Getting the most out of cannabis means doing your homework on cannabinoids and the Entourage Effect.
Every day, cannabis and pain management go hand in hand for thousands of people. Sadly, millions living with chronic pain are also locked into an addition cycle with pharmaceuticals. Patients, however, report that cannabis is not able to completely treat certain types of tough pain. This may be due to lack of access to the proper strain or inappropriate cannabinoid concentration ratios.
For minor pain, cannabis is able to manage just as well as the most common type of pharmaceutical pain relievers: nonsteroidal anti-inflammatory drugs (NSAIDs). You may recognize these as Motrin or Advil. While these are relatively safe in the short term, chronic, daily use of NSAIDs can increase one’s chance of heart attack, stroke, and stomach ulcers. So, why not give cannabis a try? It has no adverse side effects and is not addictive.
Cannabis Offers More Than Cannabinoids
The two most researched cannabinoids are THC and CBD. THC is an intoxicating cannabinoid that creates the elevated state experienced when consuming cannabis. CBD, on the other hand, is non-intoxicating. Both of these cannabinoids have pain-relieving properties, however, these are just the start for pain management.
In every cannabis plant there exists a wide range of plant compounds, including terpenes, flavonoids, and other phytocannabinoids. Each one contributes to the plant’s health benefits. There is a growing body of evidence that full spectrum, or whole plant medicine, is what is best for pain management?
It’s called the ‘entourage effect’ and terpenes have a major role to play. Linalool, a sedating and aromatic terpene acts as both an anti-inflammatory and a pain killer. It can be used to treat arthritis and cancer pain. Other conditions for which the healing powers of linalool could be of benefit include: MS, chronic pain, and dystonia. Linalool boosts the painkilling properties of a cannabis strain, above and beyond cannabinoid content.
This is why isolates (pure CBD) may not work as well. A study published in Frontiers of Pharmacology found that there was a bell curve for CBD effectiveness. After a certain dose (based on patient weight), the CBD isolate lost effectiveness. The same was true for the other end of the curve, when the dose was too small. CBD isolates tend to have tolerance issues as well, whereby the therapeutic dose has to be bumped up or the patient needs to take a tolerance break.
The compounds in cannabis work synergistically to prevent a bell curve response.
The Synergy of CBD and THC
What has been established in the scientific literature is that the combination of CBD and THC provides effective pain management for a number of conditions. This is because the majority of pain comes from a combination of inflammation and nerve irritation.
Also, CBD is an antagonist for THC. This means that is prevents THC from binding to receptors, resulting in reduction of the psychoactive effects of THC. This is the reason that clinical studies studying pain often use THC in combination with CBD. Similarly, many physician recommendations and prescriptions are for 1:1 (CBD:THC) strains. Patients feel effective pain relief without getting “high”.
During clinical trials, researchers were able to use higher THC doses to improve pain management when they included CBD to curb the feelings of intoxication.
What Type of Pain Does THC Target?
THC strongly activates the CB1 receptor. It then has an impact on the serotonergic, dopaminergic, and the glutamatergic systems, which all contribute to THC’s pain relieving effects.
Research says that THC is most effective for neuropathic pain. Neuropathic pain is created and sustained through the glutamatergic system, which is a neurological pathway in the body that regulates the stimulation of neurons. You can think of the glutamatergic system as an on and off switch. It’s an important part of our body, but not great for pain when the switch is stuck in the “on” position.
Interestingly, there has been some new research on THC and pain relief. These suggest that THC is biphasic, meaning that high doses of isolate can actually increase pain. Again, we see the benefits of whole plant medicine.
What Type of Pain Does CBD Treat?
CBD has become a popular option for people who want to reduce pain caused by inflammation. It has also been a popular trial for patients that are not comfortable with the intoxicating effects of THC.
Researchers believe that CBD works through different receptors than THC, primarily TPRV1. It may also work through GPR55 receptor (AKA CB3). Additionally, CBD may stop endogenous cannabinoids (anandamide, for instance) from breaking down. As a result, the build up of these compounds may reduce pain signalling.
CBD is also inhibits glutamate’s release, as well as the release of other inflammatory agents. In other words, it’s a neuroprotective agent and has a role to play in decreasing the burning and tingling sensations associated with neuropathic pain.
The great thing about CBD is that it doesn’t reduce inflammation through the same mechanisms as conventional medications. In other words, CBD is much safer than NSAIDs. It won’t increase your risk of heart attacks, strokes, or stomach ulcers. Some research has even shown that CBD as an anti-inflammatory can be up to twenty times more effective than NSAID agents. That’s remarkable! And great news for patients.
Which Should Cannabis Should You Consume for Pain Management?
Whether you consume a product rich in THC or CBD for your pain is going to depend on a wide range of factors such as legality, goal for the day, and the type of pain you experience. Cannabis and pain management can be trial and error to start with but with time it will get easier.
As with most things in life, your own personal experience and experimentation will help you decide what works best for your pain management. Whatever the case, start low and go slow. And don’t be afraid to experiment with different methods of consumption.