Definitions of Pain
All of us have experienced physical pain at some point in our lives, and we often go to great lengths to avoid it. Although pain typically has a negative connotation, it does serve a very real purpose.
Protective pain alerts us to abnormalities or episodic bodily injury, so we will either seek medical attention or stop the circumstances causing the injury. Experiential pain teaches us to avoid situations or occurrences that lead to pain or injury. Both protective and experiential pain is purposeful, in helping us understand both our bodies and our environments. It also minimizes our movements to ensure we give our bodies uninterrupted time to heal. However, too much pain or long durations of pain can quickly move beyond the purpose and become a hindrance both physically and emotionally.
The Pain Pathway and Pain Therapies
Current Pain Medications
Categories of current pain medications include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Acetaminophen, such as Tylenol
- Corticosteroids, such as dexamethasone and prednisone
- Opioids, to include natural, synthetic, and semi-synthetic
- Muscle relaxants
- Some anti-anxiety drugs
- Some anticonvulsant drugs
- Selective serotonin reuptake inhibitors (SSRIs)
- Cannabinoid-based products (cannabinoids, like CBD, may help relieve pain and inflammation)
NSAIDs are over-the-counter (OTC) medications often used for mild to moderate pain and inflammation. Although predominantly seen as safe, prolonged use can increase the risk of heart attack and stroke, as the FDA warned in 2005. Similarly, acetaminophen is an over-the-counter anti-inflammatory and analgesic, yet is the most common cause of acute liver failure due to overconsumption and misuse.
Corticosteroids can be used as an immunosuppressant for conditions such as rheumatoid arthritis, where the immune system attacks the joints causing severe pain and inflammation. However, corticosteroids are hormones, and by default, can have a wide range of side effects following consistent use (i.e. weakened muscles, nausea, insomnia, and mood swings). Opioids and muscle relaxants have long been used for effectively managing acute pain, but the evidence does not support long-term use of opioids for relieving chronic pain, as they are highly addictive, often leading to overuse and overdose. So much so, that the Department of Health and Human Services declared opioid abuse a public health crisis in 2018. Similarly, muscle relaxants also have the potential for abuse and addiction, as they act on the central nervous system as depressants, with side effects ranging from dizziness, agitation, and decreased blood pressure.
Acute pain (both nociceptive and neuropathic) is often treated with analgesics and anesthetics, which seems to be the common thread amongst these established pain medications; effective for acute pain, but unsafe for prolonged use (chronic pain). That is, except for cannabis-based products.
CBD for Neuropathic and Nociceptive Pain
We discuss neuropathic pain above, which is essentially pain caused by damage or disease affecting the somatosensory nervous system. The function of the somatosensory nervous system is to interpret bodily sensations, such as touch, pressure, vibration, temperature, and pain. Both the conception and continuation of neuropathic pain is often due to the glutamatergic system. Glutamate is the predominant neurotransmitter in the nervous system, as it is used in more than 90% of synapses. It is a powerful excitatory neurotransmitter that is responsible for sending signals between nerve cells, and under normal conditions, it plays an important role in learning and memory. It is the neuroprotectant qualities of CBD that may inhibit glutamate release, allowing CBD to potentially dull the prickling, tingling, and burning sensations associated with neuropathic pain.
Inflammation is an established root cause of nociceptive pain and becomes problematic when it moves from acute to chronic inflammation. This means the immune system cannot breakdown the irritant or pathogen, or the immune system is malfunctioning by attacking healthy tissue. Research has shown both CB1 and CB2 receptors of the Endocannabinoid System have been found on immune cells, which suggests that cannabinoids could play a critical role in regulating the immune system. Because of this, oral applications of CBD may show effectiveness in relieving chronic inflammatory and neuropathic pain. Additionally, a topical application of CBD may help in relieving localized inflammation and pain. Where CBD and other cannabis-based products separate themselves from other OTC and prescription pain medications is they are safe for prolonged use, meaning they are safe for chronic pain and inflammation. According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…To date, there is no evidence of public health-related problems associated with the use of pure CBD.”
In short, cannabinoid-based products show great potential for relieving both pain and inflammation. Not only because of the thousands of peer-reviewed scientific publications documenting its therapeutic properties. And not just because cannabis has been used therapeutically for thousands of years. But because patients suffering from acute and chronic pain want and deserve safe, effective, and non-addictive relief.