pain intensity over one year was observed in the cannabis group… but not in the control group”.
No matter what the condition proper dosing of medical cannabis can be a tricky prospect. A recent study looking at neuropathic pain from spinal cord injury and disease addressed this issue by offering two different doses of vaporized THC compared to a placebo dose. Not surprising, there was more pain relief with THC than placebo. The authors also concluded, “Because the 2 [THC] doses did not significantly differ from each other in terms of analgesic potency, the lower dose appears to offer the best risk-benefit ratio in patients with neuropathic pain associated with injury or disease of the spinal cord.” This underscores the clinical mantra of cannabis physicians and nurses: Start low, go slow.
Finally, Americans for Safe Access (ASA) has also looked at this issue of chronic pain and medical cannabis preparing an excellent booklet entitled “Chronic Pain and Medical Cannabis”. The 27-page booklet can be bought online or you can download the PDF version for free.
Do you use cannabis for chronic pain? Tell us about your experiences.