Marijuana and the Management of Chronic Nonmalignant Neuropathic Pain

Marijuana and the Management of Chronic Nonmalignant Neuropathic Pain

What is Chronic Nonmalignant Neuropathic Pain?

Chronic nonmalignant pain  referes to an “unpleasant sensory and emotional experience accompanied with actual or potential tissue damage” which can last for either 3 months or longer or longer than expected given a certain injury. This pain can result from trauma, a disease process, or an unknown cause. The cause of pain is a direct result of damage or compression of a nerve reason it is called neuropathic pain. Chronic malignant pain on its part is associated with a severe/worsening known disease process, and is often experienced by patients suffering with cancer.

 

 The medicine commonly prescribed to patients with chronic pain are Opioids  which are a useful and effective therapy for many but can lead to severe side effects, addiction/dependence, and death in cases of overdose. Some patients even develop abnormal/unhealthy drug-related behaviors.

 Research has revealed that Cannabinoid therapies (including whole-plant) may be an effective treatment option for chronic pain, and that they have the potential to work as add-on therapies to help reduce the opioids dosages of patients. Some anecdotal proves have revealed that whole-plant cannabis has been is able to fully replace opioid use. In October 2014, a study  was published in JAMA Internal Medicine which found that opioid-related deaths were 25% lower in states where medical cannabis is legal. Although this study found an association, rather than a cause-effect relationship, given highly favorable safety profile of marijuana compared to opioids, further research is needed to justify the results

Results of the Review

In winter 2015, a systematic review of 13 studies on the topic of cannabinoid therapy use for chronic neuropathic pain, was published in  Journal of Oral & Facial Pain and Headache, which  suggested that cannabinoids may provide effective analgesia [i.e. pain relief] in chronic neuropathic pain conditions that are refractory [i.e. not fully responsive] to other treatments.

 The researchers used several online databases, as well as print sources dating back to 1950 in gathering a sample of papers to review. Terms used in the searches included: marijuana, marihuana, cannabis, cannabinoids (endogenous, phytocannabinoids found in cannabis, synthetic cannabinoids), nabilone (a synthetic cannabinoid that functions like THC, currently FDA-approved for the treatment of chemotherapy-induced nausea and vomiting), dronabinol (synthetic THC, currently FDA-approved for the treatment of chemotherapy-induced nausea and vomiting), delta- 9-tetrahydrocannabinol (THC, a phytocannabinoid), cannabidiol (CBD, a phytocannabinoid), ajulemic acid (a synthetic cannabinoid that is a breakdown product of THC, has demonstrated an ability to provide pain and inflammation relief without producing psychoactive effects), pain, chronic disease and neuropathic.

The search was limited to randomized placebo-controlled trials  by the researchers and reduction in pain intensity and harmful events were compared among the studies. 13 studies were analyzed and rated using the Jadad Scale, which is used to assess the quality of clinical trials and to measure bias in pain research.

The researchers discovered that, marijuana-based medicinal extracts used in different populations of chronic nonmalignant neuropathic pain patients can provide effective analgesia in conditions that are not fully responsive to other treatments and the side effects were minor in.  The researchers also noted improvements in “sleep quality, appetite, nausea, and anxiety.

Conclusion

Cannabinoid therapies have been found to be effective and with minimal adverse side effects. Thus, this study adds to growing evidence that cannabinoid therapies such as phytocannabinoids and isolated/synthetic cannabinoids may be safe and clinically useful therapies in the management of chronic nonmalignant neuropathic pain.