Interest in Medicinal Use of Cannabis Growing

The medicinal properties of cannabis have been recognized for centuries, and it has been used informally in traditional Chinese and Indian medicines, and more recently in western cultures without medical approval, to treat a wide range of symptoms. Over the last decade, interest in the medicinal benefits of cannabis has started to garner attention, and consequently there has been an increase in research to provide evidence of these medical effects (1).  

Many western countries, including the United States, Canada and Germany now allow the medical use of cannabis. In Germany, cannabinoid medications prescribed by a physician to patients with severe diseases and no alternative treatment options are covered by health insurance (2).

The principal cannabinoid compounds derived from the cannabis plant are delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabinol (CBN). These cannabinoids act on the cannabinoid receptors CB1 and CB2 in the endocannabinoid system, which is found throughout the human body. A 2022 scoping review of cannabis research related to pain (1) highlights current research on the effects of cannabinoids and cannabis-based medicines on pain relief. 

According to the review, clinical studies have shown that cannabinoids possess analgesic properties and can be effective at relieving acute pain, as well as chronic pain associated with debilitating health conditions such neuropathy, multiple sclerosis, rheumatic diseases, and cancer.

Aiding Cancer Pain Relief

Pain is one of the greatest fears most cancer patients face. Cancer-related pain can emanate from the cancerous tumor itself, or it can be the result of postoperative pain, chemotherapy, or side effects from medications. It can lead to a decrease in quality of life, disrupted sleep, and can cause mental health symptoms such as anxiety and depression, which can inhibit the patient's ability to cope with the disease. Treatment with NSAIDs and opioids is currently the most common method of treating pain in cancer patients, providing relief for 71-86% of patients treated. However, since these conventional pain relief methods are ineffective at managing pain in some cancer patients, there is growing interest in researching cannabinoid-based medications as an alternative treatment option.

A study (3) that compared the effect of THC:CBD extract, THC without CBD, or a placebo to relieve pain in cancer patients over a two week period showed an improvement with THC:CBD extract (Sativex ®) compared to the placebo, but there was no change when THC was taken alone. However, patients in the THC:CBD group reported that nausea and vomiting was worse compared to the placebo. An extension study (4) found that pain severity decreased in patients treated with THC:CBC, and they also slept better and felt less fatigued. 

Despite these positive preliminary results, due to limitations such as the sample size of these studies, there is still no strong argument to support the use of cannabinoids as a stand-alone treatment to manage cancer-related pain (5). Further scientific research is necessary to fill this knowledge gap as cannabis shows potential for managing chronic cancer-related pain, especially in patients where other treatment options are ineffective, and even for treating the cancer itself (6). 

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Sources

(1) Camila Pantoja-Ruiz, Paula Restrepo-Jimenez, Camilo Castañeda-Cardona, Alexandra Ferreirós, Diego Rosselli. Cannabis and pain: a scoping review. Brazilian Journal of Anesthesiology (English Edition). Volume 72, Issue 1 (2022), pp. 142-151

(2) W. Hauser, M.-A. Fitzcharles, L. Radbruch, et al. Cannabinoids in pain management and palliative medicine. Dtsch Arztebl Int, 114 (2017), pp. 627-634

(3) A.H. Lichtman, E.A. Lux, R. McQuade, et al. Results of a double-blind, randomized, placebo-controlled study of nabiximols oromucosal spray as an adjunctive therapy in advanced cancer patients with chronic uncontrolled pain. J Pain Symptom Manage, 55 (2018) 179-188.e1 Google Scholar

(4) T.D. Brisbois, I.H. de Kock, S.M. Watanabe, et al. Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial. Ann Oncol, 22 (2011), pp. 2086-2093 Google Scholar

(5) D. Pascual, E.M. Sanchez-Robles, M.M. Garcia, et al. Chronic pain and cannabinoids. Great expectations or a christmas carol. Biochem Pharmacol, 157 (2018), pp. 33-42 Google Scholar

(6) Towards the Utilization of Cannabinoids as Anticancer Agents