Written by Nicole Nowlan, PharmD
More than 1 in 5 adults in the United States experience chronic pain and that number is expected to rise with an aging population, increase in diabetes and increase in cancer survival rates.1 Severe chronic or intractable pain of neuropathic origin, or severe chronic or intractable pain is one of the 23 conditions that the Pennsylvania Department of Health has certified as a qualifying condition for medical marijuana use.
Chronic pain is defined as pain that lasts longer than 12 weeks. Pain can be inflammatory, neuropathic or nociceptive in origin. Nociceptive pain is usually due to tissue damage, where inflammatory pain is an overreaction of the immune response and neuropathic pain is caused by nerve irritation or damage.
Depending on type of pain, the goals of the patient would guide the marijuana regimen. Topicals, flower, vaporizable oil, suppository, capsules, concentrates, tinctures, solutions can all be beneficial for chronic pain patients. Most pain patients find it necessary to have a short-acting and a long-acting form for pain relief, similar to use of short-acting and long-acting opiates. Short-acting is used for breakthrough pain while long-acting for maintenance.
CBD is often used for inflammatory pain while THC is used for neuropathic and nociceptive pain. Different terpenes are also known to aid in pain relief. Caryophyllene is known for its anti-inflammatory properties while myrcene has muscle relaxant properties. Finding the right balance for each individual’s pain relief needs can be challenging and involves trial and error. Setting patients expectations of goal pain relief is important. Pain patients sometimes require high doses of cannabinoids for pain relief. Starting low and gradually increasing a patient’s dose is beneficial in finding therapeutic dose and minimizing side effects. Patients often think they are maxed out on a dose but if they are not experiencing negative side effects, they can continue to increase their dose.
Another thing to consider for pain patients is their mental health. People with chronic pain are three times more likely to develop depression and anxiety compared to those without chronic pain.2 Marijuana can also help with anxiety associated with chronic pain.
Many patients report an overall increase in quality of life when using marijuana for pain management, including better sleep and decreased anxiety. It is important that patients talk to their healthcare provider or pharmacist about potential drug interactions of pain medication and marijuana.
Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. DOI: http://dx.doi.org/10.15585/mmwr.mm6736a2
Harvard Health Publishing. (2017, March 21). Depression and pain.
Retrieved from: https://www.health.harvard.edu/mind-and-mood/depression-and-pain
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