Chronic pain – what it is and how medical cannabis can help relieve symptoms in some patients.

1 in 2 medicinal cannabis patients in Australia are prescribed cannabis to treat chronic pain. Learn about the signs and symptoms of chronic pain and how cannabis may help.

by

Polln - Emily O.

August 2022

table of contents

5

min read

Chronic pain syndrome is a condition affecting millions of Australians daily. About half of all medicinal cannabis patients in Australia are prescribed cannabis treatments to help relieve the symptoms of chronic pain. 1

In this blog post we’ll explore what chronic pain is and how medicinal cannabis (also known as ‘medical marijuana’) can help relieve pain and discomfort in some patients.

What is chronic pain?

Chronic pain is defined as pain that lasts for at least three months. It may be a consistent or intermittent pain that comes and goes without apparent cause, and it can occur in nearly any part of your body. Chronic pain is distinct from acute pain – such as pain from an injury that develops quickly and then subsides – in that it persists beyond the normal healing time of an injury or illness. 

What are the types of chronic pain?

There are several different types of chronic pain, including bone, muscle or joint pain, nerve pain and pain due to cancer. Some of the most common types of chronic pain include:

  • Back pain
  • Neck pain
  • Neuropathic pain
  • Headaches and migraines
  • Fibromyalgia pain
  • Arthritic or joint pain
  • Musculoskeletal pain
  • Neurogenic pain
  • Cancer pain

Chronic pain can be caused by an illness such as migraine, arthritis or a musculoskeletal condition, or may be a lingering result of an injury or surgery. However, sometimes there is no apparent cause of chronic pain, making treatment extremely difficult.

What are the signs and symptoms of chronic pain?

The signs and symptoms associated with chronic pain will depend on the type of chronic pain you are experiencing. For example, if you have chronic pain in your lower back, you may experience pain that runs from the lower back and down your legs, while an injury or issue in the neck may cause pain in various other parts of the body. Other symptoms associated with chronic pain may include:

  • Pains, aches and burning sensations
  • Sleep problems
  • Anxiety
  • Depression
  • Mood problems
  • Loss of energy
  • Fatigue
  • Decreased activity
  • Pins and needles
  • + more

Acute pain, such as pain from an injury, surgery or illness, can develop into chronic pain syndrome if left untreated or not treated correctly. The longer acute pain remains untreated, the greater the risk of the pain becoming chronic and more difficult to treat. 

When should I seek treatment for pain?

If you are experiencing pain that persists beyond the normal healing time of an injury or illness, or that has no apparent cause, is worsening or is not responding to simple treatment, then it may be time to see a doctor. 

While there are no definitive guidelines for when to seek help for pain or chronic pain, if the pain is persistent and is impacting things like your mood, quality of life and sleep, then a visit to the doctor might be needed to help determine the cause and appropriate treatment for your pain. 

How is chronic pain traditionally treated?

The main goal in chronic pain treatment is to treat the underlying cause of the pain, rather than just the pain symptoms. This means there are a range of surgical and non-surgical treatment methods employed to treat chronic pain, depending on the cause of the pain itself. Non-surgical treatments like physiotherapy and both over-the-counter and prescription medications are some of the most common treatments for chronic pain.

All medications can cause adverse side effects, from over-the-counter medications like ibuprofen to stronger prescription pain medications like opioids. When it comes to pain relief medication, opioids in particular are associated with a range of mild to severe adverse effects – from dizziness and nausea to dependence and fatal overdose. In fact, in 2018 opioids accounted for just over 3 deaths per day in Australia, with the majority of these opioid-induced fatalities being unintentional overdoses involving the use of pharmaceutical opioids, often in the presence of other substances.2 It is for these reasons that opiate medications are not always seen as a suitable or preferable treatment option for many patients suffering from chronic pain, leading some patients to seek alternative therapeutic options.

Is cannabis prescribed for chronic pain in Australia?

About half of all medical cannabis patients in Australia are prescribed medical cannabis to treat chronic pain symptoms, making chronic non-cancer pain the number one category for medicinal cannabis approvals in Australia. The treatment of chronic pain with medicinal cannabis has been shown to result in improved pain and functional outcomes. With one 2016 study of 274 participants3 finding that medical cannabis reduced pain symptoms, pain severity and pain interference with daily tasks in most patients, and even resulted in a significant reduction in opioid use.

In 20174 the Australian Government Department of Health commissioned a team from the University of New South Wales, University of Sydney and University of Queensland under the coordination of the National Drug and Alcohol Council (NDARC) to review the available evidence for the use of medicinal cannabis in patients with chronic non-cancer pain (CNCP).

A meta-analysis of all randomised studies in CNCP averaging across all medicinal cannabis treatments indicated that “medicinal cannabis was more likely than placebo to produce 30% and 50% reductions in pain scores and more likely than placebo to produce a significantly greater reduction in pain intensity ratings.”

The TGA has approved medicinal cannabis as a treatment for over 130 conditions, including chronic pain. The types of chronic pain cannabis may treat are nerve pain, arthritic pain, cancer pain and musculoskeletal pain. However, there is no specific list of conditions or types of chronic pain that the TGA has approved for medical cannabis treatment. This means that a prescribing doctor will need to assess you on an individual basis to determine whether medicinal cannabis treatment may be right for you and your chronic pain symptoms.

Cannabinoids for pain relief

The two main cannabinoids found in cannabis – cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) – can help with relieving pain both on their own and when taken in conjunction. Depending on the individual patient and their symptoms, condition and type of chronic pain, a doctor may prescribe CBD, THC or a treatment containing both cannabinoids to help relieve pain symptoms. 

Here are some of the varying ways THC and CBD interact with the body to relieve pain in some patients:

CBD

  • Has an analgesic or pain relieving effect
  • May interact with cannabinoid receptors indirectly to regulate pain
  • Anti-inflammatory
  • Non-psychotropic (won’t get you high)

THC

  • Has an analgesic or pain relieving effect
  • Works directly with cannabinoid receptors to help with communication between nerve cells to relieve the perception of pain
  • Anti-inflammatory
  • Psychoactive (produces a ‘high’ feeling)

Like any medication, cannabinoid treatments may not work for everyone and are not guaranteed to relieve chronic pain symptoms.

In some patients, using a combination of CBD and THC may lead to a better result and greater relief from their symptoms – this is known as the ‘entourage effect’ where different components of the cannabis plant work synergistically to enhance their overall therapeutic benefits.

Exploring medical cannabis treatment options for chronic pain

To be eligible for medicinal cannabis access as a patient in Australia, the TGA states that you must have a chronic medical condition (lasting 3 months or more) that conventional treatments have failed to treat and/or caused you unwanted side effects. Therefore if you have had chronic pain symptoms for 3 months or more and you are not satisfied with your current or past treatments, you may be eligible for medicinal cannabis access.

If you are interested in exploring medical cannabis treatment options for chronic pain, the first thing you’ll need to do is talk to a doctor. Our Polln practitioners are experts in medicinal cannabis who can help determine whether cannabis is a suitable treatment option for you, and which type of cannabis treatment might be right for the type of chronic pain you’re experiencing.

While cannabis is not a first line treatment in Australia, it is also not a last resort. Meaning you do not need to have exhausted all of your treatment options to be eligible for medicinal cannabis access. If you’re not sure whether you might be eligible, you can take our free eligibility quiz or sign up as a Polln patient to discuss your options with one of our expert doctors. 

References
  1. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2019. Canberra: AIHW; 2020.
  2. Australian Bureau of Statistics, Opioid-induced deaths in Australia. 2019
  3. Haroutounian S, Ratz Y, Ginosar Y, Furmanov K, Saifi F, Meidan R, Davidson E. The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study. Clin J Pain. 2016 Dec;32(12):1036-1043. doi: 10.1097/AJP.0000000000000364. PMID: 26889611.
  4. Therapeutic Goods Administration (TGA), Guidance for the use of medicinal cannabis in the treatment of chronic non-cancer pain in Australia. Version 1, December 2017.

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