Marijuana is quite effective in pain relief. Yet, healthcare experts do not encourage taking it without a doctor’s prescription as it may lead to substance abuse.

A Lowdown on Medical Marijuana and Its Effectiveness in Pain Management

Medical marijuana is popular among patients who suffer from chronic pain, however, most patients don’t consult their doctor before using it for this purpose.

A Lowdown On Medical Marijuana And Its Effectiveness In Pain Management

Overview

Marijuana (Cannabis) is a psychoactive substance we obtain from the cannabis plant. The psychoactive component in marijuana is THC (Tetrahydrocannabinol). Apart from this there are above 400 active compounds in cannabis, more than 70 of which are cannabinoids. It&rsquo;s popular for its recreational and spiritual purposes but has also been a part of traditional medicine for a long time.&nbsp; 
 
The use of marijuana for medicinal purposes has been a topic of debate and has elicited strong reactions from the medical community. The much-publicised positive effects of marijuana are scoffed at, outright dismissed or at the very least taken with a grain of salt. The fact remains that many patients use it and find it effective.

However, medical science hasn&rsquo;t gotten around to conclusively proving this yet. Due to limited production capacity, the vast number of chemicals in cannabis and government restrictions, this hasn&rsquo;t been very rigorously tested through clinical research. Marijuana is now legal in 37 states in the United States including Washington DC. It&rsquo;s also legal in Australia, Canada, Chile, Colombia, Germany, Greece, Israel, Italy, the Netherlands, Peru, Poland, Portugal, and Uruguay. 
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medical marijuana

Doctors have been known to prescribe cannabis or cannabinoids in order to deal with certain ailments. Mostly patients use it on their own to manage symptoms of their illness and reported positively about its therapeutic effects. It&rsquo;s mostly used for pain management.&nbsp; 
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But doesn&rsquo;t it get you high? That is where the distinction comes in. The marijuana used for medicinal purposes tends to have more CBD (cannabidiol) than THC in it. These cannabinoids interact with the cannabinoid receptors located in the brain (CB1) and all over the body (CB2). CB1 receptors are responsible for the psychoactive effects and CB2 receptors control process such as mood, memory, inflammation, appetite and pain. Patients taking CBD dominant marijuana do not suffer any altered consciousness or get a high. 
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So far, we have seen that evidence for the usefulness of medical marijuana is insufficient, inconclusive and heavily anecdotal or biased. Although, based on that alone, we have found it to be effective for the following reasons:

 
For Pain Management: Chronic pain plagues millions of people especially as they age, medical marijuana or cannabinoids are increasingly being utilised to manage this. It has been found to be safer than opioids in palliative care since the potential for abusing opioids is well documented. Another option for pain management is NSAIDs but they don&rsquo;t have a very alluring side effect profile either. What does one do in such cases then? Medical marijuana can help us manage this kind of pain. For example, nerve pain in multiple sclerosis is managed via Pregablin/Gabapentin both of which causes drowsiness and other adverse effects. You can eradicate that completely by employing medical marijuana instead. 
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Some other diseases where pain management is paramount have also shown improvement with medical marijuana, these are;&nbsp;&nbsp;

<ul>
	<li>Endometriosis</li>
	<li>Fibromyalgia</li>
	<li>Interstitial cystitis</li>
	<li>Rheumatoid arthritis&nbsp;</li>
</ul>

A systemic review published by BMJ (a peer-reviewed medical journal published by the trade union the British Medical Association) in 2021 assessed 32 trials and found that there is increased likelihood that medical marijuana is effective in pain management, better sleep, and physical functioning while it does have the usual side effects associated with marijuana. We need more randomised control trials before we dive into systemic reviews to pass the final verdict regarding its effectivity in pain management.&nbsp; 
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Some other uses of medical marijuana have been documented for the following ailments:

1.&nbsp;<a href="https://merisehat.pk/disease/epilepsy" target="_blank">Epilepsy</a>: There are a few conditions FDA has approved Epidiolex (Cannabidiol) for

<ul>
	<li>Lennox-Gastaut Syndrome: it&rsquo;s used as adjunct therapy for seizures.&nbsp;</li>
	<li>Dravet Syndrome: Charlotte&rsquo;s Web, a CBD dominant strain, has shown dramatic improvement in children with this severe form of childhood epilepsy.&nbsp;</li>
	<li>Tuberous Sclerosis Complex.</li>
</ul>

2. Nausea/Vomiting: It&rsquo;s associated with chemotherapy, Dronabinol and Nabinol are FDA approved synthetic formulations of cannabinoid medicine. Some studies have also found cannabis to be more effective than regular anti-emetic medications (promethazine, metoclopramide).

3. Weight loss, appetite loss, anorexia, pain and wasting syndrome associated with HIV/AIDs.&nbsp;

4. Insomnia

5.&nbsp;<a href="https://merisehat.pk/disease/anxiety" target="_blank">Anxiety</a>

6.Glaucoma

7.&nbsp;<a href="https://merisehat.pk/disease/migraines-73">Migraines&nbsp;</a>

8. Tourette syndrome &mdash; aids in improving tics

9.&nbsp;<a href="https://merisehat.pk/disease/schizophrenia" target="_blank">Schizophrenia</a>

10.&nbsp;<a href="https://merisehat.pk/disease/alzheimers-disease" target="_blank">Alzheimer&rsquo;s disease&nbsp;</a>

11. PTSD in veterans

12. Irritable bowel syndrome&nbsp;

13. Chron&rsquo;s disease&nbsp;

14. Spasticity &mdash; tight or stiff muscles

15. Tremors &mdash; In Parkinson&rsquo;s. 
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Any substance that modulates the normal functioning of our brain comes with its own specific side effect profile, some of the side effects associated with medical marijuana are:&nbsp;

<ul>
	<li>Dizziness</li>
	<li>Fatigue</li>
	<li>Tachycardia</li>
	<li>Hallucinations</li>
	<li>Low BP</li>
	<li>Dry mouth/Cotton mouth</li>
	<li>Orthostatic hypotension</li>
	<li>Pruritus</li>
	<li>Bloodshot eyes</li>
	<li>Impaired coordination</li>
	<li>Impaired judgment</li>
	<li>Cognitive and memory issues</li>
	<li>Adversely impacts mental development (if used by teenagers, it&rsquo;s contraindicated in pregnancy since it effects brain development in utero as well)</li>
	<li>Increased risk of bronchitis and lung damage if smoked</li>
	<li>Cannabinoid Hyperemesis Syndrome &mdash; long term use leads to nausea and vomiting</li>
	<li>Dependency</li>
	<li>Paranoia</li>
	<li>Psychosis</li>
	<li>Diarrhea</li>
	<li>It&rsquo;s considered a &lsquo;gateway drug&rsquo; into stronger addictions 
	&nbsp;</li>
</ul>

<ol>
	<li>Smoking or inhaling a vapor has an effect is felt faster via this method.</li>
	<li>Edibles (cookies, brownies, lollipops etc) take up to 1-2 hours to work.</li>
	<li>Topical application via lotion, cream, oil or sprays, dermal patches.&nbsp;</li>
	<li>Tinctures or sublingual drops.</li>
	<li>Capsules</li>
	<li>Lozenges&nbsp;</li>
	<li>Oromucosal spray (nabiximols) 
	&nbsp;</li>
</ol>

Bottom Line

US Drug Enforcement Administration (DEA) classifies marijuana as a Schedule I drug which means that it&rsquo;s in the same league as heroin, ecstasy and LSD. However, big strides have been made in order to reclassify it as Schedule II drug instead to make it easier to study its effects. Further research will help us understand the real impact of this substance and help determine the actual efficacy of it. Doctors being forthcoming and easier to approach regarding this will also help bridge the gap we see in clinical practice and patient practices.&nbsp;

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