Treatment of Chronic Pain - Is Medicinal Cannabis Useful?

Introduction:

Chronic pain is a prevalent health concern in the United States, affecting approximately 1 in every 5 Americans. It is a multifaceted condition that imposes significant physical, mental, and emotional strain on individuals. As a result, the treatment of chronic pain necessitates a comprehensive approach involving pharmacological, non-pharmacological, and interventional measures. Given the opioid epidemic, medicinal cannabis has emerged as a potential remedy for chronic pain. With the increasing legalization of medical marijuana in different states, healthcare professionals must comprehend the mechanism of action, applications, contraindications, role, and contentious aspects of medicinal marijuana in managing chronic pain.

Function:

Cannabis comprises numerous compounds, with 60 pharmacologically active cannabinoids being the most prominent. These cannabinoids interact with the body's endogenous cannabinoid receptors. The primary compounds found in cannabis are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is responsible for the psychoactive effects of marijuana, such as euphoria and psychosis. Conversely, CBD does not induce psychoactive effects and is known for its anti-anxiety and anti-psychoactive properties. The therapeutic effects of medicinal cannabis depend on the concentration of THC and the THC to CBD ratio. Recreational cannabis generally contains higher THC levels, while medicinal cannabis has a higher CBD concentration to mitigate psychoactive effects.

There are two main types of endocannabinoid receptors, namely cannabinoid receptors type 1 (CB1) and cannabinoid receptors type 2 (CB2). Both receptors are classified as G-protein coupled receptors. CB1 receptors are predominantly found in the central and peripheral nervous systems, specifically within pain modulation centers in the brain, nociceptive pathways in the spinal cord, and peripheral nerves. Conversely, CB2 receptors are primarily located in the peripheral systems, such as the immune and hematological systems, and function in reducing inflammation. THC acts as a partial agonist at both CB1 and CB2 receptors, inhibiting the release of glutamate and 5-hydroxytryptamine, and modifying dopaminergic function, thereby influencing pain pathways. CBD, on the other hand, acts as a negative allosteric modulator of CB1 receptors and interacts with serotonin, vanilloid, and various other receptors.

Issues of Concern

In light of the growing support for the therapeutic use of cannabis, it is crucial to have a comprehensive understanding of the federal and state policies surrounding the legalization of marijuana. At present, a total of 36 states have legalized medical marijuana, each with varying regulations regarding the number and proximity of dispensaries. While medical cannabis is recognized as a potential treatment for chronic pain and is legal in more than half of the United States, it is still classified as a Schedule 1 drug with a high potential for abuse and lacking FDA approval for medical purposes due to safety concerns and limited medical acceptance.

Like any medication, medicinal cannabis carries potential adverse effects. The acute side effects associated with tetrahydrocannabinol (THC) use include anxiety, panic, disorientation, impaired attention, short-term memory loss, and compromised driving performance. Consequently, it is advisable to exercise caution when considering medicinal cannabis for patients with psychiatric conditions, such as schizophrenia, as it may exacerbate symptoms. Furthermore, research has shown that approximately 50% of individuals who experience cannabis-induced psychosis go on to develop schizophrenia or bipolar disorder.

Among the adverse effects of cannabidiol (CBD), the most common is diarrhea. Additionally, CBD has the potential to interact with conventional pharmacotherapies through its interaction with cytochrome P450 (CYP 450) enzymes involved in drug metabolism.

Clinical Significance

The history of medical marijuana usage can be traced back over 5000 years, when Chinese physicians employed it for various purposes such as pain relief during childbirth, treatment of rheumatic pain, malaria, and even alleviating constipation. In the 19th and 20th centuries, medicinal cannabis was widely utilized as documented in the United States Pharmacopoeia. California became the first state to legalize marijuana for medical use under the supervision of healthcare professionals in 1996 with the enactment of the Compassionate Use Act.

Over the span of several years, numerous studies have been conducted to examine the efficacy of medicinal cannabis in the treatment of chronic pain. One noteworthy study focused on gathering insights from 984 chronic pain patients regarding the use of medical marijuana. This diverse group included individuals suffering from neuropathic pain, back pain, arthritis, post-surgical pain, headaches, and abdominal pain. The study revealed that two-thirds of the patients reported pain relief as the primary advantage of utilizing marijuana for medicinal purposes. Additionally, improved sleep was identified as the second most commonly reported benefit. Conversely, the main concern expressed by these patients was the cost associated with obtaining medicinal cannabis, which averaged around two thousand dollars per year depending on the specific form and preferred method of administration. Unlike many other medications, medical insurance does not cover the expenses related to medicinal cannabis, resulting in increased financial burdens for patients. Other negative aspects associated with the use of medicinal cannabis, as voiced by these patients, included the occurrence of adverse effects and the perceived bias against marijuana usage.

Furthermore, another study indicated that chronic pain patients who incorporated medical marijuana into their treatment experienced a significant decrease of 64% in opioid use. These individuals encountered fewer adverse effects and reported an overall enhancement in their quality of life. Given the prevalent opioid crisis, the potential of medicinal cannabis as an alternative treatment has gained substantial importance. Unlike opioids, marijuana does not induce respiratory depression, thereby leading to a lower mortality rate. A study focusing on the impact of marijuana dispensaries on the incidence of adverse outcomes related to opioid use demonstrated a remarkable 17% reduction in opioid-linked fatalities. Moreover, these dispensaries also exhibited a similar influence on admissions to treatment centers related to opioid use, emphasizing the substitutability of medicinal marijuana.

Another study specifically highlighted the effectiveness of medical marijuana in managing chronic non-cancer pain, neuropathic pain, medication-rebound headache, and allodynia. However, it did not exhibit the same level of efficacy as non-opioid analgesics when treating acute pain. Additionally, within this particular study, medicinal cannabis displayed no superior effectiveness compared to a placebo in alleviating visceral pain and only provided minimal analgesic effects for cancer-related pain.

Furthermore, several randomized controlled trials have been conducted to investigate the optimal dosing and administration of medicinal cannabis. In one specific study, experts from nine different countries collaborated to develop three distinct treatment protocols for using cannabis to alleviate chronic pain in patients. According to the agreed routine treatment protocol, the initiation of treatment should involve a CBD-predominant strain of cannabis with a dosage of 5 milligrams, which is to be taken twice daily due to its favorable safety profile. If administering a daily dosage of 40 milligrams or more of CBD fails to deliver adequate pain relief, the appropriate starting dose of THC has been determined to be 2.5 milligrams.

As per the consensus, THC can be gradually increased to 2.5 milligrams every two to seven days until reaching a maximum of 40 milligrams daily. If the mentioned dosing fails to provide adequate pain relief, it is recommended to seek expert consultation from a cannabinoid specialist or an experienced medicinal cannabis clinical. In the conservative treatment protocol, the initial CBD dose is 5 milligrams once or twice daily, with a maximum of 40 milligrams daily. If the maximum CBD-predominant dose does not provide sufficient pain control, an initial dose of 1 milligram of THC can be added. The THC dose can then be increased by 1 milligram every seven days, up to a maximum dosage of 40 milligrams daily.

For the rapid protocol, a balanced CBD to THC type of cannabis is used. The starting dose is 2.5 to 5 milligrams of each cannabinoid once or twice daily. The dosage can be increased by 2.5 to 5 milligrams every two to three days, once or twice daily, until reaching a maximum dosage of 40 milligrams THC.

Other Issues

Regarding the potential benefits of medicinal cannabis in treating chronic pain, many studies have been performed with small sample sizes. The classification of marijuana as a Schedule 1 substance contributes to the lack of ample data. However, as more states legalize marijuana, larger studies will likely be conducted in the future. The variability of regulations across states makes it challenging to prescribe medicinal cannabis for chronic pain. While preliminary data supports its use, further research is needed to determine its true role in pain management. The opioid epidemic has sparked interest in exploring alternative treatments for chronic pain, including cannabis and psychedelics.

Enhancing Healthcare Team Outcomes

Treating chronic pain requires an interprofessional approach. A thorough history and physical exam are essential when determining appropriate treatment options. The complexity of chronic pain treatment is due to its subjective nature, individual pain tolerance, and the psychosocial impact. Therefore, effective collaboration among various disciplines, such as physiatrists, physical therapists, psychologists, pain management physicians, neurologists, psychiatrists, and social workers, is necessary to achieve the best outcomes. Patients can be provided with questionnaires and other forms to monitor symptomatic improvement in pain and quality of life after initiating cannabis use.

You can buy weed online for medicinal purpose from many sites on Google. But you should check the legality of cannabis use in your area.