Pain Management

Pain can be either acute (short-term, often related to injury or surgery) or chronic (long-term, persisting for months or years), and represents a complex interplay of physiological and psychological factors.

Common Conditions Related to Pain Management

Some of the most prevalent conditions requiring pain management include:

• Chronic Pain: Includes conditions such as osteoarthritis, rheumatoid arthritis, and chronic back pain.
• Neuropathic Pain: Often linked to diabetes, multiple sclerosis, or spinal cord injuries.
• Cancer Pain: Caused by the cancer itself, treatments such as chemotherapy, or surgical interventions.
• Fibromyalgia: A condition characterised by widespread musculoskeletal pain, fatigue, and issues with sleep and memory.
• Post-Operative Pain: Pain that occurs after surgery, which can sometimes become chronic if inadequately managed.
• Headaches and Migraines: These can often be chronic and may arise from underlying conditions or as standalone issues.

Conventional Treatments for Pain Management

Pain management typically involves a combination of pharmacological and non-pharmacological approaches. Conventional pharmacological treatments include:

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen and naproxen are commonly used for mild to moderate pain.
• Paracetamol (Acetaminophen): Frequently used for mild pain relief and reducing fever.
• Opioids: Drugs such as morphine, oxycodone, and fentanyl are prescribed for moderate to severe pain, particularly for cancer or post-surgical pain.
• Antidepressants: Tricyclic antidepressants (e.g., amitriptyline) or serotonin-noradrenaline reuptake inhibitors (SNRIs) are used to manage neuropathic pain.
• Anticonvulsants: Medications like gabapentin and pregabalin are effective for neuropathic pain.
• Muscle Relaxants: Prescribed for muscle-related pain or spasms.
• Steroids: Corticosteroids such as prednisone are used to treat inflammation-related pain in conditions like arthritis.

However, these conventional treatments often come with significant side effects. NSAIDs can cause gastrointestinal complications, while opioids carry a high risk of dependency, overdose, and long-term health consequences, which has contributed to the global opioid crisis.

How Cannabis Can Help

Medical cannabis, particularly cannabinoids like tetrahydrocannabinol (THC) and cannabidiol (CBD), has shown promise in managing various forms of pain, both acute and chronic. Cannabis interacts with the body’s endocannabinoid system (ECS), which is integral to regulating pain, inflammation, and immune responses. By targeting receptors in the ECS, cannabis can reduce both pain perception and inflammation.

Cannabinoids and Pain Management: Clinical Evidence

Chronic Pain

• A 2015 systematic review and meta-analysis published in The Journal of the American Medical Association (JAMA) reviewed 28 randomised clinical trials and concluded that cannabinoids were associated with significant reductions in chronic pain, particularly neuropathic pain.
• The Canadian Agency for Drugs and Technologies in Health (CADTH) also found moderate evidence supporting the efficacy of medical cannabis for chronic pain.

Neuropathic Pain

• A 2018 review in Frontiers in Pharmacology demonstrated that both THC and CBD could reduce pain intensity in patients with neuropathic pain, particularly those who had insufficient relief from conventional therapies.
• A clinical trial published in Neurology found that cannabis-based medicines provided a 30% reduction in neuropathic pain, comparable to first-line treatments like gabapentin.

Cancer Pain

• A 2010 randomised, double-blind, placebo-controlled trial published in The Journal of Pain and Symptom Management revealed that patients with cancer using a THC extract experienced significant reductions in pain intensity compared to those given a placebo.
• An observational study conducted by Portenoy et al., published in The Journal of Pain, found that medical cannabis was well-tolerated and contributed to pain relief while reducing the need for opioid analgesics.

Fibromyalgia

• A 2011 study published in Clinical and Experimental Rheumatology indicated that patients using cannabis for fibromyalgia reported significant relief, including reductions in pain severity and improved sleep quality.
• Another survey conducted by Fitzcharles et al. found that up to 60% of fibromyalgia patients considered cannabis a useful adjunct therapy when traditional treatments failed.

Post-Operative Pain

• A study in The British Journal of Anaesthesia suggested that cannabinoids may reduce opioid use in post-operative settings, thereby lowering the risk of opioid dependency and associated side effects.
• A study published in The Journal of Pain Research demonstrated that medical cannabis use post-surgery led to significant pain relief and reduced opioid requirements.

Mechanisms of Action

Cannabis works through the activation of CB1 and CB2 receptors within the endocannabinoid system:

• CB1 Receptors: Found primarily in the central nervous system, these receptors are involved in modulating pain perception. THC binds to CB1 receptors, reducing the intensity of pain signals sent to the brain.
• CB2 Receptors: Located in immune cells, CB2 receptors mediate anti-inflammatory effects. CBD, which interacts with these receptors, helps alleviate pain caused by inflammation.

Additionally, the entourage effect—where THC, CBD, and other cannabinoids work synergistically—enhances the therapeutic potential for pain relief. This holistic approach minimises the psychoactive effects associated with THC while maximising its analgesic benefits.

Conclusion

Medical cannabis offers a promising alternative or adjunctive therapy for managing a range of pain conditions, including chronic pain, neuropathic pain, cancer pain, and fibromyalgia. With growing evidence supporting its efficacy and a more favourable safety profile compared to opioids, cannabis is emerging as a viable treatment option for patients seeking effective pain relief with fewer side effects.

By operating within the regulatory framework and ensuring adherence to strict guidelines, healthcare providers and organisations like AKOS Bio can offer safe and regulated access to cannabis-based medicines, improving the quality of life for patients who struggle with pain where conventional treatments have proven insufficient.