Cannabis & Pain Relief

Chronic Pain


When chronic pain impacts one’s ability to function in daily life, it needs to be addressed. While acute pain is only bothersome for a short duration, chronic pain persists. Chronic pain may involve pain signals that keep firing in the nervous system over an extended period of time. Over 100 million individuals in the United States suffer from chronic pain, and it affects more Americans than diabetes, heart disease, and cancer combined.  Chronic pain often significantly impacts quality of life and overall well-being.

Pain Control You Need and Safety You Expect

There are many ways to keep pain under control, and effective pain management often requires the right combination of different therapies. Many treatment options exist for chronic pain including but not limited to medications, acupuncture, electrical stimulation, surgery, psychotherapy, relaxation techniques, physical therapy, and cognitive-behavioral therapy. Patients deserve effective pain relief that does not burden them with intolerable side effects or safety concerns associated with their treatment. Current medications available to relieve pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, and acetaminophen (TYLENOL), have adverse effects that limit their use. Medical cannabis offers the potential for effective pain relief with an improved safety and tolerability profile relative to other widely-used pain relievers.

Did You Know?

In a study of hospitalized patients with terminal conditions, more than half of these patients experienced pain in the last days of their lives. Research shows that 50-75% of patients dying from cancer pass away in moderate to severe pain.

Source: Journal of the American Medical Association, link to the right

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Medical Cannabis


A New Therapeutic Option for Patients in Florida

Medical cannabis and active cannabinoids show great promise in helping control chronic pain. Medical cannabis may be used as to complement current pain therapy or to better manage breakthrough pain, or it may be used in place of other therapies that are not meeting the patient’s needs. Medical cannabis should be offered as a therapeutic option when a trial is warranted and part of the pain management conversation for appropriate patients who are suffering from chronic pain.

The U.S. Food and Drug Administration has not approved Cannabis or cannabinoids for use in treating acute or chronic pain. However, the state of Florida allows qualified patients who are suffering from cancer, chronic seizureschronic muscle spasms, and terminal conditions (with less than one year to live) access to low-THC cannabis or medical cannabis depending on their qualifying condition. In Florida, medical cannabis use for pain management should be initiated and monitored by a qualified doctor in compliance with all state laws.

How Can Medical Cannabis Help with Pain Relief?

[Testimonial]

  • Cannabinoids found within the human body (also known as endocannabinoids) are involved in many normal physiological functions, including the modulation of pain and control of inflammation.

  • Tetrahydrocannabinol (THC) is the most studied active cannabinoid derived from the Cannabis plant. THC has a demonstrated ability to reduce pain, spasticity, and nausea and to stimulate the appetite. THC also has psychotropic effects including euphoria, relaxation, heightened sensory perception, and altered perception of time.

  • Cannabidiol (CBD), another abundant and important active cannabinoid found in the Cannabis plant, has been shown to reduce inflammation, pain, spasticity, seizures, and nausea. Unlike THC, CBD does not appear to produce euphoria or intoxicating effects.

  • Both THC and CBD are potentially useful as analgesics, or pain relievers, across a broad range of painful conditions.

  • Medical cannabis may also be effective in treating other common symptoms associated with pain, including anxiety, sleep disturbance, nausea and vomiting, and cachexia.

Promise of Medical Cannabis in Pain Relief: Available Evidence

Expanding evidence indicates that medical cannabis relieves both neuropathic and non-neuropathic pain. Neuropathic pain is chronic pain resulting from injury to the nervous system. The best evidence of the efficacy of medical cannabis comes from studies of neuropathic pain. Promising results have been seen in clinical studies of medical cannabis in painful diabetic neuropathy, neuropathic pain associated with HIV, and chronic neuropathic pain. In general, the reductions in patient pain scores in these studies are modest and similar to those reported for opioids and other pain relievers. See links below for more information. Many of these studies involved inhaled medical cannabis that was titrated to the right dose for the patient.

Medical cannabis also shows promise in treating cancer pain and chemotherapy-induced neuropathic pain. The National Cancer Institute (NCI) provides a summary of the current information available on Cannabis and cannabinoids in the treatment of patients with cancer, including their use in pain relief. Separate Information Summaries for patients and health care professionals can be found at the links below.

Early single-dose studies of cannabinoids for pain control showed that the active therapeutic agent evaluated was superior to placebo and at least as effective as codeine 60 mg in treating acute pain. Evidence suggests that the combination of medical cannabis with opioid treatment may relieve pain better than the opioid alone or may enable a decrease in the opioid dose, but there is limited evidence to date to prove this relationship.

With regard to long-term use, a prospective cohort study was conducted to better understand safety issues associated with medical cannabis use among individuals with chronic non-cancer pain. The patients were evaluated at seven pain management centers across Canada and treated with a standardized THC cannabis product over 12 months at a median daily cannabis dose of 2.5 grams per day (12.5% THC) compared to a control group. This study reported a significant and sustained reduction in chronic pain and overall improvement in quality of life at 12 months, no difference in the risk of serious adverse events between the groups, and increased risk of non-serious adverse events (e.g., headaches, nausea, sleepiness, dizziness) in the cannabis-treated group that were mostly mild to moderate. Of note, this study was conducted in experienced cannabis users who were closely monitored by healthcare professionals.

In a number of countries outside of the U.S., an oromucosal spray containing a combination of THC and CBD in equal proportions is approved for chronic neuropathic pain, central neuropathic pain in multiple sclerosis, and cancer pain.  Randomized, controlled clinical trials have demonstrated the efficacy and safety of this product in chronic neuropathic pain, rheumatoid arthritis, and diabetic neuropathic pain. In studies of the treatment of cancer pain, this product has shown mixed results with additional studies ongoing. This pharmaceutical product is not approved for use in the United States.

See a spotlight on research literature below:

Cancer Pain


Medical cannabis also shows promise in treating cancer pain and chemotherapy-induced neuropathic pain. The National Cancer Institute (NCI) provides a summary of the current information available on Cannabis and cannabinoids in the treatment of patients with cancer, including their use in pain relief. Separate Information Summaries for patients and health care professionals can be found at the links below.

Excerpted from the National Cancer Institute:

Have any clinical trials (research studies with people) of Cannabis or cannabinoid use by cancer patients been conducted?

  • Combining cannabinoids with opioids: In a small study of 21 patients with chronic pain, combining vaporized Cannabis with morphine relieved pain better than morphine alone, while combining vaporized Cannabis with oxycodone did not produce significantly greater pain relief. These findings should be tested in further studies.

  • Delta-9-THC taken by mouth: Two small clinical trials of oral delta-9-THC showed that it relieved cancer pain. In the first study, patients had good pain relief as well as relief of nausea and vomiting and better appetite. A second study showed that delta-9-THC could be given in doses that gave pain relief comparable to codeine. An observational study of nabilone also showed that it relieved cancer pain along with nausea, anxiety, and distress when compared with no treatment. Neither dronabinol nor nabilone is approved by the FDA for pain management.

  • Cannabis plant extract medicine: A study of an extract of Cannabis that contained specific amounts of cannabinoids, which was sprayed under the tongue, found it was effective in patients with advanced cancer whose pain was not relieved by strong opioids alone. Patients who received the lower doses of cannabinoid spray showed markedly better pain control and less sleep loss compared with patients who received a placebo. Results showed that, for some patients, control of their cancer-related pain continued without needing higher doses of spray or higher doses of their other pain medicines

Source: The National Cancer Institute

The Future of Medical Cannabis Research

Although there have been significant gains in medical cannabis research over the last two decades, there is a need for larger and well-designed clinical studies to evaluate the efficacy and safety of medical cannabis and active cannabinoids in the management of pain. As reported in the largest NIH clinical study database, numerous studies of medical cannabis are ongoing and planned in patients experiencing pain due to diverse conditions including:

  • Low Back Pain
  • Chronic Pain and Palliative Care
  • Diabetic Neuropathy 
  • Osteoarthritis
  • Spinal Cord Injury
  • Multiple Sclerosis
  • Cancer Pain
  • Peripheral Neuropathy
  • Sickle Cell Disease
  • Cerebral Palsy

The Opioid Epidemic


The Need for Safer Pain Relievers for Patients in Florida

Overdose deaths involving prescription opioid pain relievers, such as oxycodone and hydrocodone, have increased and now exceed deaths involving heroin and cocaine combined. The medical and public health communities have made great strides in ensuring the appropriate use of opioids in pain management. The CDC Guideline for Prescribing Opioids for Chronic Pain was published in March 2016 and provides recommendations for the appropriate prescribing of opioid pain relievers and other treatment options to improve pain management and patient safety.

U.S. Centers for Disease Control and Prevention (CDC): Facts about Opioid Abuse

  • Between 1999 and 2010, sales of prescription opioids in the U.S. have quadrupled.

  • An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids.

  • Nearly 2 million Americans abused or were dependent on prescription opioids in 2014.

  • From 1999 to 2014, more than 165,000 people died from overdose related to prescription opioids.

  • In 2014 alone, 18,893 people died from overdose related to prescription opioids.

  • Drug overdose is the leading cause of accidental death in the U.S.

Source: http://www.cdc.gov/drugoverdos...

Opioid Use in Florida

The Florida Prescription Drug Monitoring Program was created by the 2009 Florida Legislature in an effort to encourage safer prescribing of controlled substances, including opioid pain relievers, and to reduce drug abuse and diversion throughout the state of Florida. Florida has directly addressed the opioid abuse problem within the state, and this has resulted in a significant decline in drug overdose deaths.

With recent reductions in the use of opioids and also a promising drop in overdose deaths due to opioids in Florida, it remains imperative to effectively manage the pain of patients in Florida.

Relief of Pain, Relief of the Burden of Opioids

Medical cannabis has the potential to help address important limitations of other pain therapies. As Florida strives to become a healthier state and ensure the safe and appropriate use of drug therapy, medical cannabis may be a part of the solution when used appropriately. In an analysis published in the peer-review journal JAMA Internal Medicine, states with medical cannabis laws during the time period of 1999 to 2010 had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws. This trend generally strengthened over time following implementation of the law. Please see the link to the left.

CHT Medical is committed to keeping Florida safe and pain free!

Spotlight on Research


Efficacy Studies in Chronic Pain: Selected Medical Conditions

Intractable Cancer-Related Pain

Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain.  

http://www.ncbi.nlm.nih.gov/pu...

Diabetic Neuropathy

Wallace MS, Marcotte TD, Umlauf A, Gouaux B, Atkinson JH: Efficacy of inhaled cannabis on painful diabetic neuropathy. J Pain 16:616-627, 2015

http://www.sciencedirect.com/s...

Painful Neuropathy Associated with HIV

Abrams DI, Jay CA, Shade SB, Vizoso H, Reda H, Press S,Kelly ME, Rowbotham MC, Petersen KL: Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial. Neurology 68:515-521, 2007

Rheumatoid Arthritis

Blake DR, Robson P, Ho M, Jubb RW, McCabe CS: Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology (Oxford) 45:50-52, 2006

Fibromyalgia

Skrabek RQ, Galimova L, Ethans K, Perry D: Nabilone for the treatment of pain in fibromyalgia. J Pain 9:164-173, 2008 

Chronic Non-Cancer Pain 

Lynch ME, Ware MA: Cannabinoids for the treatment of chronic non-cancer pain: An updated systematic review of randomized controlled trials. J Neuroimmune Pharmacol 10:293-301, 2015

Chronic Neuropathic Pain

Andreae MH, Carter GM, Shaparin N, Suslov K, Ellis RJ, Ware MA, Abrams DI, Prasad H, Wilsey B, Indyk D, Johnson M, Sacks HS: Inhaled cannabis for chronic neuropathic pain: A meta-analysis of individual patient data. J Pain 16:1221-1232, 2015

Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H: Low-dose vaporized cannabis significantly improves neuropathic pain. J Pain 14:136-148, 2013

Neuropathic Pain Associated with Multiple Sclerosis

Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain: http://www.ncbi.nlm.nih.gov/pu...

A randomised controlled trial of cannabis based medicinal extract in central neuropathic pain due to multiple sclerosis: http://www.sciencedirect.com/s...

Sativex® in the treatment of pain of neurological origin or symptoms of Multiple Sclerosis: Interim analysis of a long-term, open label, safety and tolerability study: http://www.sciencedirect.com/s...

Neuropathic Pain from Spinal Cord Injury and Disease

An Exploratory Human Laboratory Experiment Evaluating Vaporized Cannabis in the Treatment of Neuropathic Pain from Spinal Cord Injury and Disease: http://www.sciencedirect.com/s...

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