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Updated November 2023.
Cannabis for Pain
In the United States, 20 million people suffer from chronic depression, sometimes resulting in suicide. Another 40 million are adversely affected by social anxiety, often so severely that they develop agoraphobia and cannot leave their homes. Both of these metrics are eclipsed, however, by the 50 million Americans who suffer from chronic pain.
Pain is a symptom of literally thousands of diseases and conventional therapies, from fibromyalgia to arthritis to common cancer treatments. The proper management of pain, for millions of patients, is the difference between daily anguish and a productive, happy life.
Types of Pain
Cannabis for Pain. Before attempting to understand a patient's options for managing pain, it is first important to possess a solid comprehension of its types. The two major categories of pain are acute and chronic, as detailed below.
Acute pain: Can be mild or severe. Comes on suddenly and is temporary. Durations last from a few seconds to weeks. Typically results from damage to tissues such as bone, muscle, and organs. In extreme cases, acute pain can last months, but is not long term.
Chronic pain: Like the acute variety, can be either mild or severe, but is long term (and typically associated with long-term illnesses such as osteoarthritis). The unrelenting nature of chronic pain, especially for patients with severe levels, often manifests as clinical depression, anxiety, and insomnia. Often the result of nerve damage.
Pain Treatment Options
Cannabis for Pain. A wide variety of treatment options are available to patients suffering from pain, from heat therapy to opioids to cannabis. The efficacy of such treatments is highly subjective, meaning patients and their caregivers must experiment to determine the optimal treatment regiment, including titration (dosing) levels.
Treatment options fall into three major categories: Therapy, medications, and alternative treatments, as detailed below.
Therapy: Although many perceive the management of pain as limited to popular pharmaceutical drugs, it includes physical therapy and cognitive-behavioral therapy. Physical therapy and therapist-directed exercise increases pain tolerance while simultaneously reducing actual pain. Cognitive-behavioral therapy, a more controversial alternative approach, teaches patients to understand the nature of their pain and how they can live productive lives via management of their pain levels.
Medications: The most commonly prescribed approach to the treatment of all types of pain, both acute and chronic. Medications administered for pain include antidepressants, steroids, anti-seizure meds, non-steroidal anti-inflammatory drugs (NSAIDs; includes over-the-counter drugs like ibuprofen, naproxen, and aspirin), opioids (morphine and fentanyl), and non-opioid painkillers (acetaminophen).
Alternative treatments: A wide variety of alternative pain treatments are available, including meditation, cannabis, therapeutic massage, biofeedback, and transcutaneous electrical nerve stimulation (TENS). Two common alternative approaches include heat therapy and cold therapy. Heat therapy has been shown to improve circulation and blood flow to a particular area, which can reduce discomfort and increase muscle flexibility. Cold therapy (also called cryotherapy) has the opposite effect of reducing blood flow to a particular area, which can help with conditions such as inflammation and swelling, which frequently result in pain.
During recent years, conventional pain therapies—the most common of which is opioids—have resulted in what some experts are labeling an epidemic. Popular examples of opioids include prescription painkillers such as oxycodone (marketed under the brands OxyContin and Percocet), fentanyl (Duragesic), and hydrocodone (Norco and Vicodin).
Unfortunately, the most common approaches to pain management are also those that typically deliver the most negative side effects. Liver damage, abdominal bloating, constipation, brain damage, nausea and vomiting, depression, and fatigue are all commonly experienced side effects from the administration of these drugs.
Pain Statistics
Cannabis for Pain. According to Time Magazine's Alexandra Sifferlin, "Data shows the number of prescriptions written for opioids, as well as opioid overdose deaths, have skyrocketed in recent years, highlighting a growing addiction problem in the U.S."
In January 2015, the National Institutes of Health (NIH) published a report that provided a revealing and shocking snapshot of America's opioid epidemic.
In January 2015, the National Institutes of Health (NIH) published a report that provided a revealing and shocking snapshot of America's opioid epidemic. The NIH report found that, between 1991 and 2011, the number of opioid prescriptions for pain increased from 76 million to 219 million. According to related data from the Centers for Disease Control and Prevention (CDC), there were about 17,000 opioid-related overdose deaths in 2011 alone.
"Between 2007 and 2010, the number of hospitalizations due to opioid addiction quadrupled."
Even more revealing is the fact that, between 2007 and 2010, the number of hospitalizations due to opioid addiction quadrupled. These statistics also pertain to the nation's heroin problem; both prescription opioids (like Vicodin) and black market heroin offer similar highs. Heroin, however, is less expensive and readily available on the black market without a prescription.
The trend of opioid addiction, including its resulting health implications and deaths, has been pronounced in the eastern U.S. and Midwest, with states like Pennsylvania, Florida, and Ohio hit especially hard.
In January 2018, the Washington Post reported, "In California and several other Western states, there were no significant changes in the number of [opioid] deaths." This is typically attributed to harm reduction opportunities in those states, including legal medical and adult use cannabis and programs to prevent and treat opioid addiction. According to a Kaiser Health analysis of data from the CDC, deaths from opiates, cocaine, and methamphetamines increased by 35 percent in the United States between May 2015 and May 2017.
Problems from Opioids
Use of opioids presents three primary problems:
The negative side effects associated with standard prescribed use.
A high incidence of addiction.
Its role as a gateway to common (and less expensive) hard drugs, such as heroin. According to Dr. Andrew Kolodny, the chief medical officer of the rehabilitation nonprofit Phoenix House (a chain of addiction treatment clinics with dozens of locations in ten U.S. states), "There's been 175,000 deaths [from opioids] over 15 years."
Safety Profile of Cannabis for Pain
Cannabis for Pain. These statistics are especially significant in light of the fact that cannabis, better known as "marijuana" or "pot," has throughout history resulted in zero documented deaths. One of the chief reasons that the plant is such an effective and safe treatment for a variety of diseases and conditions, including pain, is the fact that it is impossible to overdose on the herb.
"There's been no history of any verified reports of a death from cannabis ever," said Dr. Alan Shackelford, a Harvard-trained physician.
"There's been no history of any verified reports of a death from cannabis ever," said Dr. Alan Shackelford, a Harvard-trained physician with a practice in Colorado that evaluates patients for their eligibility for a medical marijuana recommendation.
However, Shackelford was certainly not the first to bring attention to the safety profile of hemp and cannabis. In a 68-page report to the Reagan Administration in 1988 in which he recommended the federal medical legalization of the herb, DEA Administrative Law Judge Francis Young cited the relatively strong safety profile of cannabis.
"In strict medical terms marijuana is far safer than many foods we commonly consume. For example, eating 10 raw potatoes can result in a toxic response. By comparison, it is physically impossible to eat enough marijuana to induce death. Marijuana in its natural form is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within the supervised routine of medical care," wrote Young in his report more than 30 years ago.
Cannabis for Pain is Complex
The argument of the efficacy of cannabis for pain is overly simple. At a molecular level, it is two categories of chemicals, cannabinoids and terpenes, that work together in a delicate synergistic interplay (called the entourage effect) to provide three chief benefits to patients (and this consideration completely ignores the highly efficacious flavonoids):
Tetrahydrocannabinol, or THC, is the infamous cannabinoid that delivers not only medical efficacy, but also psychoactive effects. This is partly because THC is one of the few molecules allowed to permeate the body’s extremely selective blood/brain barrier to reach specialized CB1 receptors in the brain.
Cannabidiol, or CBD, delivers medical efficacy—and analgesic (pain killing) properties—that are very similar to its sibling THC. CBD, however, provides no psychoactive effect. This is a significant characteristic and difference in light of the number of people with sensitive occupations, including pilots, drivers, and child care professionals, who cannot (or may desire to not) experience a psychotropic effect from their cannabis-derived medicine.
Many companies in legal states like Colorado and California are beginning to formulate CBD-rich products that feature different levels of THC. This allows patients to determine the amount of psychoactive effect they will achieve and to find the particular balance of CBD and THC that works for their particular ailment and lifestyle.
Another superiority of cannabis over conventional opiates is its ability to kill pain without inducing nausea or sleep.
Another superiority of cannabis over conventional opioids is its ability to kill pain without inducing nausea or sleep. This is important for a large percentage of pain management patients, including busy professionals and parents who must maintain active lifestyles and cannot afford to be sidelined by their malady or its treatment.
History of Cannabis for Pain
Cannabis for Pain. Cannabis has a long history of use in the treatment of pain and other conditions that dates back thousands of years. British physician Dr. John Clendinning in the early 19th century documented his successful use of cannabis in the treatment of migraine headaches.
"Cannabis was commonly administered to soldiers during the U.S. Civil War for the treatment dysentery. In 1868, Sir John Reynolds infamously prescribed a cannabis-infused tea to Queen Victoria for her menstrual cramps."
In the United States, cannabis was commonly administered to soldiers during the Civil War for the treatment dysentery. In 1868, Sir John Reynolds infamously prescribed a cannabis-infused tea to Queen Victoria for her menstrual cramps, noting its superiority as a painkiller.
"The bane of many opiates," wrote Reynolds, "is that the relief of the moment is purchased at the expense of tomorrow’s misery," noting the withdrawal symptoms and gastrointestinal distress that often are associated with the use of opiates in the management of pain.
Effective Cannabis Cultivars for Pain
Cannabis for Pain. Finding the right cultivar (strain) for one's pain can be a challenge. This is compounded by the highly subjective nature of cannabis efficacy, affecting different patients in sometimes markedly contrasting and even polarized ways.
Many cultivars (strains) of marijuana have proven, through both chemical analysis and empirical evidence, to be better than their peers at managing pain. However, because there are different types of pain, a single cultivar of cannabis cannot accurately be recommended.
"For headaches and migraines, cultivars such as Blueberry Headband and Purple Arrow have proven, through anecdotal evidence, to provide relief."
For example, for generalized pain, the cultivars ACDC and Blackberry Kush have been found to provide relief to patients (ACDC is also known for its relatively high CBD content). For inflammation, Harlequin (another CBD-rich cultivar) and Blue Widow have shown to help patients. This is especially beneficial to those suffering from arthritis, asthma, ulcerative colitis, Crohn's disease, hepatitis, fibromyalgia, and other conditions characterized by systemic inflammation.
For headaches and migraines, cultivars such as Blueberry Headband and Purple Arrow have proven, through anecdotal evidence, to provide relief. Other cultivars that have been reported to reduce pain include Dynamite, Cataract Kush, and Redwood Kush. Patients are encouraged to seek organic cannabis that has been laboratory tested and is free of contaminants such as pesticides, molds, and mildew.
Cannabis for Pain Studies
Cannabis for Pain. A 2015 clinical study published in the American Pain Society's Journal of Pain involved 431 adult patients. It revealed cannabis to be not only an effective analgesic, but also to provide a reduction in secondary symptoms, including depression and anxiety.
The patients—split between 215 who consumed cannabis and 216 within a control group who did not receive marijuana—all suffered from chronic pain. The study allowed participants the option of smoking flowers, vaping concentrates, or consuming edibles, all of which contained 12.5 percent THC.
"Both patient groups exhibited a reduction in pain. Those consuming cannabis, however, also experienced significantly decreased anxiety and depression."
Both patient groups exhibited a reduction in pain. Those consuming cannabis, however, also experienced significantly decreased anxiety and depression. The study's researchers noted that cannabis was effective in treating not only the pain itself, but also in alleviating the symptoms resulting therefrom—including fatigue and psychological manifestations like hopelessness (one of the chief causes of suicide).
It should be noted that some patients within the cannabis group experienced minor sleeplessness. The researchers concluded, however, that patients consuming cannabis experienced greater pain reduction than the control group. In addition, members of the cannabis group experienced no decrease in their ability to function in day-to-day life, an area of negative impact for members of the non-cannabis group who consumed conventional opioids such as fentanyl and hydrocodone.
The researchers also noted that, when used as part of a monitored treatment program over the course of a year, cannabis medicine posed no threats because it features a "reasonable safety profile."
A 2008 study published in the journal Therapeutics and Clinical Risk Management found efficacy in the pain management properties of several different molecular components of cannabis, including the major cannabinoids THC and CBD.
"The anti-inflammatory contributions of THC are also extensive…THC has twenty times the anti-inflammatory potency of aspirin and twice that of hydrocortisone."
The study concluded that "the anti-inflammatory contributions of THC are also extensive...THC has twenty times the anti-inflammatory potency of aspirin and twice that of hydrocortisone."
Regarding CBD, the other major cannabinoid in cannabis, the study observed that "cannabidiol, a non-euphoriant phytocannabinoid common in certain strains, shares neuroprotective effects with THC, inhibits glutamate neurotoxicity, and displays antioxidant activity greater than ascorbic acid (vitamin C) or tocopherol (vitamin E)."
Like the 2015 Canadian study, researchers noted the lack of negative side effects of cannabis, including its chief components THC and CBD. "Cannabinoid analgesics have generally been well tolerated in clinical trials with acceptable adverse event profiles. Their adjunctive addition to the pharmacological armamentarium for treatment of pain shows great promise."
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"Cannabinoid analgesics have generally been well tolerated in clinical trials with acceptable adverse event profiles. Their adjunctive addition to the pharmacological armamentarium for treatment of pain shows great promise."
A 2010 study published in the journal CMAJ found that more than 10 percent of patients suffering from pain were self-medicating with cannabis. "About 10 to 15 percent of patients attending a chronic pain clinic use cannabis as part of their pain strategy," wrote the researchers.
Cannabis for Pain Conclusions
Cannabis for Pain. The promise of cannabis and its myriad cannabinoids and terpenes for the treatment of conditions like pain is great, offering tens of millions of Americans an alternative to conventional treatments, like opioids, that deliver a slew of negative side effects.
"Unfortunately, the U.S. federal government categorizes marijuana as a Schedule 1 drug, meaning that it is officially considered as dangerous and addictive as heroin and bath salts."
Unfortunately, the U.S. federal government categorizes marijuana as a Schedule 1 drug, meaning that it is officially considered as dangerous and addictive as heroin and bath salts (which reside in the same category). Meanwhile, dangerous drugs like cocaine and methamphetamines are categorized as Schedule II, meaning they can legally be prescribed by a physician.
Until cannabis is rescheduled, academic institutions, hospitals, and research laboratories wishing to conduct clinical studies and experiment with the medical efficacy of cannabis have their hands tied. Fortunately, studies regarding the health benefits of cannabinoids like CBD and THC are are being conducted in countries like Canada, Israel, and the United Kingdom.
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