From Chronic to Manageable – Is Cannabis an Effective Pain Treatment?

"Chronic pain has been a relentless adversary throughout my career, but it has also been a profound teacher. It taught me resilience, patience and the true meaning of perseverance. Every day is a new fight, a challenge I meet with gratitude because it means I'm still pushing forward, still striving." - Serena Williams

If you have chronic pain, you can likely relate to this quote. On the other hand, being grateful for chronic pain is a big ask. Yet, many find cannabis for pain helps them let go of frustration and anger. This alternative treatment offers, for some, profound relief, by altering their mindset about  the nature of pain. 

Emotional and Psychological Aspects of Pain

Pain isn't just physical; it's also emotional and psychological. Emotions like frustration, anger and fear can lead to psychological symptoms like depression and anxiety. All of which heightens pain sensations. But know this: an emotional response to pain works in the other direction as well, meaning a more balanced perception of pain can significantly alter it's impact for the better. Consider your desired outcome and imagine reframing your perception of pain. Cannabis brings this nuanced approach to pain management.

Physical Pain

Acute pain is an inconvenient truth that signals our bodies when something is wrong. It acts like a valuable early warning system guiding us to protect the body from further damage. Although further damage is unavoidable. This is the type of pain that settles in for the long haul. In other words, your acute pain has now become chronic. Chronic pain is medically diagnosed if pain is expected to last three months or more beyond its onset and you have tried and failed one or more therapeutic options. According to the CDC, around 50 million Americans suffer from chronic pain which they define as pain on most days or every day in the past six months. 

Current Landscape of Pain Management

If you have chronic pain, you are well aware of the mainstream approach to pain management. It’s a tiered strategy, starting with over-the-counter (OTC) pain relievers and anti-inflammatories, progressing to prescription painkillers and culminating in invasive treatments. The current landscape of pain management needs alternative treatments. This is evident by the opioid crisis, a high rate of failed back surgery syndrome (FBSS), and the fact that common OTC medications come with some serious risks. 

Does Your Pain Management Strategy Need a Tuneup? 

Chronic pain is the most commonly cited reason for using medical cannabis. Why? Because it's delivering results. A recent review entitled, Cannabinoids and Pain: New Insights From Old Molecules, looked at  over 10,000 scientific abstracts and found, “conclusive or substantial evidence supporting the effectiveness of cannabis or cannabinoids in managing chronic pain.”

This comprehensive study found cannabis works for painful spasticity in adults as well. Spasticity is another term for stiff muscles. It involves uncomfortable muscle spasms that culminate with extremely tight muscles that stay contracted, sometimes in awkward positions.  In my pre-cannabis nursing career, I worked in a nursing unit specializing in these conditions. I now realize conventional options offered minimal relief to these patients.

Bottom line: there's never been a more crucial time to explore alternative and adjunct treatments. 

The Promise of Cannabis: Animal Studies

One way researchers study pain relief is by jolting things, mostly animals, with electricity or heat, and then giving them a substance. In chronic pain studies, the animals are exposed to persistent painful stimuli, simulating ongoing pain conditions in humans. When cannabis is administered to these animals after the painful stimuli, findings indicate cannabinoids lessen the intensity of pain signals, effectively decreasing overall pain perception. Observing animals' reduced responsiveness to persistent pain with cannabis gives us the means to explore its potential as a viable treatment for chronic pain in human trials, especially when the effectiveness of cannabinoids in chronic pain studies rivals that of opiates.

Other Methodologies to Study Pain

I like the research on cannabis that doesn’t include animal studies, such as spontaneous pain scores, overall quality of life (QOL) scores and degree of pain intensity using numerical scales. My favorite being the QOL measurements. Cannabis patients often score well when surveyed with a QOL questionnaire by indicating significant improvements in pain intensity/severity, sleep quality, level of depression, level of anxiety, ultimately providing these patients with a vastly improved overall better quality of life. May this consistent improvement in overall QOL serve as a beacon of hope for those seeking relief and treatments that genuinely make chronic pain manageable. To understand how cannabis works in the body, though, you need to know about the Endocannabinoid System. 

Exploring the Endocannabinoid System (ECS)

Every human, in fact every creature with a backbone has an Endocannabinoid System. Let’s call it the ECS for short. This 500 million year old body system has been preserved over time because it’s important. Vital even, for human (and pet) health and wellness. 

The ECS is a signaling network composed of receptors and endocannabinoid molecules. Endocannabinoids are “inner-cannabis” signaling molecules that respond to pain. They function in everybody, even those who have never gotten so much as a whiff of cannabis. In a delightful twist of evolutionary fate, the ECS very much responds to the many cannabinoids extracted from the cannabis plant. This dual nature of the ECS highlights the unique position cannabis has to influence human health. 

Lifting the Veil on Cannabis Research and Findings

Pain Thresholds 

THC, or tetrahydrocannabinol, is a compound found in cannabis known for its psychoactive properties, but it also plays a significant role in modulating pain thresholds. A pain threshold is the minimum level a person begins to sense a stimulus as painful. Catching them early is key to pain management. People who regularly ingest cannabis to relieve pain are modulating their pain thresholds. 

Reducing Intensity 

Exploring an analogy to illustrate how cannabis diminishes pain intensity, imagine cannabis as a calming teacher in a classroom of excited children. This is how cannabinoids act on pain signals in the body. Just as a teacher makes sure messages are delivered in a controlled way, cannabis interacts with the body's endocannabinoid system to reduce the intensity of pain signals reaching the brain. When cannabis moderates pain signals, it doesn't completely stop those pain signals from being transmitted but makes the 'conversation' less overwhelming. By lowering the perceived intensity of pain signals, cannabinoids help make pain more tolerable.

Cannabis as a "Pain Traffic Controller"

Cannabis acts as a "pain traffic controller," reducing the flow of pain signals from the body to the brain. This modulation of pain signal transmission by cannabinoids enhances the overall impact, lessening the severity of the signals. By regulating this flow, cannabis helps manage pain perception, making it more tolerable for the individual.

Dampening Pain Pathways 

Pairing inhaled cannabis with a topical application can boost pain relief effectively at the same time. You've already learned how cannabis consumption works systemically for pain in the preceding paragraphs, but adding a topical offers localized relief by forming a barrier around the pain site, which prevents pain signals from traveling to the brain temporarily. This localized action offers a metaphorical "quiet zone" for areas affected by pain, showcasing yet another facet of cannabis pain management.

Cannabis and Self-Efficacy

Cannabis helps with self-efficacy. Self-efficacy means you trust and believe that you can handle life’s challenges, even learn and grow from them. Chronic pain erodes this trust. Yet, people who use cannabis for chronic pain, when effective, say they are more adept at handling life's curve balls and letdowns. Making pain less emotionally burdensome can supply additional pain relief on top of the relief cannabis supplies. All of which increases self-efficacy. I call this an “upward spiral.”

Cannabis: The Inflammation Manager

Cannabinoids address pain by addressing inflammation. When a part of the body becomes inflamed, it’s often accompanied by swelling, redness and heat. Cells get inflamed too, you just can’t see it. 

Cannabis is a big reliever of inflammation. Here’s the best way to sum up why cannabis is such a good anti-inflammatory. It comes from Dr. Adrianne R Wilson-Poe, a Portland neuroscientist who has been studying cannabis, opioids, and their interaction for her entire career. She equates whole flower cannabis to “potentially a couple dozen anti-inflammatory molecules.” The emphasis on “a couple of dozen” is mine!

Controlling systemic inflammation with cannabis has the potential to change your life, but dosing is a long process. Be patient. Heed the advice that rings throughout the cannabis industry, whether medical or adult-use, which is to start low and go slow. If at first you aren’t getting results with low and slow, then take your time and begin titrating your dose up.

More on Inflammation 

When cells or organs are injured or inflamed, they will not stop sending pain signals to the brain until something is done to stop the process. These constant signals are often at the heart of chronic pain, and in many cases, it’s accompanied by insomnia, depression, anxiety and inactivity. All of which make pain worse, yet may potentially be alleviated by cannabis. 

As you can probably tell, I’m a big proponent of cannabis for its ability to balance inflammation. 

A Nurse’s Words of Caution and Confidence

Compelling evidence supports cannabis has a place in chronic pain management and the lack of mainstream medical endorsement is unfortunate.  But, if you are under the care of a healthcare provider, communicate your informed decision to use cannabis for chronic pain knowing that the effects of cannabis for pain are highly individualized.  If you encounter too much pushback from your provider, seek out a professional with a more holistic approach.

The Quest for a Less Painful Reality

Now that you understand how cannabis compounds can potentially alleviate symptoms and the associated psychological effects of chronic pain, approach your exploration with caution but remain open to discovering how it can improve your quality of life. Know that you are not alone; pain relief is among the most common reasons for medical cannabis use, covering conditions like chronic pain, inflammation, migraines, neuropathic pain, muscle soreness, spinal injuries, fibromyalgia, and endometrial pain. Find a trusted canna-guide to help you tailor your pain management approach.

Contributed to Weedgets LLC by Maureen “Mo” Smyth, BSN RN — Health Revolutionary, cannabis content writer, Founder of Cannabis Public School at Smyth Med.

As a registered nurse, it's important that I clarify smoking cannabis is not a replacement for medicine or medicinal options. Always consult your chosen healer or physician before use. Excessive inhalation can lead to lung issues. Weigh your options. Use with caution. Be intentional. 

Sources

Hammell, D. C., Zhang, L. P., Ma, F., Abshire, S. M., McIlwrath, S. L., Stinchcomb, A. L., & Westlund, K. N. (2016). Transdermal cannabidiol reduces inflammation and pain‐related behaviours in a rat model of arthritis - Hammell - 2016 - European Journal of Pain - Wiley Online Library (London, England), 20(6), 936–948. 

Frontiers in Pharmacology. (2018, November 12). Neuropharmacology (Vol. 9).  Cannabinoids and Pain: New Insights From Old Molecules. Sonja Vučković, Dragana Srebro, Katarina Savić Vujović, Čedomir Vučetić, Milica Prostran

Orhurhu, V. J., Chu, R., & Gill, J. (2023). Failed Back Surgery Syndrome. In StatPearls. StatPearls Publishing.

Russo, E. B., & Marcu, J. (2017). Cannabis Pharmacology: The Usual Suspects and a Few Promising Leads. Advances in pharmacology (San Diego, Calif.), 80, 67–134. 

Sulak, D. (2021). Handbook of Cannabis for Clinicians: Principles and Practice. W.W. Norton & Company