Is Weed All You Need for Chronic Pain?

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I live and practice in Colorado, which is arguably the weed capital of the earth right now given that we were one of the first states to approve medical, and then recreational, marijuana. Hence, I have seen both the good and bad behind legalized pot. For example, you can now buy CBD laced chocolate bars in my local grocery store. Also, raising kids with both legal alcohol and pot is always a worry. Having said that, many of my patients swear by this stuff, so time for a blog.

I have many patients that use CBD oil to help their pain. The latter is an extract of a compound that also reportedly has pain-relieving effects, but without the THC induced high. In the meantime, researchers have been studying whether marijuana can help pain and the results are interesting. Given that we have an opioid crisis, pot for pain may not be so bad. After all, marijuana is likely much safer than Oxycontin.

What Is Cannabis and Medical Marijuana?

Cannabis is a plant that when dried is known as marijuana. Cannabis contains a tetrahydrocannabinol (THC), which is the psychoactive substance that provides the “high” in those who use marijuana. The FDA lists cannabis as a Schedule 1 controlled substance. Schedule 1 drugs, under federal law, can’t be used clinically nor can prescriptions be written for these drugs; however, 33 states in U.S. have now legalized the medical use of marijuana, meaning patients can purchase it for medical purposes. This means researchers are getting larger and larger subject pools to gather data from on this topic, so we will continue to see numerous and larger studies coming down the pike.

According to the research study we’ll dive into today, 65% of patients who use medical marijuana report they use it for chronic pain.

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Understanding Chronic Pain

Millions of people in the U.S. suffer from chronic pain. A simple Internet search will show a wide range in how many millions (between around 50 and 100 million), but the CDC puts this number at 50 million (or 20% of the population). Whatever the case, the fact is, there’s a staggering number of Americans dealing with chronic pain. Chronic pain is typically described as daily, or almost daily, pain for six months or longer.

While all of this chronic pain has created an epidemic of painkiller abuse (with dangerous and addictive opioid narcotics, currently front and center), now it seems that more Americans are starting to turn to cannabis, or marijuana, for their chronic pain. So is it effective?

Study Examines if Cannabis Use Is Effective for Chronic Pain

The new study consisted of data collected and analyzed using 10,000 abstracts of prior studies on patients using cannabis (medically or recreationally) in legalized states. The results? Researchers concluded that there was evidence that chronic pain did improve with cannabis use. However, they pointed out that they lacked comprehensive data to determine why the specific subjects had chronic pain and instead used nationwide estimates for the study, which certainly limits the findings of this study. Outside of chronic pain, the study also concluded that spasticity in patients with multiple sclerosis, as well as nausea and vomiting symptoms after chemo, were also improved with cannabis use.

On the other end of the spectrum, another study I covered on marijuana, a couple of years ago, actually found that while THC (the active ingredient in marijuana) seemed to improve mental performance in old mice, it caused a significant mental decline in young mice. The problem at this point is, we need to know about marijuana’s effects, and most of the studies leave us with more questions than answers.

CBD Oil and Pain

While medical cannabis used for pain has some published research support, the use of CBD oil and pain has very little. What is CBD oil? How is it different than THC?

Cannabidiol (CBD) is one of many unique “cannabinoid” compounds that can be found in the sticky resin often found concentrated on cannabis flowers, commonly called “buds”. This stuff contains both THC and CBD and various aromatic terpenes. CBD oil is extracted from this resin. It can also be extracted from Hemp. It doesn’t give you the same “high” associated with THC.

First, many of my patients swear by CBD oil, They rub it on the affected joint or take it orally. As I said, my local grocery store here in Boulder, Colorado now sells CBD laced chocolate bars. I have yet to personally try one.

How much research is there that CBD oil helps pain? Remarkably little at this point. One study I found used it in osteoarthritic dogs and found excellent pain relief. Outside of that, I found few clinical trials.

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A Word of Caution

One thing I’d like to say is that if you have pain, it’s a symptom of something going wrong. Hence, whether you cover it up with narcotics or weed, that’s still not spending energy on figuring out what’s wrong and how to fix it. Hence, please get in to see someone who can diagnose why you hurt.

The upshot? I have no problems with my adult patients using marijuana or CBD oils to treat pain. There is some data that THC may impact stem cells, so we generally restrict those patients from taking the stuff for several weeks before and after a procedure. Having said that, this is not something I would ever recommend to a pediatric or young adult patient due to concerning data in that age group. Nor do I prescribe these products, They are plentiful enough where I practice that if a patient wants to try an alternative to narcotics, they simply have to walk down the street to buy the stuff.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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