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Cannabinoids and Pain Management: an Insight into Recent Advancements

  • Amna ShaikhEmail author
  • Sarah Money
Pain Management (S Mace, Section Editor)
Part of the following topical collections:
  1. Pain Management

Abstract

Purpose of Review

This review discusses the recent advancements in research on Cannabinoids’ role in pain, including its use in cancer pain, neuropathic pain, fibromyalgia, headache, visceral pain, postoperative and failed back pain management, and concurrent use with opioids.

Recent Findings

Current research suggests that a potential role exists for medical cannabis in pain management, although research shows varied effectiveness by the type of pain. Moreover, its coadministration with opioids may result in reduced opioid requirements.

Summary

Patients with neuropathic pain, cancer pain, and migraine headache may benefit from the analgesic effects of a cannabis-based medicine (CBM), but not necessarily patients with chronic abdominal pain. Equivocal results were shown in fibromyalgia and postoperative orthopedic pain. Interestingly, the opioid-sparing properties of CBM make it an attractive option for pain management. However, the scale and quality of studies conducted are limited. Further research is necessary to establish recommendation guidelines for medical cannabis in pain management.

Keywords

Cannabinoids and pain THC and pain Tetrahydrocannabinol and pain Cannabis and pain Marijuana and pain 

Notes

Compliance with Ethical Standards

Conflict of Interest

Amna Shaikh and Sarah Money declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Russo EB. History of cannabis and its preparations in saga, science, and sobriquet. Chem Biodivers. 2007;4:1614–48.CrossRefGoogle Scholar
  2. 2.
    •• Savage SR, Romero-Sandoval A, Schatman M, et al. Cannabis in pain treatment: clinical and research considerations. J Pain. 2016;17:654–68 This is a comprehensive review of cannabinoids, including an interesting history of its use, development and cultivation over time, and more current uses in medicine, as well as a physiologic review of its function. CrossRefGoogle Scholar
  3. 3.
    National Conference of State Legislatures. 2019. State medical marijuana laws. Available at http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx (last accessed June 18, 2019). Google Scholar.
  4. 4.
    Bestrashniy J, Winters KC. Variability in medical marijuana laws in the United States. Psychol Addict Behav. 2015;29:639–42.CrossRefGoogle Scholar
  5. 5.
    Light MK, Orens A, Lewandowski B, et al. Market size and demand for marijuana in Colorado. The Marijuana Policy Group. 2014. Available at www.colorado.gov/pacific/sites/default/files/Market%20Size%20and%20Demand%20Study,%20July%209,%202014%5B1%5D.pdf (last accessed November 17, 2016).
  6. 6.
    Ilgen MA, Bohnert K, Kleinberg F, Jannausch M, Bohnert ASB, Walton M, et al. Characteristics of adults seeking medical marijuana certification. Drug Alcohol Depend. 2013;132:654–9.CrossRefGoogle Scholar
  7. 7.
    Baron EP, Lucas P, Eades J, Hogue O. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort. J Headache Pain. 2018;19:37.CrossRefGoogle Scholar
  8. 8.
    Sznitman SR, Bretteville-Jensen AL. Public opinion and medical cannabis policies: examining the role of underlying beliefs and national medical cannabis policies. Harm Reduct J. 2015;12:46.CrossRefGoogle Scholar
  9. 9.
    National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington, DC: The National Academies Press; 2017.Google Scholar
  10. 10.
    Munro S, Thomas KL, Abu-Shaar M. Molecular characterization of a peripheral receptor for cannabinoids. Nature. 1993;365:61–5.CrossRefGoogle Scholar
  11. 11.
    Matsuda LA, Lolait SJ, Brownstein MJ, Young AC, Bonner TI. Structure of a cannabinoid receptor and functional expression of the cloned cDNA. Nature. 1990;346:561–4.CrossRefGoogle Scholar
  12. 12.
    Alexander SP, Mathie A, Peters JA. Guide to receptors and channels (GRAC), 5th edition. Br J Pharmacol. 2011;164(Suppl 1):S1–324.CrossRefGoogle Scholar
  13. 13.
    Hohmann AG, Herkenham M. Regulation of cannabinoid and mu opioid receptors in rat lumbar spinal cord following neonatal capsaicin treatment. Neurosci Lett. 1998;252:13–6.CrossRefGoogle Scholar
  14. 14.
    Hohmann AG, Herkenham M. Localization of central cannabinoid CB1 receptor messenger RNA in neuronal subpopulations of rat dorsal root ganglia: a double-label in situ hybridization study. Neuroscience. 1999;90:923–31.CrossRefGoogle Scholar
  15. 15.
    Hohmann AG, Briley EM, Herkenham M. Pre- and postsynaptic distribution of cannabinoid and mu opioid receptors in rat spinal cord. Brain Res. 1999;822:17–25.CrossRefGoogle Scholar
  16. 16.
    Narang S, Gibson D, Wasan AD, Ross EL, Michna E, Nedeljkovic SS, et al. Efficacy of dronabinol as an adjuvant treatment for chronic pain patients on opioid therapy. J Pain. 2008;9:254–64.CrossRefGoogle Scholar
  17. 17.
    Kevin P. Hill, Matthew D. Palastro, Brian Johnson, and Joseph W. Ditre. Cannabis and cannabinoid research. Dec 2017.ahead of print  https://doi.org/10.1089/can.2017.0017
  18. 18.
    Fallon MT, Albert Lux E, McQuade R, Rossetti S, Sanchez R, Sun W, et al. Sativex oromucosal spray as adjunctive therapy in advanced cancer patients with chronic pain unalleviated by optimized opioid therapy: two double-blind, randomized, placebo-controlled phase 3 studies. Br J Pain. 2017;11(3):119–33.CrossRefGoogle Scholar
  19. 19.
    Häuser W, Welsch P, Klose P, Radbruch L, Fitzcharles MA. Efficacy, tolerability and safety of cannabis-based medicines for cancer pain: a systematic review with meta-analysis of randomised controlled trials. Schmerz. 2019.Google Scholar
  20. 20.
    Aviram J, Samuelly-Leichtag G. Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2017;20:E755–96 ISSN 2150–1149.Google Scholar
  21. 21.
    Bar-Sela G, Vorobeichik M, Drawsheh S, Omer A, Goldberg V, Muller E. The medical necessity for medicinal cannabis: prospective, observational study evaluating treatment in cancer patients on supportive or palliative care. Evid Based Complement Alternat Med. 2013;2013:510392.CrossRefGoogle Scholar
  22. 22.
    Portenoy RK, Ganae-Motan ED, Allende S, et al. Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain. 2012;13(5):438–49 ISSN 1526–5900.CrossRefGoogle Scholar
  23. 23.
    Johnson JR, Lossignol D, Burnell-Nugent M, Fallon MT. An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. J Pain Symptom Manag. 2013;46(2):207–18.CrossRefGoogle Scholar
  24. 24.
    Kremer M. Antidepressants and gabapentinoids in neuropathic pain: mechanistic insights. Neuroscience. 2016;338:183–206.CrossRefGoogle Scholar
  25. 25.
    Whiting PF, Wolff RF, Deshpande S, di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313:2456–73.CrossRefGoogle Scholar
  26. 26.
    Wallace MS, Marcotte TD, Umlauf A, Gouaux B, Atkinson JH. Efficacy of inhaled cannabis on painful diabetic neuropathy. J Pain. 2015;16:616–27.CrossRefGoogle Scholar
  27. 27.
    Wilsey BL, Deutsch R, Samara E, et al. A preliminary evaluation of the relationship of cannabinoid blood concentrations with the analgesic response to vaporized cannabis. J Pain Res. 2016;9:587–98.CrossRefGoogle Scholar
  28. 28.
    Cannabis use in patients with fibromyalgia: effect on symptoms relief and health-related quality of life. PLoS One. 2011;6:e18440.Google Scholar
  29. 29.
    Calandre EP, Rico-Villadermoros F, Slim M. An update on pharmacotherapy for the treatment of fibromyalgia. Expert Opin Pharmacother. 2015;16:1347–68.CrossRefGoogle Scholar
  30. 30.
    van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain. 2019;160(4):860–9.CrossRefGoogle Scholar
  31. 31.
    Walitt B, Klose P, Fitzcharles MA, Phillips T, Häuser W. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD011694.Google Scholar
  32. 32.
    Baron EP, Lucas P, Eades J, Hogue O. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort. J Headache Pain. 2018;19:37.CrossRefGoogle Scholar
  33. 33.
    Rhyne DN, Anderson SL, Gedde M, Borgelt LM. Effects of medical marijuana on migraine headache frequency in an adult population. Pharmacotherapy. 2016;36:505–10.CrossRefGoogle Scholar
  34. 34.
    de Vries M, et al. Tetrahydrocannabinol does not reduce pain in patients with chronic abdominal pain in a phase placebo-controlled study. Clin Gastroenterol Hepatol. 2017;15(7):1079–1086.e4.CrossRefGoogle Scholar
  35. 35.
    de Vries M, Van Rijckevorsel DC, Vissers KC, Wilder-Smith OH, Van Goor H. Single dose delta-9-tetrahydrocannabinol in chronic pancreatitis patients: analgesic efficacy, pharmacokinetics and tolerability. Br J Clin Pharmacol. 2016;81(3):525–37.CrossRefGoogle Scholar
  36. 36.
    Hickernell TR, Lakra A, Berg A, Cooper HJ, Geller JA, Shah RP. Should cannabinoids be added to multimodal pain regimens after total hip and knee arthroplasty? J Arthroplast. 2018;33(12):3637–41.  https://doi.org/10.1016/j.arth.2018.07.027. Epub 2018 Aug 3.CrossRefGoogle Scholar
  37. 37.
    Mondello E, Quattrone D, Cardia L, Bova G, Mallamace R, Barbagallo AA, et al. Cannabinoids and spinal cord stimulation for the treatment of failed back surgery syndrome refractory pain. J Pain Res. 2018;11:1761–7 Published 2018 Sep 6.CrossRefGoogle Scholar
  38. 38.
    • Nielsen S, Sabioni P, Trigo JM, Ware MA, Betz-Stablein BD, Murnion B, Lintzeris N, Khor KE, Farrell M, Smith A, le Foll B Opioid-sparing effect of cannabinoids: a systematic review and meta-analysis. Neuropsychopharmacology. 2017;42(9):1752–1765. doi: https://doi.org/10.1038/npp.2017.51. This review examines the potential of cannabinoids to reduce opioid burden and provides a review of available studies with calculated opioid dose reduction.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology, Pain Management and Perioperative MedicineHenry Ford HospitalDetroitUSA

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