Cannabis and Pain
Image by Pixabay
Cannabis has been used in medicine dated back as long ago as 2900 BC (1). This has to do with your endocannabinoid system- a system in your body that modulates eating, sleeping, pain, and virtually every other process. Cannabis, when used, alters this system. Likewise, endocannabinoids- your body's natural cannabis-like molecules- alter this system too. For some time, scientists have studied this system and how it manages pain.
Endocannabinoids indirectly increase pain tolerance and decrease inflammation in response to pain (2). They also are a first responder to painful stimuli and stress (3). So when you place your hand on a hot stove, endocannabinoids are immediately recruited in your brain.
Likewise, cannabis has been found to act as a pain reliever in your brain (4,5,6,7,8). Interestingly, a study came forth where scientists found that smoking cannabis increases pain when consuming in high doses, but offsets pain if consumed at a more moderate dose (7). From this we know that the dose you take is crucial, which is why self-medication can be risky.
Despite the potential benefits of cannabis as a pain-reliever, there have been no long-term studies to see if cannabis use increases pain in the long run, as is the case with opioids (9). It is possible that pain could increase in the absence of steady cannabis consumption (9). However, this is a possibility for virtually all painkillers, so pick your poison.
Essentially, we don't know enough about cannabis at present to say whether it is safe or not. But opioids, the traditionally prescribed painkillers, are definitely not as safe as they seem. As Tanisse mentioned last week, opioid-related overdoses killed more people during the first year of the COVID-19 pandemic than COVID itself did (10).Remarkably, cannabis has been shown to help those taking opioids to ween off (9). There has also been talk of cannabis and opioids working together to help manage pain (11).This is likely because they activate similar pathways in the brain (9).
Still, using cannabis as a pain reliever is a tricky line to walk. Cannabis won't kill you from overdose, unlike opioids, and the withdrawal from cannabis is a cake-walk compared to the withdrawal from opioid addiction. But again, in the long-term, we don't know whether this is good for us. It is possible that treating pain with opioids, followed by cannabis, could drastically increase pain when abstaining from both.
There are a handful of studies out there that show cannabis to have a placebo effect when treating pain (12,13). Because the evidence is divided on cannabis and pain management, it is hard to conclude whether cannabis is a placebo or not. That being said, even if it is a placebo, this can still have positive effects on your life. Pain is subjective- meaning the experience of pain can be altered by your emotions and mental state (9). If cannabis can bring you to a better state of mind, even if it isn't a pharmaceutical painkiller, it may still help with pain relief.
All this is to say, if you suffer from chronic pain, do what works for you. If it makes your quality of life better, who cares if it's a placebo? Like with anything, use in moderation and educate yourself on what you are putting in your body. Research your drug of choice, especially if you are self-medicating. Always go with the lowest-risk option when it comes to pain management. If for you, that's cannabis, all the power to you. Do what you've got to do to make it through the day.
Written by Jessica
Touw M. The religious and medicinal uses of cannabis in China, India and Tibet. J Psychoactive Drugs. 1981;13:23–34.
Rice AS. Cannabinoids and pain. Cuurr Opin Investig Drugs. 2001;2:399–414.
Hohmann AG, Suplita RL, Bolton NM, et al. An endocannabinoid mechanism for stress-induced analgesia. Nature. 2005;435:1108–1112.
Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems, a clinical review. JAMA. 2015;313:2474–2483.
Lim G, Sung B, Ji RR, et al. Upregulation of spinal cannabinoid-1-receptors following nerve injury enhances the effect of WIN55,212-2 on neuropathic pain behaviour in rats. Pain. 2003;105:275–283.
Johanek LM, Heitmiller DR, Turner M, et al. Cannabinoids attenuate capsaicin-evoked hyperalgesia through spinal and peripheral mechanisms. Pain. 2001;93:303–315.
Wallace M, Schulteis G, Atkinson JH, et al. Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology. 2007;107:785–796.
Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313:2456–2473.
Hill, Kevin P., et al. "Cannabis and pain: a clinical review." Cannabis and cannabinoid research 2017; 96-104.
BCCSU. Opioid deaths in B.C. far outpaced those from COVID-19 [Internet]. Opioid deaths in B.C. far outpaced those from COVID-19. 2021 [cited 2022 Nov 4]. Available from: https://www.bccsu.ca/blog/news/opioid-deaths-in-b-c-far-outpaced-those-from-covid-19/
Elikottil, Jaseena, Pankaj Gupta, and Kalpna Gupta. "The analgesic potential of cannabinoids." Journal of opioid management 2009; 341.
Abrams DI, Jay CA, Shade SB, et al. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 2007; 68(7): 515– 21.
Wilsey B, Marcotte T, Tsodikov A, et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain 2008; 9(6): 506– 21.