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Chronic Pain

Cannabis Acceptance as Legitimate Pain Relief Medication

A new survey shows how frequently cannabis is used to treat chronic pain.

Key points

  • A new study shows 31 percent of chronic pain sufferers have tried cannabis for pain relief, most within the past 30 days.
  • Cannabis use for chronic pain substitutes for opioid doses in over half of cannabis users.
  • Nonsteroidal analgesics reduce pain and inflammation by enhancing our natural cannabinoid chemistry.

Fifty million American adults (20 percent) suffer from chronic pain, with almost 20 million having high-impact chronic pain, defined as substantially restricting activities for six months or more. A new study, reviewed by Johns Hopkins School of Public Health, now shows how well-accepted cannabis has become as a treatment for chronic pain in states permitting its medicinal use.[1]

Research on medical cannabis use for chronic pain

The study surveyed 1,661 adults from March to April 2022 aged 18 years or older (mean age 52) with noncancer chronic pain who lived in states with active medical cannabis programs. Two questions were asked. First, whether people ever used medical cannabis for their pain, and if they had, whether they had used it in the past 12 months or past 30 days. Second, whether or not they substituted cannabis in place of any other pharmacologic treatments (prescription opioids, prescription nonopioid analgesics, and over-the-counter analgesics) or common nonpharmacologic treatments (physical therapy, meditation, cognitive behavioral therapy).

Thirty-one percent reported having ever used cannabis to manage their pain, 26 percent in the past 12 months, and 23 percent in the past 30 days. The study found cannabis was rarely used as the sole treatment for chronic pain. Ninety-five percent also used at least one other pharmacologic treatment, and 71 percent used at least one nonpharmacologic pain treatment.

Of particular interest, more than half of adults who used cannabis to manage their chronic pain reported that use of cannabis led them to decrease use of prescription opioid, prescription nonopioid, and over-the-counter pain medications, and less than 1 percent reported that use of cannabis increased their use of these medications. This is consistent with earlier reports that Medicare prescriptions for opiates are significantly lower in states with legal medical cannabis.

Initial studies of people visiting medical cannabis clinics had often reported a high proportion of young males complaining of chronic pain. Because this fit the profile for recreational cannabis users more than the profile for chronic pain patients, shade was thrown on the value of cannabis as legitimate pain medication. This shade was dispelled by the National Academies of Sciences, Engineering, and Medicine 2017 report, The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.

After reviewing over 10,000 scientific articles, the Academies concluded there is substantial scientific evidence that both THC and CBD (and especially the two together) reduce pain and inflammation.

How cannabis reduces chronic pain

Here is how cannabis reduces chronic pain. Levels of cannabinoid receptors and natural cannabinoid molecules (2-AG) rise in inflamed areas to regulate the immune system response to injury or infection. Adding cannabinoid stimulation (i.e., THC and CBD) to activate the increased population of receptors enhances their anti-inflammatory action. CBD also increases the level of our natural cannabinoid anandamide by interfering with the enzyme that breaks anandamide down. Increased anandamide reduces inflammation.

I chuckle when I hear people say they are against cannabis-based medication. Most are unaware they already take drugs that interfere with the breakdown of 2-AG to prolong its stimulation of cannabinoid receptors to reduce inflammation. Billions of people around the globe already use this strategy for inflammatory pain relief without knowing it. NSAIDs, such as acetaminophen (also known as Tylenol) and ibuprofen, interfere with inflammatory enzymes that destroy 2-AG, thereby increasing its anti-inflammatory effect. Every day, more than 30 million Americans take an NSAID to enhance their brain’s natural cannabinoid chemistry to soothe pain and inflammation stemming from injuries, headaches, arthritis, and other daily discomforts.

Cannabis-based treatment of chronic pain is here to stay. Over time, science will find ways to increase its effectiveness and decrease its side effects. Eventually, people will lose track of how their favorite pain relievers originated in cannabis plants, just as most people are unaware that aspirin originally came from willow bark. Nearly a third of chronic pain sufferers have already experimented with cannabis, and many more manipulate their natural cannabinoid chemistry with Tylenol. It is past time that we should all learn more about cannabis.

To check your general knowledge about cannabis, visit "Test Your Science Literacy About Cannabis."

References

[1] Bicket M, et al, Use of Cannabis and Other Pain Treatments Among Adults With Chronic Pain in US States With Medical Cannabis Programs, JAMANetwork Open | Substance Use and Addiction, January 6, 2023

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