Cannabis for the Treatment of Chronic Pain

By Gooey Rabinski | February 15, 2016

The two most powerful therapeutic applications of cannabis are as an analgesic (pain reliever) and in the role of an anti-inflammatory. Because inflammation often leads to pain, cannabis medicine works on multiple levels to provide relief to many patients. Use of this herb for pain management is nothing new. According to Harvard University psychiatry professor Dr. Lester Grinspoon, cannabis has been used as medicine and to treat symptoms like pain for more than 5,000 years.

For those suffering chronic pain — often the result of an accident, operation, or serious disease — cannabis is a non-addictive alternative to opiates and other potentially harmful treatments. Neuropathic, or “nerve-related,” pain is a major problem for sufferers of cancer, dystoniadiabetes, HIV/AIDS, and multiple sclerosis, among dozens of other diseases that feature a core symptom of recurring or unabating pain.

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Said Dr. Donald Abrams, a professor of clinical medicine and chief of the Hematology-Oncology Division at San Francisco General Hospital,

“Pain is a big problem in America and chronic pain is a reason many people utilize the health care system.”

Chronic Pain Defined

Chronic pain, which persists and sometimes never ceases, is characterized as discomfort that slowly increases over time until it becomes a consistent pain. This is very different from acute pain, which is episodic in nature, features a sudden onset, and results from an accident or injury. Unlike most cases of chronic pain, acute types are treatable with a wide range of drugs and therapies (including cannabis). Chronic pain is sometimes defined as pain that lasts three months or longer, regardless of the cause.

It is estimated that chronic neuropathic pain affects more than one in five adults. In the United States, which features a population of 322 million, roughly 75 million Americans suffer from daily pain, while 25 million experience acute pain resulting from an accident or operation.

Unfortunately, chronic pain is often unaffected by conventional medical treatments or pharmaceutical drugs. This is the major reason that so many patients seek out cannabis medicine — often without a doctor’s recommendation. Standard pharmaceutical drugs used to treat pain include opiates and NSAIDs (non-steroidal anti-inflammatory drugs). Unfortunately, for millions of Americans, these conventional treatments are simply ineffective at relieving neuropathic and other forms of chronic pain.

A 2010 Canadian study found that more than one in ten patients suffering from pain were self-medicating with cannabis. “About 10 to 15 percent of patients attending a chronic pain clinic use cannabis as part of their pain strategy,” reported researchers of the study. Additional causes of chronic pain include conditions such as carpal tunnel, arthritis, back and spinal injury, and fibromyalgia.

Better Than Opioids

The vast majority of the medical establishment in America obviously doesn’t embrace medical cannabis or rely on the efficacy of cannabinoids and terpenes to heal patients, either physically or psychologically. This is unfortunate, because opioids, the most popular way of treating pain, are both addictive and often feature significant tolerance building. Long-term use of opioids can produce gastric bleeding and may result in kidney or liver disease.

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Other potential adverse side effects of the long-term use of conventional analgesic drugs include stroke, heart attack, and erectile dysfunction, among others. Of course, one of the biggest risks of consuming opioids for any period of time is overdose. An entrepreneur in Seattle shared a story with Whaxy regarding his conservative neighbor, a man in his 60s who adopted cannabis to manage his pain — but only after overdosing on Vicodin and a frightening trip to a hospital emergency room. (Vicodin is intended for pain relief and combines the opioid hydrocodone with acetaminophen [Tylenol], an analgesic and fever reduction drug.)

Stories continue to accumulate of how patients who have undergone surgery that results in chronic pain have chosen to replace pharmaceutical drugs with medical cannabis. It is believed that more than 75,000 Americans are hospitalized each year due to overdose or other complications of opiates, resulting in nearly 8,000 deaths that can be directly attributed to these dangerous and addictive drugs.

Preventing Suicide

Suffering pain for merely a few minutes can be a very stressful experience for any patient, including those who are acclimated to it. The psychological impact of continuous, never-ending pain can easily push patients to the edge of their limits. One of the biggest challenges for those suffering chronic pain is avoiding the impulses that accompany suicidal thoughts. The sad part of the equation is that most chronic pain sufferers are not inherently suicidal; rather, they are simply trying to end their own suffering.

According to Jill Harkavy-Friedman, Vice President of Research at the American Foundation for Suicide Prevention, 90 percent of those who die from suicide have a “diagnosable and potentially treatable illness, including depression, anxiety, [and alcoholism].” Harkavy-Friedman goes on to describe how suicide can be triggered by chronic pain, the symptoms of which include:

“Unrelenting low mood, pessimism, hopelessness, desperation, and/or anxiety.”

Fortunately, cannabis — especially strains high in the psychoactive cannabinoid THC — is a known euphoriant. Put simply, cannabis improves one’s mood and makes patients, even those who are terminal, happier. American physician and professor Hobart Amory Hare after long ago as 1887 celebrated the ability of cannabis to subdue anxiety and calm a terminally ill patient’s mind. He wrote:

“The patient, whose most painful symptom has been mental trepidation, becomes more happy.”

This effect of cannabis minimizes and often eliminates the “pessimism, hopelessness, [and] desperation” that sometimes results in suicidal thoughts. Thus, all parties involved, from patients and caretakers to budtenders, recommending physicians, and dispensary owners can assume that high-quality examples of medical cannabis are fully capable of preventing suicide.

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In fact, due to its very low occurrence of physical addiction and almost complete lack of negative side effects, cannabis may be the best treatment for those who suffer from chronic pain that leads to suicidal thoughts. The fact that many strains of this highly medicinal plant also act as a powerful analgesic simply solidifies the argument that sick patients should be legally permitted to cultivate, possess, and consume cannabis.

The Studies

A 2002 study conducted at McGill University in Montreal, Canada and published in the journal Pain Research & Management concluded that “small doses of smoked cannabis may improve pain, mood, and sleep in some patients with chronic pain.” The study, like many regarding cannabis or cannabinoids, cited the need for clinical trials “to test these effects.”

A 2008 study conducted by cannabis research pioneer Ethan Russo and published in the journal Therapeutics and Clinical Risk Management found that “particular difficulties face the clinician managing intractable patients afflicted with cancer-associated pain [and] neuropathic pain” and that “available opiates, antidepressants, and anticonvulsant drugs” are insufficient for adequately treating such pain. This study concluded:

“Cannabinoids may offer significant ‘side benefits’ beyond analgesia.”

It continued: “These include anti-emetic effects [anti-nausea and vomiting], well established with THC, but additionally demonstrated for [the cannabinoid] CBD.”

Why are the strong anti-emetic properties of cannabis of value? Simply because pain patients, almost always prescribed opioids, often suffer a primary side effect of nausea and vomiting. The fact that cannabis can treat both pain and nausea is a testament to its healing powers and widespread efficacy. These benefits obviously do not include the mood enhancing benefits that are powerful enough to prevent suicidal thoughts from becoming suicidal actions.

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A 2011 study conducted at the University of California at San Francisco involving another medical cannabis research pioneer, Donald Abrams, found cannabis — when combined with certain opiates — to be an effective treatment for chronic pain. The study, published in the journal Clinical Pharmacology and Therapeutics, involved use of a high-end desktop vaporizer for consumption of ground cannabis flowers and long-acting morphine or oxycodone. The study concluded that chronic pain patients who consumed both cannabinoids and conventional opiates enjoyed a greater reduction in pain than those who were treated with opiates alone.

A study conducted in 2014 and published in the Canadian Urological Association Journal found that nearly half of the participants, all of whom suffered chronic prostatitis/chronic pelvic pain syndrome, reported using cannabis in an effort to reduce their pain. The study found that 61 percent of those who used cannabis to treat pain “reported improvement in symptoms as a result of use.”

A 2014 study conducted by Israeli physicians and published in The Journal of Pain and Palliative Care Pharmacotherapy examined the effect of cannabis to reduce otherwise untreatable nerve pain in a small group of human patients. Because human trials are largely prohibited or denied in the United States, any cannabis study involving humans that occurs outside the U.S. is of great significance.

Study participants consumed, via vaporization, only 15 mg of cannabis, yet reported significant reductions in pain after a relatively short period of time. Reported the study’s researchers:

“A significant 45 percent reduction in pain intensity was noted 20 minutes post inhalation.”

Although not a study, a 2013 poll conducted by the New England Journal of Medicine found that 75 percent of clinicians would recommend cannabis for a hypothetical cancer patient.

More Research Needed

Until cannabis is removed from Schedule I of the Controlled Substances Act, the federal government will continue to consider it more dangerous and addictive than methamphetamines and cocaine — both of which are less-restricted Schedule II drugs that can be prescribed by a physician. Congress has continually opposed robust research and human trials of cannabis as medicine for any condition, regardless of severity or the number of Americans affected.

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Federal prohibition perpetuates a system in which patients with a wide range of diseases involving chronic pain will needlessly suffer due to a lack of research data and information. As long as Congress and most of the medical establishment continues to bury their collective heads in the proverbial sand, opiate overdoses and deaths from pain-induced suicides will continue to plague innocent patients who are denied safe access to laboratory-tested, pesticide-free cannabis medicine.

Gooey Rabinski

Gooey Rabinski is the author of Understanding Medical Marijuana.

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