Chronic Pain and Medical Marijuana

Did you know that one out of three people in the U.S. suffer from chronic pain? One hundred million Americans have intractable, constant pain that affects their quality of life. Per the Institute of Medicine, chronic pain absences and lost work productivity cost approximately 560 to 635 billion dollars a year to the states.

By all accounts, pain is a very complex function. It is the body’s way of saying, “Something is wrong.” The most common reason why people seek out medical help and medical cannabis is to ease chronic pain.

There are two types of chronic pain: nociceptive and neuropathic. Nociceptive pain is caused by tissue damage or inflammation. Neuropathic pain involves the nervous system which has been damaged or is malfunctioning.

There are three pain paths to the brain:

Somatic pain. Signals travel from peripheral nerve systems to the brain. Typically, experienced as a dull, constant ache in the injured area.
Visceral pain. This is gut pain. Abdominal cavity organs or tissues become stretched or disturbed. Pain signals deep within the gut result in feelings of pressure in the abdomen. Visceral pain seems to come from one part of the body though it may originate in another. This phenomenon is known as “referred pain.”
Neuropathic pain. Nerves are injured in some form. It is often experienced as a burning sensation to touch. This pain doesn’t usually respond to opiate painkillers.

Endocannabinoids and Receptors

The endocannabinoid system (ECS) is the body’s naturally occurring cannabinoid receptors located in the brain and central and peripheral nervous system. The ECS is involved in a plethora of physiological processes including pain sensation, and mediation of the psychoactive effects of cannabis and cannabinoids are the body’s naturally occurring pain mediators.

The ECS supplies its own cannabinoids, which is why the receptors exist in the first place.

There are two major endocannabinoid receptors in the body, CB1 and CB2. These two receptors differ not only in their bodily locations but by their physiological actions The CB1 receptors are found mainly in the brain, as well as the central nervous system and peripheral organs and nerves.

The CB1 receptors are primarily located in the “old” brain, which controls emotions and the most basic of physiological functions, as well as the central nervous system and peripheral organs and nerves. The receptors react with THC and help to mediate pain and mood.

CB1 receptors are well represented in the hippocampus, cerebellum and the basal ganglia, which control base emotions and the most basic of physiological functions.

CB2 receptors are found mainly in peripheral nerves, especially throughout the immune system and related organs like the thymus gland, spleen and tonsils. It is also found in the brain but not as densely populated as the CB1 receptors.

CB2 receptors have been known to reduce inflammation and boost immune function. CB2 receptors decrease nociception in a variety of clinical trials. A good sign for medical use.

CB1 and CB2 receptors sometimes share structural similarities but their distribution and activity diverge. Activation of one or both receptors by the addition of cannabinoids simultaneously leads to physiological events such as nerve signal mediation (read: “pain reduction” and “anti-inflammatory”) by the neurotransmitters acetylcholine, glutamate and dopamine.

When someone adds additional cannabinoids through smoking or ingesting marijuana, it is thought to act as supplementation to the body’s own cannabinoids.

THC and CBD

The introduction of plant-based cannabinoids (phytocannabinoids) triggers the pain control and anti-inflammatory qualities of the receptors.

The two best studied phytocannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC was the first compound identified as a major psychoactive component. THC prefers CB1 receptors but there are CB2 receptors which also respond to THC.

CBD has practically no psychoactive activity and has a low affinity for CB1 and CB2 receptors. But activity at CB2 receptors seems to account for anti-inflammatory qualities and pain control.

Studies of cannabis use revealed an “entourage effect.” This is based on the fact that cannabinoids work in concert to create the best pain-relieving profile. Single compound doses (for example, the use of only THC) resulted in less efficacy of medical marijuana administration.

In a Harvard-led review of 28 studies, it was concluded, “Use of marijuana for chronic pain, neuropathic pain and spasticity due to multiple sclerosis is supported by high quality evidence.” This could be surmised to be effective with other diseases with similar symptoms.

The Legal Solution: Opioids or Medical Marijuana?

Since 1999, opioid prescriptions in North America increased by 400 percent. With the increase in use is a concomitant rise in overdoses. Forty people a day die from prescription narcotic overdoses.

Opiates are powerful painkillers for most pain scenarios and these typically include oxycodone; hydrophorphone; morphine and codeine. These drugs work by locking into the body’s natural opioid receptors, which are different from endocannabinoid receptors, blocking nerves from sending pain signals.

Unfortunately, after a short period of use, the body becomes aware of the overstimulation of receptors and the brain starts to remove receptors. This phenomenon is known as “tolerance.” The higher someone’s tolerance of an opioid, the more they must ingest to get the same effect.

There are reports of many patients on opioids, progressing to cheaper, more potent heroin. However, other reports demonstrate that where medical marijuana is legal, opioid use drops. And with it, so does opioid addiction and overdoses.

In fact, the Journal of the American Medical Association found that when states have medical cannabis on the books, there is a nearly 25 percent drop in opioid overdose deaths compared to states without medical cannabis.

Research has also revealed that patients begin to reduce their opioid use when they begin to ingest medical marijuana. A 2011 published in the Journal of Clinical Pharmacology and Therapeutic confirmed that patients who used medical cannabis reported higher pain relief without a concurrent rise in opiate dosing.

Furthermore, reports have found that the use of marijuana is an effective substitute for patients with a high potential to abuse opiates. A 2016 study out of the University of Michigan demonstrated that cannabis improved the quality of life of the patient, decreased side effects of other meds and, reduced opioid use by 64 percent, on average.

Sadly, the physician community in the U.S., continues to claim that there aren’t enough confirmed world-wide studies that measure up to the American standard of research methods. Because of this, the community refuses to formally endorse the use of medical cannabis to alleviate chronic pain and inflammation.

Until marijuana is removed from the federal drug Schedule 1 which purports there is no medicinally redeeming quality in cannabis, America’s physicians and researchers have their hand’s tied. And, chronic pain and inflammation sufferers will continue to self-medicate, laws be damned.

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