Chronic pain is by far the most common reason that patients are prescribed medical cannabis, accounting for around two-thirds of all prescriptions.
Yet chronic pain is a complicated condition and there's still plenty of confusion as to how different types of pain respond to medical cannabis and what kinds of treatment options work best.
Here are some of the most common questions people have about medical cannabis and chronic pain, answered by the Alternaleaf clinical team.
How Effective Is Medical Cannabis In Treating Different Types Of Pain?
There are three major types of pain – nociceptive, neuropathic and nociplastic – and they each respond differently to medical cannabis.
Most of the current medical cannabis research has been done on nociceptive pain, which is pain caused by the direct stimulation of pain receptors. In general, studies show that THC offers significant improvements in cancer-related pain and general quality of life, with many participants reporting an up to 50% reduction in pain levels.
Neuropathic pain, or pain caused by issues with the nervous system, operates differently to nociceptive pain. High quality studies are more limited for neuropathic pain, yet tend to show a 30% or more reduction in pain scores. Interestingly, neuropathic pain appears to respond better to CBD, although the exact mechanism of action remains unclear.
Nociplastic pain – pain felt due to post-traumatic reprogramming of pain pathways – is the least common form of pain. There is currently insufficient evidence to say how effective medical cannabis is on nociplastic pain.
Conventional pain treatments can be of limited benefit: studies show that for one-fifth of patients, pain reduction is less than 50%. In addition, many treatments, such as opioids or anti-inflammatories can be unsuitable for long term use.
We're still working out exactly why medical cannabis seems to be effective in the treatment of pain – and studies are still in their early stages – but in general it appears to offer a promising new option for patients struggling with chronic pain.
How Should Chronic Pain Patients Take Medical Cannabis?
Everyone is different and you'll work with your doctor to create a treatment plan that responds to your own symptoms, preferences and medical history.
However, broadly speaking, inhaled products, such as cannabis flower or vape carts, allow for faster relief, or administration in patients who struggle with oral intake (i.e. a chemotherapy patient).
Meanwhile, ingested products, such as oils or lozenges, provide slower but longer lasting effects and may be more suitable for helping chronic pain patients sleep.
How Can You Balance Medical Cannabis With Conventional Pain Treatments?
Pain is a complicated bio-psycho-social phenomenon, meaning that your individual physiology, attitudes, beliefs and social structure can influence how a person feels and expresses pain.
It's important not to take a "one size fits all" approach to managing chronic pain. You should take a multi-pronged approach, one that might include a pain specialist, GP, psychological or social support and perhaps a medical cannabis clinician.
You should also be aware that pain is rarely something that can be simply treated with medication. A holistic treatment plan may also include exercise, dietary changes, cognitive strategies, meditation and more.
Finally, when it comes to medical cannabis, everyone is different and cannabinoid dosing is very individual. Working closely with your prescribing doctor is key to finding the right dose and format for you.
There is some emerging evidence to suggest that chronic pain patients who use medical cannabis are often able to lower their doses of other treatments. If you are considering lowering doses of your usual treatments, make sure to do it under the supervision of a doctor to ensure you’re well supported.
How Can You Avoid Developing Tolerance To Medical Cannabis?
While THC tolerance is a known long-term result of cannabis use, some research indicates that even though a patient may build tolerance to the psychoactive effects of THC, the pain-relieving benefit remains.
With that said, it’s generally accepted that tolerance breaks are a safe and effective way of ‘giving your receptors a rest’. When your receptors are continually exposed to THC, they ‘downregulate’, or retreat back into the cell. This is a normal physiological response and research indicates the receptors upregulate again after about 4 weeks of complete abstinence, but some patients may see benefits from shorter, more frequent breaks.
If you do need to take a "T-break", it’s best to discuss your individual situation with your health care provider.
Do Some Cannabis Strains Work Better For Different Kinds Of Pain?
At this stage the research is still unclear on the individual effectiveness of particular cannabis strains.
In general, we’re moving away from traditional labels like indica and sativa, in favour of classifying medical cannabis based upon the chemical profile of terpenes and cannabinoids it contains.
The research around these classifications is still very young, so there’s not a specific, ideal treatment plan or dosing regime yet – and there may never be one. A plant’s effects are mediated by an individual’s physiology, meaning your particular receptor expression may be different from the next person, producing slightly different effects person to person.
There will sometimes be a period of trial and error in the early stages of a medical cannabis treatment regimen while you and your doctor find the right combination of products. Rest assured, this is entirely normal, but it's important to be upfront with your doctor if certain parts of your treatment plan aren't working for you.
Can Medical Cannabis Help With The Mental Health Aspects Of Chronic Pain?
Pain and mental health are inextricably linked; the pain pathways in your body literally pass through the emotion and memory processing areas in the brain
There is some good evidence that CBD interacts with some of these pathways to attenuate the signal running through these areas. This can be likened to turning the volume down: it doesn’t necessarily remove the fear or stress associated with pain, but it may help to make that response a bit quieter.
Medical cannabis can also help some patients sleep and we know that when we sleep better we have more ‘reserve’ in our system to cope with pain and emotions. More generally, cannabis is also commonly associated with mood elevation and that’s one of the most interesting things about medical cannabis – it can have positive benefits on a range of symptom areas.
How Do Different Consumption Methods Compare In Terms Of Pain Relief?
Everyone’s bodies are different and the best dosing, administration method and product for one person may not be effective for someone else, even if the symptoms being treated are similar.
Sometimes, an inhaled product (like vaping flower or a rosin cart) can be useful for getting on top of pain quickly, as the active compounds make it to your bloodstream, and therefore receptors, much more quickly than ingestion. However, the effects of inhaled cannabinoids also wear off faster.
An ingested product, like an oil, can take a bit longer to start working, but will provide relief over a longer time period. Edibles and oils are the same for all intents and purposes, although edibles are still not widely available in Australia.
This is why it’s important to keep in close contact with your clinical team when starting medical cannabis treatment. Your treatment plan will be individualised to your own situation and can be adjusted as you work out the best approach for you, your pain and your lifestyle.