Cannabis for chronic pain: Myth or Reality?

The use of cannabis for chronic pain management is a highly debated topic. Advocates argue that cannabis offers effective pain relief with fewer side effects compared to traditional medications, while critics point to the lack of extensive, high-quality research and the potential for addiction and misuse.

While cannabis may offer an alternative to traditional pain medications, its use is not without risks. Addiction remains a significant issue, requiring an approach that considers both the benefits and the potential harms of cannabis use.

What is chronic pain?

Chronic pain is pain that persists for longer than three months, beyond the usual recovery period or alongside a chronic health condition such as arthritis. Unlike acute pain, which is a direct response to an injury or illness and subsides as the body heals, chronic pain continues even after the initial cause has been resolved.

It can be continuous or intermittent and may impact various aspects of life, including the ability to work, engage in physical activities, and maintain a social life. Common causes of chronic pain include conditions such as:

• Arthritis
• Migraines
• Endometriosis
• Fibromyalgia
• Nerve damage

Sometimes, chronic pain occurs without a clear underlying cause, making diagnosis and treatment difficult. Effective management often requires medications, lifestyle changes, physical therapy, and psychological support.

What is Cannabis?

Cannabis, commonly known as marijuana, is a plant that has been used for medicinal, recreational, and industrial purposes for centuries. The primary active components of cannabis are tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC is the psychoactive component responsible for the “high” associated with marijuana use. It interacts with the brain’s cannabinoid receptors, affecting mood, perception, and cognition. Medicinally, THC is used for pain relief, appetite stimulation, and reducing nausea, particularly in conditions like cancer and AIDS.

CBD, on the other hand, is non-psychoactive and does not produce a high. Its potential therapeutic effects have gained popularity, including anti-inflammatory, analgesic, anti-anxiety, and seizure-suppressant properties. CBD is often used to manage conditions such as chronic pain, anxiety, epilepsy, and some neurodegenerative disorders.

THC and CBD interact with the body’s endocannabinoid system, which plays a crucial role in regulating a range of physiological processes, including pain, mood, appetite, and immune response.

Positive findings

Some studies have shown the potential benefits of cannabis in managing chronic pain. Cannabis and its properties, THC (tetrahydrocannabinol) and CBD (cannabidiol) have been shown to provide pain relief for various chronic conditions:

1. Neuropathic pain: Cannabis has shown efficacy in treating neuropathic pain, a type of pain caused by nerve damage. A study involving an oromucosal spray containing equal amounts of THC and CBD indicated a moderate pain-relieving effect in patients with neuropathic pain. This formulation also helped improve overall quality of life and reduced the need for opioid medications.
2. Multiple sclerosis: In patients with multiple sclerosis, cannabis-based treatments have been found to alleviate muscle spasms and pain. Clinical trials using cannabis extracts, including Sativex (a THC and CBD oromucosal spray), have reported significant reductions in spasticity and pain associated with MS.
3. Chronic non-cancer pain: A large prospective observational study evaluated the effects of plant-based medical cannabis on chronic non-cancer pain over a year. The study found that medical cannabis significantly reduced pain severity and improved quality of life, with patients reporting fewer side effects and a reduction in the use of opioid medications.

Negative findings

Some studies indicate minimal to no effect of cannabis on chronic pain, highlighting the variability in individual responses and the potential for placebo effects.

1. Inconsistent evidence: Reviews have found inconsistent or limited-quality evidence supporting the efficacy of cannabis for chronic pain. For instance, while some formulations (like high THC oral treatments) showed small pain-relieving effects, others had insufficient evidence to support their use. The variability in response can be attributed to differences in study designs, patient populations, and types of cannabis products used.
2. Placebo effect: Some studies suggest that the pain relief experienced by patients using cannabis may be partly due to the placebo effect. The psychological expectation of pain relief can contribute significantly to perceived benefits, complicating the assessment of cannabis’s true efficacy.
3. Adverse effects: High THC formulations were associated with a higher likelihood of adverse effects, such as dizziness and cognitive impairment, which led to increased patient withdrawal from studies. This raises concerns about the safety and tolerability of cannabis-based treatments, especially for long-term use.
4. Cannabis addiction: Excessive consumption of cannabis can lead to cannabis use disorder, which is a form of addiction. This disorder is characterised by a compulsion to use cannabis despite experiencing negative consequences, developing a tolerance that requires more of the substance to achieve the same effect, and suffering from withdrawal symptoms when not using

While cannabis shows potential in managing certain types of chronic pain, its efficacy varies, and the risk of adverse effects must be carefully considered. More large-scale, longitudinal studies are needed to understand its benefits and limitations better.

Short-term risks of cannabis use

Cannabis use can lead to several short-term side effects that impact both the body and mind. Common short-term effects include:

1. Dizziness: Cannabis can cause a drop in blood pressure, leading to dizziness or fainting, especially when standing up quickly.
2. Cognitive impairment: Users often experience impaired memory, concentration, and problem-solving abilities. This can result in confusion, disorientation, and slower reaction times, which can be particularly dangerous while driving or operating machinery.
3. Anxiety and panic attacks: While some users feel relaxed, others may experience increased anxiety, paranoia, or panic attacks. These effects are more likely at higher doses or with cannabis strains high in THC (the psychoactive component of cannabis).

Long-term risks of cannabis use

Prolonged cannabis use carries several potential long-term health risks, particularly affecting mental health and dependency:

1. Mental health issues: Long-term cannabis use is associated with a higher risk of developing mental health disorders. Studies indicate a connection between chronic cannabis use and conditions such as depression, anxiety, and schizophrenia, particularly in individuals with a predisposition to these conditions. Regular use can exacerbate symptoms of existing mental health issues and lead to conditions like paranoia and hallucinations.
2. Cognitive decline: Persistent use of cannabis, especially when started in adolescence, can lead to lasting impairments in cognitive functions such as memory, attention, and learning. These effects might persist even after stopping use and can impact academic and occupational achievements.
3. Dependency: Cannabis has addictive potential, and regular use can lead to cannabis use disorder. Symptoms of this disorder include cravings, increased tolerance, and withdrawal symptoms when not using the drug.

How we can help

UKAT provides a variety of rehab services tailored to combat cannabis addiction. The treatment program typically includes the following key components:

Dialectical Behavioral Therapy (DBT) (to treat emotional dysregulation, which is often linked to substance use disorders).

Family therapy (encouraged in order to address any relational issues and to support the patient’s recovery journey).

Holistic therapies (can include mindfulness, meditation, yoga, and other wellness activities designed to promote overall well-being and stress management).

Relapse prevention (provided post-treatment in order to help patients maintain their recovery and prevent relapse. This includes ongoing counselling, support groups, and access to recovery resources)/

UKAT’s approach ensures that each patient receives personalised care which addresses both the psychological and physical aspects of cannabis addiction.