Treatment with medicinal cannabis for chronic pain

Cannabinoid therapy with THC and CBD can alleviate chronic pain. For many patients, medicinal cannabis can be an important complementary therapy module in the overall structure of pain therapy.
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PAIN THERAPY WITH CANNABINOIDS Treating pain with medicinal cannabis

Cannabinoids (such as THC and CBD) modulate the process of pain perception in the body and influence the transmission of pain. Accordingly, medical cannabis can be an important therapeutic component in the overall structure of pain therapy for many patients when alternatives fail.

Treatment with cannabis can help to achieve pain relief and can also significantly improve the perceived quality of life in some cases.

Our cooperating doctors will be happy to check whether treatment with medicinal cannabis could be an option for you and will carry out an individual anamnesis.

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Why can medicinal cannabis help in pain therapy?

Insight into study results:

  • The endocannabinoid system is closely linked to nociception (pain perception), including the activation of pain inhibition, pain transmission and stress reduction.[1]Finn DP, Haroutounian S, Hohmann AG, Krane E, Soliman N, Rice ASC. Cannabinoids, the endocannabinoid system, and pain: a review of preclinical studies. Pain. 2021 Jul 1;162(Suppl 1):S5-S25. doi: 10.1097/j.pain.0000000000002268. PMID: 33729211.
  • Cannabinoids can alleviate chronic pain.[2]Maharajan MK, Yong YJ, Yip HY, Woon SS, Yeap KM, Yap KY, Yip SC, Yap KX. Medical cannabis for chronic pain: can it make a difference in pain management? J Anesth. 2020 Feb;34(1):95-103. doi: 10.1007/s00540-019-02680-y. Epub 2019 Sep 18. PMID: 31535218.[3]Karst M, Wippermann S, Ahrens J. Role of cannabinoids in the treatment of pain and (painful) spasticity. Drugs. 2010 Dec 24;70(18):2409-38. doi: 10.2165/11585260-000000000-00000. PMID: 21142261.
  • Negative side effects such as sleep disorders and depression can also be positively influenced.[4]Aviram J, Pud D, Gershoni T, Schiff-Keren B, Ogintz M, Vulfsons S, Yashar T, Adahan HM, Brill S, Amital H, Goor-Aryeh I, Robinson D, Green L, Segal R, Fogelman Y, Tsvieli O, Yellin B, Vysotski Y, Morag O, Tashlykov V, Sheinfeld R, Goor R, Meiri D, Eisenberg E. Medical cannabis treatment for chronic pain: Outcomes and prediction of response. Eur J Pain. 2021 Feb;25(2):359-374. doi: 10.1002/ejp.1675. Epub 2020 Nov 9. PMID: 33065768.[5]Piper BJ, DeKeuster RM, Beals ML, Cobb CM, Burchman CA, Perkinson L, Lynn ST, Nichols SD, Abess AT. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol. 2017 May;31(5):569-575. doi: 10.1177/0269881117699616. Epub 2017 Apr 4. PMID: 28372506.
  • Treatment with medical cannabis under medical observation is potentially associated with fewer side effects compared to other medications such as opiates and can even lead to their reduction.[6]Boehnke KF, Litinas E, Clauw DJ. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain. 2016 Jun;17(6):739-44. doi: 10.1016/j.jpain.2016.03.002. Epub 2016 Mar 19. PMID: 27001005.[7]Kvamme SL, Pedersen MM, Rømer Thomsen K, Thylstrup B. Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample. Harm Reduct J. 2021 Jul 10;18(1):72. doi: 10.1186/s12954-021-00520-5. PMID: 34246279; PMCID: PMC8272272. [8]Piper BJ, DeKeuster RM, Beals ML, Cobb CM, Burchman CA, Perkinson L, Lynn ST, Nichols SD, Abess AT. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol. 2017 May;31(5):569-575. doi: 10.1177/0269881117699616. Epub 2017 Apr 4. PMID: 28372506.
  • The effect of cannabis on the human body is very individual and also depends on the type of medication used.[9]Aviram J, Pud D, Gershoni T, Schiff-Keren B, Ogintz M, Vulfsons S, Yashar T, Adahan HM, Brill S, Amital H, Goor-Aryeh I, Robinson D, Green L, Segal R, Fogelman Y, Tsvieli O, Yellin B, Vysotski Y, Morag O, Tashlykov V, Sheinfeld R, Goor R, Meiri D, Eisenberg E. Medical cannabis treatment for chronic pain: Outcomes and prediction of response. Eur J Pain. 2021 Feb;25(2):359-374. doi: 10.1002/ejp.1675. Epub 2020 Nov 9. PMID: 33065768.[10]Schmidt-Wolf G, Cremer-Schaeffer P. Begleiterhebung zur Anwendung von Cannabisarzneimitteln in Deutschland – Zwischenauswertung [Interim analysis of the survey accompanying insurance-covered prescriptions of cannabis-based medicines in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019 Jul;62(7):845-854. German. doi: 10.1007/s00103-019-02968-0. PMID: 31143965.

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Symptoms, diagnosis and causes

The function of pain as a warning signal is partially lost in chronic pain. This means that the pain symptoms persist even though the underlying cause may already have been resolved. Chronic pain is defined as pain that lasts for at least three months and significantly restricts the patient’s quality of life. Frequent localisation sites are the lower back and the neck region. The former pain symptoms eventually develop into a disease in their own right. Chronic pain can be localised or generalised.
Chronic pain is not only a medical problem, but can also have a negative impact on the mental health and well-being of the person affected. This is very individual, but can lead to a complete loss of independence for some people. Almost half of people who suffer from chronic pain suffer from depressive episodes. Diagnosis and treatment is usually a lengthy process involving consultations with various specialised doctors.

The treatment of chronic pain is carried out as “multimodal therapy” or “specialised pain therapy” and consists of various components. These include, for example, drug therapy, physiotherapy, psychotherapy and minimally invasive and surgical procedures. Antidepressants, (non-)opioid painkillers and antiepileptic drugs can be used in the medication strategy. Active coping strategies and educating patients about the role of psychosocial aspects are also crucial.
Cannabinoids modulate the process of pain perception in the body through an inhibitory effect in the central nervous system, among other things. In this respect, it is not a classic analgesic. The exact mechanisms of action are part of the latest research. In order to achieve pain relief and improve quality of life, cannabis for medicinal purposes can be an important component in the overall structure of pain therapy for many patients. Opioids, but also non-opioid medications, can have serious negative effects, especially when taken long-term. The combination of pharmaceuticals and cannabis-based treatments can help patients to reduce their pain medication and opioid doses while minimising adverse effects.

MEDICAL CANNABIS Cannabinoid therapy

Other conditions for which medicinal cannabis can help

ADHD
Depression
Migraine
Sleep disorders
Osteoarthritis
Further treatments
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References

1) Finn DP, Haroutounian S, Hohmann AG, Krane E, Soliman N, Rice ASC. Cannabinoids, the endocannabinoid system, and pain: a review of preclinical studies. Pain. 2021 Jul 1;162(Suppl 1):S5-S25. doi: 10.1097/j.pain.0000000000002268. PMID: 33729211.

2) Maharajan MK, Yong YJ, Yip HY, Woon SS, Yeap KM, Yap KY, Yip SC, Yap KX. Medical cannabis for chronic pain: can it make a difference in pain management? J Anesth. 2020 Feb;34(1):95-103. doi: 10.1007/s00540-019-02680-y. Epub 2019 Sep 18. PMID: 31535218.

3) Karst M, Wippermann S, Ahrens J. Role of cannabinoids in the treatment of pain and (painful) spasticity. Drugs. 2010 Dec 24;70(18):2409-38. doi: 10.2165/11585260-000000000-00000. PMID: 21142261.

4) Boehnke KF, Litinas E, Clauw DJ. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain. 2016 Jun;17(6):739-44. doi: 10.1016/j.jpain.2016.03.002. Epub 2016 Mar 19. PMID: 27001005.

5) Kvamme SL, Pedersen MM, Rømer Thomsen K, Thylstrup B. Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample. Harm Reduct J. 2021 Jul 10;18(1):72. doi: 10.1186/s12954-021-00520-5. PMID: 34246279; PMCID: PMC8272272.

6) Aviram J, Pud D, Gershoni T, Schiff-Keren B, Ogintz M, Vulfsons S, Yashar T, Adahan HM, Brill S, Amital H, Goor-Aryeh I, Robinson D, Green L, Segal R, Fogelman Y, Tsvieli O, Yellin B, Vysotski Y, Morag O, Tashlykov V, Sheinfeld R, Goor R, Meiri D, Eisenberg E. Medical cannabis treatment for chronic pain: Outcomes and prediction of response. Eur J Pain. 2021 Feb;25(2):359-374. doi: 10.1002/ejp.1675. Epub 2020 Nov 9. PMID: 33065768.

7) Piper BJ, DeKeuster RM, Beals ML, Cobb CM, Burchman CA, Perkinson L, Lynn ST, Nichols SD, Abess AT. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol. 2017 May;31(5):569-575. doi: 10.1177/0269881117699616. Epub 2017 Apr 4. PMID: 28372506.

8) Schmidt-Wolf G, Cremer-Schaeffer P. Begleiterhebung zur Anwendung von Cannabisarzneimitteln in Deutschland – Zwischenauswertung [Interim analysis of the survey accompanying insurance-covered prescriptions of cannabis-based medicines in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019 Jul;62(7):845-854. German. doi: 10.1007/s00103-019-02968-0. PMID: 31143965.

* The treatment decision is made by cooperating doctors during the initial consultation. Remote treatment is not possible in every case. The prerequisites are compliance with recognised professional standards within the meaning of Section 630a of the German Civil Code (BGB) (taking into account scientific findings, medical experience that is necessary to achieve the medical treatment objective and has proven itself in trials) and the determination that, depending on the clinical picture, no personal contact between doctor and patient is necessary.

Referenzen

Referenzen
↑1 Finn DP, Haroutounian S, Hohmann AG, Krane E, Soliman N, Rice ASC. Cannabinoids, the endocannabinoid system, and pain: a review of preclinical studies. Pain. 2021 Jul 1;162(Suppl 1):S5-S25. doi: 10.1097/j.pain.0000000000002268. PMID: 33729211.
↑2 Maharajan MK, Yong YJ, Yip HY, Woon SS, Yeap KM, Yap KY, Yip SC, Yap KX. Medical cannabis for chronic pain: can it make a difference in pain management? J Anesth. 2020 Feb;34(1):95-103. doi: 10.1007/s00540-019-02680-y. Epub 2019 Sep 18. PMID: 31535218.
↑3 Karst M, Wippermann S, Ahrens J. Role of cannabinoids in the treatment of pain and (painful) spasticity. Drugs. 2010 Dec 24;70(18):2409-38. doi: 10.2165/11585260-000000000-00000. PMID: 21142261.
↑4, ↑9 Aviram J, Pud D, Gershoni T, Schiff-Keren B, Ogintz M, Vulfsons S, Yashar T, Adahan HM, Brill S, Amital H, Goor-Aryeh I, Robinson D, Green L, Segal R, Fogelman Y, Tsvieli O, Yellin B, Vysotski Y, Morag O, Tashlykov V, Sheinfeld R, Goor R, Meiri D, Eisenberg E. Medical cannabis treatment for chronic pain: Outcomes and prediction of response. Eur J Pain. 2021 Feb;25(2):359-374. doi: 10.1002/ejp.1675. Epub 2020 Nov 9. PMID: 33065768.
↑5, ↑8 Piper BJ, DeKeuster RM, Beals ML, Cobb CM, Burchman CA, Perkinson L, Lynn ST, Nichols SD, Abess AT. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol. 2017 May;31(5):569-575. doi: 10.1177/0269881117699616. Epub 2017 Apr 4. PMID: 28372506.
↑6 Boehnke KF, Litinas E, Clauw DJ. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain. 2016 Jun;17(6):739-44. doi: 10.1016/j.jpain.2016.03.002. Epub 2016 Mar 19. PMID: 27001005.
↑7 Kvamme SL, Pedersen MM, Rømer Thomsen K, Thylstrup B. Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample. Harm Reduct J. 2021 Jul 10;18(1):72. doi: 10.1186/s12954-021-00520-5. PMID: 34246279; PMCID: PMC8272272.
↑10 Schmidt-Wolf G, Cremer-Schaeffer P. Begleiterhebung zur Anwendung von Cannabisarzneimitteln in Deutschland – Zwischenauswertung [Interim analysis of the survey accompanying insurance-covered prescriptions of cannabis-based medicines in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019 Jul;62(7):845-854. German. doi: 10.1007/s00103-019-02968-0. PMID: 31143965.