BudMed Bulletin for 19 September 2024

Medical Cannabis for Pain Management: A Comprehensive Review

Next issue: Cannabis for Cancer

Introduction

Chronic pain affects millions worldwide, significantly impacting quality of life and well-being. Opioids remain the mainstay of pain management, but their limitations, including addiction potential and severe side effects, necessitate exploration of alternative approaches. In this context, medical cannabis has emerged as a promising option for a variety of chronic pain conditions.

Evidence for Efficacy

This report compiles evidence from high-quality research, primarily randomised controlled trials (RCTs), the gold standard in medical research, to investigate the effectiveness of cannabis for pain management. Notably, a scoping review of RCTs published between 2012 and 2023 identified ten studies using THC-containing preparations showing the most conclusive evidence for pain relief. This is by no means and exhaustive list - far from it! I have a lot more research collated that I will share in subsequent issues.

Clinical Applications

This issue showcases studies demonstrating the efficacy of cannabis in managing pain associated with diverse conditions, including:

Chronic pain: A recent study found that “Clinically, there is moderate evidence that cannabis-based medicines (CBM) can contribute to a significant reduction in pain, especially the associated pain affect, and improvement in physical function and sleep quality in a proportion of patients with chronic pain.”

Another study indicates that medical cannabis use was associated with significant reductions in self-reported pain intensity and pain interference. Additionally, there were significant improvements in quality of life, general health, mood/depression and sleep.

And a study of medical cannabis to treat pain in States with medical cannabis programs found: “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 non opioid, and over-the-counter pain medications, and less than 1% reported that use of cannabis increased their use of these medications.”

Studies are great and needed, but so too are patient testimonies. Here’s a few.

“Meet Bill, a bipolar manic depressive with chronic back pain who uses medical marijuana to maintain a more comfortable standard of living.” In this National Geographic video, Bill demonstrates how fast and effective cannabis is in treating his pain.

Meet Mike, in this CBS News video. Mike suffers from terminal throat cancer, and finds cannabis not only relieves his pain, but helps with sleep, appetite and anxiety.

Medical Cannabis for Women

Dysmenorrhoea effects up to 90% of women of reproductive age. “Dysmenorrhea” is the medical term for painful menstrual periods. A comprehensive review of the literature found, two-thirds of the clinical trials summarised confirmed positive analgesic outcomes.

Meet Lucy. “Premenstrual dysphoric disorder symptoms can include cramps, headaches, joint and muscle pain, yet also emotional symptoms, which led Lucy, a mum-of-one, to suicidal thoughts. Every month, she struggled with the anguish - debilitating period pains and a low mood. In the past year, she has found success with medical cannabis, where she is privately prescribed dosage by a doctor to help relieve pain and mood swings. "It's been life-changing," she said.”

 Neuropathic pain

 Neuropathic pain: Several studies, including a recent RCT (Random Controlled Trial - considered the gold standard of trials), highlight the effectiveness of cannabis in reducing pain intensity in this often-challenging form of chronic pain. In 2023 a comprehensive review of RCT’s from 2012-2023, found that ten studies using phytocannabinoid preparations containing THC alone had the most evidence for pain relief.

In 2023, a study was released on the effects of cannabis and cannabinoids on neuropathic pain and pain medication use in people with spinal cord injury. The results were astounding finding that “87.9% noted that cannabis reduced their neuropathic pain intensity by more than 30%, and 92.3% reported that cannabis helped them to better deal with their neuropathic pain symptoms. Most participants (83.3%) also reported substituting their pain medications with cannabis, with the most substituted medication categories being opioids (47.0%), gabapentinoids (42.8%) and over-the-counter pain medications (42.2%).”

 Ehlers-Danlos syndrome: Case reports exemplify the dramatic pain relief and improved quality of life observed in patients with this complex syndrome upon initiating cannabinoid-based treatment.

Here is one such case. “On initiating cannabinoid-based treatment, her pain was drastically reduced, immediately enhancing the patient's quality of life. As the patient continued to self-administer, she was able to eliminate her opioid requirement.”

The Ehlers-Danlos UK reported this, ““In general, I find medical cannabis is one of the best quality of life medications for EDS because it affects multiple systems and symptoms across multiple domains,” says Dr Gordon “EDS is not just about being hypermobile, like many of us are taught in medical school, patients also suffer from a number of symptoms that can be difficult to treat and are often misdiagnosed. When you have this correlation of chronic pain, fatigue and poor sleep, which is often what EDS patients experience, medical cannabis can help with all these symptoms. Although it’s not a cure, in my experience, it often works better, with less side effects than the medications they are currently taking.”

 Headaches and migraines

Headaches and migraines: Studies demonstrate positive outcomes for cannabis in reducing migraine duration and frequency, offering relief for both chronic and episodic headaches.

A review of studies demonstrated that medical marijuana has a significant clinical response by reducing the length and frequency of migraines.

Another review of 34 studies found “This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin.”

Cluster Headaches. Cluster Headaches are a rare condition affecting maybe 1 in 100,000 and therefore research is very limited. But as I related in my last issue, cannabis has kept my son’s attacks at bay for years now.

Additional Benefits

Beyond pain relief, cannabis exhibits several potential benefits for pain management:

 Opioid reduction: Evidence suggests that cannabis can lead to decreased use of opioids, contributing to harm reduction efforts in the ongoing opioid crisis.

 Improved quality of life: Research confirms that cannabis improves sleep, mood, and general health in patients with chronic pain, enhancing their overall well-being.

 Patient preference and tolerability: Studies and patient reports indicate that cannabis is often well-tolerated and preferred by patients for pain management.

Conclusion:

The compiled evidence from reliable sources, including Random Controlled Trials, RCTs, case reports, and population studies, overwhelmingly supports the effectiveness of medical cannabis in managing chronic pain across various conditions. Its ability to reduce pain, improve quality of life, and potentially facilitate opioid reduction positions it as a valuable tool for pain management alongside conventional therapies.

Next issue: Cannabis and Cancer

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Disclaimer: The content provided in this newsletter by BudMed Bulletin is for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition or the use of medical cannabis.