Cannabis and Pain

A recent systematic review and meta-analysis of cannabinoids for medical use that examined 28 randomized trials among 2454 patients with chronic pain indicated that, compared with placebo, cannabinoids were associated with a greater reduction in pain and greater average reduction in numerical pain rating. The study concluded that there was moderate evidence to support the use of cannabinoids for the treatment of chronic pain. In this review, neuropathy was the most commonly cited source of chronic pain. The majority of studies focused on testing the effects of plant-derived cannabinoids. Only 5 of the 28 trials assessed the effects of vaporized or smoked cannabis plant flower.

One recent study not included in the meta-analysis was a placebo-controlled trial of inhaled aerosolized cannabis, which demonstrated a dose-dependent reduction in diabetic peripheral neuropathy spontaneous pain ratings among patients with treatment-refractory pain. Finally, and most recently, a randomized, placebo-controlled crossover trial was conducted utilizing vaporized cannabis. The patient group consisted of 42 participants with central neuropathic pain related to spinal cord injury and disease. Results concluded that vaporized cannabis flower reduced neuropathic pain scale ratings.

Many patients have described a decreased need for prescription opioids after starting medical cannabis regimens. Many substances with addictive properties utilize common neural pathways, providing a theoretical basis for such anecdotes. Recently, rigorous studies have begun to provide evidence for these anecdotes as well. The numbers show that states with medical cannabis laws have significantly lower annual opioid overdose mortality rates compared to states without medical cannabis.

Much of this comes as no surprise to our patients. Science is catching up to the power of this plant, and we are proud to be part of the charge as the country follows suit.