Pain and Inflammation: Pain, MS/Spasm, HIV, 

The treatment of pain is one of the oldest uses of cannabis.  In controlled studies with acute pain, cannabinoids have been found useful against both chemical and thermal pain.  It has also been studied in chronic pain of both neuropathic and inflammatory origin and found to be effective.  In both situations the combination of cannabis and non-steroidal anti-inflammatory medications such as ibuprofen has been shown to be synergistic.  Cannabinoids are involved in the release of endogenous opioids which further moderate pain.  The pain mediation responses of cannabis are related to the location of CB1 receptors in central nervous system and peripheral nerves.  CB2 receptors are active in both acute and chronic pain, especially that of inflammatory origin.

While some studies have suggested that cannabis is no more effective than codeine in controlling pain (due to dose limitations because of psychoactive side effects), the side effect profile of cannabis vs narcotic pain control is worth considering as a factor- something not done in the initial study.  Early studies used very low doses of cannabinoids and were somewhat inconclusive.  Later studies used higher levels with more significant impacts on chronic pain and quality of life

Examples of studies concerning the use of cannabis as pain control include:

  • In Multiple Sclerosis several studies (including one with over 600 patients) showed that Marinol (a synthetic form of THC) had modest but significant affects on pain levels.  A second study with Sativex (cannabis extract) showed further reduction of neuropathic MS pain.
  • Use of cannabis extract in the post operative period reduced the need for ‘rescue’ analgesic with narcotics compared to placebo.
  • In a questionnaire study of over 500 HIV patients, >90% of those admitting to cannabis use reported resulting decrease in neuropathic and muscular pain.
  • A clinical trial (25 patients) with neuropathic pain using ajulemic acid (a CB1 agonist derivative of THC) produced effective pain relief without psychoactive side effects.  This suggests multiple subtypes of CB1 receptors (CB1a and CB1b) separating the pain and psychotropic actions of CB1 agonists.

With inflammation, there are multiple sites of action for both CB1 and CB2 agonists in the immune system.  Stimulation of the immune system by bacterial toxins and other agents prompts the release of endocannabinoids and their related enzymes.  They act in an anti-inflammatory capacity.

For further discussion of the anti-inflammatory and cytoprotective aspects of CB1 and CB2, see the discussion on CNS, Cardiovascular and Respiratory, and Inflammatory Bowel Disease.

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