Cannabis for Pain Management

CANNABIS CULTURE- Cannabis doesn’t seem to work on the same area of the brain that codes for the sensation of pain like opiates and opioids do, but rather the part of the brain that regulates our emotions and how we react to pain.

This has sparked a debate, one side argues cannabis a pain killer, while others label the plant based therapies as “pain distractors.”

Are we just playing with semantics at the moment? Could cannabis not in fact be an actual pain killer – it’s just that we don’t fully understand all the mechanisms that cause pain? This is certainly possible, and cannabis research is certainly putting to question what we traditionally thought pain was. To look at how cannabis beats pain, we ought to look at what areas of the body it effects as far as we know so far …

Endocannabinoid Receptors
There are two main cannabinoid receptors located throughout the body: CB1 receptors, which are found mostly in the central nervous system (CNS), but also the lungs, liver and kidneys; and CB2 receptors, which are found in the peripheral nervous system (PNS), and in expressed the immune system and hematopoietic cells (stem cells that give rise to other types of blood cells). THC has an affinity for the endocannabinoid receptors; CBD has a low affinity for the body’s cannabinoid receptors, but influences the endocannabinoid receptors in a more “indirect” way and also has effects on other receptors in the body.

This paper, entitled ‘Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes’ explains how cannabis helps manage pain more thoroughly, but to give the gist:

Cannabis regulates nociceptor thresholds. Nociceptors are receptors in the body that detect pain.
Cannabis also acts on non-nervous tissues as well as nervous tissues, which is why it can be so helpful for so many different types of pain, whether physical, mental or emotional.

THC and CBD can help control the pain signals being received by nociceptors

Cannabis can inhibit the release of proinflammatory factors by non-neuronal cells.

Cannabis Indirectly stimulates opioid receptors, in particular μ-opioid and δ-opioid receptors.

Cannabis can also work synergistically with opioids as well.

THC works on the endocannabinoid receptors, whereas CBD works on the vanilloid, serotonin and adenosine receptors and the endocannabinoid receptors in a less direct way.

To quote from the paper:
“Cannabinoid receptor agonists modulate nociceptive thresholds by regulating neuronal activity [4], but they also relieve pain by acting on non-nervous tissues. CB1 receptor is involved in the attenuation of synaptic transmission, and a proportion of the peripheral analgesic effect of endocannabinoids can be attributed to a neuronal mechanism acting through CB1 receptors expressed by primary afferent neurons. However, recent findings suggest that CB1 receptors are also present in mast cells and may participate in some anti-inflammatory effects. Thus, activated CB1 receptors present in mast cells induce sustained cAMP [cyclic adenosine monophosphate – a signal transmitter]elevation, which, in turn, suppresses degranulation [146 – “degranulation” is a cellular process that releases antimicrobial cytotoxic or other molecules from secretory vesicles called granules found inside some cells].
On the other hand, although CB2 receptors have been related traditionally to the peripheral effects of cannabinoids (mainly modulation of the immunologic responses), they also contribute to antinociception by inhibiting the release of proinflammatory factors by non-neuronal cells located near nociceptive neuron terminals. CB2 receptors are expressed in several types of inflammatory cells and immunocompetent cells. For that reason, activation of peripheral CB2 receptors generates an antinociceptive response in situations of inflammatory hyperalgesia and neuropathic pain [66, 160], while selective CB2 receptor agonists are not antihyperalgesic against chronic inflammatory pain in CB2 knockout mice [160].”

Remember though that many of these studies are on mice, and phytocannabinoids generally have different effects on humans.

Vanilloid Receptors

In particular Transient Receptor Potential Cation Channel Subfamily V member 1 (TRPV1). Plays a part in the mediation of inflammation, pain perception and body temperature. Inhibiting this receptor may help reduce pain, as CBD effectively “occupies” or “blocks” the areas in the cells where pain signals are sent to.

Adenosine Receptors

In particular, Adenosine A3 Receptors. Adenosine receptors play a role in the release of the neurotransmitters dopamine and glutamate. Augmenting adenosine levels can be augmented by inhibition of metabolism via adenosine kinase or the generation of the enzyme nucleotidase. This makes cannabis potentially very useful for neuropathic pain.

Serotonin Receptors

In particular, 5-Hydroxytryptamine receptor, subtype 1A (5HT1A), although other subtypes have been implicated in the ability to control pain. 5HT1A receptor in particular binds serotonin. 5HT1A and 5GT7 receptor agonists and 5HT2A and 5HT3 antagonists may be of particular use for managing pain. This is why SSRIs are so often used as painkillers, and also why CBD may be just as effective – or even more effective – a painkiller or antidepressant.

Can Marijuana Decrease Pain Tolerance?

Some studies have shown that long-term cannabis consumption may decrease one’s ability to withstand pain. Laura Mitchell and her colleagues at Glasgow Caledonian University found that male marijuana users kept their hands in freezing cold water for much shorter durations than non-users. However, the study had a low sample number of 90 people, and there doesn’t seem to be too many controls in place that might help explain how other variables may have an effect on a marijuana user’s pain tolerance. Also, much of the scientific literature out there suggests marijuana is an effective painkiller.

However, to do some justice to Laura Mitchell’s work, whilst there are many studies out there showing that cannabis has painkilling or pain-distracting qualities, some of those studies also show that some people’s tolerance to pain does indeed decrease under the influence of cannabis. This suggests that cannabis is like many other medications out there, i.e. helpful for some, neutral for others, and negative for the remainder.

Should I Go for THC or CBD?

Quite simply, both, if you want to get the best effects out of them (the entourage effect). Both cannabinoids also have antiinflammatory effects, so getting rid of one means no more than half the work gets done.

Though many people report most therapeutic effects with a THC:CBD ratio of 1:1, this can depend upon the person and condition the person is suffering from (for example, different types of cancer respond to different cannabinoid concentrations). Moreover, cannabis may actually be more effective for treating certain types of pain that opioids don’t treat effectively, like neuropathic pain.

For most types of pain, however, it is probably best to start on a low dose 1:1 THC:CBD ratio, then slowly upping the cannabinoid concentration until you find your ideal “range”, where the effects are pleasant and not too discomforting. Should you still not find any pain relief from a 1:1 THC:CBD concentrate, then try out different ratios

A 3:1 THC:CBD ratio will provide quite a strong psychoactive effect, which may provide pain relief for conditions that cause spasms (e.g. multiple sclerosis). A 1:3 THC:CBD ratio, on the other hand, will have a limited psychoactive effect, and can be useful for decreasing anxiety and inflammation. Many also report a 2:5 THC:CBD ratio – which can be found in strains like Harlequin – to be very useful for pain, with a “soft” psychoactive yet still relaxing effect. High concentrations of CBD to THC (e.g. THC:CBD ratios of 1:20) may be useful for epilepsy, phantom leg, depression, anxiety and Parkinson’s disease, but may not be as useful for severe pain.

However, CBD can reduce inflammation and help beat anxiety, so it might be best to “mix up” the cannabinoid concentrations for different times of day, different conditions, different levels of pain and so on. You might want a more clear-headed feeling a CBD-rich sativa might bring for daytime use, whilst you might want something a bit more psychoactive for nighttime use, and then something more balanced but with plenty of CBD in it for bedtime.

Of course, the level of pain relief depends upon the condition/s you suffer from as well: some types of cancer and some mental conditions do not respond well to THC, whereas some others do. This is one reason why the 1:1 THC:CBD ratio works so well for so many people – it’s a nice “balance”, and is less likely to aggravate any existing conditions you may have. A 1:2 or 2:1 THC:CBD ratio will produce psychoactive effects either way, with a 2:1 THC:CBD ratio being significantly more powerful than a 1:2 ratio. Both can be useful, though, and it could be a ratio suitable for both daytime and nighttime use.
Hopefully, we have given you some helpful information on how and why cannabis can be used for pain management. Unfortunately, making any hard-and-fast claims is difficult with regards to marijuana’s painkilling properties, what with the fact that it’s hard to carry out scientific and medical research on a federally illegal substance. But if you’re suffering from severe pain, and your doctor prescribes you nothing but opioids, barbiturates and benzodiazepines, it might be worth getting yourself a medical marijuana card and trying out something that’s less harmful and addictive.


featured image courtesy Denali Healthcare

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