Deep Dive: Cannabis for Insomnia from Pain

Updated: Sep 30

A January 2020 research study entitled "Medical Cannabis & Insomnia in Older Adults with Chronic Pain: A Cross-sectional Study" that was published in the journal BMJ Supportive & Palliative Care explored the potential ability of cannabis to assist chronic pain patients who suffer insomnia.

The study noted that "chronic pain is a debilitating condition that includes difficulty initiating sleep, disrupted sleep, and early morning awakenings." It explained that many patients with chronic pain often also suffer from insomnia, including "difficulty initiating sleep, disrupted sleep, and early morning awakenings." The research noted that pain and insomnia "have independent detrimental effects for individuals" and that their combined impact results in greater "suffering and lost productivity."


The study's authors noted that "one of the most common areas of medicine in which medical cannabis (MC) has been integrated is chronic pain" and that there is "relatively strong clinical evidence that MC is an efficacious pain reliever."


There is "relatively strong clinical evidence that medical cannabis is an efficacious pain reliever."

In addition to pain, the study reported that management of sleep disorders "has been widely reported as a motivation for cannabis use by cannabis patients." It noted that the human endocannabinoid system (ECS) plays a role in the "regulation of sleep, including the maintenance and promotion of sleep."


The researchers noted that prior studies on the topic "reported a significant and positive impact on sleep" by MC. That said, they also noted that regular consumption of the primary psychoactive cannabinoid produced by cannabis, tetrahydrocannabinol (THC) "is related to tolerance to the sleep enhancing effects of cannabis."

The scientists noted that most studies to date on the subject have investigated the efficacy of MC "in the context of orally administered synthetic cannabinoids with a 1:1 THC/cannabidiol (CBD) ratio," despite the fact that "the vast majority of MC patients use the whole plant" (typically via smoked or vaporized loose-leaf flower).


"The cannabis flower differs from synthetic cannabis-based medicines in that the former consists of over 500 different compounds" and that despite the fact that CBD and THC are the most famous cannabinoids, "others are likely to have important effects as well."


The Study

The research study was designed "to examine the association between sleep problems and MC in middle age and older (50+ years of age) chronic pain patients" and noted that this approach was taken due to the fact that both pain and chronic sleep problems increase as humans age.


The research study was designed "to examine the association between sleep problems and MC in middle age and older (50+ years of age) chronic pain patients."

Participants for the study were recruited from the Rambam Institute for Pain Medicine in Haifa, Israel from January to December of 2018. All had been prescribed MC for chronic neuropathic pain and had been in a pain relief clinic for a minimum of one year. According to Israeli law, the patients had also exhausted all other pain management treatment strategies.


Exclusion criteria included an age of under 50 and those with a diagnosis of "post-traumatic stress disorder, anxiety, clinical dementia, multiple sclerosis, Parkinson's disease, brain tumour, traumatic brain injury, stroke or serious mental illness, cancer patients who currently receive chemotherapy, and individuals who do not understand Hebrew."

Out of 263 candidates, including a control group of pain and insomnia sufferers who did not consume cannabis, 129 met inclusion criteria and agreed to participate. Study participants featured a mean age of 61, of which about half (51 percent) were female. The cannabis consumption group included 63 subjects and the non-consuming group was populated by 66 participants.


Of these, 24 percent of participants "reported always waking up early and not falling back asleep," while 20 percent experienced regular "difficulties falling asleep" and 27 percent reported "always waking up during the night."


24 percent of participants "reported always waking up early and not falling back asleep," while 20 percent experienced regular "difficulties falling asleep" and 27 percent reported "always waking up during the night."

Interestingly, the cannabis consuming group had, on average, used MC for four years and consumed 31 grams per month. They were found to consume "different strains [cultivars] through different modes." Primary consumption avenues included smoking (69 percent of consuming participants), oil extracts (21 percent), and vaporization (20 percent). The average THC level was 16 percent and the average CBD level was three percent.


Results

The study reported that MC patients who suffered pain and insomnia "were less likely to report waking up at night." They noted that MC "may help with sleep problems with more limited adverse side effects" than conventional pharmaceutical drugs.


The most commonly reported sleep issue among chronic pain patients was found to be staying asleep. "Our findings showed that MC patients were less likely to report problems with staying asleep compared with non-MC patients," reported the scientists.

"No differences between medical and non-MC patients were found for the other sleep measures (ie, falling asleep and waking up early)," noted the researchers. They reported that this data suggests that MC "may have a sleep-promoting characteristic in terms of minimising awakenings during the night, but not in terms of other types of sleep problems."


Medical cannabis "may have a sleep-promoting characteristic in terms of minimising awakenings during the night, but not in terms of other types of sleep problems."

Some prior research indicated that cannabis dose "modulates the effect of cannabis on sleep," although the present study "did not show a relationship between MC dose or potency and sleep."


Conclusions

The study concluded that its sample "of older (50+ years) chronic pain patients" revealed that "medical cannabis may be related to fewer awakenings at night" when used by pain patients. However, the researchers also noted that pain patients "may also develop tolerance to the sleep-aid characteristics of MC."

The study's authors noted that their results "may have large public health impacts considering the ageing of the population, the relatively high prevalence of sleep problems in this population, [and the] increasing use of medical cannabis."


Like most research of its nature, the study noted that "future studies are needed to confirm whether cannabis may have specific effects on particular sleep problems and, if so, [identify] the mechanisms of action."


These results "may have large public health impacts considering the ageing of the population, the relatively high prevalence of sleep problems in this population, [and the] increasing use of MC."

"Much more research using animal and human models and with longitudinal and randomized control designs is needed to better understand the potential acute and long-term effects of different strains/doses and modes of administration of MC on different sleep parameters," summarized the scientists.


View the original study.


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