The Biology of Cannabis vs. Opioids for Pain Relief
Pain results from the coordinated activation of brain cells.
While these brain regions lead to the sensation of pain, they can also modulate the strength of the pain signals. In some instances, you can have a physical injury (i.e., nociceptive pain) without the sensation of pain (imagine a car accident victim who can walk around pain-free in the initial moments after the accident).
The opposite is also possible, where you can have pain in the absence of physical injury (i.e., central pain). This highlights the importance that factors like mood, context, and attention-to-injury play in the sensation of pain, which can also be used to inform optimal cannabis-based treatment strategies.
Cannabis and Nociceptive Pain
Nociceptive pain (i.e., inflammatory pain) results from tissue damage. It is subjectively described as sharp, aching, or throbbing pain that follows physical damage.
When you get injured, the damaged tissues recruit numerous inflammatory and immune cells to repair the damage. These cells release proteins and chemicals that activate receptors on nerves that make their way into the spinal cord and up to the brain, causing the sensation of pain.
To retain pain-relieving efficacy while reducing tolerance risk, one should consider balanced THC and CBD products for long-term pain treatment. Nociceptive pain can be weakened by reducing the pain signals at the site of injury by blocking the inflammatory process itself or the signals they elicit.
Another strategy is to dampen their effects as they make their way up the spinal cord to the brain. Cannabis can target both of these processes to reduce pain.
The abundant cannabinoids, THC and, CBD can reduce pain at the site of injury.
Both have potent anti-inflammatory effects. THC’s anti-inflammatory properties are primarily driven through activation of CB2 receptors on immune cells which dampens the body’s pain-inducing response to injury.
CBD also reduces inflammation by blocking inflammitory mediators and shifting the activated macrophage repair cells from the pro-inflammatory type to the anti-inflammatory type.
Indeed, the benefits of THC and CBD for relieving nociceptive pain have been well-documented in rodent models of inflammation and in human clinical trials. Cannabis is known to relieve pain, but pain can arise for a variety of reasons which makes choosing the right cannabis product tricky.
Knowing which cannabinoids (e.g. THC, CBD) have been shown to treat different pain types is useful information. The different types of pain fall into three general categories
- Nociceptive Pain
- Neuropathic Pain
- Central Pain (there’s no firm agreement on the name for this type of pain; Fibromyalgia is a common example).
Since each type of pain has a different origin, each type has an optimal treatment strategy. Now, let’s turn our attention to recent research studies regarding cannabis and the cannabinoids CBD and THC vs opioids in the treatment of pain.
Research Shows That Cannabis is Better for Pain than Opioids
Israeli researchers found marijuana gave substantial pain relief to more than half of 1,200 cancer patients who used it for 6 months.
In a review of 16 published studies including more than 1,700 participants with chronic nerve pain, German researchers found that marijuana-based remedies increased the number of people who reported a 50% or more reduction in pain relief.
But they also concluded that the risks may outweigh the benefits. People taking marijuana-based remedies were more likely to have sleepiness, dizziness, and confusion.
In a small study of 47 patients with Parkinson’s disease, Israeli researchers found a 27% improvement in pain with marijuana use. Medical marijuana helped to ease the pain in 26 patients with fibromyalgia, a condition in which the body has ”tender” points. Half the patients stopped taking any other medicines for fibromyalgia, but 30% did have mild side effects.
A study from the European Academy of Neurology found that cannabinoids given at various doses eased pain experienced migraine patients by 40% or more. CBD helped cut pain in people with cluster headaches, too, but only if the patient had a history of childhood migraines.
Marijuana and cannabinoids may have modest effects on the pain and muscle spasticity that come with multiple sclerosis, according to an Australian review that looked at 32 studies.
Will Cannabis Replace Pharmaceutical Opioids As a Safer Pain Killer?
Some research suggests that marijuana could take the place of opioids. Two recent studies found that states with medical marijuana laws or legalized recreational use may have a decline in opioid prescriptions.
In another study, researchers polled nearly 3,000 medical marijuana patients, including about a third who said they had used opioid pain medicines in the past 6 months. Most said the marijuana provided relief equal to their other medications, but without the side effects.
While 97% said they were able to lower the amount of opioids they took if they also took marijuana, 81% said that taking marijuana alone was more effective than using both marijuana and opioids.