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Adapted from Medical marijuana: Dr. Kogan’s Evidence-Based Guide to the Health Benefits of Cannabis and CBD from dr. Mikhail Kogan, MD & Joan Liebmann-Smith, PhD with a foreword by Andrew Weil, MD (Courtesy of Avery Books, a member of the Penguin Group United States of America, a Penguin Random House company. Copyright © 2021, Michail Kogan, MD).
Pain is the most common illness affecting mankind and the main reason people seek medical help. Annual pain-related healthcare costs run at over $ 300 billion, which is higher than the combined costs of heart disease, cancer, and diabetes. According to a landmark report from the National Academies of Sciences, Engineering and Medicine, “There is conclusive or substantial evidence that cannabis or cannabinoids are effective in treating chronic pain in adults.”
Cannabis products have been used for conditions such as joint pain, migraines, neuropathic pain, and even convulsions, to name a few, since ancient times. And modern science confirms what our ancestors knew. The recently discovered endocannabinoid system (ECS) controls inflammation – one of the main sources of pain – as well as pain from other causes. By activating certain receptors in the ECS, cannabis can relieve pain and inflammation.
Pharmaceutical cannabinoids
the FDA has two synthetic forms of. authorized THC – Marinol (dronabinol) and cesamet (nabilone) – which are only available by prescription, usually in tablet form. Both are approved for the treatment of chemo-related nausea, and Marinol has been approved as an appetite stimulator for HIV Patients but not cancer patients. Unfortunately, these drugs have not been very effective in treating chronic pain. They weren’t very popular with patients either.
Another pharmaceutical cannabinoid product, Sativex (Nabiximols), is a natural, herbal tincture made from cannabis that contains both THC and CBD, the non-intoxicating component of the cannabis plant. Although it is used successfully as an oral spray for multiple sclerosis pain and spasticity as well as neuropathic (nerve) pain in England, Canada and other countries, Sativex is not yet approved in the USA.
Medical marijuana for pain relief
Recent surveys suggest that more than 90 percent of medical marijuana users have used it for pain relief. According to a recent review article, chronic pain sufferers generally prefer the good old-fashioned natural cannabis flower to the more modern, man-made marijuana. And those who use synthetic cannabinoids tend to stop using them due to their ineffectiveness and / or side effects.
Compared to Rx cannabinoid pills, inhaled and some other forms of marijuana are more desirable because they work faster and have fewer side effects. And according to the review mentioned above, “Scientific evidence suggests the inhaled (vaporized) option is more predictable, effective, and potentially more tolerable than oral supplements.” That said, there are some potential problems with vaping [which are discussed elsewhere in the book]. As with any drug, medical marijuana should be used with caution, ideally under the supervision of a doctor or qualified health care provider.
Too often, chronic pain sufferers have not carefully identified and treated the causes of their pain. Before recommending medicinal cannabis, I often refer pain sufferers to manual medicine experts first, including osteopathic doctors, physical therapists, and massage therapists. For countless patients, these referrals relieve their pain and restore their physical function. In addition, mind-body techniques, particularly the much-studied mindfulness-based stress reduction programs, have proven to be very helpful for chronic pain.
Another very common problem I see with chronic pain is poor nutritional status and inflammation. I estimate that at least half, if not more, of all chronic pain patients would benefit from magnesium and B-complex even if there was no deficiency. Once these core issues are addressed and the pain persists, I recommend cannabis. But the method and route of administration are essential.
CBD not that effective on its own
Unfortunately, there is a huge gap in knowledge about what cannabinoids, combinations, and ratios work best for different types of pain. This is in part because there is virtually no federal funding to support this type of clinical research. Fortunately, some cannabis companies are beginning to step in to conduct important research into cannabis use and CBD in pain patients.
Many patients swear by the beneficial effects of CBD for pain alone, but to date there is no clinical evidence of this. I have seen a number of patients who clearly experience less pain after using it CBD alone, the majority needed at least some supplements THC.
There is evidence that the combination CBD with a common terpene, β-caryophyllene (BCP), can relieve pain better than CBD alone. In addition to imparting aroma and taste to cannabis, terpenes can increase its potency – a phenomenon known as the entourage effect. BCP can also improve cognition, improve digestion, and induce relaxation without sedation. BCP can be found in common spices including cinnamon, oregano, clove, and black peppercorns.
Several lesser known cannabis compounds, particularly cannabidiolic acid (CBDA) and cannabigerol (CBG), have been shown to be effective in animal studies for chronic pain and other diseases. Unfortunately, they have rarely been studied in humans and are not yet as widespread as THC or CBD. However, more and more clinicians have reported that their patients find them helpful with some types of chronic pain.
Cannabinoid combinations
I think that CBDA can be very helpful for inflammatory pain; it is now one of my standard tools for patients with inflammatory pain conditions like rheumatoid arthritis. While some patients with these disorders may not be having complete pain relief CBDA alone, at high doses of 100 to 200 mg / day, some have achieved complete or partial remission of their arthritis. I agree CBDA combined with CBD can be especially helpful in older adults with osteoarthritis. I recommend 1: 1 CBD:CBDA in an oral or sublingual dose from about 10 to 15 mg CBD and CBDA Titrate twice daily and, if necessary, up to 50 to 100 mg twice daily.
I’ve also found the full spectrum CBDA Hemp oil in sublingual, oral, or topical form can be very effective in relieving muscle soreness from minor trauma or overuse. I’ve seen more and more athletes lately CBD and CBDA for mild pain after exercise and find it very helpful. In view of this, this is a welcome change CBD and CBDA are safer in the long run than conventional drugs such as Advil and Tylenol.
Add to CBG to other cannabinoids like CBD and THC may help relieve osteoarthritis and neuropathic pain in some patients. CBG is also helpful for reducing anxiety. However, it should not be taken at night as it can be quite stimulating and can disrupt sleep. For patients who are sensitive to a lot of THC during the day I find that with a combination CBD, CBDA, and CBG in the morning can be very helpful for different types of pain, including neuropathic pain and inflammatory pain due to osteoarthritis and other conditions. Similar to CBDA, that CBG Dose is usually much lower than CBD, in the range of 5 to 10 mg, taken once a day in the morning.
Whatever your smallest effective dose, this is your best dose! “Stop when you get where you need to go.” You also save money.
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