How Does Medical Cannabis Work to Manage Pain?
Cannabis relieves pain by making it more bearable, rather than actually reducing it. Over the years researchers have found that people benefit more from using cannabis as a pain reliever because of small changes cannabis creates within their brain. Humans are all born with an Endocannabinoid system and their receptors are found throughout the body. In each tissue, the cannabinoid system performs different tasks, but the goal is a stable internal environment despite fluctuations in the external environment. The compounds in cannabis mimic the natural chemicals that the body produces. Researchers have identified two cannabinoid receptors: CB1, predominantly present in the nervous system, connective tissues, gonads, glands, and organs; and CB2, predominantly found in the immune system and its associated structures. Many tissues contain both CB1 and CB2 receptors, each linked to a different action while THC acts as an antagonist to reduce pain when combined with CBD.
Dr. Michael Lee of Oxford University's Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) recognized that "cannabis does not seem to act like a conventional pain medicine. Some people respond really well, others not at all, or even poorly. Brain imaging shows little reduction in the brain regions that code for the sensation of pain, which is what we tend to see with drugs like opiates. Instead cannabis appears to mainly affect the emotional reaction to pain in a highly variable way." Since cannabis does not affect the pain centers of the brain, it does not have the same addictive capabilities as opiates, there for cannabis has a much lower likelihood of addiction.
When individuals use prescription opioids, once taken they are absorbed into our blood vessels. Once the opioids reach the brain, transporters help them travel to their target cells where they bind to specific receptors. That binding leads to pain relief and other positive feelings.
As time passes there is more and more opiates bound to these receptors. After a few weeks, a process of tolerance occurs as the opioid receptors begin to lower the signal and decrease receptor binding to where it was before opiates were used. While the opiates are in the blood, they are not acting like they had originally acted when they were started; soon they are no longer affecting the brain as they had originally. This ultimately means that for the exact same dose of opiates used at the start of the treatment program there is eventually less of an effect, the patients ultimately perceives this as needing more pain medication to create the exact same ability to relieve their pain. When this happens the patient is now said to have reach a place of tolerance. Because he is no longer getting optimal pain relief he then begins the abuse process by increasing, on his own the dosage of his medication, and at this point the addiction process is set in motion.
Two things now happen almost simultaneously: 1) the patient increases his daily dosage of opiates, and 2) he starts developing an intense need for more opiates both to manage his pain as well as make him feel better. This process can in some individual lead to eventually taking an overdose wherein they either survive, sometimes only with the help of paramedics, an emergency room and skilled doctors, or, if these are not available, they die
With the recognition of the value of medical cannabis many medical practitioners and patients are now choosing to go to rehabilitation, get entirely off opiates, and then either, in many cases, use another prescription pain medication, which are generally is not quite as effective as the opiates were, or they are started on medical cannabis .
This now presents a new problem, the current separation, in most states, between medical cannabis being Recommended by doctors, who while offering Recommendations are not actually managing the client-patient they have just Recommended to use medical cannabis and the patients family medical doctor or specialist who knows letter or nothing about using medical cannabis. For a perfect system, they should be the same person. The family medical doctor or specialist should be skilled in managing medical cannabis or the specialist skilled in Recommending medical cannabis should be managing the patient. To prevent abuse all members of the patient’s team should know about use of all pain medication options, including medical cannabis, and they should also be managing the patient when medical cannabis is being used. Patients should not be split between two professionals who each have half the skills and abilities to get them well. Seeing special doctors to obtain their Recommendations and leaving the primary doctor out is a recipe for disaster that we in the medical cannabis field must now work on and prevent.
Today, most Western allopathic medical doctors are not yet trained to use and manage their patients with medical cannabis; we must do something about this. This gap has significantly slowed down the capacity of the medical establishment to remove patients at significant risk for addiction, overdosing and premature death and getting them off opioids and then starting them on the less problematic medical cannabis.
Benefits and Limitations of Medical Marijuana for Pain Relief
While opioids have one and only one value, pain relief, their limitations and risks are many. Obviously, the most important risk is addiction, overdosing and premature death. While the main and only benefit opiates have is their patients ability to control and manage pain, the risk of abuse, addiction, and premature death is exceedingly high and in most situations when there are other options, such as medical cannabis, these risks are now much too great to allow unfettered routine use of opioids.
On the other hand, medical cannabis, while it does have some limitations and negative side effects is rarely blamed for unnecessary deaths and in most cases the benefits, even those not necessary in relation to their original complaint of pain, are significant enough to suggest that medical cannabis is clearly the best choice available.
CBD and Pain Relief?
While most varieties of cannabis have the ability to help manage and control pain, and since opiates are only used to manage pain, the ability to switch pain sufferers from opiates to medical cannabis immediately reduces their risk of opiate abuse, addiction, and premature death. A simple move for a significantly important mission, to replace opiates with a pain medication that are equally or more effective, are not addicting, and are also cost effective for the patient.
We ourselves in our practice tend, for our patients, to recommend those varieties and products high in CBD (Cannabidiol). Not only is CBD highly effective but when formulated specifically for the patient's unique needs is highly effective. With low levels of THC, many individuals can still function normally without getting high and still have the capacity and ability to work. We always suggest that the individual best take his morning dosage after reporting to work so that during the day he gets optimal pain relief and by the late afternoon, when he will be soon driving home, the CBD has completely worn off. Obviously, since it is illegal in every state and territory to drive under the influence, he should not drive until he is capable and he should not during the day operate and machinery wherein he or someone else could be injured.
There are currently 11 Randomized Controlled Trials underway for Cannabinoids for the Treatment of Chronic Pain. 7 studies demonstrated cannabinoid exhibited analgesic effect that was significantly better than the control. The conclusion of the studies was that cannabinoids demonstrated an analgesic effect and are safe in the management of chronic pain. (M E Lynch, Mark Ware, 2016)
There are, of course, other pain medication options wherein opiate addiction can be avoided. It is likely in many cases medical cannabis has been the last resort after these other options have either failed or were found to be inadequate in some way. In every case, the choice of pain medication and the ability to avoid opiate addiction must be one of care and forethought. Those individuals who have a history of addiction or substance abuse issues with cannabis should talk with their physician and consider trying all other options before settling on medical cannabis.
Medical cannabis should is an excellent option for those individuals who medically require pain relief, who have had a history of opiate addiction or abuse, who have had poor results with other medications, and when medical cannabis is the best choice for dealing with pain and the patients ability to live a normal life and function optimally.
Allen Lawrence, M.D., M.A., Ph.D. – Medical Director, Earth Healthcare Medical Group
Len May, Master, Certified Cannabis Specialist (MCCS)