What the Research Says About Pain and Cannabis

Due in large part to the pain pill epidemic and addiction, the scientific community has made treatment for pain one of their top research priorities. “The treatment of chronic pain has relied heavily on opioids, despite their potential for addiction and overdose and the fact that they often don’t work well when used on a long-term basis,” said Helene Langevin, M.D., director of NCCIH. “There’s an urgent need for more effective and safer options.” 

Patient Data

Using the largest database of real-time recordings of the effects of common and commercially available cannabis products in the United States (U.S.), researchers at The University of New Mexico (UNM) found strong evidence that cannabis can significantly alleviate pain, with the average user experiencing a three-point drop in pain suffering on a 0-10 point scale immediately following cannabis consumption.

The researchers relied on information collected with Releaf App, a mobile software program developed by co-authors Franco Brockelman, Keenan Keeling, and Branden Hall. The app enables cannabis users to monitor the real-time effects of the breadth of available cannabis-based products, which are always variable, of course, given the complexity of the cannabis plant from which these products are obtained.

Among the study’s findings the greatest analgesic responses were reported by people that used whole dried cannabis flower, or ‘buds,’ and particularly cannabis with relatively high levels of tetrahydrocannabinol, otherwise known as THC. The more recently popularized cannabinoid, cannabidiol or CBD, in contrast, showed little association with the momentary changes in pain intensity, based on the massive database explored in the study.

“Perhaps the most surprising result is just how widespread relief was with symptom relief reported in about 95 percent of cannabis administration sessions and across a wide variety of different types of pain,” added lead author of the study, Xiaoxue Li.

The National Academies of Sciences

In 2017, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a comprehensive review of studies titled Health Effects of Cannabis and Cannabinoids. The NASEM committee found that chronic pain patients treated with medical cannabis can experience a significant reduction in pain symptoms.

The group further reported that, “There is conclusive and substantial evidence that cannabis or cannabinoids are effective: 1) for the treatment of chronic pain in adults; 2) as antiemetics in the treatment of chemotherapy-induced nausea, and 3) for improving patient-reported multiple sclerosis spasticity symptoms.” The institution further reported that: “there is no conclusive evidence that the drug effects of marijuana are casually linked to subsequent abuse of other drugs.”

Published Research

In a study titled Chronic Pain Patients’ Perspectives of Medical Cannabis published in PAIN, The Journal of the International Association for the Study of Pain, the authors noted that their research revealed that medical cannabis patients, including two-thirds with chronic-pain, report health benefits including improved pain management and sleep. Pharmacoeconomic factors were the greatest limitation of medical cannabis.

Another study titled Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees examined Medicaid prescription data from 2011 to 2016. That data revealed a 5.88% reduction in opioid prescriptions in states where medical marijuana was legalized and a 6.38% drop where adult-use marijuana was legalized. A related study. which encompassed a longitudinal analysis of the number of opioid prescriptions filled under Medicare Part D, showed that when medical marijuana laws went into effect in a given state, opioid prescriptions fell by 2.21 million daily doses filled per year. When medical marijuana dispensaries opened, prescriptions for opioids fell by 3.74 million daily doses per year. These reductions in daily opioid doses were particularly notable for hydrocodone (Vicodin) and morphine prescriptions. In the editorial accompanying these studies, the authors noted, “We do not know whether patients actually avoided or reduced opioid use because of increased access to cannabis (marijuana).” However, given that millions of prescriptions for opiates were not written, and consequently there were millions of fewer bottles of prescription opiates consumed, sold, diverted, or abused, it does not seem to be too big a leap to infer that opiate use was avoided, or at least reduced.

Widespread Pain

Pain has long been characterized as a subjective experience encompassing sensory-physiological, motivational-affective, and cognitive-evaluative components.

  • Approximately, 100 million U.S. adults are encumbered by chronic pain
  • Pain motivates greater than 50% of all annual physician visits
  • Recent estimates indicate a pain-related financial burden in excess of $600 billion in annual healthcare costs and lost productivity.

Continuing Research

In September of 2019, it was announced that nine universities would be receiving federal grants totaling $3 million to study the “potential pain-relieving properties” of minor cannabinoids and cannabis-sourced terpenes. These studies are ongoing and not yet complete. Investments in research such as this does indicate that government agencies are committed to exploring medicinal uses for marijuana and new data revealed from scientific evidence will be available soon to validate those uses. 

  • Mechanism and Optimization of CBD-Mediated Analgesic Effects, led by Boston Children’s Hospital’s Zhigang He, Ph.D., B.M., and Juan Hong Wang, Ph.D.; Ongoing through August 2024.
  • Neuroimmune Mechanisms of Minor Cannabinoids in Inflammatory and Neuropathic Pain, led by University of California’s Judith Hellman, M.D., and Mark A. Schumacher, M.D., Ph.D.;]Minor Cannabinoids and Terpenes: Preclinical Evaluation as Analgesics, led by Research Triangle Institute’s Jenny L. Wiley, Ph.D.; 
  • Identifying the Mechanisms of Action for CBD on Chronic Arthritis Pain, led by New York University School of Medicine’s Yu-Shin Ding, Ph.D.;
  • Synthetic Biology for the Chemogenetic Manipulation of Pain Pathways, led by University of Texas’s Andrew Ellington, Ph.D.;
  • Exploring the Mechanisms Underlying the Analgesic Effect of Cannabidiol Using Proton Magnetic Resonance Spectroscopy, led by University of Utah’s Deborah A. Yurgelun-Todd, Ph.D.;
  • Mechanistic Studies of Analgesic Effects of Terpene Enriched Extracts from Hops, led by Emory University’s Cassandra L. Quave, Ph.D.;
  • Systematic Investigation of Rare Cannabinoids With Pain Receptors, led by University of Illinois’ David Sarlah, Ph.D.; and
  • Analgesic efficacy of single and combined minor cannabinoids and terpenes, led by Temple University’s Sara J. Ward, Ph.D.