Dec
Health care providers often identify chronic pain as one of the most challenging conditions to treat. Chronic pain is inherently complex and multidimensional, influenced by various factors such as our individual biology, mood, social environment, and past experiences. If you or someone you care about is grappling with chronic pain, you’re likely familiar with the significant burden it imposes.
People are looking for novel, non addictive ways to treat pain
Given the ongoing challenges in managing chronic pain, exacerbated by the repercussions of the opioid epidemic, both pain management practitioners and their patients are actively exploring alternative, effective, and safer options than opioids for pain relief. The legalization of marijuana in numerous states, along with growing cultural acceptance for both recreational and medical use, has sparked heightened interest in utilizing cannabis to address various medical issues, particularly pain.
Cannabis, primarily derived from the Cannabis indica and Cannabis sativa plants, consists of three major components: cannabinoids, terpenoids, and flavonoids. Among the numerous cannabinoids, the two major ones are tetrahydrocannabinol (THC) and cannabidiol (CBD). While historical attention has been focused on THC, the psychoactive component responsible for the euphoric “high,” there has been relatively less scientific exploration of CBD, a non-psychoactive element of the cannabis plant.
What’s the thinking behind using cannabis for chronic pain?
CBD is emerging as a promising pharmaceutical agent for the treatment of pain, inflammation, seizures, and anxiety, distinct from the psychoactive effects associated with THC. Ongoing research is shedding light on the role of CBD in pain management, and findings from animal studies indicate that CBD achieves its pain-relieving effects through intricate interactions and modulation of the endocannabinoid, inflammatory, and nociceptive (pain-sensing) systems.
The endocannabinoid system comprises cannabinoid receptors that interact with naturally occurring cannabinoids in the body. This system plays a crucial role in regulating various bodily functions, including metabolism and appetite, mood and anxiety, and the perception of pain. As our understanding of CBD’s mechanisms deepens, it offers potential as a non-psychoactive option for addressing pain and other medical conditions.
What’s the research that CBD works in humans?
Despite promising results in animal models, the lack of substantial human studies on the efficacy of CBD is a notable limitation. While CBD is hailed for its relative safety, non-psychoactive attributes, and low potential for abuse, the current scientific literature does not sufficiently support its broad application as a panacea for various conditions, as often advertised.
As of now, pharmaceutical CBD has received FDA approval solely as an adjunct therapy for a specific and rare form of epilepsy. Notably, CBD alone is not sanctioned by the FDA for pain treatment in the United States. However, Health Canada has approved a combination medication containing both THC and CBD in a 1:1 ratio for prescription, particularly for central neuropathic pain in multiple sclerosis and the management of cancer pain unresponsive to optimized opioid therapy. It’s essential to underscore that robust research backing the use of CBD in isolation for pain treatment remains lacking.
Why is CBD presented to the public this way, when it is not without risks?
The evolving legal landscape of cannabis, along with the allure of novelty and driven by considerable profit potential, has fueled an explosion in the advertising of cannabinoids, especially CBD. However, the FDA unequivocally states that marketing CBD by incorporating it into food or labeling it as a dietary supplement is illegal. The FDA also issues warnings about potential side effects of CBD, cautioning against the misconception that its use is entirely risk-free. Notably, CBD can induce liver injury and impact the male reproductive system, as demonstrated in laboratory animal studies.
Crucially, CBD’s interactions with other crucial medications, such as blood thinners, heart medications, and immunosuppressants, are significant concerns. This interaction can alter the levels of these vital medications in the blood, leading to potentially catastrophic consequences, including death. Moreover, more research is imperative to understand the safety of CBD in specific populations, including the elderly, children, immunocompromised individuals, and pregnant or breastfeeding women.
Many of the CBD products on the market are unregulated
The FDA has taken regulatory action by issuing warning letters to companies and individuals promoting unapproved new drugs purportedly containing CBD. As part of its regulatory efforts, the FDA has conducted testing on the chemical content of cannabinoid compounds in certain products. The results revealed that many of these products did not contain the levels of CBD as claimed by the manufacturers. This underscores the need for stringent oversight and accurate labeling in the rapidly expanding market of CBD-based products.
Beware of powerful testimonials
It’s crucial to approach anecdotal wisdom with caution. While positive experiences shared by patients and health professionals may highlight potential benefits, it’s essential to recognize that individual responses can vary significantly. What works well for one person may not have the same effect for another due to the uniqueness of each individual. This variability is particularly prominent in the context of pain, where various factors such as mood, stress levels, environment, other medical conditions, and past experiences can influence pain perception.
It’s advisable to exercise caution and critical thinking, bearing in mind that some testimonials might serve as marketing tools aimed at encouraging product purchases. As the CBD market is projected to reach $20 billion by 2024, consumers should be mindful of potential commercial interests and seek evidence-based information.
The bottom line: Don’t make CBD your first or only choice for pain relief
Dr. Robert Shmerling’s guidance on the dos and don’ts in selecting a CBD product is valuable for individuals contemplating the use of CBD. In the absence of robust scientific evidence in humans, making a recommendation for the routine use of CBD in chronic pain management remains challenging. It’s important for individuals to exercise caution, conduct thorough research, and consult with healthcare professionals before incorporating CBD into their pain management regimen. As the scientific understanding of CBD continues to evolve, staying informed about the latest research findings and evidence-based recommendations is crucial.
