Does Cannabis Help Relieve Pain?
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The current body of evidence suggests that cannabis may provide modest and short-term pain relief for some patients, particularly those with chronic neuropathic pain. However, the clinical significance of these benefits is often limited, and the potential for adverse effects is considerable. More high-quality, long-term studies are needed to better understand the balance of benefits and harms of using cannabis for pain management.
Cannabis has been used for centuries for its medicinal properties, particularly in pain management. With the increasing legalization of cannabis for medical and recreational use, there is a growing interest in understanding its efficacy in relieving pain. This synthesis aims to evaluate the current scientific evidence on whether cannabis helps relieve pain.
Key Insights
- Modest Pain Relief:
- Cannabis-based medicines may provide modest pain relief for chronic pain conditions, including neuropathic pain, but the evidence is not strong and is often of low quality1 2 3 4 6.
- Some studies suggest that cannabis can achieve a 30% or greater reduction in pain for a subset of patients, but the clinical significance of these findings is uncertain2 3 5.
- Short-term Efficacy:
- Comparison with Placebo:
- Adverse Effects:
- The use of cannabis for pain management is associated with several adverse effects, including dizziness, sedation, and gastrointestinal issues. These side effects may outweigh the benefits for some patients2 3 4 6 7.
- There is a higher rate of withdrawal from studies due to adverse events in patients using cannabis-based medicines compared to placebo2 3.
- Reduction in Opioid Use:
- Some epidemiological studies suggest that the use of medical cannabis may reduce the need for opioid pharmacotherapy for pain, although more research is needed to confirm this finding1.
Does cannabis help relieve pain?
Joshua Aviram has answered Uncertain
An expert from Technion Israel Institute of Technology in Cannabis
The question “does cannabis help relieve pain?” has no simple answer.
First of all, cannabis is not a single compound as it is accepted in traditional western medicine. Cannabis is a general name for a variety of “strain names” that varies between cannabis cultivators. Furthermore, cannabis inflorescence components percentages, meaning Phyto-cannabinoids, terpenes, flavonoids vary between cultivators, batches, seasons etc.
Additionally, ‘pain relief’ concept is problematic. For one, pain intensity is a subjective feeling, subjected to many confounders like social, financial and psychological factors. Moreover, there are different types of pain, starting from nociceptive pain (healthy, normal pain sensation), cancer pain and chronic non-cancer pain, which includes neuropathic, inflammatory, dysfunctional and visceral chronic pain, as well as headaches. Every one of these pain etiologies has specific sub-etiologies with their own specific disease mechanism.
To date, in the medical literature, there are more review papers, meta-analyses, meta-analyses of meta-analyses, as well as expert reviews that discuss clinical trials of cannabinoids effects on pain intensity than the number of the trials themselves. Additionally, these clinical trials are mostly investigating cannabis-based medicines (CBMs), which contain THC alone or combination of THC and CBD. Only few (5 trials) investigated whole plant cannabis effects on pain intensity, but unfortunately, these trials reported on THC percentages only (disregarding about 200 compounds that are presumed to have biological effects), the placebo utilized were 0% THC whole plant cannabis (same disregard), very short-term follow-up on patients, not reporting on whether patients knew if they received the treatment or the placebo (as it is recommended for clinical trials, in order to verify the blinding of patients).
The shortcomings of the clinical data on the effects of cannabis on pain became clear to me while I worked on a meta-analyses with a colleague (https://www.researchgate.net/publication/319930160_Systematic_Review_Efficacy_of_Cannabis-Based_Medicines_for_Pain_Management_A_Systematic_Review_and_Meta-Analysis_of_Randomized_Controlled_Trials). In this paper, we found that while most CBMs and whole plant cannabis were superior to placebo in reducing pain intensity, in most trials, this change was only statistically, but not clinically significant. In addition, although pain reduction was superior for whole plant inhalation than CBMs consumption, the studies on whole plant inhalation were inferior due to small sample size and very shot-termed follow-up (which are very important in order to create clinical guidelines).
Nonetheless, in my PhD thesis I followed-up prospectively on more than 1,000 chronic non-cancer pain patients before and during one year of cannabis treatment (by inflorescence or oil extracts). Although these findings are yet to be published, so I can not disclose, most of the responses of patients were positive (you can follow my project to see the results when they will be published: https://www.researchgate.net/project/Multi-center-Medical-Cannabis-MC-prospective-registry-study-for-chronic-pain-patients). Nowadays I am in the process of a post-doctoral studies, in a similar project on cancer pain patients (https://www.researchgate.net/project/Multi-center-Medical-Cannabis-MC-prospective-registry-study-for-oncology-patients).
To conclude, thus far, it is very difficult to answer the question “does cannabis help relieve pain?”. In order to answer this clinical question in a reasonable degree of certainty, the specific cannabinoids and terpenes needs to be identified, extracted, and utilized in a randomized double-blind, placebo-controlled study on a large population for long-term period. However, due to the “Phyto” nature of the cannabis plant, it is unlikely that any pharmaceutical company will support such study, due to the understandable reason of inherent difficulties of patenting plant materials and return the huge financial expenditure that is required for such a trial.
In the meanwhile, unfortunately, its every patient for himself, in a trial-by-error manner of finding out which type, “strain” and dose best fits (if at all) to their own pain etiology.
Does cannabis help relieve pain?
Alex Bekker has answered Near Certain
An expert from Rutgers New Jersey Medical School in Cannabis
Chronic pain is usually treated by a combination of opioids, NSAIDs, anticonvulsants, counseling, and various alternative therapies. However, these treatments do not alleviate pain in some patients. Moreover, the side effects associated with medical therapies may add to the patients’ suffering.
There are numerous studies that show that cannabis reduce pain and improve a quality of life of patients with chronic pain. For example, a systematic review of randomized controlled clinical trials (766 patients) assessing salutary effects of cannabinoid in treating chronic non-cancerous pain showed significant analgesic effect of these treatment (Lynch et al, Br J Clin Pharm, 2011, 72:735). An investigation that examined the effects of cannabis use in patients with chronic non-cancerous pain treated with opioid suggested that pain relief achieved from cannabis compared very favorably with the same from opioids (Degenhardt et al. Drug Alcoh Depend 2015, 147:144-50). A recent review of the literature based on a conference that took place at Beth Israel Deaconess Medical Center, Boston, MA concluded that the use of marijuana for chronic non-cancerous pain is supported by high-quality evidence (Hill K, JAMA 2015, 313:2474-83)
Does cannabis help relieve pain?
Lanfranco Pellesi has answered Likely
An expert from University of Copenhagen in Pharmacology, Neuroscience
Based on this review of the evidence.
Does cannabis help relieve pain?
Mário Barroso has answered Likely
An expert from Instituto Nacional de Medicina Legal e Ciências Forenses in Toxicology
Pain treatment is undoubtedly the most studied therapeutic indication of cannabis. In general, researchers have found that cannabis-based medicines are probably effective for treating neuropathic pain and painful spasms usually associated to multiple sclerosis, as well as neuropathic pain associated to diabetes, HIV, and other illnesses. However, it is unclear whether or not smoked marijuana is effective in reducing pain in multiple sclerosis. Cannabis can be used to treat chronic pain associated to cancer and other causes, and studies generally suggested cannabis-related improvements in chronic pain measures in cancer patients. Most studies used Sativex® preparations, and have generally shown positive results. However, care should be taken in what concerns smoked marijuana, since those studies were performed using medicinal cannabis preparations, in which the administered doses are well known.
Does cannabis help relieve pain?
Francesco Crestani has answered Near Certain
An expert from San Luca Hospital in Medicine
I fully agree with the conclusions of the ad hoc committee of the National Academies of Sciences, Engineering and Medicine (2017):
“There is conclusive or substantial evidence that cannabis or cannabinoids are effective: For the treatment for chronic pain in adults (cannabis)”
My opinion derives from the study of all the literature in this regard. that has been condensed by the opinion of the committee, and above all by the daily application in my practice of pain therapy specialist. Like any other drug, cannabis is not good for all the pathologies of all patients, but it is an additional weapon in the fight against pain.
Does cannabis help relieve pain?
Ethan Russo has answered Likely
An expert from International Cannabis and Cannabinoids Institute in Cannabis
This all depends on the preparation and dose.
Does cannabis help relieve pain?
Roger Pertwee has answered Likely
An expert from University of Aberdeen in Pharmacology
Certainly some of its constituents can do this. These include the phytocannabinoids, tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabigerol (CBG). Indeed, a medicine containing THC and CBD was approved in Canada a few years ago for the relief of cancer pain, and there is evidence that CBG can relieve persistent inflammatory pain by activating noradrenaline receptors (α2-adrenoeptors).
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