Cancer Pain
Pain relief has historically been the most common condition to be treated with cannabis, from headaches to childbirth (Grotenhermen, 2004). Over the years, we have learned more about cannabis’ pain relieving effects, and the mechanisms of action, along with user’s preferences to use cannabis over traditional pain medications. In two recent studies from 2013 and 2014, 87 and 94 percent of medical marijuana card holders, respectively, indicated that they used medical cannabis for “pain” or “severe pain” (Ilgen et al., 2013; Light, Orens, Lewandowski, & Pickton, 2014). This is an overwhelming majority, and a good indication that cannabis is an effective pain reliever for a wide variety of users. Although opioid medications have been historically used to treat acute pain and help relieve chronic pain for some patients, their addiction risk presents a dilemma for healthcare providers. The Department of Health & Human Services has declared that we are in the midst of an opioid overdose epidemic. The need for non-addictive pain relieving treatments is becoming of more importance.
Check out this interesting account of the opioid epidemic from Nora Volkow M.D. at the NIH, and her thoughts on creating initiatives to identify new pain relievers with reduced incidence of abuse, tolerance, and dependence risk. Current treatments for pain are largely pharmaceutical (hydrocodone, tramadol, Percocet, morphine, etc.). Despite the differences in their mechanism of action, their effects, lack of tolerability and addictive qualities appear to be similar. Phytocannabinoids, including CBD, have been shown to be a robust treatment for an array of chronic pain disorders, including cancer-related pain, with minimal and tolerable side effects. Contrary to the addictive effects of traditional pain medications, CBD has been proposed to possibly attenuate opiate use (Boehnke, Litinas, & Clauw, 2016), while aiding in pain relief and increasing quality of life.
A recent randomized controlled trial in cancer patients suffering from inadequate pain control with traditional opioid therapy compared a CBD/THC nasal spray to both pure THC, as well as placebo in 177 patients. Their results found that patients receiving the CBD/THC nasal spray showed a pain score reduction of more than 30%, while THC did not show a significant change over placebo (Johnson et al., 2010). Another study involving 263 patients using the same nasal spray showed that CBD significantly reduced daily pain from baseline to end of study, with patients reporting superior pain relief (Portenoy et al., 2012). An additional study on 125 patients with treatment-resistant neuropathic pain demonstrated a significant reduction in pain scores after while taking CBD/THC (Nurmikko et al., 2007).
Check out this recent user’s guide to cannabinoid therapies in oncology.
Boehnke, K. F., Litinas, E., & Clauw, D. J. (2016). Medical cannabis associated with decreased opiate medication use in retrospective cross-sectional survey of chronic pain patients. The Journal of Pain, 17(6), 1–6. https://doi.org/10.1016/j.jpain.2016.03.002
Grotenhermen, F. (2004). Pharmacology of cannabinoids. Neuroendocrinology Letters, 25(1–2), 14–23. https://doi.org/NEL251204R01 [pii]
Ilgen, M. A., Bohnert, K., Kleinberg, F., Jannausch, M., Bohnert, A. S. B., Walton, M., & Blow, F. C. (2013). ARTICLE IN PRESS Characteristics of adults seeking medical marijuana certification. Drug Alcohol Depend. https://doi.org/10.1016/j.drugalcdep.2013.04.019
Johnson, J. R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E. D., Potts, R., & Fallon, M. T. (2010). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. Journal of Pain and Symptom Management, 39(2), 167–179. https://doi.org/10.1016/j.jpainsymman.2009.06.008
Light, M. K., Orens, A., Lewandowski, B., & Pickton, T. (2014). Market size and demand. Report prepared for the Colorado Department of Revenue. Retrieved from https://www.google.es/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCAQFjAA&url=http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheadername1=Content-Disposition&blobheadername2=Content-Type&blobheadervalue1=inline;+filename=%22
Nurmikko, T. J., Serpell, M. G., Hoggart, B., Toomey, P. J., Morlion, B. J., & Haines, D. (2007). Sativex successfully treats neuropathic pain characterised by allodynia: A randomised, double-blind, placebo-controlled clinical trial. Pain, 133(1–3), 210–220. https://doi.org/10.1016/j.pain.2007.08.028
Portenoy, R. K., Ganae-Motan, E. D., Allende, S., Yanagihara, R., Shaiova, L., Weinstein, S., … Fallon, M. T. (2012). Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: A randomized, placebo-controlled, graded-dose trial. Journal of Pain, 13(5), 438–449. https://doi.org/10.1016/j.jpain.2012.01.003
Cannabinoid Buccal Spray for Chronic Neuropathic Pain: A Review of Clinical Effectiveness, Safety, and Guidelines [Internet]. 2016
Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy. 2015
Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). 2015
Do cannabinoids have a role in cancer pain management? 2009