I have been asked about the impacts of cannibis oil on chronic pain by various patients who are interested in the management of their chronic pain. The rise of cannabis oil use correlates with the increase in questions I am asked about it. This blog aims to independently, aside of politics, look at the latest research testing cannabis oil as a management tool for chronic pain.

Chronic pain is an emerging public health issue, affecting one in every four elderly people (1), and 19% of all adults. 6% of adults attempt to medicate using cannabis, which is why it has become a hot topic (2).

The media has covered apparent improvements in some patients’ pain levels recently, and the Advisory Council on the Misuse of Drugs (ACMD) has suggested the rules may be changed if cannabis oil medications are proven to be safe.

Another possible reason for the increased demand for cannabis oil as a medication for pain relief is the opioid crisis. The over-prescription of opioid medication for pain has become big news recently, mainly because of its undesirable effects on the body after long-term use. There is even an ailment now known as opioid use disorder due to the over-prescription of the drug (3).

But why do we need to listen to the evidence about cannabis oil? It is important to refer to scientific evidence with every medical supplement, just as it is important to scrutinise every pill, surgery technique and skin cream you use to make sure the positive benefits outweigh the bad. It’s all about assessing the risk in order to make a well-informed choice that’s right for you.

Let’s be specific

Let’s start out with some definitions:

• Chronic pain – pain that has persisted past the normal time of healing (4). This is typically 3 months.
• Cannabis oil – oil derived from the hemp plant, which contains psychoactive properties (5). The two main extracts we will mention are:
  • Tetrahydrocannabinol (THC) 
  • Cannabidiol (CBD)

The reason this is such a controversial topic is that cannabis is an illegal drug due to its high levels of THC, which gives the cannabis plant its psychoactive effect. However, some of the ingredients in cannabis (including cannabidiol, which does not contain psychoactive properties) are already active ingredients in pain medication. This medication is called Sativex and this can help with relief from painful muscle spasms in multiple sclerosis sufferers.

The current situation with drugs containing THC is that the quality of the produce has been variable. This lack of consistency has made it difficult to guarantee safe usage. Another issue is that it is difficult to gather reliable medical evidence.

Why is it hard to find the evidence?

The main obstacle seems to be the quality of the required evidence. Many of the published articles have been funded by companies with a vested interest in a positive outcome, or their research techniques have not been to the standard required to be deemed as reliable.

Presently, research is looking into patients experiencing pain due to:

• Cancer
• Glaucoma
• Lack of appetite
• Epilepsy; particularly in children under 16 years of age

What do we know?

If you are considering taking such medication, we do have insights into some ill-advised consumption options. There have been concerns regarding the safety of butane hash oil, which has been shown to lead to higher THC exposure, lung damage and burns (6).

If taken medically, we know that cannabis oil has some positive side-effects unrelated to pain; these include:

• Nausea relief (7)
• Cancer inhibition (8)
• Antioxidant effects (9)
• Improvement of with respect to insomnia (10)

Finally, studies have also shown that cannabis oil (with a THC content lower than 10%) does moderately reduce chronic pain, but studies showing the safety of this when compared to traditional chronic pain medication have not been carried out/published. Interestingly, the inhalation of smoked cannabis oil seems to be more effective in pain reduction than taking it orally, but taking it orally has been shown to improve sleep, quality of life and patient satisfaction (11).

Lifestyle advice

For any further questions, please don’t hesitate to ask:

0161 209 2980

info@movementandwellbeingclinic.co.uk

Ed Madeley M.Ost

References 

1. Affective, behavior and cognitive disorders in the elderly with chronic musculoskelatal pain: the impact on an aging population. Frondini C, Lanfranchi G, Minardi M, Cucinotta DArch Gerontol Geriatr. 2007; 44 Suppl 1():167-71.
2. ABC News, USA Today, Stanford Medical Center Poll. Broad experience with pain sparks search for relief [online] 2005. URL: http://abcnews.go.com/images/Politics/979a1TheFightAgainstPain.pdf. 
3. Opioid use disorder in chronic non-cancer pain in Germany: a cross sectional study. Just JM, Schwerbrock F, Bleckwenn M, Schnakenberg R, Weckbecker KBMJ Open. 2019 Apr 3; 9(4):e026871.
4. Merskey H, Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 2nd ed. Seattle, WA: IASP Press; 1994
5. Russo EB, Jiang HE, Li X, Sutton A, Carboni A, del Bianco F, Mandolino G, Potter DJ, Zhao YX, Bera S, Zhang YB, Lü EG, Ferguson DK, Hueber F, Zhao LC, Liu CJ, Wang YF, Li CS
6. Anderson RP, Zechar K. (2019), Lung injury from inhaling butane hash oil mimics pneumonia. Respir Med Case Rep. 2019 Jan 4;26:171-173. doi: 10.1016/j.rmcr.2019.01.002. eCollection 2019.
7. Pertwee RG. Cannabidiol as a potential medicine. In: Mechoulam R ed. Cannabinoids as therapeutics. Basel, Switzerland: Birkhäuser Verlag; 2005. pp. 47–65
8. Cannabinoids and cancer. Kogan NM, Mini Rev Med Chem. 2005 Oct; 5(10):941-52.
9. Cannabidiol and (-)Delta9-tetrahydrocannabinol are neuroprotective antioxidants. Hampson AJ, Grimaldi M, Axelrod J, Wink D Proc Natl Acad Sci U S A. 1998 Jul 7; 95(14):8268-73.
10. Russo EB, Guy GW, Robson PJ. Cannabis, pain and sleep: lessons from therapeutic clinical trials of Sativex® cannabis based medicine. Chem Biodivers. 2007a;4:1729–43.
11. Cannabinoids and Pain: New Insights From Old Molecules S., Vučković, D., Srebro, K., S. Vujović, Č., Vučetić, M, Prostran (2018) Front Pharmacol. 2018; 9: 1259. Published online . doi: 10.3389/fphar.2018.01259