Cannabis has emerged as a popular treatment for pain relief in recent years; in fact, the majority of medical cannabis users are seeking pain relief.
For massage therapists, using cannabis in sessions with clients is limited to using topical CBD lubricants and analgesics derived from hemp—and one should check local and state laws before implementing CBD in session. Any other approach, such as taking CBD orally, must be contained to personal self-care practice.
About 50 million Americans—around 20%—have some form of chronic pain.1 The cost of treating pain in the U.S. is staggering: annually, it has been shown to cost up to $635 billion.2 These costs increase as pain severity worsens, which it often does for many people. Chronic pain has widespread effects, negatively impacting mental health, sleep, family, work and social functioning.3
A wide range of over-the-counter and prescription drugs are consumed by millions of people on a daily basis. At best, these products provide short-term relief; at worst, they contribute to an ongoing opioid epidemic that has claimed over half a million lives.4 Most medications, including over-the-counter options, carry a risk of side effects. Even such non-steroidal anti-inflammatories as aspirin kill over 7,000 people a year.5
Clearly, safe and effective treatments are desperately needed.
People Use Cannabis for Pain Relief
A recent study that looked at almost 650,000 medical cannabis users found that 62% are using it to treat enduring pain.6 Many of these users report benefits, with a 2018 survey finding an average of 74.7% pain reduction in response to the question, “How effective is medical cannabis in treating your symptoms or conditions?”7
There are several cannabis-based pharmaceutical medications, including Marinol, Syndros and Cesamet (which are synthetic THC compounds), and Epidiolex and Sativex (which are naturally derived CBD and THC/CBD compounds, respectively).
Research on Cannabis for Pain Relief
When evaluating clinical research, the highest quality evidence comes from meta-analyses, which are statistical analyses that combine results from multiple studies. In this way, they provide a truer effect that is less distorted by the errors that are likely found in individual studies.
There have been several published meta-analyses that looked at the effect of cannabis-based medicines containing THC over the last several years. The most recent, published by Yanes and colleagues in 2019,8 analyzed 25 studies with a total of 2,248 patients.
Treatments included plant cannabis (as the whole plant or a plant extract) and synthetic cannabinoids, and subjects had pain from a variety of conditions, including cancer, fibromyalgia, arthritis, neuropathic pain, chronic pain, headache and diabetes. The analysis found that pain decreased substantially with cannabis treatment. Similar findings were also observed by two other recent meta-analyses9,10.
Research has increasingly been studying CBD in isolation, especially given the passing of the 2018 Farm Bill that legalized hemp and hemp-derived cannabinoid containing products in the U.S. However, clinical research on CBD is lacking for most medical outcomes, including pain.
Pre-clinical research has shown very promising results. In animal models of pain conditions that widely affect humans, including arthritis11,12 and myofascial pain,13 CBD has been shown to be a safe and effective treatment. At this point, there is an overwhelming body of preclinical research supporting the use of CBD for pain.14
Cannabis-based products consisting of THC and CBD in a 1:1 ratio were rated highest quality-of-life scores of 79 (out of 100), followed by CBD-dominant products at 75 and THC- dominant products at 72. In comparison, oxycodone scored in the 40s, and morphine and fentanyl in the 30s.
The analysis found that even if pain reduction and quality-of-life scores for THC/CBD and THC were halved, their balance of efficacy relative to safety would remain better than those of more commonly used non-cannabinoid drugs.15 While these findings may not generalize to all types of pain, they highlight the impressive safety and efficacy profile of cannabinoids.
What About Safety, Addiction or Dependence?
In 2017 the World Health Organization announced that CBD in humans exhibits no evidence of abuse or dependence potential. There is no evidence of public health-related problems associated with the use of pure CBD.
Also, a recently published study found there was no evidence of withdrawal in healthy volunteers after abrupt cessation of CBD use at high doses. This contrasts with opioids, which have a high potential for dependency.
Other Evidence for Cannabis for Pain Relief
Cannabis has a very long history of being used to treat pain16. There is evidence of its use as a medicine in civilizations around the world going back thousands of years, including in Ancient Egypt, Greece and India. Records show that cannabis was used to treat a broad range of conditions like sore nails, pain with childbirth and headaches.
As recently as the early 20th century, cannabis was widely sold in U.S. pharmacies, and was one of the most popular medicines prescribed for pain. While this type of evidence does not satisfy modern criteria for evidence of safety and efficacy, the persistence of cannabis as medicine across millennia supports its therapeutic value, and can be used to provide some context for our current understanding.
A Personal Approach to Using Cannabis for Pain Relief
Cannabis has long been used to treat pain, and there is increasing research supporting its use in a range of pain-related disorders.
The medical consensus is that cannabis may be an effective pain reliever, which is illustrated by the position statements of the U.S. National Academies of Sciences, Engineering and Medicine, and the Canadian Pain Society that support the use of cannabis and cannabinoids for the treatment of some types of pain.
There is much less research specific to CBD or other non-THC components of cannabis and pain, although supportive pre-clinical evidence is accumulating, especially for CBD.
Using a personalized approach, many people may experience pain relief from using cannabis, including the whole plant and other cannabinoid preparations.
Author’s note: This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician.All viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions or before beginning any nutrition, supplement, or lifestyle program. Neither Genevieve Newton, publishers of this content, nor Fringe, Inc. takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
About the Author
Genevieve Newton, DC, PhD, is the scientific director of fringeheals.com. She “brings the science” that supports education, courses and product development. Newton has four degrees: a BSc, DC, MSc, and PhD. She has spent thousands of hours studying every system of the body and dissecting how it works. Shr has worked in research labs with cells, animals and human tissues, and has run clinical trials and observational studies with people ranging from preschool-aged children to adults.
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