Cannabinoids in pain control

Cannabinoids for pain control is an old idea. The Victorians knew about it. Napoleon’s medics studied it (De Aquina 2018; Thaler 2011). Medieval physicians in the Islamic world used it, with careful dosing to avoid intoxication. The exact mechanisms are now being discovered. The endocannabinoid system itself, the part of the body’s onboard neurological signaling system that makes the body sensitive to cannabinoids, was mapped in the 1990’s (Rahn 2009), and data is accumulating about which cannabinoids do what within this system. It appears that modulation of pain, partly through this system, happens in the central nervous system and the periphery (Gonçalves 2014), and that particular exogenous plant-based and synthetic cannabinoids exert known analgesic effects in particular conditions, as do chemically related compounds like the terpenes, commonly found in food. Δ9-tetrahydrocannabinol (THC) is limited for clinical use because of its psychoactive effect. But combinations of other cannabinoids, like cannabidiol (CBD), or cannabinoid-like compounds, like β-caryophyllene, a terpene, are promising in this respect, and do not appear to carry with them serious adverse effects (Fine 2013). The modern, evidence-based rationale for cannabinoid-based drug development has matured quickly in recent years. Pharmaceutical products are starting to appear on the market (we at PureForm transform ours from terpenes), and pre-clinical evidence continues to support the efficacy of cannabinoids generally across a variety of pain disorders (Starowicz 2017).

Not all pain is the same. (Neuropathic pain is different from inflammatory pain, at its most basic.) Not all sample populations or testing techniques are the same, either. And systematic trials have only begun. For these reasons, there is lack of true consensus yet on the exact role of selective cannabinoids for pain. But the data are encouraging. One recent review of 1,219 patients across 11 randomized controlled trials made this point, drawing attention to variability in the studies in the quality of reporting, kind of pain, and type and dose of drug (Meng 2017). It did concede that patients with chronic neuropathic pain do derive some analgesic benefit. Another meta-study has called the evidence for pain-relief in chronic conditions ‘moderate-quality’ (Whiting 2015). Large, well designed studies are still needed, particularly ones that evaluate psychological mediation of pain. A very recent review suggests indeed that while cannabinoids may produce a small increase in pain thresholds, their real function might actually be to make the emotional experience of pain more palatable – that a pain-related ‘negative affect’ may underlie an unsupported belief that cannabis relieves pain (De Vita 2018). It may also be that the broad scope of these large reviews is actually a limitation in their usefulness. The question, ‘do cannabinoids help pain’, is possibly too reductionist. A 2017 review of reviews observed that inhaled cannabis does consistently reduce chronic non-cancer pain, and that oral cannabinoids seem to improve some aspects of pain, like sleep quality, but they are not effective in acute post-operative pain, or abdominal chronic pain, or rheumatoid pain (Romero-Sandoval 2017). Available literature really suggests, read closely, that cannabinoids are indeed useful, just not universally so. This is true of any class of drug, so nobody should be surprised.

So it is that  Canadian Family Physician carried an article in 2013, by way of example, that specified neuropathic pain as the place to involve cannabinoids (Allan 2013). A contribution to  American Family Physician has said that the opposite is probably true of non-neuropathic pain, but added that the studies are still too heterogeneous to be conclusive (Ebell 2018). Studies like these ones, but focussed on efficacy in particular syndromes, are where the answers doubtless lie. One such study on brachial plexus aversion pain, which is a homogenous cohort in terms of the nature of injury, pain descriptions, and patient demographics, shows that THC and cannabidiol probably do help neuropathic pain (Berman 2004). Another, by De Vries, et al. (2017), shows that THC is not effective in chronic abdominal pain secondary to surgery or pancreatitis. Johnson (2013), Portenoy (2012), Johnson (2010), and Russo (2008) all show absolutely that an oromucosal spray derived from THC and cannabidiol does help patients with cancer pain that doesn’t respond to opiates. Cannabidiol (CBD) may conceivably work in inflammatory pain (Costa 2004, 2007), including the kind that involves over-activation of the immune system (Booz 2011), though probably not in rheumatoid conditions (Fitzcharles 2016). Much is yet to be learned, but the field is certainly opening.

Oral cannabinoids do no harm, properly administered. (This refers to the pharmaceutical grade ones, not the dangerously untested and unregulated recreational synthetics.) On this there is no real disagreement as the data comes in. Reported adverse effects are not usually serious, are not unique to cannabinoids, and are dose-dependent, and resolve by themselves. Cannabidiol in particular displays no abuse liability, either (Babalonis 2017). Evidence for this is that patients do not seek to increase their doses, even after long-term use (Johnson 2013). In extended use and across populations it seems that cannabinoids are well tolerated by patients and are safe (Fanelli 2017; Ware 2015), and in general do seem to offer some pain-relief effects.

PureForm CBD™ is bioidentical to CBD extracted from hemp and cannabis but without residual cannabinoids like THC or any of the impurities or chemicals associated with plant-derived production processes. Our molecular assembly technique, that synthesizes CBD from aromatic terpenes instead of cannabis, assures you the food and pharmaceutical-grade quality that you need for quality-conscious customers. If you are interested in PureForm CBD™ or want to partner on any other of the 140+ known cannabinoids, please contact Damian Peters at 310-666-4869, or email info@pureformglobal.com. 

The foregoing is a report on trends and developments in the cannabinoid industry. No product described herein is intended to diagnose, treat, cure or prevent any disease or syndrome.