Cannabis for Chronic Pain

Chronic pain, in and of itself, is considered an often intractable condition that millions of Americans suffer from every year. Chronic pain generally refers to persistent pain experienced by a person for 3 months or longer. It is often debilitating, frustrating, and depression-inducing for the person suffering it. So, when "treatments" come along that have the potential to provide relief to sufferers, my ears always perk up hopefully to the possibilities. Recently, a review in the Annals of Internal Medicine evaluated the existing and available evidence involving the use of cannabis as a choice in treating chronic pain. Disappointingly, the results are inconclusive.

As a pain management physician, I think cannabis and cannabinoid products have the potential for reducing the use of prescription opioids, and that's a good thing for chronic pain patients. Anecdotally, I have plenty of patients who volunteer that they regularly use cannabinoids in some form – usually CBD creams or gummies of some sort. Many say they are helpful. Others say they've tried them with only minimal or moderate benefit.

The good news is that there are already several options available to lower the use of prescription opioids, ranging from alternative pharmaceuticals to neuromodulation procedures, to proper and effective education and learning about pain science. I certainly believe patients are open to trying cannabinoids – some forms more than others. But being a chronic pain patient can mean many different things. In my experience, most "typical" patients view cannabinoids as "possibly" or "hopefully" effective, rather than having an unrealistic view of their role in the management or “cure” of chronic pain.

The assumption that cannabinoids are "harmless" is held by many lay individuals. Still, there are obvious risks associated with cannabinoids that must be considered, studied, and reported. One major issue to consider is the unintended side effects of any intervention, including cannabis. The Annals of Internal Medicine review specifically describes limitations in the study relative to reports of adverse events such as psychosis, cannabis use disorder, mood, and cognitive deficits. These are potentially significant issues, as are long-term efficacy and long-term effects.

There is currently a disappointing lack of robust studies to determine whether cannabis or cannabinoids can effectively treat chronic pain. The truth is chronic pain is a challenging condition for any intervention to prove efficacy. Pain studies have a robust placebo response that can be difficult to overcome in clinical trials. The reality also exists that so many different and varying factors can cause chronic pain, that pain is subjective to the individual experiencing it, and that it is incredibly complex. Pain is not simply about an electrical signal. Emotional and environmental conditions affect pain in a person, as well as expectations and other contributing factors. In these ways, chronic pain is challenging to measure. But the other social, legal and political aspects of cannabis and cannabinoids further complicate the ability to study their effects on chronic pain easily.

I believe chronic pain is best treated in a holistic and multidisciplinary fashion with combinations of education and learning, autonomic quieting, exercise, optimizing sleep, neuromodulation, and judicious use of medications. For most patients, no silver bullet pill or medication is overwhelmingly responsible for successfully managing chronic pain. As a neurologist, my approach to pain treatment is based on a thorough knowledge of how the body works and how the brain contributes to suffering from pain, not just how injections, pills, medicinal options such as cannabis or cannabinoids, or other interventions can "cover" or "block" pain. My goal is to manage pain for patients so that they can continue to live their everyday lives, but ultimately, I want to get to the bottom of what is causing the pain and fix it.

Sources:

https://www.vernonwilliamsmd.com/Professional-Expertise/Pain-Medicine.aspx

Dr. Williams’ answers from Email Interview on 6/4/22

https://www.vernonwilliamsmd.com/Conditions-Treated/Pain-Medicine.aspx