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How To Use Cannabis To Manage Chronic Pain

Table of contents
  1. Introduction
  2. Cannabis As A Medicine For Pain
  3. Using Medical Marijuana To Treat Headaches and Migraine Pain
  4. Is there a cannabinoid-terpenoid profile and method of ingestion that is “best” for headaches and migraines?
  5. Using Medical Marijuana To Treat Back & Neuropathic Pain
  6. Using Cannabis to Treat Muscle Pain
  7. How To Replace Your Opiate Medication With Cannabis
  8. Cannabis Strains That Can Help Replace Opiates & Opioids
  9. Cannabis, Pain and Insomnia – What’s the Relationship?
  10. Find Out More

Introduction

“Pain” is more complex than we give it credit for. When Dame Cicely Saunders introduced the concept of “total pain”, which includes physical, emotional, social and spiritual distress, she helped foster a revolution in medical professionals’ idea of what pain constitutes. They began to understand that there are many different kinds of pain, and they all often feed into one another. Physical, chronic pain is worsened by mental pain, anxiety and depression, with the feeling that one will never get better can itself create physical pain. Total pain also asks us the all-important question:

“What is the actual source of pain, and what is the best way to treat it?”

Dame Cicely Saunders
Dame Cicely Saunders, who came up with the concept of total pain. https://commons.wikimedia.org/wiki/File:EWS21.13.jpg

Pain requires a variety of different treatment methods. Yes, it’s important to treat the physical source of pain, but it is just as important to also treat the depression and anxiety that accompanies the everyday grind of having to face physical pain. Many people who suffer from chronic pain are  prescribed a cocktail of different drugs, depending upon the severity of their pain, including analgesics (e.g. tylenol), non-steroidal anti-inflammatory drugs (NSAIDs e.g. ibuprofen), beta blockers, steroids, benzodiazepines, antidepressants and opioids.

Whilst some of these medications have their potential uses, they all have one big problem: they can all cause overdose, and they often work in conjunction with one another. For example, even everyday analgesics such as tylenol can increase the strength of opioids. Moreover, having to take a cocktail of pills everyday can be psychologically as well as physically tiring.

Opioids are effective at beating physical pain, but they are dangerously addictive and come with a whole host of other unpleasant side-effects (i.e. mental pain). Benzodiazepines are also often used for chronic pain, despite a lack of evidence for their efficacy for it and the potential for negative reactions with opioids. This asks another important question:

“Are we effectively treating pain if we’re just replacing one type of pain with another?”

We need a safe and effective alternative in the field of healthcare, and in cannabis we may just well have it.

Cannabis As A Medicine For Pain

This is where cannabinoid-based medications can come into play. Due to the entourage effect and the variety of cannabinoids available in the cannabis plant, many different types of pain can be treated in one simple and safe medicine. Why take a whole host of pills, all designed for different purposes and all telling your body to do different things, when you can use one medication that covers them all? This is one very good reason why cannabis seems so popular for chronic pain amongst patients withall sorts of conditions.

Here are a few examples of the types of pain cannabis and cannabinoids may help beat …

Cannabis on left, white pills on right. Cannabis could help replace addictive painkillers.
A single marijuana flower bud positioned to the left side of several white prescription pills. They are studio shot on a white background with a macro lens.

Using Medical Marijuana To Treat Headaches and Migraine Pain

Headaches and migraine are complex conditions, perhaps mostly due to the fact that no one really knows where they come from. There are thought to be a variety of causes, including:

  • Inflammation
  • Irritation of blood vessels
  • Head injuries
  • Infection
  • Tumors
  • Stress
  • Allergic reactions
  • Dehydration
  • An increase in intracranial pressure
  • Sleep deprivation
  • Gastrointestinal disorders
  • An underlying neurological condition
  • Overuse of medication
  • Sensitivity to external stimuli

There may be many more besides, but the precise mechanisms of how they are all caused is not known.

Due to the huge number of conditions that can cause headaches, treatment varies widely. Often, headaches are separated into “primary” (not dangerous, but can be benign, including migraine) and “secondary” (potentially dangerous, and may be caused by a life-threatening or debilitating condition). Whether there is a common cause of all types of headache is not known, but one theory is that headaches could be caused by a deficiency of serotonin. Overactivation of the trigeminovascular pathway is also implicated in headaches of all types.

Whilst there is little clinical evidence in the use of cannabis for headaches and migraines, there are many positive anecdotal and preliminary results, as well as neurobiological mechanisms, that suggest cannabinoids could be of use for the treatment of migraine and headaches. Some of these neurobiological mechanisms include:

  • Vasodilatory effects of THC, allowing more oxygen to get into the brain. THC also lowers blood pressure. Alpha-pinene, a terpene found in cannabis, also has bronchodilatory properties.
  • Downregulation of cytokine production and inflammation by both THC and CBD.
  • Increasing serotonin production via attenuation of the serotonin receptors.
  • Some people have reported an increase in headaches after cannabis use, and some people also report “rebound headaches” after cessation of cannabis use. Smoking may also induce headaches in some, and there have also been reports that edibles are less effective. Headaches/migraines may be best treated with a mixture of both CBD and THC.

Is there a cannabinoid-terpenoid profile and method of ingestion that is “best” for headaches and migraines?

As with so many other health problems, the best treatment for headaches depends upon where the headache is arising from.Assuming no benzodiazepine-based medications are being used at the same time, starting with a tincture containing a high CBD ratio (e.g. 20:1) may be helpful, and then work down from there (e.g. 18:1, 9:1, 3:1, 1:1) to see which works best for you.

Migraine; headache; cannabis for headaches; cannabis for migraine; cannabinoids; medical marijuana; medical condition; serotonin.
Migraine/headache.

Vaporizing may help for immediate effects when sudden headaches appear, but be careful of substances such as glycol in the extract you are using.

As for whether there are any specific strains that are useful for headaches and migraines, this is difficult to say. In our study, most patients preferred indicas, but this is not to say sativas and hybrids were not used as well. Trying some indica strains high in CBD may be helpful, but this is not to say sativas and hybrids are not useful.

How Do I Use Medical Marijuana for Back Pain or Neuropathic Pain?

Much of the advice given above regarding which cannabinoid-terpenoid profile and strains to use for headaches and migraines applies here to back pain, too. I.e., start off with a tincture high CBD to THC ratio (e.g. 20:1, 18:1), and then if that does not work, try a tincture with a different ratio (e.g. 9:1, 3:1, 1:1), ideally working down in stages. You may also find that you prefer different ratios for different times of day.
ore THC in it. See what works best for you personally, as different people respond differently to different issues.

Also, as pain of all types tends to affect sleep, terpenes such as myrcene and linalool and THC may be more helpful in getting to bed than looking at CBD alone. Indeed, high CBD may keep some people awake! Beta-caryophyllene also has many painkilling properties.

Yet, there are some different treatment methods when it comes to back pain. Topicals and transdermals could be of use to treat localized nerve pain associated with back pain, alongside tinctures. CBDA is also a COX-1 and COX-2 enzyme inhibitor, and THCA, CBG and CBGA also have significant anti-inflammatory effects, meaning they could be of immense use for all kinds of inflammatory pain, including headaches/migraines. CBD may also enhance healing in fractures.

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When it comes to spinal injuries, as well as neuropathic pain (nerve pain), indicas were overwhelmingly preferred by patients in our study. CBD was also much sought-after. Both anandamide and 2-AG  are produced by injured tissue in order to suppress sensitization and inflammation. THC, which mimics anandamide, will likely also control inflammation via activation of the CB1 receptor.

CBD, meanwhile, binds to TRPV1, which controls pain perception, as well as raising endocannabinoid levels in the brain’s synapses. CBD, despite having little affinity for CB1 and CB2 receptors, seems to control the levels of cannabinoids available overall. To what extent this is so, it is not known, but it certainly gives CBD a very unique pharmacology.

Acidic cannabinoids, as well as THC, CBD and beta-caryophyllene, could be of huge use for back pain. Linalool, myrcene, humulene, limonene, alpha-pinene and beta-pinene are terpenes that may be useful for their painkilling properties. A mixture of cannabinoids and terpenoids may be best for neuropathic pain.

How Do I Use Medical Cannabis to Treat Muscle Pain?

Many of those suffering from neurological conditions are likely to suffer from muscle pain as well, due to all the cramps and spasms that are often associated with such conditions. Athletes and those who are generally active are also likely to be prone to muscle pain and injuries, so a way of relaxing the muscles to ease aches and pain safely and without the use of harsh pharmaceuticals is important. Terpenoids such as linalool, which is found in jasmine and is often used in massage and bath oils, can help aide relaxation. There is some suggestion that CBD may reduce the amount of spasticity a person feels, and there is much evidence that CBD does seem to act as both an anticonvulsant and antispasmodic. THC, too, seems to help prevent spasms and therefore cramping.

How Do I Replace Opiate- or Opioid- Based Medications With Cannabis?

As cannabis can have negative interactions with many kinds of opiates and opioids, decreasing the amount of opiate-based medications taken over the course of the day will be necessary. Sadly, for many, this also means withdrawal symptoms arising from opiate addiction. Fortunately, cannabis can provide a crutch to some extent, beating cravings whilst also being a painkiller and/or distractor. THC and THCA could be of use for withdrawal,

but other cannabinoids and terpenoids also help due to their painkilling and anti-addictive properties as well.

Beta-caryophyllene chemical structure; CB2 agonist; cannabinoid-terpenoid; black pepper.
Beta-caryophyllene – a cannabinoid with painkilling and anti-addictive properties.

CBD and THC are also allosteric modulators at the mu- and delta-opioid receptors, although to what extent this is the case in humans still needs to be seen. This does, however, lend credence to the idea of cannabis as an “exit” away from opioids, as cannabinoids can be used to affect opioid receptors without the need to use opiates. Cannabinoid receptors seem to “cross link” and “talk” to one another, so cannabis may somehow tell the opioid receptors to “quieten down”!

Due to their synergistic reaction, slowly tapering off of opioids and using small doses of high-THC cannabis may be necessary.

Other treatment methods may also need to be utilized, such as lifestyle changes, counselling and naloxone, but any treatment method that avoids the use of other opioids and benzodiazepines may be ideal in order to truly beat opiate addiction. Cannabis provides a far safer crutch than many of the drugs currently administered for the treatment of opioid misuse.

Cannabis Strains That Can Help Replace Opiates & Opioids

Whether there’s any particular strain or cannabinoid-terpenoid profile that is particularly useful for opioid addiction is, once again, difficult to say. High amounts of THC may help in the initial stages of opioid withdrawal, and then slowly lowering the amount of THC as cravings subside. Beta-caryophyllene, myrcene and humulene may also help. Edibles, tinctures and concentrates may

be ideal for opioid withdrawal. Strains such as Gorilla Glue, White Rhino/Medicine Man, Super Silver Haze and Strawberry Cough may be useful, but the name alone does not necessarily tell you which strain has a high concentration of THC and other cannabinoids and terpenes – only testing can do this.

Is There a “Best” Weed for Headaches and Different Kinds of Pain?

Not necessarily, as what works well for one person may work differently for someone else. However, there are patterns of sorts. For inflammation, neuropathic pain and headaches, CBD and beta-caryophyllene may be quite effective. For chronic pain where opioids may otherwise be prescribed, as well as pain associated with treatments like chemotherapy, some more THC may be appropriate to help distract from the pain. THC also increases the appetite, which can be helpful if a patient isn’t eating properly. Other cannabinoids and terpenes also contribute to cannabis’ anti-inflammatory and painkilling properties, so isolates may not be as useful as more balanced cannabinoid-terpene profiles.

Insomnia - list of complications
Häggström, Mikael (2014). “Medical gallery of Mikael Häggström 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain.

Cannabis, Pain and Insomnia – What’s the Relationship?

There is a link between pain and insomnia, and most chronic pain patient report having sleep troubles. Moreover, a lack of sleep can increase the likelihood of infection and the chances of getting ill, cause inflammation, cause headaches & migraine, and increase joint & nerve pain. Fibromyalgia and migraine sufferers may develop musculoskeletal pain due to long-term insomnia.

Nobody knows precisely what the link is between pain and insomnia. However, as pain detection, the sleep cycle and the immune system & inflammatory processes (as well as anxiety and depression) are all interlinked, it is reasonable to believe that the endocannabinoid system (ECS) is involved.

Find Out More

If you’d like to know more about cannabis and its painkilling properties, check out our page on chronic pain. In more than a few instances, replacing prescription painkillers with cannabis has made a hugely positive impact on people’s lives. When it comes to beating pain, there are few medications that compare with cannabis’ ability to treat all aspects of total pain, whilst at the same time being generally quite safe in terms of its LD50. It is no wonder that chronic pain is the often the most common use for medical cannabis.

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