Cannabis as an Effective Pain Reliever: Uwe Blesching’s Evidence-Based Response to the Opioid Crisis
Part 1 in an ongoing series on the benefits of medical marijuana by Uwe Blesching, Ph.D.
Did you know that effective pain relief actually reduces healing times of damaged tissues?
There is a reason we find ourselves so focused on pain. Ancient evolutionary forces have hard-wired us to respond very quickly to the experience of pain, because effective pain control is imperative for our survival and well-being.
But selecting the right method of pain relief can be daunting, given the range of products out there. This article, the first in a series, contrasts two common avenues to pain relief:
The use of opioids
The use of cannabis or cannabis-containing products
The choice of pain reliever that will work best for you, depends on what specific kind of pain you are dealing with.
Naturally, effective treatment is only possible after first determining the pain’s underlying pathology, that is, the specific mechanisms involved in creating it.
For example, there is a difference between inflammation vs acute pain or trauma.
With inflammation, the elements that cause inflammatory pains such as a microbial infection or a minor trauma (with the hallmark symptoms of heat, swelling, and redness) are going to be different from those of nociceptive pain (acute pain or trauma), where pain is caused by a noxious stimulus (e.g. stepping on a thumb tack) that once removed relatively quickly calms the pain.
So, before we are able to answer the question of which form of pain relief will be right for you, let’s break down pain, in general, into specific types of pain.
What Does the Evidence Tell us About The Benefits of Medical Marijuana for Pain Relief?
When I wrote my book Breaking the Cycle of Opioid Addiction: Supplement Your Pain Management with Cannabis. I had the opportunity to review the relevant scientific literature that together produce the scientific basis for making an informed and discerning decision about which type of analgesic (pain reliever) is best suited in the treatment of a particular pain.
To find out what pain-relief mechanism is optimal for specific types of pain, I first had to collect, categorize, and distinguish the research data according to whether opioids or cannabinoids (compounds found in cannabis) were studied; and second I separated the data by type of pain.
In other words, there are different data pools with differing results for inflammatory pain when compared to noxious pain (also known as nociceptive pain).
There are eight basic pains commonly mentioned in the literature that are not specifically married to a particular condition (cancer pain is an example of a particular condition’s pain).
Researchers often assign grades for effectiveness when trying to understand and determine what analgesic works best for a specific pain with five potential grades:
Two very important things stood out early on in my research when I looked at the data.
When I focused on finding patterns and specific information relevant for all the different patient populations that could benefit from it, here’s what stood out:
The only place where opioids get a high grade is in the context of treating acute pains, that is, pains that are usually self-correcting over a period of days or a couple of weeks (e.g. burns, cuts, surgery wounds).
Cannabis ranked higher in all other types of pains when compared to the use of opioids.
Now let’s discuss addiction risks: Opioids vs cannabis
As my research progressed, other significant insights arose.
Opioids act very differently in the body than cannabinoids in a number of ways.
Most modern pharmaceutical opioids tend to be a single-molecule compound that creates the analgesic effects by intensely targeting a very few G-protein-coupled receptor sites—i.e., mu (μ), delta (δ), and kappa (κ)].
These sites tend to be concentrated in the central nervous system, where they affect cognition and mood, and in the gastrointestinal tract.
This fairly narrow and focused impact of opioids is responsible for their effectiveness in the treatment of acute pains.
However, opioids are also responsible for the high addiction potential, high risk of adverse effects including overdoses, and of course overdose-elated fatalities.
In contrast, complete cannabis (full-spectrum plant material) is a polypharmacological gift of nature that interacts with a much more complex network of receptor sites in the human body (the Endocannabinoid System) than that employed by opioids.
This complex physiological network of receptor sites is likely the reason why medical marijuana is so much safer than opioids, and why cannabis and cannabinoids work so well for all types of pain with the exception of acute pain.
How exactly does the endocannabinoid system work?
Endocannabinoids = those made by the human body; endo- meaning “within.”
This graphic shows all of the currently known receptor sites or mechanisms by which the key cannabinoids (THC, CBD), endocannabinoids (e.g. anandamide, produced within the human body), and a couple of other plant-based compounds (e.g. echinacea, beta-caryophyllene) bind with endocannabinoid receptor sites to produce analgesic effects.
As we can see, the endocannabinoid system is a comprehensive physiological system.
So let’s break down some of the pathways and mechanisms of the endocannabinoid system.
CB1 and CB2 cannabinoid receptors
Cannabis-based analgesia is realized not just through the classical endocannabinoid receptors CB1 and CB2 (the first ones discovered and also the most active) but also via other G-protein- coupled receptor sites (GPR’s) (i.e., 3, 18, 55).
PPAR’s (pronounced peepars) and TRP channels (pronounced trips)
Additional analgesia-producing pathways are produced via nuclear receptor proteins called peroxisome proliferator-activated receptors or for short, PPAR’s (pronounced peepars); via ionic cannabinoid receptors aka transient receptor potential (TRP) channels (pronounced trips); via activation of various neurotransmitters activation through (+ or -) allosteric mechanisms.
Finally, there are enzymatic pathways of endocannabinoid degradation that increase the bioavailability of anandamide, the human body’s own endocannabinoid possessing analgesic and even euphoric properties (think runner’s high, or Rocky Mountain high).
The synergistic qualities of other herbs on the endocannabinoid system
Echinacea, for example, is another overlooked pain reliever.
You may notice in the Endocannabinoid System Diagram: that I included echinacea, a non-cannabinoid herb with pain-relief benefits. It binds with CB2 at about half the strength of THC at the same receptor site.
Supplementing with echinacea (available as a tincture) to treat inflammatory pain especially may be an additional and relatively inexpensive synergistic option to support your endocannabinoid system.
The option to benefit from medical marijuana without getting high is important
Many cannabis users still associate the substance with getting high.
Here are two very important reasons why having the option to benefit from cannabis without getting high so important.
Children with conditions such as epilepsy can benefit from cannabis as medicine for preventing seizures, and this group needs to avoid psychotropic effects for obvious reasons—they are children.
At the other end of life, seniors represent one of the largest group of patients new to medical marijuana, and one of the most common reasons seniors visit the doctor’s office is for the treatment of various types of pain.
And pain is never just a purely physical sensation. It always has a psychological (mind-body) component to it, which can, in fact, be harnessed to produce the most effective cannabinoid-based analgesia possible.
Consider this: studies have shown that when people are fearful, their pain threshold goes down; in other words, their sensitivity to pain increases.
The opposite is true for when people feel safe and secure—their pain threshold goes up and their sensitivity to pain decreases.
Sadly, many members of older generations have been misinformed by the narrative accompanying the war on drugs.
More often than not they come to the doctor’s office with a mental architecture filled with fear and worries about the “evil weed from Mexico.”
However, once seniors learn that they have some agency over what kind of cannabis experience they wish to have, any previous concerns about using cannabis or cannabis-containing products can be reduced.
With this agency or choice, older patients are empowered and practically supported, which in turn counters any anxiety and as such will fortify effective analgesia.
Now let us look at what type of cannabis can contribute to effective pain relief (for virtually all types of pain) without changes in cognition or getting “high.”
The future of medical marijuana will move beyond strains and towards a chemotype-based classification system
The type of cannabis I am referring to here has nothing to do with the common industry distinction of sativa and indica (different cannabis species’ Latin names) to which assumed medicinal properties are attributed in generalized claims that are not evidence-based, and which are subject to change between grow cycles.
Such descriptions as “sativas get you high and indicas relax and slow you down” are woefully unreliable and imprecise.
Two people can use the same identical seeds or clones to grow a specific cannabis species—but even subtle differences in their growing environments can significantly change the chemical composition of all plant constituents.
Environmental (epigenetic) signals such as temperature, nutrition, and quality of light will initiate specific changes in genetic expressions without changing the plant’s genome or DNA.
As such, even though the two cannabis species are genetically identical, the therapeutic (or adverse) effects they engender could be as different as mixing up a Zoloft with a Vicodin.
Furthermore, none of the assumed qualities are evidence-based, making any success you may have had a good guess at best, further complicating consistently repeatable results. (The ability to repeat results is a hallmark of effective therapy.)
Using the old sativa vs. indica system may still have value in the general context of breeding cannabis strains or as a means to discuss terpene profiles, for example, but solely relying on the cannabis strain (indica or sativa) in a medical context is not enough.
It is nearly impossible to use the abundance of available scientific literature to align the sativa/indica distinctions with the specific patient’s health needs.
This is because a patient’s health needs require a specific set of prime cannabinoids (tetrahydrocannabinol (THC) and cannabidiol (CBD) in as precise a ratio as possible to actually treat the patient’s health issue.
What is a chemotype-based classification system?
Chemotype-based classification system is an updated, newer, scientifically informed system that is becoming increasingly accessible and useful.
This classification system addresses all the shortcomings of the old indica vs sativa classification system.
The last four decades of research have discovered that there are three basic numbers in any type of cannabis plant which form the keys to predicting specific therapeutic effects for the treatment of pain (although these values are not the only variables).
These key numbers for predicting specific therapeutic effects of cannabis in the treatment of pain are:
1) The amount of the primary psychoactive cannabis constituent THC
2) The amount of the non-psychoactive cannabis constituent CBD
3) The ratio of THC to CBD. It is these three factors, as expressed by two percentages and a ratio, that allow us to discern three basic types of cannabis.
Here’s a detail of how a chemotype-based classification system works.
A chemotype I strain contains more THC than CBD.
A chemotype II contains relatively equal amounts of THC and CBD.
A chemotype III contains more CBD than THC.
Understanding cannabis chemotypes facilitates an evidence-based approach to prescribing cannabis that in turn will produce consistent and precise effects sought after by so many different patient populations, especially those with chronic conditions for which there is no cure within orthodox medicine.
Choosing the Right form of Pain Relief
So now, let’s go back and answer the question about which type of cannabis can produce effective non-psychoactive cannabis based pain relief without changes in cognition.
A cannabis chemotype III such as Cannatonic (0.8%THC:~21%CBD) or Charlotte’s Web (0.5%THC:17%CBD) can provide effective analgesia without the “high,” all the while giving the patient a choice over the kind of cannabis experience desired.
This gives patients the opportunity to choose the cognitive effects they experience when using medical marijuana.
This new choice can undo much of the damage done by decades of negative belief-building by anti-cannabis propaganda and the war on drugs’ misinformation campaign that still keep a great number of patients from what otherwise could be an effective pain reliever.
Now, look back to the Endocannabinoid System Diagram above.
You can also see the specific pathways or mechanisms by which a cannabis chemotype III produces effective pain relief, and you can see what happens when you cross out all the blue dots representing THC.
What you will notice is that all pain-reducing mechanisms are still in place, with the exception of GPR18.
As such, the vast majority of the known and complex mechanism by which cannabis produces pain relief is still at work and ready to be employed.
Summary of the top 5 evidence-based reasons why cannabis is an effective Pain Reliever as compared to opioids
The scientific literature to-date suggests that opioids work great in reducing acute pains, and their efficacy is largely limited to this type of short-term use.
Cannabis- assisted analgesia gets higher performance grades than opioids in the setting of alleviating chronic, central, peripheral, inflammatory, noxious, pathological, and mental-emotional pains.
Taking agency in terms of what kind of cannabis experience you wish to have is a reassuring and self-empowering act that in and of itself can contribute to effective analgesia.
Patients can achieve effective analgesia without getting high by understanding and using cannabis chemotypes.
A chemotype III can produce effective analgesia by employing the G-protein- coupled -receptor sites CB1, CB2, GPR3, and GPR55; by engaging PPAR and TRP receptor sites; by (+/-) allosteric (indirect) neurotransmitter modulation; and finally by blocking the enzyme (FAAH) that breaks down the pain-relieving endogenous cannabinoid anandamide—all of which can contribute to the relief of pain.
This article is based on research conducted by Uwe Blesching for his book Breaking the Cycle of Opioid Addiction: Supplement Your Pain Management with Cannabis. If you are interested in more specific details or the scientific basis for the topics discussed in this article, his book provides in-depth and extensively annotated information.
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