- One of the known side effects of medical cannabis is pain relief
- Does therapeutic marijuana work against all types of pain or just against some? We will look at this in today's article
Therapeutic cannabis is well known for its analgesic (painkiller) effects. However, there are many types of pain and their origin is diverse. Choosing the right variety, dose and route of treatment for cannabis can thus be quite tricky for many patients. We now know that different cannabinoids ( THC & CBD ) act differently on different types of pain. Knowledge of what types of pain cannabinoids affect and which do not is essential for patients to choose the right variety.
Types of pain and their treatment
All types of pain fall into three general categories:
- Nociceptive pain
- Neuropathic pain
- Central pain (researchers have not yet agreed on a universal name for this pain; for example, pain occurring in fibromyalgia)
For the treatment of pain, it is necessary to choose the optimal treatment strategy, as each type of pain has its own cause and origin.
Pain sensation is caused by the coordinated triggering of certain brain cells. These cells are able to send a pain signal and at the same time adjust its intensity, as needed. In some shock situations where there is a physical injury (nociceptive pain), the pain may not be felt at first due to the late reaction of the cells. Just remember the picture of someone walking on the road in confusion moments after a car accident, as if it hadn't frosted.
However, the situation can also be quite the opposite - central pain means pain occurring seemingly without cause, without observable physical injury or condition. Factors such as mental state, mood and general context also have a great influence on the perception of pain in patients. Knowledge of all these factors can then be used to summarize the ideal treatment plan (here with medical cannabis), which will of course vary to some extent from case to case.
Therapeutic cannabis against physical (nociceptive) pain
So let's look at the first type of pain - nociceptive. Nociceptive pain generally results from tissue damage. Affected people most often describe this type of pain as stabbing, sharp, and throbbing pain that occurs immediately after an injury. In an effort to repair the damaged site, the injured body tissue immediately begins to produce the required amount of immune and inflammatory cells. Through the transmission of proteins and other chemicals, the spinal nerves are activated and the brain cells responsible for creating the feeling of pain are activated.
"The patient should carefully consider the variety and dosage he wants to treat for pain. By optimizing these two factors, the effect will be made more effective and the development of an unnecessarily high tolerance will be prevented. "
Nociceptive pain can be alleviated by preventing it from occurring directly at the site of injury (numbing) or by blocking the inflammatory response. Another strategy may be to gradually alleviate pain signals directly during their spinal cord journey. Therapeutic cannabis is able to help in both cases.
THC and CBD, by far the most abundant cannabinoids, are effective at the site of injury and in the pain site. In addition, both have a strong anti-inflammatory effect. The mechanism of action is mainly the ability of THC to suppress the anti-inflammatory response directly in immune cells by activating the endocannabinoid receptor CB2. CBD also helps by "switching" cells called macrophages, which instead of pro-inflammatory chemicals begin to carry anti-inflammatory substances. In addition, both of these functions have been confirmed several times during official research on both human and animal subjects.
Furthermore, activation of CB1 receptors by THC also suppresses the intensity of spinal cord travel signals to the brain and increases the emphasis on opiate receptor activation. In addition, CBD increases the number of leached endogenous (self-created) cannabinoids of anandamide, which essentially function as the body's own THC.
CBD also targets receptors outside the endocannabinoid system in the body. In the case of pain, these are mainly GABA inhibitors. By supporting GABA inhibitors with CBD, a better inhibitory effect is created - blunting of signals during their path to the brain.
An important factor is also the ability of cannabis to support the overall feeling of well-being. When a person is well, he perceives pain less. By focusing on things that make us happy, the intensity of pain signals is naturally alleviated. In this case, it is also a demonstration of the mechanism of "mind over body", when the transfer of focus to more pleasant matters will lead to a direct change in the physical body.
Tolerance to cannabis reduces effects
The effect of satisfaction, activation of endocannabinoid receptors and thus pain relief begins to decline when the patient begins to develop an unnecessarily high level of tolerance for their dose. In some cases, when the patient's body gets used to too high a dose of THC, tolerance can be balanced by increasing the amount of CBD used.
"So you can switch to a variety with a high CBD content or addCBD oil or extract directly to the treatment."
In addition, a side effect of CBD is an overall improvement in mood and well-being, which occurs through the activation of serotonin receptors. As deteriorating mood and often depression often occur in patients suffering from chronic pain, psychological encouragement is a welcome effect here.
Therapeutic cannabis and neuropathic pain
Neuropathic pain differs from the above-mentioned nociceptive pain in that it is not pain caused by tissue injury, but directly by the nervous system. Neuropathic pain may sound rare, but it is very common. This type of pain affects about 7-10% of the population and is caused by either an injury, a pinch, or a puncture, during which nerve damage occurs. Neuropathic pain may also develop during certain diseases and conditions.
For example, during multiple sclerosis, the insulating layer of nervous tissue breaks down, further leading to the development of neuropathic pain. Other diseases causing neuropathic pain are, for example, HIV, diabetes or Parkinson's disease. Chemotherapy is also one of the common causes of this pain.
Neuropathic pain is much more complicated than nociceptive treatment. Because neuropathic pain is not rooted in the body's inflammatory response, it is not possible to focus on the source of pain with conventional drugs such as ibuprofen. However, many patients, due to a variety of causes, whether injuries or amputations, turn to medical cannabis in an effort to treat neuropathic pain.
"As with nociceptive pain, at too high a dose of THC, CB1 receptors become dull (increased tolerance) and consequently the required effects are reduced. By balancing the doses and ratios of THC: CBD, it is possible to make the effectiveness of the treatment more effective and to use it in the long term. "
Even in this case, medical cannabis is a potentially high-quality aid and medicine. The utility and effectiveness of cannabis therapy in this case was confirmed during studies in animal and human subjects.
Types of Marijuana with a high content of CBD for pain
CBD is also useful, for example, as a defensive preventive measure against the development of neuropathic pain during chemotherapy. CBD can be used in this way as a prophylactic therapy (preventing damage) mainly due to the fact that its application does not reduce the effectiveness of chemotherapy itself.
Apart from chemotherapy, a classic example of neuropathic pain is squeezing of the sciatic nerve, where there is pain in the lower back, hind thigh and tingling in the legs. During sciatica, there is also an increase in the number of CB2 receptors, as made for activation and a consequent reduction in pain - yes, for example byCBD .
Research into the potential benefits of activating these receptors confirms that in this way a numbing of the signals in the nervous system can be achieved and thus the desired reduction in the pain perceived by the patient.
Therapeutic marijuana and treatment of central pain
Central pain is a name that has recently taken hold as a general description of all pain that originates in dysfunction of the nervous system. In some cases, central pain may develop after a physical injury, but in most cases it is pain that appears to have no cause. In this case, fibromyalgia is a classic example of a disease that causes the erroneous exchange of signals in the nervous system. By disrupting the proper exchange of nerve impulses, patients experience seemingly causeless feelings of pain.
The mystery of central pain and the difficulty in determining its cause are, of course, slowed down by research into the use of cannabis as a treatment. The only measure here is a study of 26 patients suffering from fibrobialgia, where all participants agreed that the application of therapeutic cannabis against symptoms helps.
"A surprisingly positive result from a study of 26 patients with fibromyalgia was the fact that half of them completely discontinued the original pills thanks to the use of medical cannabis."
Thus, we can assume that medical cannabis is a potential aid for all patients suffering from both fibromyalgia and other types of central pain.
Therapeutic cannabis or opiates?
To get a good idea of how many people are seeking treatment for various pains, it is good to take into account that there are more of them than all diabetics, people with heart disease and cancer patients combined. One of the most frequently offered therapies is the common prescription of analgesics and opiate drugs such as Vicodin or Tramal.
"If we use very low doses of cannabis or painkillers, we will not achieve the desired effect. However, the moment we combine both substances, the effect is many times higher. "
Excessive prescribing of opiates to anyone who "stings a little" has spiraled out of control, especially in the United States. Unsurprisingly, the situation in the states is called the "opiate epidemic" and the state costs about $ 504 billion a year. The main damage, of course, is the loss of life (up to 30,000 victims a year in the United States alone) and the suffering of the families of the deceased. It is clear from the situation that it is necessary to take proper action against the unfortunate situation. However, the US federal government and other governments in today's world often ignore a very promising solution: medical cannabis.
We have already explained that medical cannabis is able to help with various types of pain. It is now good to realize that in certain cases it can also be used in combination with opiates and analgesics, if necessary. The advantage here lies in the ability to significantly reduce the doses of opiates used and thus the risks associated with them.
Painkillers activate CB1 receptors
Opium, as a substance used to relieve pain, dates back thousands of years, to the region of Southwest Asia in the period about 3,500 BC. Cannabis followed half a millennium. It is not known whether the two drugs were ever used together between today and history. However, those who sometimes thought of it were certainly pleasantly surprised.
Today's scientific findings shed light on the mechanism of the joint action of cannabis and opiates. In combination, there is some synergy and an increase in the effects of the treatment. This effect is most noticeable in small doses - if you take only a minimal amount of THC or analgesics solo, pain will not be suppressed. However, the combination of the minimum doses of both substances has a multiple, positive effect.
Marijuana and combinations with pills
For example, in a recent double-blind, placebo-controlled study (the gold standard for clinical research), researchers examined the effects of a small dose of cannabis (using a 5.6% low THC variety) in combination with a small amount of the commonly used painkiller, oxycodone (2.5.mg). . In isolation, these doses of painkillers did not work, as the researchers expected. However, in combination, patients were able to withstand higher levels of simulated pain in the tests.
The question, of course, is: is it possible that THC cannabinoid-activated CB1 receptors are able to interact with opiate receptors? Today's evidence suggests that it is.
Take, for example, mice that have been bred so that they do not have CB1 receptors in the body (yes, everyone can grow mice to their own taste!). If we start giving these mice cocaine, amphetamines or nicotine, they will have fun for them and more and more passionately. However, giving opiates does not cheer them up, because they are simply not able to perceive heroin. This also tells us that drugs such as heroin are able to create a feeling of euphoria, among other things, by activating the receptors of the endocannabinoid system.
"Morphine is normally a very effective painkiller. However, if we give it to mice without CB1 receptors, it becomes a completely unusable drug. "
Thus, CB1 receptors are responsible firstly for the ability of opiates to act in a pleasant manner and secondly for reducing pain. Pain is a subjective feeling and its level is determined by several important factors:
- Incoming signals from the place of disability (eg inflamed knee)
- Cognitive factors (focusing on or ignoring pain)
- Contextual factors (do you expect something to hurt?)
- Mood factor (adding depression, anxiety)
- Chemical factors (various functions of opiate and endocannabinoid receptors)
Opioid drugs target two of these factors in particular: they reduce incoming signals from the site of disability and at the same time lift the patient's subjective mood by flushing out dopamine.
However, long-term administration of opiates leads to direct changes in the brain and a reduction in the number of CB1 receptors. Thus, the desired effect of the drugs is also reduced, followed by an increase in doses. This is a classic phenomenon of increased tolerance. At this point, there is the greatest risk of treatment: the possibility of overdose.
Cannabis and Opiates: Receptor Cooperation
Nerve excitations transmitting the feeling of pain arise at the site of injury and immediately travel to the nerve highway (spinal cord) and then to the brain. Once the signals leave the spinal cord, critical pain processors are activated, including the thalamus, cortex, and end-brain. Therefore, if you are to suggest a cure for pain, you will mainly want to limit the departure of signals from the pain site and prevent them from traveling through the spinal cord.
"Interestingly, CB1 receptors and opiate receptors stick together in the regions of the brain that are responsible for processing pain."
During the research, the researchers observed a special interaction of these receptor groups as well as a generally similar way of signaling. The theory here is that they are capable of interacting. When the right, small dose of opiates is given together with plant cannabinoids , both receptors are activated in synchronization and have multiple effects against pain.
Among other things, THC is able to activate CB2 receptors, but their interaction with opiate receptors is much less studied. By far the most important evidence for the positive effect of CB2 receptor activation is, as we mentioned in the first part of the article, acting directly at the site of injury by reducing both pain and the inflammatory response.
Promising cannabis research on the rise
Studies addressing the potential therapeutic effects of cannabis are increasing as mushrooms after rain, and no wonder. Although some research reports only weak effects of cannabis against pain, in most such cases it is the use of the wrong type of variety. As mentioned above, the use of a high-THC and low CBD type of marijuana results in both a faster onset of tolerance and an increased chance of adverse side effects.
Some cannabis products with a high THC content are able to work well against pain at first, but they are not an absolutely optimal strategy for the long-term treatment of pain.
"Instead, experienced patients prefer cannabis extracts from CBD or try to find varieties with a balanced content of both cannabinoids ."
Author: Josh Kaplan