Medical Marijuana for Chronic Pain
Chronic pain conditions continue to be among the top reasons people seek out medical marijuana. At the birth of this trend, pharmaceutical narcotics were provided with little forethought of the future, and the potential impact it has on society. As a result, narcotic dependency from opioid pain medications and related drug abuse soon became a national concern requiring more guidelines on the dispensing of these drugs and forcing both patients and practitioners to begin looking for alternatives for pain management.
CBD From Hemp or Medical Marijuana?
CBD (cannabidiol) is a cannabinoid compound extracted from the cannabis plant. Various cannabis species exist and supply over 100 cannabinoids. However, medicine has focused primarily on either tetrahydrocannabinol (THC) or cannabidiol (CBD) for pain management over recent years.
Cannabis indica is a small plant and densely populated with broad leaves. This species is often referred to as marijuana since it contains up to 30% of the psychoactive cannabinoid known as THC. THC can be harvested from its flowering tops for its euphoric properties. Cannabis indica naturally contains very little CBD, which counteracts the psychoactive properties of THC. However, some strains of marijuana can be bred to promote higher levels of CBD. Commercially growing high-CBD strains of marijuana for medical use is becoming more popular for patients suffering from chronic pain.
Cannabis sativa is a taller and more narrow species, relatively low in THC but it’s rich in CBD. This species is traditionally known as hemp, and like medical marijuana, is grown commercially under controlled conditions. It may sometimes be referred to as “industrial hemp” because it can be harvested for a variety of commercial uses.
It’s important to note that CBD from either medical marijuana or hemp is an identical substance. The body does not recognize its source. By dry weight, CBD is more concentrated in marijuana plants, but after the oil is extracted from each, the difference is insignificant. Hemp grows faster than high-CBD strains of medical marijuana, making it an environmentally sustainable and a great source of CBD.
How Cannabinoids Act on the Body
Both CBD and THC act upon a comparatively recently discovered communication system in the body, known as the endocannabinoid system. This system is laced throughout the central and peripheral nervous system. The complex nature of this system is still being researched. However, we know there are two primary receptors through which THC and CBD can attach and carry out their effects on the body. One receptor is called CB1 and when activated by a compound such as THC. THC stimulates pathways that promote the mind-altering effects associated with traditional marijuana. The second receptor is called CB2, and when it’s activated by a compound such as CBD, it not only helps to improve the actions of CB1 but helps the body manage pain.
CBD and Medical Marijuana for Pain Management
Cannabinoids such as THC and CBD have been studied extensively for their use in various chronic pain conditions. They are especially helpful agents for controlling neuropathic pain. This is chronic pain of the nerves that waxes and wanes, and may even lead to tingling or numbness such as complex regional pain syndrome. It often arises as a result of peripheral nerve injury but can be mediated by other factors as well.
Cannabinoids like CBD may also help alleviate pain by targeting and activating glycine receptors in the central nervous system. These receptors are located in various regions of the brain and spinal cord and plan an essential role in reducing chronic inflammatory pain and neuropathic pain. Inflammatory factors, such as prostaglandins are present. Inflammatory pain receptors often shut down these receptors, which increases the sensation of pain, but CBD can reactivate these receptors and decrease pain hypersensitivity.
References
Di Marzo, V., &Piscitelli, F. (2015). The Endocannabinoid System and Its Modulation by Phytocannabinoids. Neurotherapeutics, 12(4), 692–698. http://doi.org/10.1007/s13311-015-0374-6
Boychuk, D. G., Goddard, G., Mauro, G., & Orellana, M. F. (2015). The Effectiveness of Cannabinoids in the Management of Chronic Nonmalignant Neuropathic Pain: A Systematic Review. Journal of Oral & Facial Pain and Headache, 29(1), 7-14. doi:10.11607/ofph.1274
Morales, P., Hernandez-Folgado, L., Goya, P., &Jagerovic, N. (2016). Cannabinoid receptor 2 (CB2) agonists and antagonists: a patent update. Expert Opinion on Therapeutic Patents, 26(7), 843-856. doi:10.1080/13543776.2016.119315
Iseger, T. A., &Bossong, M. G. (2015). A systematic review of the antipsychotic properties of cannabidiol in humans. Schizophrenia Research, 162(1-3), 153-161. doi:10.1016/j.schres.2015.01.033
Xiong, et al. (2012). Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors. The Journal of Experimental Medicine, 209(6), 1121–1134. http://doi.org/10.1084/jem.20120242