Chronic pain is common as well as distressing and it is also linked significantly to patients’ quality of life and wellbeing. Additionally, this impacts the patient’s socioeconomic burden and potentially puts a burden on their families, and society at large. Chronic pain is that which persists or recurs for over three months. Statistically, it is more common among elderly persons, women, indigenous populations, veterans, and socioeconomically disadvantaged people. Finding a treatment solution to manage and live with the pain is often a bit of trial and error.
In the last few years since the government has legalised Medicinal Cannabis there are many patients with chronic pain who opt to use medicinal cannabis as an alternative as they continue to search for the most appropriate therapeutical way to treat the condition and have reported successful outcomes. Besides, medical cannabis has gained popularity over the past years in the management of chronic pain, especially through the jurisdictions that have led to policies to minimize the use of opioids to manage the pain.
The increased legalization of cannabis across the globe has escalated the use of medical cannabis by patients with chronic pain. Insufficient training on the application of medical cannabis, inconsistent guidance from relevant professionals and federal agencies, and escalated use of the substance by the patients have confused the understanding of the role of medicinal cannabis in people with chronic pain. Cannabinoids are said to affect chronic pain through various pathways such as the endocannabinoid system. Moreover, the system contains receptors within the central nervous, immune, periphery, and hematologic systems.
It is worth noting that cannabis contains more than a hundred cannabinoids, two of which are the most popular; delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The THC leads to inhibition of glutamate while 5-hydroxytryptamine is released, thus increasing dopamine secretion. On the other hand, CBD promotes the signaling of adenosine receptors, reduction of reactive oxygen species, T cell proliferation, and tumor necrosis factor, while the psychoactive effects caused by THC are not involved. The anti-inflammatory and multifaceted analgesic properties exhibited by the cannabinoids may lead to a positive effect on the patients’ perception of pain across various conditions.
There are still concerns as to whether the use of medical marijuana is an appropriate alternative in the management of chronic pain. Evidence from various clinical trials proves the therapeutical importance of cannabis, especially THC and other cannabinoids in the reduction of chronic pain. Some of the secondary results of increased use of Medicinal Cannabis has been the rapid reduction in the prescription of opioids and antidepressants. Moreover, there was data released by the US government to show that the prescription of medicinal cannabis may assist in preventing deaths that are associated with opioid addiction.
Various clinical investigations show that medicinal cannabis is effective in the management of chronic pain. Furthermore, it is employed in the treatment of pain especially due to its action on the CB1 and CB2 receptors. The CB1 receptors are usually at very high levels in various brain regions where they mediate many psychoactive effects of cannabinoids. Their major importance is to manage the release of various neurotransmitters like dopamine, glutamate, and serotonin. On the other hand, the CB2 receptors are more restricted where they are found in several immune cells and neurons. Their activation suppresses the central neuroinflammation, reactive behavior of microglia, and leads to the protection of neuroinflammatory conditions. Therefore, clinical research supports the use of medical cannabis to relieve various types of chronic pain, that include neuropathic pain and spasticity that is linked with various sclerosis.
Chronic relief is the major reason that is cited by patients under the medicinal cannabis treatment. Besides, its use continues to rise and it is therefore important for pharmacists to be aware of both the pros and cons of cannabis. Moreover, it is significant to put into consideration that the majority of clinical cannabis products especially the products that affect the CB1 and CB2 receptors are related to increased psychoactive behavior and cognitive dysfunctions. Therefore, chronic pain patients must be advised on the cautious use of cannabis products by their primary health providers.