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Pain management

Medicinal cannabis and the treatment of chronic pain

The Lambert Initiative is researching the application of phytocannabinoids to assist in the treatment and management of chronic and neuropathic pain.

Chronic pain conditions comprise three of the top ten clinical problems contributing to burden of disease in Australia (back pain at number one, neck pain at number four, and migraine at number eight). One in five Australians, including children and adolescents, lives with chronic pain. This number rises to one in three for those over the age of 65.

Chronic pain is pain that continues beyond the time expected for a painful condition or injury to heal, usually about three months. Neuropathic pain is a type of chronic pain that occurs following damage to the nervous system itself. It is also called nerve pain or nerve-damage pain.

Current medications for the management of chronic and neuropathic pain have many adverse side effects. Opioids (e.g. morphine, codeine, endone) are commonly used to treat severe acute pain or cancer pain. However opioids are not universal painkillers, and are often not very effective in chronic pain that is not caused by cancer.

Long-term use of opioids is also associated with potentially serious harm, which includes both opioid-related side effects, and an increased risk of accidental fatal overdose, dependence or addiction. Non-opioid pain relievers, such as paracetamol and non-steroidal anti-inflammatory drugs can be effective for mild chronic pain, but are generally short-term measures. In many cases of chronic pain, inflammation is not the cause, so anti-inflammatory medicines may not be helpful.

Medicinal cannabis has several potential beneficial effects. Evidence already suggests that it helps reduce chronic pain and muscle spasms and can also be used for reducing nausea during chemotherapy, improving appetite in HIV/AIDS, improving sleep, and improving tics in Tourette syndrome.

When usual treatments are ineffective, cannabinoids have also been recommended for anorexia, arthritis, migraine, and glaucoma. Cannabis appears to be somewhat effective for the treatment of chronic pain, including pain caused by neuropathy and pain due to fibromyalgia and rheumatoid arthritis. 

Pain is also the main reason people turn to medicinal cannabis. Pain as a result of migraines, disease such as cancer, or a long-term condition like glaucoma or nerve pain, has been shown to be reduced by the application, inhalation or ingestion of medicinal cannabis.

Many patients suffering from chronic pain and inflammatory disease use illicitly sourced cannabis to ease their suffering. However the most effective cannabinoids to use for pain and inflammation are not yet known.

The body’s own endocannabinoid system regulates pain and inflammation in the body. The purpose of our research into the use of phytocannabinoids (such as tetrahydrocannabinol and cannabidiol) to assist in pain management is important, as it may be possible to enhance the body’s natural response to pain and inflammation with the application of these cannabinoids.