Medical Cannabis and Chronic Pain

Pain is a critical national health problem, and the relief of pain is one of the greatest objectives in medicine.

Pain is the most common reason for medical appointments in the U.S., it costs over $100 billion each year in health care and lost productivity costs, and chronic pain affects more than 50 million Americans per year.  Pain affects more Americans than diabetes, heart disease, and cancer combined.

What is “chronic” pain?

Defining when pain goes from “acute pain” to “chronic pain” is difficult.  Generally, pain that lasts longer than the normal course of an illness or injury may be defined as chronic pain.  Some clinicians define chronic pain as pain lasting beyond three months.  Chronic pain can persist for months, years, or even decades.

Common sources of chronic pain include:

  • Back pain
  • Headache pain
  • Arthritis
  • Tendonitis
  • Carpal tunnel syndrome
  • Fibromyalgia/Myofascial pain syndrome
  • Reflex Sympathetic Dystrophy (RSD)
  • Peripheral neuropathy/neuralgia
  • Temporomandibular Joint (TMJ) Disorder
  • Complex Regional Pain Syndrome

All pain has a psychological component, and psychological, environmental, and cultural factors must be taken into account when evaluating a patient with chronic pain.  Some examples of how psychological factors affect pain mechanisms include:

  • Emotional arousal can enhance nociception (the perception of pain)
  • Heightened sympathetic activity can sensitize or activate pain receptors
  • Reflex muscle spasms caused by anxiety can contribute to a positive feedback loop which activates pain receptors

The treatment of chronic pain can be very challenging.  The development of a sound treatment plan is the cornerstone.  Treatment modalities may include a variety of pharmaceutical medications, surgical interventions, psychological counseling, general health maintenance, and a variety of complementary and alternative treatment options.

Pharmaceutical medications commonly used in the treatment of chronic pain often include non-steroidal anti-inflammatories (NSAIDS), antidepressants, anxiolytics, antiepileptics, spasmolytics (muscle relaxants), CNS depressants, triptans, and opioids.  Combination of a variety of different medications is standard practice in the treatment of chronic pain.

While pharmaceutical medications have many benefits, they are also associated with a variety of side effects, some even potentially fatal.

According to the Centers for Disease Control (CDC), approximately 36,000 people die each year in the U.S. specifically due to drug overdoses, most caused by prescription drugs.  The FDA reported 82,724 deaths due to adverse drug events (side effects) associated with the use of pharmaceutical drugs in 2010 (a 425% increase in the last decade!).

  • NSAID use has been associated with serious adverse effects including gastric injury, gastric ulceration and renal damage.
  • Antidepressants may cause sedation, insomnia, confusion, seizures, and sexual disturbances.
  • Muscle relaxants may cause drowsiness, increased seizure activity, and withdrawal symptoms.
  • Opioid medications may cause respiratory depression, constipation, drowsiness, confusion, the need for escalating dosages, and addiction.

Many patients report that medical cannabis provides a very effective option in treating their chronic pain and associated symptoms.  Patients commonly say that medical cannabis provides relief of their pain better than pharmaceutical medications with significantly fewer side effects.  Medical cannabis also provides effective relief in treating associated symptoms of muscle spasms, anxiety, depression, and insomnia.

Through the use of medical cannabis, many patients are literally able to throw away their bag full of pill bottles, control their symptoms, improve their health, and re-gain control of their lives.

Scientifically, there is basis for the use of cannabis in the treatment of chronic pain.  Two of cannabis’ key medicinal ingredients, tetrahydrocannabinol (THC) and cannabidiol (CBD), haves been well documented to have pain relieving and anti-inflammatory properties.  Medical cannabis has also been shown to have anti-anxiety, mood elevating, and sedating effects that may be beneficial.  In particular, cannabinoids may have particular use in the treatment of spasms and neuropathic pain.

Highlights from the Scientific Literature

Burns TL, Ineck JR (2006, Creighton University Medical Center, Omaha, NE). Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain.

Conclusions:  Cannabinoids provide a potential approach to pain management with a novel therapeutic target and mechanism. Chronic pain often requires a polypharmaceutical approach to management, and cannabinoids are a potential addition to the arsenal of treatment options.

Ware MA, et al. (2010, McGill University, Montreal, Canada).  Smoked cannabis for chronic neuropathic pain: a randomized controlled trial.

Conclusions: A single inhalation of 25mg of 9.4% tetrahydrocannabinol herbal cannabis three times daily for five days reduced the intensity of pain, improved sleep and was well tolerated.  Further long-term safety and efficacy studies are indicated.

Besides smoking, delivery methods for the use of medical cannabis include vaporization, tinctures, teas, and edible products.  Most commonly reported side effects from the use of medical cannabis include dry mouth, red eyes, increased appetite, and tiredness.   There has never been a death attributable to a medical cannabis overdose.  Medical cannabis should be used in consultation with a physician who specializes in cannabinoid medicine.

Tips for Coping with Chronic Pain

  • Learn deep breathing techniques or meditation.
  • Reduce stress.  Stress intensifies chronic pain.
  • Release natural endorphins with exercise.
  • Reduce alcohol consumption, which can make sleep problems worse.
  • Join a support group.
  • Don’t smoke cigarettes.  Smoking can worsen chronic pain by impairing circulation.
  • Keep a log or journal to track your pain level and activities.
  • Learn biofeedback to decrease pain severity.
  • Try massage therapy to reduce stress and relieve tension.
  • Eat a healthy diet.
  • Find activities that distract you from pain.

References and Resources

American Chronic Pain Association.  http://theacpa.org/default.aspx

Burns TL, Ineck JR. Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain. Annals of Pharmacotherapy. 2006; 40(2):251-260. http://www.ncbi.nlm.nih.gov/pubmed/16449552

Centers for Disease Control and Prevention (CDC). Policy Impact: Prescription Painkiller Overdoses.  http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

NINDS Chronic Pain Information Page.  National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH).  http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

U.S. Food and Drug Administration (FDA). Adverse Events Reporting System (AERS). AERS Patient Outcomes by Year. http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/ucm070461.htm

Ware MA, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial.  Canadian Medical Association Journal (CMAJ). 2010; 182(14): E694-E701.  http://www.cmaj.ca/content/182/14/E694.full.pdf+html

WebMD. Pain Management Health Center. http://www.webmd.com/pain-management/tc/chronic-pain-topic-overview

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About markrabe

Mark L. Rabe, MD, ABIHM Integrative Holistic Medicine Centric Wellness 2308 6th Avenue San Diego, CA 92101 Telephone: (619) 546-0420 Fax: (619) 615-2346 E-Mail: info@CentricWellness.com

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