How To Use Cannabis To Manage Chronic Pain

“Pain” is more complex than we give it credit for. When Dame Cicely Saunders introduced the concept of “total pain”, which includes physical, emotional, social and spiritual distress, she helped foster a revolution in medical professionals’ idea of what pain constitutes. They began to understand that there are many different kinds of pain, and they all often feed into one another. Physical pain is worsened by mental pain, and anxiety and depression with the feeling that one will never get better can itself create physical pain. Total pain also asks us the all-important question: “What is the actual source of pain, and what is the best way to treat it?”

Dame Cicely Saunders
Dame Cicely Saunders, who came up with the concept of total pain. https://commons.wikimedia.org/wiki/File:EWS21.13.jpg

Pain requires a variety of different treatment methods. Yes, it’s important to treat the physical source of pain, but it is just as important to also treat the depression and anxiety that accompanies the everyday grind of having to face physical pain. Many people who suffer from chronic pain are  prescribed a cocktail of different drugs, depending upon the severity of their pain, including analgesics (e.g. tylenol), NSAIDs (e.g. ibuprofen), beta blockers, steroids, benzodiazepines, antidepressants and opioids.

Whilst some of these medications have their potential uses, they all have one big problem: they can all cause overdose, and they often work in conjunction with one another. For example, even everyday analgesics such as tylenol can increase the strength of opioids. Moreover, having to take a cocktail of pills everyday can be psychologically as well as physically tiring.

Opioids are effective at beating physical pain, but they are dangerously addictive and come with a whole host of other unpleasant side-effects (i.e. mental pain). Benzodiazepines are also often used for chronic pain, despite a lack of evidence for their efficacy for it and the potential for negative reactions with opioids. This asks another important question: “Are we effectively treating pain if we’re just replacing one type of pain with another?” We need a safe and effective alternative in the field of healthcare, and in cannabis we may just well have it.

Temazepam pills falling out of a bucket on its side. Benzodiazepines.
Temazepam – a benzodiazepine. https://commons.wikimedia.org/wiki/File:Temazepam_10mg_tablets-1.jpg

Cannabis As A Medicine For Pain

This is where cannabinoids-based medications can come into play. Due to the entourage effect and the variety of cannabinoids available in the cannabis plant, many different types of pain can be treated in one simple and safe medicine. Why take a whole host of pills, all designed for different purposes and all telling your body to do different things, when you can use one medication that covers them all? This is one very good reason why cannabis seems so popular for chronic pain amongst patients with all sorts of conditions.

Here are a few examples of the types of pain cannabis and cannabinoids may help beat …

Using Medical Marijuana To Treat Headaches and Migraine Pain

Headaches and migraine are complex conditions, perhaps mostly due to the fact that no one really knows where they come from. There are thought to be a variety of causes, including:

  • Inflammation
  • Irritation of blood vessels
  • Head injuries
  • Infection
  • Tumors
  • Stress
  • Allergic reactions
  • Dehydration
  • An increase in intracranial pressure
  • Sleep deprivation
  • Gastrointestinal disorders
  • An underlying neurological condition
  • Overuse of medication
  • Sensitivity to external stimuli

There may be many more besides, but the precise mechanisms of how they are all caused is not known.

Due to the huge number of conditions that can cause headaches, treatment varies widely. Often, headaches are separated into “primary” (not dangerous, but can be benign, including migraine) and “secondary” (potentially dangerous, and may be caused by a life-threatening or debilitating condition). Whether there is a common cause of all types of headache is not known, but one theory is that headaches could be caused by a deficiency of serotonin. Overactivation of the trigeminovascular pathway is also implicated in headaches of all types.

Whilst there is little clinical evidence in the use of cannabis for headaches and migraines, there are many positive anecdotal and preliminary results, as well as neurobiological mechanisms, that suggest cannabinoids could be of use for the treatment of migraine and headaches. Some of these neurobiological mechanisms include:

  • Vasodilatory effects of THC, allowing more oxygen to get into the brain. THC also lowers blood pressure. Alpha-pinene, a terpene found in cannabis, also has bronchodilatory properties.
  • Downregulation of cytokine production and inflammation by both THC and CBD.
  • Increasing serotonin production via attenuation of the serotonin receptors.
  • Some people have reported an increase in headaches after cannabis use, and some people also report “rebound headaches” after cessation of cannabis use. Smoking may also induce headaches in some, and there have also been reports that edibles are less effective.
  • Headache; migraine; person suffering from a headache/migraine.
    From https://www.cdc.gov/vhf/ebola/resources/infographics.html

So is there a cannabinoid-terpenoid profile and method of ingestion that is “best” for headaches and migraines?

As with so many other health problems, the best treatment for headaches depends upon where the headache is arising from. Assuming no benzodiazepine-based medications are being used at the same time, starting with a tincture containing a high CBD ratio (e.g. 20:1) may be helpful, and then work down from there (e.g. 18:1, 9:1, 3:1, 1:1) to see which works best for you.

Vaporizing may help for immediate effects when sudden headaches appear, but be careful of substances such as glycol in the extract you are using.

As for whether there are any specific strains that are useful for headaches and migraines, this is difficult to say. In our study, most patients preferred indicas, but this is not to say sativas and hybrids were not used as well. Trying some indica strains high in CBD may be helpful, but this is not to say sativas and hybrids are not useful.

Using Medical Marijuana To Treat Back Pain

Much of the advice given above regarding which cannabinoid-terpenoid profile and strains to use for headaches and migraines applies here to back pain, too. I.e., start off with a tincture high in CBD, and then if that does not work, try a tincture with more THC in it. See what works best for you personally, as different people respond differently to different issues.

Also, as pain of all types tends to affect sleep, terpenes such as myrcene and linalool and THC may be more helpful in getting to bed than looking at CBD alone. Indeed, high CBD may keep some people awake! Beta-caryophyllene also has many painkilling properties.

Yet, there are some different treatment methods when it comes to back pain. Topicals and transdermals could be of use to treat localized nerve pain associated with back pain, alongside tinctures. CBDA is also a COX-1 and COX-2 enzyme inhibitor, and THCA, CBG and CBGA also have significant anti-inflammatory effects, meaning they could be of immense use for all kinds of inflammatory pain, including headaches/migraines. CBD may also enhance healing in fractures.

When it comes to spinal injuries, as well as neuropathic pain (nerve pain), indicas were overwhelmingly preferred by patients in our study. CBD was also much sought-after. Both anandamide and 2-AG  are produced by injured tissue in order to suppress sensitization and inflammation. THC, which mimics anandamide, will likely also control inflammation via activation of the CB1 receptor.

CBD, meanwhile, binds to TRPV1, which controls pain perception, as well as raising endocannabinoid levels in the brain’s synapses. CBD, despite having little affinity for CB1 and CB2 receptors, seems to control the levels of cannabinoids available overall. To what extent this is so, it is not known, but it certainly gives CBD a very unique pharmacology.

Acidic cannabinoids, as well as THC, CBD and beta-caryophyllene, could be of huge use for back pain. Linalool, myrcene, humulene, limonene, alpha-pinene and beta-pinene are terpenes that may be useful for their painkilling properties.

Beta-caryophyllene chemical structure; CB2 agonist; cannabinoid-terpenoid; black pepper.
Beta-caryophyllene – a cannabinoid with painkilling and anti-addictive properties.

How To Replace Your Opiate Medication With Cannabis

As cannabis can have negative interactions with many kinds of opiates and opioids, decreasing the amount of opiate-based medications taken over the course of the day will be necessary. Sadly, for many, this also means withdrawal symptoms arising from opiate addiction. Fortunately, cannabis can provide a crutch to some extent, beating cravings whilst also being a painkiller and/or distractor. THC could be of use for withdrawal, but other cannabinoids and terpenoids also help due to their painkilling and anti-addictive properties as well.

CBD and THC are also allosteric modulators at the mu- and delta-opioid receptors, although to what extent this is the case in humans still needs to be seen. This does, however, lend credence to the idea of cannabis as an “exit” away from opioids, as cannabinoids can be used to affect opioid receptors without the need to use opiates.

Due to their synergistic reaction, slowly tapering off of opioids and using small doses of high-THC cannabis may be necessary.

Other treatment methods may also need to be utilized, such as lifestyle changes, counselling and naloxone, but any treatment method that avoids the use of other opioids and benzodiazepines may be ideal in order to truly beat opiate addiction. Cannabis provides a far safer crutch than many of the drugs currently administered for the treatment of opioid misuse.

Blue Rhino cannabis strain.
Blue Rhino.

Cannabis Strains That Can Help Replace Opiates

Whether there’s any particular strain or cannabinoid-terpenoid profile that is particularly useful for opioid addiction is, once again, difficult to say. High amounts of THC may help in the initial stages of opioid withdrawal, and then slowly lowering the amount of THC as cravings subside. Beta-caryophyllene, myrcene and humulene may also help. In our survey, several patients used cannabis to treat a drug addiction, with a slight preference for sativas (although indicas were not far behind).

Edibles, tinctures and concentrates may be ideal for opioid withdrawal. Strains such as Gorilla Glue, White Rhino/Medicine Man, Super Silver Haze and Strawberry Cough may be useful, but the name alone does not necessarily tell you which strain has the amount of THC in a particular plant – only testing can do this.

Find Out More

If you’d like to know more about cannabis and its painkilling properties, check out our page on chronic pain. In more than a few instances, replacing prescription painkillers with cannabis has made a hugely positive impact on people’s lives. When it comes to beating pain, there are few medications that compare with cannabis’ ability to treat all aspects of total pain, whilst at the same time being generally quite safe in terms of its LD50. It is no wonder that chronic pain is the often the most common use for medical cannabis.

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