Ed. Note: The research is probably a bit misleading as it wasn’t controlled and it was an observational study, which means it’s very difficult to ascertain the effectiveness of pain relief. So it’s probably not an accurate depiction of the possible pain relief with the use of cannabis.
The cannabis plant is one of the oldest pain medications around.
In fact, references to the herb’s therapeutic properties have been dated back to sometime between 3494 and 2857 BCE, when the plant was included in one of the oldest known Chinese medical texts, Shen Nung Pen Ts’ao Ching.
In the modern day, novel uses for the herb continue to prove this plant’s medicinal value.
Easy access to medical cannabis dispensaries in the United States, for example, has been linked to reduced opioid overdose deaths and prescriptions.
In studies of cancer patients, cannabis-based medicines have already been found to be effective in relieving pain and improving quality of life.
But, what about chronic pain unrelated to cancer?
A new study from Australian researchers suggests that when it comes to chronic pain, cannabis may not always be effective.
Medical cannabis patients, however, can still breathe a sigh of relief.
Like all studies, this research highlights a potential trend, but the results still cannot be applied broadly to all circumstances.
New study finds no evidence that cannabis helps long-term pain
A new study published July 2018 in the well-respected journal Lancet found no evidence that illegally purchased cannabis effectively reduces long-term pain or reduces the use of opioid pain medications.
In fact, over the four-year study duration, the research found that cannabis consumers tended to report higher levels of pain and anxiety than their non-consuming counterparts.
“People who used cannabis had greater pain and lower self-efficacy in managing pain,” the authors write, “and there was no evidence that cannabis use reduced pain severity or interference or exerted an opioid-sparing effect.”
The paper defines “self-efficacy” as a person’s belief that they can go about their daily lives while experiencing pain. Pain interference refers to the amount that pain disrupts daily activities, like going to the store, cooking, cleaning, and other general day-to-day tasks.
This research also looked at “opioid-sparing” as a way to test whether or not people used fewer opioid pain medications to manage their symptoms during daily life.
The entire study included 1514 participants, 295 (26%) of which reported using cannabis for pain management.
To qualify for the research, patients were required to have experienced pain lasting longer than three months. They also had to be currently prescribed an opioid medication, including fentanyl, morphine, oxycodone, buprenorphine, methadone, or hydromorphone.
The study, funded by the Health and Medical Research Council and the Australian Government, is one of the longest and largest studies on cannabis and pain management available.
Cannabis may still reduce pain
While this study is one of the first to look at cannabis for pain management over the long term, there are still some contentions to keep in mind.
This research recruited patients at pharmacies throughout Australia. Yet, medical cannabis was not decriminalized in Australia until 2016.
Recruitment for this study continued between 2012 and 2014, prior to significant cannabis reform. This indicates that the participants in this study likely would not have had safe access to consistent, targeted, or high-quality medical cannabis products.
In fact, other than reporting the frequency of cannabis use among the participants, no information regarding the types of cannabis consumed, how the herb was consumed, or which specific products were used was mentioned in the research.
The study authors acknowledge this weakness, explaining that “participants had access only to illicit cannabis and were not taking cannabis as part of structured pain management under medical supervision.”
Overall, the study found that those who consumed cannabis also tended to report greater amounts of pain than those who did not. Yet, it is still unclear whether or not patients gravitated toward the plant in an attempt to alleviate pain symptoms that were not well-controlled by their previous medications.
In addition, the numbers crunched in this study are at odds with the participants’ perspective of how cannabis managed their pain.
In self-reports, individuals rated cannabis as highly effective for pain management. On average, the herb was given a seven out of 10 in terms of pain reduction, with 10 being “extremely effective”.
It is important to keep in mind, however, that while this study found no statistical correlation between cannabis and chronic pain relief it doesn’t necessarily mean that cannabis is not effective for pain.
Instead, this data may indicate that cannabis is not associated with effective pain management given these particular circumstances.
In their discussion, the authors draw attention to this fact, writing “although we found no significant association between cannabis use and pain, it is difficult to completely understand the effects of cannabis on pain in an observational study.”
Overall, the authors encourage large-scale clinical trials to truly test the efficacy of cannabis for chronic pain management.
What you need to know about cannabis for pain
While larger trials are needed, this research does draw attention to an interesting fact: the cannabis plant may not always work like it is often marketed.
Instead of being a blind cure-all for pain, the plant may be more effective in some situations than in others.
Exactly when cannabis works for pain and when it doesn’t is something that scientists still need to explore.
However, there is some early evidence that may begin to provide some explanation for the results published in this research.
1. Dosage matters
While taking a puff or two off of a vape may ease pain at first, continuing to do so may actually cause you to become more sensitive to pain.
If a small human trial with 15 participants is any indication, tetrahydrocannabinol (THC), the primary active component in cannabis, may have biphasic effects when it comes to pain.
This means that in low to moderate doses, the plant may successfully ease some types of pain. However, as you increase the dose during a single session, the opposite can occur.
In the trial, for example, healthy volunteers were given an injection of capsaicin, a compound best known for providing the spicy kick in hot peppers.
Patients then smoked cannabis with varying percentages of THC, the lowest being 2 percent, then 4 percent, then 8 percent.
The researchers found that those given moderate doses of THC experienced the most pain relief compared to placebo. After smoking the cannabis with the highest levels of THC, participants were more likely to experience a hypersensitivity to pain.
While a larger trial is needed, taking too high of a dose of cannabis too quickly seems to increase sensitivity to pain, not provide more relief.
Because of this potential trend, it is highly recommended for medical cannabis patients with complex pain conditions to work with a medical professional to better optimize their pain management.
2. Tolerance can develop over time
There may be another solvable reason why participants in the study did not experience adequate pain relief with cannabis.
Cells in the human body are continuously adapting to their environments. After receiving high doses of cannabis for a prolonged period of time, cells may become less sensitive to the herb.
Cells in the nervous system are particularly responsive to cannabis compounds.
These cells feature special landing sites, called cannabinoid receptors, on their surfaces that allow them to respond to the effects of THC and other cannabis compounds.
Over time, these cells “shut down”, so to speak, these receptor sites after being flooded continuously with cannabis compounds.
When cells de-activate their landing sites, that’s when cannabis tolerance develops.
In chronic consumers, this tolerance can reduce the effectiveness of the herb over time.
While consuming more of the plant may cause temporary relief, the overall effects may be blunted in comparison to someone who has recently started using cannabis.
Managing tolerance is yet another reason why working with a professional is a good idea when using cannabis to manage chronic pain conditions.
While many participants try to adjust their cannabis consumption by themselves, patients who rely solely on illicit cannabis may lack access to products and cannabis varieties that would be more helpful for keeping tolerance in check.
3. Cannabis may enhance pain signaling in the spinal cord
The relationship between cannabis and pain is a complicated one. Many consumers swear that the herb is what helps them manage their pain and get through the day.
However, in the laboratory, scientists have discovered that compounds in the plant can have some odd effects.
Cannabis may be one of the oldest cultivated pain medications around, but preclinical research has found that the activation of certain cannabinoid receptors in the spinal cord may actually trigger pain signaling.
A 2009 study published in Science found that engaging certain cannabinoid receptors in the spinal cord blocks the release of neurotransmitters that are typically associated with pain relief.
While more research on this topic is sorely needed, this finding could potentially explain why cannabis compounds may sometimes make individuals more sensitive to pain. Yet, there have been no studies testing exactly how real cannabis components impact this phenomenon.
Bottom line? The story behind cannabis for pain management is more complicated than it seems.
While there is a body of scientific evidence that suggests that the herb, in fact, may be very helpful for pain, there are also circumstances where that might not be true.
For those hoping to take advantage of the emerging science regarding cannabis and pain, working with an herb-friendly medical professional is always advised.
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