The action of cannabis to stop chronic pain is effective, according to science and patients.
Cannabis is more frequently prescribed and requested as an alternative to opioids. Certainly, some patients may be able to completely replace opioids with cannabis, while others can mitigate risk of addiction and unwanted side effects by using cannabis to reduce opioids. It’s interesting to consider that cannabis has gone from a stigmatized fringe product to a respected choice for pain relief. Essentially, this is due to the effectiveness of cannabis to stop chronic pain without causing harm to the patient.
In study after study, chronic pain ranks among the top reasons to try for medical cannabis. From neuropathy to back spasms to Multiple Sclerosis, patients consistently report that cannabis is able to help them manage treatment-resistant chronic pain conditions. Furthermore, a great majority of these report that cannabis is the only thing to stop chronic pain.
Today, cannabis for chronic pain is one of the most well-studied areas in cannabis research. Significantly, there are now thousands of studies on the analgesic properties of this plant, many of which are well-controlled, randomized clinical trials. In fact, back in 2015, a systematic review on cannabis for pain already concluded, “The quality of the trials was excellent.” [1]Lynch, M. E., & Ware, M. A. (2015). Cannabinoids for the Treatment of Chronic Non-Cancer Pain: An Updated Systematic Review of Randomized Controlled Trials. Journal of Neuroimmune Pharmacology, … Continue reading
Still, cannabis is a complicated plant with hundreds of different compounds. Additionally, each of these interact with each other, and with the animal body, in myriad of ways. It’s called the Entourage Effect and we are only just beginning to understand it. While there is much more research needed in order to sort out how to stop chronic pain with cannabis, this is what we know so far.
First – What is Chronic Pain?
The National Institute of Health(NIH) defines chronic pain by comparing it to acute pain. That is to say, while acute pain is a normal and necessary means through which the nervous system alerts a body to injury, “chronic pain is different.”
Significantly, long after the injury or condition has healed, the pain persists. Furthermore, it lasts days, weeks, months, or even years after the root cause has disappeared. Frustratingly, there may be no indication of damage, but the pain still can be unbearable.
Common causes of chronic pain include injuries, arthritis, fibromyalgia, and inflammatory bowel disease, although there are plenty more. It’s important to realize that chronic pain falls into two categories: neuropathic pain and nociceptive pain. Neuropathic is related to nerve damage, while nociceptive pain comes from tissue damage related to an injury. Unfortunately, as the NIH detail, patients can have two or more types of chronic pain existing together.
Beyond the physical effects, however, chronic pain may also trigger the onset of mental health conditions — in large part due to the impact on daily life. In a 2016 literature review in the Journal of Pain Research, several secondary illnesses were of note. In particular, anxiety, depression, sleep disturbances, fear, and reduced coping skills are common psychological effects when we are unable to stop chronic pain. [2]Dueñas, M., Ojeda, B., Salazar, A., Mico, J. A., & Failde, I. (2016). A review of chronic pain impact on patients, their social environment and the health care system. Journal of pain research, … Continue reading
Societal and Personal Consequences of Chronic Pain
But, the challenges faced by chronic pain patients tend to spread well beyond the physical and psychological effects.
As the literature review presented, there are social effects as well. Importantly, these include adverse effects on work, family life, and interpersonal relationships. The authors of the aforementioned 2016 review discovered, “the discomfort suffered by the caregiver was sometimes even greater than that reported by the patient themselves.” Significantly, nearly sixty percent of patients report chronic pain impacts their relationships, and twenty-three percent report a low-satisfaction with their family life.
Unfortunately, the most common pharmaceuticals used for the treatment of chronic pain are opioid-based drugs. These are good support for acute pain, but can cause serious adverse effects and addiction over the long term. In fact, the highly addictive quality of opioids has recently received a lot of attention from media. Plus the escalating opioid crisis is spotlit as a direct result of the overprescription of these highly addictive medications for pain.
The Endocannabinoid System and Pain Management
All animals, including humans, have an endocannabinoid system. Essentially, it is a body-wide network of receptors and naturally produced molecules that work together to regulate key physiological processes such as mood, memory, appetite, and the immune system.
As per the pain control chapter in Handbook of Experimental Pharmacology, the endocannabinoid system is, “one of the key endogenous systems regulating pain sensation.” Researchers now understand that it has, “modulatory actions at all stages of pain processing pathways.” [3]Woodhams, S. G., Sagar, D. R., Burston, J. J., & Chapman, V. (2015). The Role of the Endocannabinoid System in Pain. In Handbook of Experimental Pharmacology (Vol. 227, pp. 119–143). Berlin: … Continue reading
There are two cannabinoids receptors in this system, the CB1 and CB2 receptors. Basically, the endocannabinoid system concentrates the CB1 receptors in the brain and central nervous system, and the CB2 receptor lives primarily within the immune system. Further, both of these receptor types receive biological messenges via chemical messengers called endocannabinoids. These messages then activate or deactivate different processes within the body, including pain.
How the Body Responds to Pain
In response to an injury or other damaging condition, the body sends out anandamide (AEA) and 2-arachidonoyl glycerol (2-AG), which are two natural endocannabinoids. Of course, both help manage pain. These are either full or partial agonists (activators) for both the CB1 and CB2 receptors.
Experiments with AEA, 2-AG, and the cannabinoid receptors have realized this system is responsible for regulating the sensation of pain. Researchers have given both synthetic and natural doses of both AEA and 2-AG to lab animals and discovered their powerful pain-relieving qualities. Unfortunately, the body’s natural endocannabinoids don’t have a long shelf-life, which makes it difficult to transform into pharmaceutical preparations.
Undoubtedly, the endocannabinoid system is an exciting new target for pain relief. Both synthetic cannabinoids and cannabinoids derived from cannabis, infiltrate the endocannabinoid system for a similar effect. Cannabis is a rising star as a natural, non-opioid option to treat chronic pain.
How Does Cannabis Stop Chronic Pain?
Cannabis has over a hundred cannabinoids, with more discovered all the time. These cannabinoids all work within the body’s endocannabinoid system to deliver therapeutic impact. As a matter of fact, they work much like the endocannabinoids the body naturally produces.
The two primary cannabinoids appear in the highest levels across all strains. These are tetrahydrocannabinol (THC) and cannabidiol (CBD). On top of THC and CBD, cannabis contains a dozen or more minor cannabinoids that appear in substantially lower levels.
Essentially, all cannabinoids are molecularly similar, and all demonstrate related therapeutic value. Yet, they each perform differently within the endocannabinoid system. For example, both CBD and THC are thought to stop chronic pain, but only THC works directly with a cannabinoid receptor.
Specifically, THC is unusual in the way it forms a direct bond with the CB1 receptor, rather like a hand fitting into a glove. This strong affinity creates the intoxicating experience of THC, but it also is thought to be a reason for THC’s powerful pain-relieving qualities.
According to Ethan B. Russo, in his 2018 publication, “Cannabinoids in the management of difficult to treat pain,” THC specifically works within several different subsystems for chronic pain relief. These include serotonergic, glutamatergic, and inflammatory systems. As one example, the glutamatergic system manages neuropathic pain through the release of glutamates. THC naturally inhibits glutamate release, which may be one of the ways it, therefore, reduces neuropathic pain. [4]Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245–259. https://doi.org/10.2147/tcrm.s1928
CBD May Also Help Stop Chronic Pain
On the flip side, CBD is not a strong receptor agonist. It is an antagonist, meaning it doesn’t form a bond (like THC), but it does affect the activity of the receptors through other means. Research, including a recent study using a rodent model, suggests CBD is particularly beneficial for neuropathic pain, as it works within the 5‐HT1A receptor system. [5]Ward, S. J., Mcallister, S. D., Kawamura, R., Murase, R., Neelakantan, H., & Walker, E. A. (2014). Cannabidiol inhibits paclitaxel‐induced neuropathic pain through 5‐ HT 1A receptors without … Continue reading
With more than a hundred known cannabinoids, there is the potential for each minor cannabinoids also to treat chronic pain, but as of yet, they are almost entirely unstudied. If each cannabinoid impacts the endocannabinoid system in similar ways, but through subtly different pathways, how could the minor cannabinoids provide chronic pain relief? The potential here is obvious.
Russo summarized the preliminary work into these cannabinoids in his paper. Cannabichromene (CBC) has demonstrated anti-inflammatory properties and may also have mild pain-relieving characteristics. Further, experts believe that another minor cannabinoid, cannabigerol (CBG), is a stronger pain reliever than THC. It has an incredible ability to block the release of erythema and lipoxygenase, which are both involved in pain modulation. These are only two examples of where the future of chronic pain for chronic pain could go.
So far, researchers know enough to prove that cannabis and various cannabinoids are powerful pain relievers, but even still, it is just the tip of the iceberg. Understanding the way cannabinoids work together, plus their biological impact on pain management is the next frontier of medical cannabis science.
Which Cannabinoid is Best to Stop Chronic Pain?
Chronic pain comes in many forms, which means there is no single cure-all capable of soothing all types. As a matter of fact, the lingering pain from an old injury may travel through different pain pathways than the pain related to fibromyalgia, Multiple Sclerosis, or a migraine.
Although scientists are starting to understand that certain cannabinoids work better for certain types of pain, they also are beginning to realize that combinations work best. The Entourage Effect, which is the synergistic relationship between the many different medicinally valuable compounds in cannabis, makes whole-flower medicines much more useful than the sum of their parts.
For example, several pharmaceutical preparations of cannabis, including Cannador and Sativex, contain a combination of two cannabinoids: THC and CBD. Cannador went through clinical trials for the treatment of pain related to muscle spasticity from Multiple Sclerosis. Sativex treats central nervous system pain from Multiple Sclerosis and cancer-related pain. Both benefit from the combination of THC with CBD, for improved therapeutic effects.
Cannabinoids to Stop Chronic Pain
In 2015, a team of researchers published “Cannabinoids for the Treatment of Chronic Non-Cancer Pain: An Updated Systematic Review of Randomized Controlled Trials” in the Journal of Neuroimmune Pharmacology. Their systematic review detailed the following assessments of various cannabinoids on different types of chronic pain: [6]Webb, C. W., & Webb, S. M. (2014). Therapeutic benefits of cannabis: a patient survey. Hawai’i journal of medicine & public health : a journal of Asia Pacific Medicine & Public … Continue reading
- Mild smoked THC produces, “Statistically significant reduction of spasticity” in study participants with Multiple Sclerosis.
- THC delivered via capsule improves muscle stiffness, pain, sleep, and spasms for trial participants with Multiple Sclerosis.
- Oral spray with a THC:CBD combination promotes a reduction in pain for patients with Multiple Sclerosis.
- Oral spray with a THC:CBD combination significantly reduces peripheral neuropathic pain with allodynia (a type of neuropathic pain that causes people to be very sensitive to touch)
- Low dose THC delivered via vapor reduces neuropathic pain.
Despite what we know, the research is still in the early phases of study. Most completed studies focus on three types of chronic pain: neuropathic, spasticity related to Multiple Sclerosis, and cancer-related pain. Also, there are limited investigations of CBD for chronic pain or any secondary cannabinoids, like CBC or CBG. Additionally, much of the literature uses synthetic cannabinoids instead of cannabis-derived ones, as they have been legally easier to work historically.
Cannabis and Different Types of Chronic Pain
Spasticity
Cannabinoids for spasticity in patients with Multiple Sclerosis is a well-studied area of cannabis for chronic pain. As a matter of fact, there are dozens of placebo-controlled trials published in recent years, using both pharmaceutical cannabinoids and flower.
As only one example, “Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial” detailed significant improvements to several different pain scores from participants. In almost every evaluation, cannabis reduced pain. Their results fall in line with much of the literature on this topic. [7]Corey-Bloom, J., Wolfson, T., Gamst, A., Jin, S., Marcotte, T. D., Bentley, H., & Gouaux, B. (2012). Smoked cannabis for spasticity in multiple Sclerosis: a randomized, placebo-controlled trial. … Continue reading
Neuropathy
Issues with the central nervous system cause chronic neuropathic pain. Multiple Sclerosis, nerve damage from diabetes, and other metabolic conditions are common root causes of neuropathic pain.
There is a substantial body of literature examining cannabinoids for chronic neuropathic pain. According to a 2018 review of cannabis for neuropathic types of pain, published in The Cochrane database of systematic reviews, “Cannabis‐based medicines may increase the number of people achieving 50% or greater pain relief compared with placebo.” This review assessed studies using flowers, pharmaceutical cannabinoids, and synthetic cannabinoids to reach their conclusion. [8]Mücke, M., Phillips, T., Radbruch, L., Petzke, F., & Häuser, W. (2018). Cannabis-based medicines for chronic neuropathic pain in adults. The Cochrane database of systematic reviews, 3(3), … Continue reading
Fibromyalgia
Fibromyalgia is a painful chronic condition characterized by full-body aches, fatigue, and sleep disturbances. It is poorly understood, and patients may struggle to find a treatment option that gets their pain under control.
In 2019, researchers at the Ben-Gurion University of the Negev in Israel worked with Israeli fibromyalgia patients who were using medical cannabis. The research team found over eighty percent of the patients using medical cannabis reported at least moderate improvements to their condition without serious side effects. [9]Sagy, I., Bar-Lev Schleider, L., Abu-Shakra, M., & Novack, V. (2019). Safety and Efficacy of Medical Cannabis in Fibromyalgia. Journal of clinical medicine, 8(6), 807. … Continue reading
Cancer Related
According to some statistics, over fifty percent of cancer patients experience moderate to severe pain. Cancer patients often receive opiates for the treatment of chronic pain, although the side effects and risk profiles are undesirable. Preliminary research suggests cannabinoids are useful alternatives for difficult to treat cancer-related pain. [10]Kleckner, A. S., Kleckner, I. R., Kamen, C. S., Tejani, M. A., Janelsins, M. C., Morrow, G. R., & Peppone, L. J. (2019). Opportunities for cannabis in supportive care in cancer. Therapeutic … Continue reading
In “Opportunities for cannabis in supportive care in cancer” from 2019, cannabinoid receptor agonists (like THC) seem to work well at treating cancer-related pain.
The research exploring cannabis for cancer-related pain is limited in scope and not always controlled by placebo. Still, the early and anecdotal evidence is positive. While two randomized control trials did not find measurable reductions in pain-scores, other recent work has determined cannabis is, “safe and effective palliative treatment” for cancer-related pain. Essentially, more research will be needed to clarify the role cannabinoid therapy plays in the reduction of cancer pain.
Recommended Strains to Stop Chronic Pain
Firstly, a few thoughts as the internet is rife with “Best-of” lists on which strains are best for chronic pain. While helpful as a place for patients to get started, it’s important to know almost none of these lists are based on scientific study.
Importantly, cannabis is a highly individual experience. Further, there are a multitude of different types of chronic pain, from inflammatory to migraines to cancer. It’s incredibly challenging, if not entirely impossible, to create a top ten list of best strains for cannabis when there is just so much individual variation between people and types of pain.
So, without robust and well-controlled studies, where can patients get started if they are looking for the best strains for chronic pain? The most accurate suggestions come from patient surveys and session reports. While these do have their limitations, they are helpful in that they come from other people using cannabis for chronic pain. Patients may also find inspiration within the current research, some of which we touched on earlier.
Ultimately, the best strain to stop chronic pain will depend on the patient. Undoubtedly self-experimentation and careful titration are needed to match strain with the type of chronic pain.
Patient-Driven Suggestions for the Best Strains for Chronic Pain
With these caveats out of the way, if you experience chronic pain, you might be curious about which strains may provide the most benefit. Based on patient reports (see below) and the research summarized earlier, the best strains for pain seem to have several properties in common:
- Many have a well-balanced cannabinoid profile with a relatively even THC:CBD ratio.
- All have at least some THC
- Hybrids have a slight advantage over pure sativa or indica
The following seven popular strains come from RYAH Data‘s “September Report on Chronic Pain” and “Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort” from Baron et al. from the Journal of Headaches and Pain. [11]Baron, E. P., Lucas, P., Eades, J., & Hogue, O. (2018). Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic … Continue reading
Royal Purple Kush
This is the most popular strain among RYAH’s patients for the treatment of chronic pain. Strain websites report this is a highly-potent option that is best suited to people with a high tolerance to THC.
OG Shark
This strain was reported by patients in Baron et al.’s survey as preferred for the treatment of chronic pain and a top contender for arthritis. According to their lab analysis, OG Shark contains 21.4 percent THC and under one percent CBD.
CBD House Blend
Another option reportedly useful for the treatment of chronic pain is a CBD House Blend. While Baron et al. did not test this strain, a typical CBD house blend contains minimal levels of THC with significant levels of CBD.
Sweet Skunk CBD
Patients with arthritic pain reported this as the best strain in Baron et al.’s survey. The lab results detail this as a well-balanced strain with 9.1 percent THC and 11.2 percent CBD.
Skywalker OG
Noted in Baron et al.’s study as the top strain preferred by patients to reduce headaches. Their lab results measured 22.9 percent THC and under one percent CBD in this strain.
Dream Queen
The second most effective strain on the RYAH platform for the treatment of chronic pain. Strain reviews suggest this highly potent plant can contain around twenty percent THC.
LA Confidential
The third preferred strain for chronic pain from RYAH’s September Report. Leafly highlights this strain as high in THC (around seventeen percent) and low in CBD (under one percent).
Plant-Based and Patient Preferred, Cannabis is Relief of Chronic Pain
In one of the most extensive reviews to date, the National Academies of Sciences reported cannabis as an effective treatment for chronic pain. In their 2017 publication, “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research,” the reviewers concluded, “In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.” [12]The National Academies Press. (2017). The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington, DC.
Need more convincing on the powers of cannabis for chronic pain? In just about every single patient survey on medical cannabis use, people consistently report pain as a primary condition treated. Also, if the reports are true, patients in states with legal access favor cannabis for pain over opioids for pain.
Effectively, based on the hard-science and the growing patient reports, it seems evident that cannabis is an effective treatment for certain types of chronic pain. Two types, in particular, have gotten the attention of researchers: neuropathic and pain related to Multiple Sclerosis. But, there may be a place for cannabis medicine in many more types of chronic pain given more research.
Significantly, the treatment of chronic pain is moving away from traditional ideas towards cannabis based-medicines. It will be fascinating to see where the research takes us in five or ten years.
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