Most people use CBD to control chronic pain, arthritis and joint pain. Research on CBD
Cannabidiol, or CBD, is one of the many compounds found in the cannabis plant and that is becoming the flagship product of the health industry. Producers see it as a quick solution to treat many disorders, from anxiety to attention deficit hyperactivity disorder (ADHD), although it has been legal in the United States for a short time.
Kevin Boehnke, Ph.D., a researcher in the department of anesthesiology and the Center for Chronic Pain and Fatigue Research at the University of Michigan believes that the excitement that CBD has aroused among researchers is enormous, which is very good since That cannabis has been used for thousands of years and people know that it is a safe substance. But being safe does not imply that it is efficient. Does CBD work to treat pain?
Before delving into this topic we must analyze the pain. What constitutes pain? Experts classify pain into three types. One of them is neuropathic pain, that is, pain caused by nerve damage or inflammation. For example, carpal tunnel syndrome or sciatica.
There is also acute or nociceptive pain, which is the acute pain that usually occurs as a result of a tissue injury or damage, such as a broken bone or arthritis caused by bone rubbing.
And finally there is centralized pain, which has recently been called nociplastic. For example, fibromyalgia or some of the other conditions of chronic overlapping pain, such as migraines and tension headaches, which have been more difficult to catalog scientifically and clinically because there is no specific pathology that can be identified on an x-ray.
But the reality is that different types of pain do not always respond to medication in the same way and, therefore, it is difficult to make generalizations about the effect of CBD for the treatment of pain.
Until December 2018, the federal government classified CBD as a substance in Annex I (along with marijuana), which has made the investigation very complicated. But since President Trump promulgated the Farm Bill, according to which hemp is another agricultural product, the situation could change.
Many animal studies have already been carried out and the conclusion is that CBD is a great anti-inflammatory and that it has an analgesic effect. But it is also true that animal research has not always been extrapolated to humans.
Of course there are numerous studies focusing on medical marijuana and pain. Most of them focus on the use of CBD together with THC, or delta-9-tetrahydrocannabinol, the compound in cannabis that has psychoactive effects, as researchers believe that these two cannabinoids work best together.
If you take them together you can tolerate more THC without having the same psychoactive effects. Also, taking CBD and THC together, compared to a similar amount of THC alone or CBD alone, seems to have better analgesic effects.
The truth is that several analyzes have been published that corroborate the effectiveness of cannabis in treating pain. The problem is that they have reached somewhat conflicting conclusions.
A 2017 study by the Department of Veterans Affairs found evidence that cannabis preparations with a THC-CBD content in a 1: 1 ratio can alleviate neuropathic pain but evidence insufficiency with other types of pain.
However, another report carried out by the National Academies of Science, Engineering and Medicine (NASEM) and that was published that same year concluded that there was conclusive and substantial evidence that marijuana is efficient for the treatment of pain Chronic, nausea and vomiting caused by chemotherapy, multiple sclerosis and any pain related to muscle spasms and stiffness.
On the contrary, a third investigation carried out by Cochrane, which is one of the most respected research organizations, concluded that there is still a lack of evidence that any cannabis-derived product works for the treatment of chronic neuropathic pain.
And yet, experts continue to believe that cannabis is very effective for the treatment of pain. Boehnke explains that previous research is very limited since they do not administer cannabis or cannabinoids to people for a prolonged period.
A major problem for research is the United States Drug Control Administration (DEA). This organization does not allow the legal production of marijuana for research. Currently, the University of Mississippi, funded by the National Institute on Drug Abuse, is the only marijuana provider allowed by the DEA. In 2016, the DEA said it would accept requests from other suppliers, but for the moment everything remains the same.
But in addition, the researchers complain that the marijuana grown by the university is of low quality, has mold and is genetically hemp and not marijuana, with extremely low levels of THC.
On the other hand, most studies use synthetic single-molecule cannabinoids instead of medical marijuana that anyone can find in a clinic and can contain more than 400 different cannabinoids.
When cannabis is consumed from a dispensary, the body obtains many different compounds that together have the ability to relieve pain, since the combination of all produces a force from synergy.
As NASEM noted in its 2017 review, very little is known about the efficacy, dosage, routes of administration or side effects of cannabis products commonly used and commercially in the United States. And that is why pain researchers worry about trying the whole cannabis plant since all those hundreds of cannabinoids can help explain why cannabis relieves pain and how it does it.
According to Canadian researchers Amol Deshpande, MD, and Angela Mailis, MD in The Journal of Applied Laboratory Medicine, it can be a mistake to assume that the main clinical effects of cannabis come solely from THC and CBD. Most likely, we are underestimating the importance of the rest of the associated compounds found throughout the cannabis plant. Although the biological activity and efficiency of many of these cannabinoids have yet to be explored, preliminary research indicates that some may operate synergistically to produce what is known as the “entourage effect.”
Experts may also discover that CBD alone can relieve pain. A recent study on animal pain investigated how CBD can interact with serotonin receptors, which are believed to play an important role in pain, depression and anxiety.
The approval of the DEA of the CBD and also the approval of the FDA of Epidiolex, a CBD-based medicine used to treat rare forms of childhood epilepsy, will lead to new research and CBD clinical studies can be carried out much more easily and assiduity.
Sativex is a cannabis-based pharmaceutical product that contains THC and CBD in a 1: 1 ratio. It is legal in several countries to treat neuropathic pain, muscle spasms and stiffness related to multiple sclerosis, and severe pain. for advanced cancer. It is already under evaluation in the United States.
Without doubt, one of the best properties of cannabis is its ability to combat opioid addiction. More and more research shows that the combination of cannabinoids and opiates is stronger than opiates alone, which implies that opioid doses could be reduced in patients. And a 2019 study showed that 80% of patients with chronic pain have replaced opiates that have traditional analgesics (both opiates and benzodiazepines) with cannabis because it has fewer side effects.
While it is true that research on CBD and cannabis is very promising, experts say it currently has important limitations to investigate further. In May of this year, the American Academy of Pain Medicine published a letter urging federal agencies to reschedule medical cannabis to encourage research in order to have responsible regulation.