The General Pain Patient

Cannabis for Pain Management

Cannabis extracts in various studies have suggested that they may be useful to treat diverse diseases, including those related with acute or chronic pain. The discovery of cannabinoid receptors, their endogenous ligands, and the machinery for the synthesis, transport, and degradation of these retrograde messengers, has equipped us with neurochemical tools for novel drug design. Agonist-activated cannabinoid receptors, modulate nociceptive thresholds, inhibit release of pro-inflammatory molecules, and display synergistic effects with other systems that influence analgesia, especially the endogenous opioid system. Cannabinoid receptor agonists have shown therapeutic value against inflammatory and neuropathic pains, conditions that are often refractory to therapy.

It is noteworthy that cannabinoid receptor agonist have been shown to be up to ten times more potent than morphine in animal models of acute and neuropathic pain. (Role of eCB in pain).

Cannabis works for pain management because the active ingredients of cannabis interact with our own natural endocannbinoid system (eCB). The CB1 receptor is actually one of the most abundant receptors in the human brain - affirming its importance and key role in our health.

Endocannabinoids are produced on demand in post-synaptic neurons (nerve cells) and can travel backwards (a rare ability for neurotransmitters) - thus inhibiting the various other neurotransmitters.

Nerve based pain - neuropathic pain - as is associated with MS, Diabetes, AIDs etc. is extremely difficult to treat. Glutamate - a stimulatory neurotransmitter fluid is found in excess - which can kills cells. Endocannabinoids and cannabinoids act to inhibit more glutamate being released - helping to alleviate neuropathic pain. Both THC and CBD have this ability.

THChas the ability to modulate the excessive production of glutamate which is invpolved in neuropathy style pain. THC seems to be the best at dulling pain and general pain management.
CBDalso has the ability to modulate glutamate and seems to be better at analgesic and anti-inflammatory pain than THC alone.

Although the psychoactive effects of these substances have limited clinical progress to study cannabinoid actions in pain mechanisms, preclinical research is progressing rapidly. For example, CB1mediated suppression of mast cell activation responses, CB2-mediated indirect stimulation of opioid receptors located in primary afferent pathways, and the discovery of inhibitors for either the transporters or the enzymes degrading endocannabinoids, are recent findings that suggest new therapeutic approaches to avoid central nervous system side effects.

Cannabinoid receptor agonists are promising at alleviating acute and chronic pain episodes. Recently, Cannabis sativa extracts, containing known doses of tetrahydrocannabinol and cannabidiol, have granted approval in Canada for the relief of neuropathic pain in multiple sclerosis. Further double-blind placebo-controlled clinical trials are needed to evaluate the potential therapeutic effectiveness of various cannabinoid agonists-based medications for controlling different types of pain.

Finally, when one considers that pain is often associated with inflammation and tissue degradation as isfound with arthritis, cannabinoids become an ideal tool to assist with chronic pain management in that they reduce both inflammation and the associated degradation.

Dr. Sunil Aggarwal discusses chronic pain and cannabis. Must Watch!

When we're in pain

Our bodies release more endocannabinoids which supports the notion that they are involved in pain modulation. Read more on the endocannabinoid system (eCB).