Cannabinoids and Chronic Pain: Why Does Medical Marijuana Work?

3/30/2020
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How's the Research Coming Along?

Chronic pain is one of - if not the - most common uses for medical marijuana amongst Leafwell patients. For patients who have been in pain for a long time, the prospect of using prescription opioids is not ideal. In fact, it's frightening. Addiction, withdrawal symptoms, cold sweats, emotional numbing, fevers, overdose... The list of side-effects goes on. Sure, opioids are great for acute pain and surgery, where sedation may be necessary. For chronic pain, however, opioids are not a solution.

Medical marijuana, on the other hand, does not have anywhere near the same number of side-effects that opioids have. Whilst there is still some scepticism, an increasing number of physicians nationwide are seeing that cannabinoid-based medications could well be the "gold standard" of long-term pain management. Here's why.

1.Cannabis is a Pharmacy in a Plant and Works on Multiple Receptor Sites

In the past, many doctors and scientists believed that targeting specific receptors (e.g. serotonin receptors, dopamine receptors, opioid receptors) was the best way to treat specific problems. To some extent, this is not entirely untrue, and it makes sense, too. You have a health problem or symptom, you find out what precisely causes it and what neurotransmitters are involved, and you create a medication specifically targeted to the receptor you are treating.

This method has its advantages, but disadvantages, too. One of the big disadvantages is that people often suffer from multiple health problems, and they may need different pills for each of them. This can lead to drugs clashing with each other (contraindication), drug synergism (an interaction between two or more drugs that causes the total effects of the drugs to increase), and becoming weary of taking huge numbers of pills at specific times of day. To make matters worse, sometimes drugs are prescribed to counteract the side-effects of other drugs!

Cannabis has turned the idea of using a specific drug for a specific receptor site on its head. The cannabis plant contains up to 150 cannabinoids and over 200 terpenes, all with different effects, many with the ability to work on more than just one receptor site. For example, CBD (cannabidiol) is:

  • An antagonist of GPR55 (G protein-coupled receptor) - making CBD potentially useful for cancer.
  • A serotonin 5HT1A receptor partial agonist - making CBD potentially useful for depression and anxiety.
  • An inverse agonist of GPR3, GPR6 and GPR12 - making CBD potentially useful for obesity and neurogenesis (growing brain cells).
  • Is a COX-2 enzyme inhibitor - making CBD useful for reducing pain and inflammation.
  • An allosteric modulator of the mu- and delta-opioid receptors - making CBD useful to beat pain.

Add beta-caryophyllene (pain-killing and anti-addictive properties), linalool (relaxing properties), pinene (anti-inflammatory properties), cannabinol/CBN (treatment of insomnia) and many other terpenes and cannabinoids, and you have a multi-receptor site medication that can be used for many different health problems.

2.The Endocannabinoid System (ECS) and Inflammation

The ECS is intimately involved in homeostasis, and plays a role in sleep, mood, memory, hunger, the pleasurable effects of exercise, and inflammation & the detection of pain. There are two main cannabinoid receptors:

  • CB1 receptors - found in the brain, spinal cord and gut. CB1 receptor agonists like THC (tetrahydrocannabinol) tend to have psychoactive effects. THC can help provide some euphoria and help people forget about any pain they are feeling. THC, and its acidic precursor THCA, are also potent anti-inflammatories and antioxidants that can help reduce pain.
  • CB2 receptors - found in the immune system, and modulates immune cell functions, including the release of cytokines that cause inflammation. Beta-caryophyllene is a CB2 receptor agonist, and can be used to reduce inflammation.

CBD is an antagonist of both CB1 and CB2 receptors, despite having low affinity for them, and can reduce the psychoactive effects of THC when used in equal or greater ratios. CBD in lower ratios than THC can both buffer and elongate the effects of THC.

There are endocannabinoid receptors in every cell in the body. This means that inflammation in different parts of the body and different types of inflammation can be targeted, whether it's inflammation of the muscles or inflammation of the nervous system. Furthermore, as endocannabinoid receptors are not as "specialized" as dopamine or opioid receptors, and because cannabinoids are broken down extremely quickly, dangerous amounts are not built up in the body. This means that having a deadly overdose on cannabis alone is more a theoretical possibility than a practical one.

3.Cannabinoids Can Help with Many Types of Pain

In the 60s, Dame Cicely Saunders came up with the concept of "total pain". Total pain includes not only physical pain, but also emotional, mental and spiritual pain. At the moment, different medications are used for different kinds of pain. Physical pain could be treated by NSAIDs and/or opioids; emotional and mental pain by the use of antidepressants and/or mood stabilizers; and spiritual pain has no medications available for it.

Cannabinoids, meanwhile, could help treat all four types of pain, all in one plant. The multi-receptor targeting mechanism of cannabinoids like CBD makes this possible. The concept of spiritual pain is difficult to define, and understandably is not necessarily something that can be assessed scientifically.

However, if we take the concept of spiritual pain to mean a lack of connection with others and with nature, then cannabis has the potential to provide this, where other prescription pharmaceuticals fail. That cannabis can potentially help one develop a connection and appreciation for nature and other people could go some way to explaining why it may be useful for treating depression and even addiction.

If you are suffering from chronic pain and are looking for an alternative to prescription opioids, then get in touch with a physician and get your doctor's certificate and medical marijuana card with Leafwell today.

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