Pain Reduction With Certain Medications?

  • Chronic pain is the most common reason patients seek to use medicinal marijuana. This is not surprising considering over 1/3 of Americans are dealing with some soft of chronic pain situation. It is now understood that certain strains of marijuana act favorably towards reducing a patient's pain. Is there a dose effect? Meaning is medicinal marijuana effective to a certain amount/dose and then does it become counterproductive above that?


    Research out of UCSD shows that there may actually be a dose dependent effect, with higher doses actually INCREASING the amount of pain patients experienced. The study at UCSD consisted of injections of capsaicin into healthy volunteers' forearms. Keep in mind that capsaicin (also known as pepper cream) is a substance normally rubbed on the skin to invoke a numbing response and pain relief. But in this case it was injected under the skin, where it becomes painful by itself.


    After injecting the painful capsaicin, the volunteers smoked marijuana at 3 doses. The low dose had no effect, while the medium dose decreased the pain substantially. However, the high dose increased pain. What happened?


    The first issue is that no one really knows how marijuana works for chronic pain. Sure, it is understood that there are receptors for the cannabinoids of marijuana in the brain and throughout the body. But what happens exactly once the cannabinoids are attached to those receptors is a mystery. It is well understood that smoking marijuana increase heart rate by 7 to 12 beats per minute. But how does the brain receiving cannabis tell the nerves not to send pain signals?


    Some research has shown that THC (the main active component of marijuana) has some pain reduction activity in cancer patients. Cancer patients would fall into the chronic pain category in reality, but technically most legal states have a separate category for cancer as a reason for usage. There have been multiple studies showing that medical cannabis is effective for chronic painful conditions such as cancer, but not for acute painful situations such as for instance severe sunburn.


    Having stated that, there has been a study looking at cannabis in conjunction with opioids for post-operative pain medication requirements. The study showed a decrease in opioid requirements as cannabis intake increased. However, that study did not go over a 15mg THC dose. Would a higher dose have made the opioid needs increase as a counter-intuitive effect?


    There is a lot we know about medical marijuana for chronic pain, and a lot of unanswered questions. The more studies that come out, the better marijuana's use for chronic pain can be aligned with specific dosing towards the condition for which it is utilized.