Treating Chronic Pain with Cannabis

Pain is the number one reason people seek medical treatment and patients seeking pain relief are the most prevalent group employing cannabis medicines. Chronic pain seriously interferes with the quality of life for many patients and ushers in depression or substance misuse problems. A typical observation by patients is that their use of cannabis doesn't necessarily take away the pain, but that they are no longer preoccupied with the pain; they are able to ignore it.  In cases of inflammatory pain, cannabis decreases the inflammation that causes the pain.  Many chronic pain patients have been prescribed strong opioids such as oxycontin, morphine, or hydrocodone to manage their pain.  However, with the use of cannabis, most patients significantly decrease or eliminate their use of these opioids.

One doctor's perseverence over a decade to investigate the potential of smoked cannabis for pain relief:

Donald Abrams, MD, UCSF School of Integrative Medicine,
Dr. Abram's study was published in February of 2007, as "Cannabis in Painful HIV-associated Sensory Neuropathy", in the Journal of the American Academy of Neurology:
http://www.neurology.org/cgi/content/...
Conclusion: Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain.

Video - Cannabis in Pain and Palliative Care -  Dr. Abrams presents methodology to the Fourth Clinical Conference on Cannabis Therapeutics, Santa Barbara, CA - April, 2006.  Dr. Abrams stresses the importance of botanicals and examines the endocannabinoid system's role in pain modulation, observes that conventional opiate treatments fail to treat neuropathy effectively, then presents the conclusions of the "Cannabis in Painful HIV-associated Sensory Neuropathy" (2007) study.

Suggested Reading:

Abrams, D. I., Jay, C. A., Shade, S. B., Vizoso, H., Reda, H., Press, S., et al. (2007). Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology, 68(7), 515-521.

Ellis, R. J., Toperoff, W., Vaida, F., van den Brande, G., Gonzales, J., Gouaux, B., et al. (2008). Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology, 34(3), 672-680.

Karsak, M., Gaffal, E., Date, R., Wang-Eckhardt, L., Rehnelt, J., Petrosino, S., et al. (2007). Attenuation of allergic contact dermatitis through the endocannabinoid system. Science, 316(5830), 1494-1497.

Lynch, M. E., & Clark, A. J. (2003). Cannabis reduces opioid dose in the treatment of chronic non-cancer pain. J Pain Symptom Manage, 25(6), 496-498.

Lynch, M. E., Young, J., & Clark, A. J. (2006). A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations. J Pain Symptom Manage, 32(5), 497-501.

Neff, G. W., O'Brien, C. B., Reddy, K. R., Bergasa, N. V., Regev, A., Molina, E., et al. (2002). Preliminary observation with dronabinol in patients with intractable pruritus secondary to cholestatic liver disease. Am J Gastroenterol, 97(8), 2117-2119.

Notcutt, W., Price, M., Miller, R., Newport, S., Phillips, C., Simmonds, S., et al. (2004). Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 "N of 1" studies. Anaesthesia, 59, 440-452.

Notcutt, W. G., Sharief, M., Mutiboko, I., Hawkes, C., Bolt, J., & Sarantis, N. (2006). Cannabis based medicine (Sativex) for chronic pain due to multiple sclerosis or other neurological dysfunction: a randomised controlled trial. European Journal of Pain, (in press).

Nurmikko, T. J., Serpell, M. G., Hoggart, B., Toomey, P. J., & Morlion, B. J. (2005). A multi-center, double-blind, randomized, placebo-controlled trial of oro-mucosal cannabis-based medicine in the treatment of neuropathic pain characterized by allodynia. Neurology, 64(6, Suppl. 1), A374.

Pertwee, R. G. (2001a). Cannabinoid receptors and pain. Prog Neurobiol, 63(5), 569-611.

Rog, D. J., Nurmiko, T., Friede, T., & Young, C. (2005). Randomized controlled trial of cannabis based medicine in central neuropathic pain due to multiple sclerosis. Neurology, 65(6), 812-819.

Russo, E. B. (2004). Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocrinol Lett, 25(1-2), 31-39.

Russo, E. B. (2006). The role of cannabis and cannabinoids in pain management. In B. E. Cole & M. Boswell (Eds.), Weiner’s Pain Management: A Practical Guide for Clinicians.(7th ed., pp. 823-844). Boca Raton, FL: CRC Press.

Wilsey, B., Marcotte, T., Tsodikov, A., Millman, J., Bentley, H., Gouaux, B., et al. (2008). A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain. J Pain, 9(6):506-21.