Higher Learning LV Staff
May 5, 20235 min
Welcome to homework assignment CAS 1.3 in the Cannabis for Anxiety seminar from Higher Learning LV. This assignment focuses on the therapeutic application of cannabis for pain patients, some of whom suffer anxiety and some of whom do not.
This assignment includes recently published peer-reviewed scientific research from the United Kingdom on the topic of the potential medicinal efficacy of cannabis for pain patients who experience comorbid anxiety.
After you complete this assignment, use the button at the bottom to return to the Cannabis for Anxiety seminar master page.
A 2023 study entitled "Comparing the Effects of Medical Cannabis for Chronic Pain Patients With and Without Comorbid Anxiety: A Cohort Study" that was published in the journal Expert Review of Neurotherapeutics investigated the effects of cannabis on two groups of chronic pain patients, those with and without anxiety. The research explored the health-related quality of life, potential adverse events, and changes in opioid medication consumption between the two groups.
The study's authors reported that more than one-third of adults in the United Kingdom suffer from chronic pain. In 12 percent of these patients, their pain is so severe that they are unable to perform daily activities. Despite the large percentage of citizens who have chronic pain, treatment options are limited and feature "known safety concerns."
These circumstances have led researchers and scientists to show increased interest in new treatment therapies and pharmaceuticals, including those that might be formulated with chemicals such as the cannabinoids produced by cannabis. The study labeled such formulations as cannabis-based medicinal products (CBMPs) and described them as including not only phytocannabinoids, but also terpenes and flavonoids. It explained that the two most common phytocannabinoids are cannabidiol (CBD) and delta-9 tetrahydrocannabinol (THC).
"The research included 1,254 participants, 57 percent (711 individuals) of whom suffered anxiety and 43 percent (543) of whom did not."
Like the previous homework assignment (CAS 1.2), this study explained that the two primary cellular receptors in the human endocannabinoid system (ECS) are CB1 and CB2. CB1 appear mostly in the brain and central nervous system (CNS), but are found in considerably lower densities throughout the body. CB2 receptors, on the contrary, are most dense in what scientists called the periphery, or the area outside of the brain and CNS. This includes all organs, tissues, and glands associated with the immune system.
The research included 1,254 participants, 57 percent (711 individuals) of whom suffered anxiety and 43 percent (543) of whom did not. Those who did suffer both pain and anxiety included those with mild anxiety (322 participants), moderate anxiety (201 patients), and severe anxiety (188 participants).
The study explained that CB1 receptors are responsible for producing both analgesic (pain reducing) and psychotropic effects, while the CB2 variety focus on modulating inflammation and inflammatory cytokines. The scientists noted that other receptor types are involved in the management of pain, including TRPV1, GPR55, and a variety of opioid and serotonin receptors.
The study found that CBMPs are associated with a "small, yet clinically significant, reduction in pain severity." However, the study's authors stressed that this data features many limitations and is of relatively low quality for a number of reasons. An area where future research should focus, according to this study, is the efficacy and safety of cannabis for anxiety and pain.
"Anxiety is at least twice as common in those with chronic neck or back pain."
The scientists reported that anxiety and pain are often comorbid, meaning that they frequently occur together (but perhaps for different reasons or one may cause the other; the topic is complex). As an example, the study noted that anxiety is at least twice as common in those with chronic neck or back pain. Despite the fact that prior studies and anecdotal evidence suggests that both CBD and THC may decrease pain, most of this data is of low quality and must be confirmed by better quality future studies.
"The relationship between anxiety and chronic pain is complex and bidirectional, as described by the biopsychosocial model of pain, in which anxiety is both a cause and consequence of chronic pain," reported the study. It noted that many patients who suffer both pain and anxiety may require more than a single treatment or drug to effectively lower negative symptoms.
The study revealed some interesting differences between the two cohort groups. Employment status was one characteristic that varied, with "most of the no anxiety cohort being employed while the majority of the anxiety cohort was unemployed." The most common reason for obtaining medical treatment among the participants in either group was chronic non-cancer pain.
As might be expected, the anxiety cohort featured more tobacco smokers (31 percent) than the no anxiety group (23 percent). Surprisingly, alcohol consumption was higher in the no anxiety group. Both groups featured equal numbers of patients who used cannabis, were previous but not current users, or who were completely "cannabis naive."
"The anxiety cohort featured more tobacco smokers (31 percent) than the no anxiety group (23 percent). Surprisingly, alcohol consumption was higher in the no anxiety group."
Patients in both cohorts were almost equally prescribed both CBD and THC, with the most common consumption avenues being sublingual/oral formulations and vaporized loose-leaf flower. The most frequently prescribed CBMP therapies were "Adven® 20 THC oil, Adven® 50 CBD oil, and Adven® EMT1 19 percent THC flower (Curaleaf International, Guernsey, UK)."
Nineteen percent of the anxiety group suffered adverse events, while only 17 percent of the no anxiety group did. In the no anxiety group, the most common adverse events were fatigue and somnolence (sleepiness, drowsiness). In the anxiety group, they were fatigue and dry mouth. In both cohorts, more than 80 percent of adverse events were mild or moderate in severity.
The study determined that pain patients who also suffer anxiety are, statistically speaking, more likely to gain relief from the use of cannabis. However, the research concluded that pain patients in both groups "demonstrated improvements in all pain-specific" characteristics after visits and treatment at one, three, and six months.
"The anxiety cohort achieved greater improvements in anxiety, sleep, and health-related quality of life...compared to the no anxiety cohort," concluded the scientists. The study reported that both the anxiety and no anxiety pain cohorts "achieved significant reductions in opioid consumption and both groups reduced their consumption levels by roughly the same volume.
The study concluded that there is an association between use of CBMPs and improvement in pain and health-related quality of life. The research noted that use of cannabis also resulted in other improvements, including reductions in opioid consumption and a relatively low number of adverse events. They interpreted this to mean that cannabis has an acceptable safety profile for use in clinical settings.
"There is an association between use of CBMPs and improvement in pain and health-related quality of life."
Patients suffering both pain and anxiety were found to gain slightly more benefit in terms of reductions in both of these indices than the cohort that suffered only pain and no anxiety. The study noted that it was the first of its exact nature and that more research is necessary "to determine that the changes observed were not secondary to confounding factors beyond the control of the study design."
View the original study.