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How Does Cannabis Reduce Pain?
Before the 1800s, pain was considered to be an existential experience and was viewed as a result of aging. Since the revolution of modern medicine in the 1900s, researchers began to understand the pathways of pain and began attempting to manage and treat it.
Current estimates state that at any given time, approximately 100 million Americans are living with chronic pain. Chronic pain is defined as pain that lasts longer than the "normal" healing time of an injury, typically longer than three months.
About 50% of all trips to the doctor every year are due to a feeling of pain. Most of the time, pain is treated by using non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids.
However, many people are turning to cannabis to treat and manage their pain, but how does it work, and is it effective?
#1 The Endocannabinoid System and Pain
"The endocannabinoid system (ECS) is now known to be one of the key endogenous systems regulating pain sensation, with modulatory actions at all stages of pain processing pathways."
Current research has found that the endocannabinoid system (ECS) is one of the primary systems our body has for regulating sensations of pain. In the ECS, there are two main types of receptors, which are called CB1 and CB2 receptors.
Of course, this system isn't dependent on consumed cannabis, but actually by endocannabinoids produced naturally in the body. The two primary endocannabinoids produced naturally are Anandamide (AEA) and 2-Arachidonoylglycerol (2-AG).
AEA preferentially binds to and modulates CB1 receptors, and 2-AG binds to both CB1 and CB2 receptors. This means that pain is reduced once these endocannabinoids are synthesized and attach to their respective receptors.
This research has implications for using cannabis as a treatment for pain because cannabinoids such as THC (CBD does not bind, but indirectly stimulates receptors) can bind to the same receptors, theoretically causing the same effects as our naturally produced endocannabinoids.
#2 Cannabis and Pain
Research has found that THC can activate CB1 receptors, which can be found at the central and peripheral levels of the pain pathway. CB2 receptors are indirectly stimulated by cannabidiol (CBD), and these receptors play a critical role in pain management. Because of this fact, cannabinoids can aid in reducing many different types of pain.
Since cannabis can reduce pain on a molecular level, many different types of clinical trials have been performed. Several trials of cannabis administered to hundreds of patients with either chronic pain, neuropathic pain, or multiple sclerosis were performed.
These trials had overwhelmingly positive results, with many patients feeling relief from the daily pain they were experiencing.
Furthermore, a meta-analysis was performed that examined cannabis for medical use among 28 different trials, including chronic pain, with over 2,000 patients studied. The conclusion of the analysis revealed that when compared with a placebo, there was an overwhelming report of pain reduction across all studies with cannabis.
#3 Terpenes and Lesser-Known Cannabinoids
It's not only cannabinoids that can reduce pain, but researchers suspect that terpenes may play a crucial role as well. When cannabis is consumed, there's more than just THC and CBD as active ingredients. Other cannabinoids and the many different types of terpenes all have effects as well!
Researchers have discovered what is known as the entourage effect, which shows that terpenes and other cannabinoids can work together in synergy to influence the therapeutic effects of cannabis.
Several terpenes have been proven to have pain-reducing effects on their own, such as d-linalool, myrcene, and β-caryophyllene. D-linalool has also been found to have sedative effects on the central nervous system.
Myrcene has been confirmed to be a pain-relieving agent in mice, and new studies suggest that it can also have the same outcome in humans. Β-caryophyllene is unique in that it can actually bind to CB2 receptors. Β-caryophyllene is also one of the most common terpenes found in cannabis.
Lesser-known cannabinoids like CBC, CBG, and THCV all have displayed pain-relieving effects as well. Still, there is much we don't know regarding these cannabinoids. Many of them can also bind to CB1 or CB2 receptors and have anti-inflammatory and soothing properties.
#4 A Safer Alternative Than Pharmaceuticals
Many people have been turning to cannabis for pain treatment due to the current questionable state of prescribed and over-the-counter pain medicines.
First, in line for pain management are non-steroidal anti-inflammatory drugs known as NSAIDs (drugs like ibuprofen). Typically used for mild or moderate pain, these drugs can be dangerous long term since they can increase the risk of heart failure and gastrointestinal problems.
Acetaminophen is another commonly prescribed or purchased over-the-counter pharmaceutical meant for mild to moderate pain. One unfortunate side effect of higher doses/constant use of this drug is liver injury.
For severe pain, opioids are prescribed, which is controversial for a multitude of reasons. While these drugs provide relief for those in severe pain, they have the grave potential for addiction and abuse. They also have side effects that include respiratory depression, cognitive impairment, sedation, and tolerance that can be built quickly - requiring more opioids for the same results. On top of all that, research indicates that opioids may not be very efficient, with only 30% of patients responding to treatment and up to 80% having adverse side effects.
The Cover of Relief is Green
"A better future via cannabis phytochemistry may be an achievable goal through further research of the entourage effect in this versatile plant that may help it fulfill its promise as a pharmacological treasure trove."
Despite the issue of the legalization of cannabis, it's being demonstrated time and time again as a powerful pain relief drug. With so many Americans (and people across the globe) experiencing pain, the general public deserves respite and recovery with a medicine that isn't going to potentially cause more problems.
Of course, that's not to say that cannabis is without its own side effects. Still, in the face of opioids and other available pain relief drugs, cannabis seems to be a safer alternative. As research continues in the fields of terpenes and cannabinoids, we may see the therapeutic benefit of cannabis become even more significant than it already is.