The use of cannabis to treat chronic pain has had a long history, with written references of its use dating back to around 2700 B.C.E. The first records in the nineteenth century were recorded by the Irish doctor William B. O’Shaughnessy, who described the use of cannabis in the treatment of cholera, rabies, tetanus, menstrual cramps and delirium tremens.
In modern times, significant research has been done around cannabis therapy in the treatment of chronic pain with very promising results.
“Medical cannabis is a very effective therapy for chronic pain patients because it affects people’s perception of pain, has the ability to mitigate the inflammatory process, and has been shown to affect voltage-gated sodium channels in nerves in a way similar to lidocaine,” reports Dr. Mark Rabe, Medical Director of Centric Wellness, am integrative holistic healthcare practice in San Diego CA and Chairman of the Scientific Advisory Board at Medical Marijuana Sciences, Inc.
The ability of cannabis therapy to help relieve chronic pain on multiple fronts rests squarely in the cannabinoid receptors – cannabinoid receptor type-1 (CB1) and type-2 (CB2). Studies have shown that CB1 receptors are located all over the body, however they have particularly high concentration in the central nervous system in areas that control pain perception. CB2 receptors, on the other hand, are primarily located in areas of the body that control immune function, such as the spleen, white blood cells, and tonsils.
The fact that these receptors are found in the two major body systems responsible for producing the sensation of pain, the immune system and the nervous system is what gives cannabis its therapeutic relevance in the chronic pain space. Additionally, and importantly, there are a lack of cannabinoid receptors in the brainstem region, the area of the brain responsible for controlling breathing, thus the dangerous side effect of respiratory depression found with high dose opioid use, is not a factor in cannabis therapy.
In practical application, cannabis therapy can be used in conjunction with other chronic pain therapies. In his clinical practice, Dr. Rabe reports, “We have many patients who come in on higher doses of opioid medications. Through using cannabis, in conjunction with other therapies, they are able to lower their daily opioid requirement.”
Numerous studies support these findings, including a 2011 study published in the Journal of Clinical Pharmacology and Therapeutics which showed that vaporizing cannabis increased the patient-reported analgesic effect of opioids, without altering plasma opioid levels. Moreover, there is an emerging body of research whose findings suggest cannabis can be used as an effective substitution therapy for patients with opiate abuse issues.
Overall, we are just at the beginning of our understanding of the possible therapeutic benefits associated with cannabis in the treatment of chronic pain. In addition to the wide range of possibilities in targeting CB1 and CB2 receptors, scientists are beginning to look at targets within the body’s endocannabinoid metabolic life cycle for potential opportunities for therapeutic intervention. Given the growing need for clinicians to transition away from an opiate dependent treatment protocol for chronic pain, hopefully these breakthroughs happen sooner rather than later. Naturally, the relaxation of government prohibition would go a long way towards supporting these efforts.
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