In the State of California, pain is the most common symptom for which patients seek medical marijuana recommendations. Marijuana seems to be particularly effective in treating all sorts of pain. There is of course acute and chronic pain. Acute pain can be from a peripheral neuropathy caused by diabetes, spinal cord injury or compression (sciatica) or trauma to joints, bones, tendons, or ligaments. It is often a burning or sharp pain. Chronic pain is more often dull, stabbing and persistent. There are countless sources of chronic pain, such as arthritis, back and cervical spine pain, fibromyalgia, spinal cord injury, diabetic neuropathy, and residual pain after joint injury or repair.
There are many “pros” of marijuana for pain: good analgesic, high dose ceiling vs. toxicity, minimal physical dependence, and little or no drug interactions.
There are very few “cons”: psychological dependence, side effects such as lethargy, headaches, and dry mouth.
Because research into medical marijuana has been hampered for decades because of FDA listing of marijuana as a schedule 1 drug (dangerous, without medical benefit), there are few scientific studies of marijuana and pain. A recent Israeli study of vaporized whole plant cannabis showed the reduction of chronic neuropathic pain by 45%. (The Journal of Pain and Palliative Pharmacotherapy, Aug.13, 2014) In a 2006 study, 70-80% of patients experienced relief of chronic, severe pain.
Traditional medicine often uses opioids, which have many long-term and short-term side effects, including the need for higher doses over time to treat the same amount of pain, and, of course, the opioids are highly addictive. Marijuana can often allow the patient to experience less pain with a reduced dose of opioids or eliminate the opioids entirely.
The raw cannabis plant contains hundreds of compounds, including about 70 cannabinoids. Three of these compounds have demonstrated psychoactive effects. Of the three, Delta-9-Tetrahydrocannabinol (THC) is the most potent. The most potent therapeutically active compound is Cannabidiol (CBD), which has no psychoactive effect, but has significant anti-inflammatory, analgesic, and antioxidant effects.
There are two types of cannabidiol receptors: CB1 receptors in the central peripheral nervous system and CB2 receptors located outside the nervous system, mainly in macrophages, which are found in all cells. By creating various hybrids, it is possible to develop strains that are higher in cannabinoids and lower in THC, and this should be more therapeutic for pain management and less psychoactive. In fact, there are now hybrids, which are pure cannabinoids and have no THC. Many patients suffering from pain will welcome the all cannabinoid marijuana.