A comprehensive analysis of self-reported patient data regarding the use of cannabis to mitigate exacerbations of chronic pain displays patterns that are potentially foretelling in regards to future management of this condition.
A Brief Overview of Chronic Pain
A somewhat nebulous term in itself, the diagnosis and subsequent management of ‘chronic pain’ has too been fraught with an inherent lack of understanding. This predisposes those who suffer from the condition to be stuck in a caustic circle of misdiagnosis and historically poor management. Though affecting greater than 20% of American adults and posing the greatest medically financial burden to western countries1, this chronic condition has persisted to dwell in the shadows of American healthcare, thriving due to our inability to both effectively recognize and properly manage it.
In order to properly identify a patient who is suffering from chronic pain we must first understand the difference between pain in the context of both its acute and chronic manifestations.
Acute pain is rapid in onset, and is often associated with trauma, surgery, and illness. Acute pain acts within the body as a herald for either existing or potential tissue damage. According to the International Association for the Study of Pain (IASP), the normal tissue healing time is 6 months. However, this timeframe may vary amongst other organizations, with some quoting healing time to be as soon as 3 months. If pain persists after the damaged tissue heals, then it is now referred to as Chronic pain.
Another key difference between acute and chronic pain is that acute pain actually serves a very practical and necessary function within the human body, whereas chronic pain serves none. Acute pain triggers a protective reaction within the body that prevents further tissue damage proceeding the initial insult. However, chronic pain serves virtually no role in preventing further tissue damage, and is therefore classified as a disease.
The Study on Medical Marijuana and Chronic Pain:
A recent study sought to analyse the efficacy of varying modalities of self-administered cannabis in patients with chronic pain disease. Data was to be compiled and analysed throughout a wide array of categorical points of interest pertaining to cannabinoid characteristics and patient response.
Problems addressed by the study
Americans are currently being plagued by an opioid crisis that has formed, in part, due to an inadequate depth of knowledge available on alternative forms of treatment, in particular cannabis due to the variable legality of its nature throughout the nation. Because of recent changes in the legislature of a select minority of states allowing cannabis to be used legally for medical purposes, we have only just begun to properly research the efficacy of cannabis use in relation to pain treatment. There is a paucity of data surrounding this subject that needs to quickly be filled.
Although there have certainly been studies authored in the past regarding medicinal cannabis, these studies have been severely limited in their ability to properly assess the wide range of cannabis products available in state-legal dispensaries. This study sought to analyse data corresponding to an array of medically relevant criteria vital in assessing the effects of cannabis products in patients suffering from chronic pain.
As stated within the publication1, the objective of this study was to:
…Estimate changes in pain severity… and the prevalence of side effects associated with cannabis consumption, and whether these effects differ by product characteristics…1
Methods by Which Data Was Collected
Data was compiled primarily through the mobile software application, Releaf App, which is the largest database of real-time cannabis administration in America. This application was designed with the intention of helping patients who use cannabis to navigate through the wide variety of products that exist in state-legal locations. It does this by recording various components of cannabis usage during the exact time when it is consumed by the patient. The categories accounted for by Releaf were: Specific symptoms to be reported on (varying per patient), symptom severity levels, cannabinoid product types, routes of administration, labelled product characteristics, major cannabinoid contents, 11 potential pain symptoms, and 47 potential side-effects from consumption. All data is self-reported directly to the application by patients during real-time sessions in which they consume cannabis.
The particular compilation of data selected to analyse was from those who used cannabis therapeutically in order to achieve immediate to short term (within 4 hours) relief of their aliment(s). These subjective pain intensity levels were reported prior to and after consumption of cannabis (along with side-effects of consumption and all other user-reported data corresponding to the aforementioned categories).
Results of the Study
During statistical analysis of the data, all cannabinoid product characteristics were included, however there was a particular focus on “combustible” forms of cannabis, i.e. dried natural flower and concentrates, as combustibles are the most commonly used cannabinoids. The 11 pain symptoms outlined by the study were compiled into 5 main pain categories: gastrointestinal, musculoskeletal, nerve, headache, and other/ non-specified pain. There were several particularly notable findings:
- Sessions involving flower resulted in similar levels of pain relief as those who used topicals and concentrates.
- Sessions involving tinctures, edibles, and pills resulted in less pain relief as compared to those who used flower
- Sativa strains were associated with less pain relief than hybrid strains
- Pain relief did not vary with combustion method
- When other product characteristics are not controlled for, THC and CBD levels are not significant predictors of pain relief
- However, when other product characteristics are controlled for, THC levels are the strongest independent predictor of greater pain relief, whereas CBD levels were usually associated with lower levels of pain relief
- THC and CBD affect pain relief differently throughout the 5 different pain categories
Clinically Significance Implications
The findings presented by this study suggest that cannabis can be used as an effective form of pain management in those who suffer from chronic pain. The degree of pain relief and side effects experienced per individual user are variable and shown to have correlation with the particular characteristics of the product used.
Prescription and non-prescription opioids are used by an increasing number of Americans for pain management. Opioid medications have saturated the healthcare system to the point where, regardless of physician intention or motivation to prescribe opioids (an entire discussion in itself), the more pertinent issue remains being that of patient quality of life (QOL). When thinking about patient QOL in particular relation to pharmaceutical/ chemical management for chronic pain, there are many metrics that can be used to assess whatever medication is being prescribed in regards to its effect on patient QOL. For the purposes of evaluating the significance of this study, it is important to look at the two most relevant metrics of patient QOL in the context of medication administration: the efficacy of the medication and the side-effects of the medication.
In the context of evaluating the degree of pain relief in patients taking opioids vs those consuming cannabis, the current finding suggests that those consuming cannabis, in particular with higher levels of THC, experience significant improvement in short-term pain reduction. Because there is no data in this study to compare the levels of pain relief reported by those who use opioids, we can further compare the two medications based on their side-effect profile.
There are certainly drawbacks to the consumption of cannabis, namely psychological addiction potential, motor vehicle impairment, short-term memory loss, and experiencing any number of uncomfortable effects during an actual session (paranoia, anxiety, mild remitting psychosis etc.) However, these adverse effects arguably pale in comparison to those experienced in opioid users who are using their medication for extended periods of time in order to manage chronic conditions.
Limitations and Drawbacks
Although this study was a strong leap forward in terms of striving to achieve a comprehensive and thorough evaluation of cannabis consumption in those seeking pain relief, it was not without its limitations.
Given that this study relied on data reported by patients using a mobile app, there is strong potential that exists for inaccurate and insufficient data reporting. Problems in data reporting can result in bias which can ultimately skew the final study results.
In addition, there was an absence of a comparison group in this study, which could either over or under-estimate the efficacy of cannabis. A comparison group can put data recorded from any study in to proper “perspective” and without this, the data is subject to being potentially unreliable.
Finally, there was a deficit of potentially important data that was not included in this study, notably:
- The use of other pain medications during cannabis sessions (this is arguably the most significant absence of data within this study, as other medications used concurrently while consuming cannabis can lead to a tainted user experience, therefore leading to inaccurate data reporting)
- The ability to verify the user data inputted
- Detailed patient demographic characteristics
- Cannabis use by patients prior to using the app
Information such as this, if included, could have increased the validity of this study.
I would like to see a future in which Americans have access to an array of highly effective options to manage chronic pain conditions. Although this study is certainly not without its limitations, it is among the first big steps forward to charting that future. Further studies will be needed in order to continuously build a stronger foundation of knowledge that we can then use to help those in our nation who deserve the ability to manage their pain in a way that is most conducive towards improvement of their overall QOL.
(Li, Xiaoxue, et al. “The Effectiveness of Self-Directed Medical Cannabis Treatment for Pain.” Complementary Therapies in Medicine, vol. 46, 1 Oct. 2019, pp. 123–130., doi:10.1016/j.ctim.2019.07.022.)1