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Thousands of Americans use cannabis for health reasons each year, and the majority do so for pain, including pain from Cancer. In fact, according to the National Academies of Sciences, Engineering, and Medicine, 8 in 10 patients use medicinal cannabis specifically to manage severe pain. [1] For those who use it in this way, its effectiveness is without question. Now science is filling in the gaps in our understanding as to how cannabis for pain works. Here is what we know.
Why cannabis for pain
To understand how medical cannabis works for pain, you first have to understand how it works in the body. The main way is through small molecules called “cannabinoids,” the most well known are THC ( Tetrahydrocannabinol, the psychoactive cannabinoid in cannabis) and CBD (Cannabidiol). These interact with what is called the endocannabinoid system, or ECS. This system was first discovered in the body in the early 90's by Dr. Raphael Mechoulam, we now know that the bodies of almost all animals (and some scientists think all animals) contain this system that produces endogenous cannabinoids, called endocannabinoids, endogenous mean made inside your own body. Endocannabinoid receptor sites exist throughout the entire body, including the brain, central nervous system, muscles, and the immune system.
Consider the ECS as a “helper system” for all other systems in the body assisting in homeostasis, everything from the gut to the liver and heart. The ECS helps to balance and regulate all other systems and organs, including those that regulate pain responses. When the endocannabinoid system becomes depleted, which happens in the face of emotional and physical stress and disease, this is when THC, CBD, and other cannabinoids from cannabis can help to reinforce and renew.
For example, THC modulates pain when it binds to endocannabinoid receptors located in pain centers in the brain. It increases opioid receptor activation and also relieves neuropathic pain by weakening pain signals at the level of the spinal cord. CBD, on the other hand, exerts its pain-relieving properties through its interaction with the ECS, inflammatory mechanisms, and pain-sensing systems.
CBD and CBG are often used with THC for pain management so the best cannabis strains should have a good balance of cannabinoids. THC and CBD suppress pain by binding to your body’s cannabinoid receptors (such as CB1) which are located in areas of the brain that control pain. We have come a long way in understanding the complicated mechanisms through which THC and CBD do this, yet researchers are still investigating the specifics as to how cannabinoids exert their effect on pain.
Some sources claim that THC weakens the intensity of neuropathic pain signals, making it easier for the patient to tolerate high pain levels. On the other hand, the euphoric feeling that comes with THC consumption may also help to numb pain. Finally, THC may also amplify the activation of opioid receptors. This second effect can have a profound effect on a person’s life, especially if they have become dependent on pharmaceutical drugs for pain. A 2016 University of Michigan study found that Patients using medical marijuana to control chronic pain reported a 64 percent reduction in their use of more traditional prescription pain medications known as opioids. [4]
CBD, which has a different action on many endocannabinoid system receptors (CB1 & CB2 especially), has been shown to relieve pain through different pathways than THC. In particular, CBD has been shown to have an effect on inflammatory mechanisms, leading to a significant reduction in systemic inflammation. CBD’s ability to instigate serotonin release may also contribute to a reduced perception of pain. Another form of CBD called CBDA has also been implicated in pain relief as well. [2] A study published in The Journal of Pain showed low-dose CBDA could be useful in providing pain relief.
In addition, a recent systematic review conducted by scientists from Syracuse University found that cannabinoids influence the experience of feeling pain. [3] Eighteen studies with a total of 442 adults were analyzed. The researchers found that cannabinoids modestly increased people’s threshold for pain and also reduced other unpleasant sensations that may come from pain, such as insomnia and loss of appetite.
A 2019 study published in the Journal of Psychoactive Drugs analyzed information from 1,000 individuals using medical cannabis in Pennsylvania. They found that 80% of the patients who used it this way found it beneficial and 82% of the patients were able to reduce or stop the use of opioids. A different study conducted by researchers from the Dent Neurologic Institute in Buffalo, New York, found that cannabis effectively relieved chronic pain and was well tolerated in people 75 years of age and older. [5]
How do you use cannabis for pain relief?
Cannabis for pain comes in different methods of consumption. Some of them include:
- Capsules
- Gummies
- Tablets
- Vapes
- Concentrates
- Tinctures
- Transdermal patches
- Sprays
The good news is that, as long as one of the forms of cannabis consumption is available in your state, you get to choose the cannabis product that is most comfortable and most convenient for you. Some cannabis products are not legal in some states, even when that state has a legal medical cannabis program. Be sure to do your own research to ensure that what you pick is both legal and available within your state.
Which cannabis strain do I choose for pain?
When it comes to both THC and CBD, the right amount of each will vary from person to person. This is because optimal doses are influenced by several factors, such as individual tolerance levels and your individual ECS. When you first start, look for a strain that has about 10% THC and move upwards until you find one that relieves your pain adequately.
Consider a dosage form that combines THC with CBD. Apart from having pain-relieving benefits, CBD also helps counter some of the adverse effects of THC. Ratio products are a great option for pain patients. Good ratios to look for when first starting out are 1:5 THC:CBD, 1:1 THC:CBD, or CBG; ratios are a great way to increase your relief.
To date, some of the best cannabis strains for pain relief include the following:
- White Widow
- Ice Cream Cake
- Kush Strains
- Gorilla Grease
- Northern lights
- Strains with more CBD
What about cannabis for pain in Utah?
Medicinal cannabis is legal in Utah, and chronic pain is one of the qualifying conditions. This means that you can legally use it to treat moderate to severe pain in the Beehive state. However, you need to be registered as a medical cannabis patient through the Utah Department of Health. Once you are registered, then you can legally purchase cannabis from any licensed Utah dispensary. For now, cannabis edibles are not legal in Utah. Legal cannabis products in Utah include the following:
- Tinctures
- Tablets and capsules
- Transdermal patches
- Gelatinous cubes
- Concentrates
- Flower
Great options for pain patients are tinctures and gelatinous cubes because they can help with pain for a longer period of time, about 6 to 8 hours. Also adding an inhaled form can help many patients with acute or breakthrough pain because they work so fast but do not last as long. Start slow with the THC content and then work your way up to a dose that works for you.
And if you think you would benefit from the advice of a certified, Doctorate-level pharmacist who is professionally trained in both pharmaceuticals and cannabis, be sure to schedule a consultation. They have decades of experience, can help you understand if cannabis is right for your unique situation, and can help you get started with specific product recommendations.
Their advice is free of charge and you can usually speak to someone within 24 hours. Start your health and wellness journey HERE!
References
1. National Academies of Sciences, Engineering, and Medicine. Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017.
2. Vigli, D., Cosentino, L., Pellas, M., & De Filippis, B. (2021). Chronic Treatment with Cannabidiolic Acid (CBDA) Reduces Thermal Pain Sensitivity in Male Mice and Rescues the Hyperalgesia in a Mouse Model of Rett Syndrome. Neuroscience, 453, 113–123
3. De Vita MJ, Moskal D, Maisto SA, Ansell EB. Association of Cannabinoid Administration With Experimental Pain in Healthy Adults: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2018;75(11):1118–1127.
4. Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain. 2016;17:739-744.
5. Cassels C. Medical cannabis safe, effective in the elderly. Medscape. www.medscape.com/viewarticle/912624. May 6, 2019. Accessed January 13, 2020.