Last updated on: 4/5/2018 12:00:22 PM PST
Is Medical Marijuana an Effective Treatment for Severe / Chronic Pain?
Pedro Oliveros, MD, Medical Director at the Physical Medicine & Rehab Center of Orlando, stated the following in his Feb. 9, 2018 article titled "Commentary: Medical Marijuana Can Help Reduce Our Opioid Dependency: Physician," available at orlandosentinel.com:
"As a physician, I have constantly searched for treatment options for my patients' chronic pain... I learned that marijuana not only has multiple potential medical uses, but it also has fewer side effects compared to other medications...
In addition to pain relief, medical marijuana provides relief to the common conditions associated with chronic pain, such as anxiety/depression and insomnia. With medical marijuana, the pharmacological management for chronic pain can be simplified with lesser need to also prescribe medications for anxiety, depression and insomnia."
Feb. 9, 2018 - Pedro Oliveros, MD
Emily Earlenbaugh, PhD, Director of Mindful Cannabis Consulting, stated the following in her Nov. 28, 2017 article titled "Here's the Science behind Cannabis Therapies for Pain, Inflammation," available at greenstate.com:
"The most common use of cannabis is as a pain reliever... Cell, animal and human trials, as well as patient reports, all confirm cannabis' efficacy for chronic pain relief...
When patients use cannabis medicinally, their natural endocannabinoid system is stimulated by cannabinoids, resulting in reduced pain and inflammation. These anti-inflammatory and pain-relieving properties make cannabis an option for ameliorating the daily suffering from common chronic pain conditions like arthritis and neuropathy, which decrease mobility and reduce quality of life.
Access to cannabis for pain management is especially important for seniors because the pharmaceutical alternatives can be deadly."
Nov. 28, 2017 - Emily Earlenbaugh, PhD
The National Academies of Sciences, Engineering, and Medicine stated the following in its 2017 report titled "The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research," published by the National Academies Press and available at nap.edu:
"Relief from chronic pain is by far the most common condition cited by patients for the medical use of cannabis... In addition, there is evidence that some individuals are replacing the use of conventional pain medications (e.g., opiates) with cannabis...
There is substantial evidence that cannabis is an effective treatment for chronic pain in adults."
2017 - National Academies of Sciences, Engineering, and Medicine
Gregory T. Carter, MD, Clinical Professor at the School of Medicine at the University of Washington, stated the following in his response titled "The Argument for Medical Marijuana for the Treatment of Chronic Pain," published in an article titled "Medical Marijuana: A Viable Tool in the Armamentaria of Physicians Treating Chronic Pain? A Case Study and Commentary," in the May 2013 issue of Pain Medicine:
"[R]esearch further documents the safety and efficacy of medicinal cannabis for chronic pain. Cannabis has no known lethal dose, minimal drug interactions, is easily dosed via orally ingestion, vaporization, or topical absorption, thereby avoiding the potential risks associated with smoking completely...
Natural cannabis contains 5-15% THC but also includes multiple other therapeutic cannabinoids, all working in concert to produce analgesia..."
May 2013 - Gregory T. Carter, MD
The Institute of Medicine published in its Mar. 17, 1999 report titled "Marijuana and Medicine: Assessing the Science Base":
"In conclusion, the available evidence from animal and human studies indicates that cannabinoids can have a substantial analgesic effect."
Mar. 17, 1999 - Institute of Medicine
"Marijuana and Medicine: Assessing the Science Base" (988 KB)
The Mayo Clinic stated in its Aug. 25, 2006 online article "Marijuana as Medicine: Consider the Pros and Cons":
"People widely used marijuana for pain relief in the 1800s, and several studies have found that cannabinoids have analgesic effects. In fact, THC may work as well in treating cancer pain as codeine, a mild pain reliever. Cannabinoids also appear to enhance the effects of opiate pain medications to provide pain relief at lower dosages.
Researchers currently are developing new medications based on cannabis to treat pain."
Aug. 25, 2006 - Mayo Clinic
Donald Abrams, MD, Professor of Clinical Medicine at the University of California at San Francisco and Cheryl A. Jay, MD, Director of the San Francisco General Hospital Neurology Clinic, et al., stated the following in their Sep. 9-10, 2005 abstract titled "Smoked Cannabis Therapy for HIV-Related Painful Peripheral Neuropathy: Results of a Randomized, Placebo-Controlled Clinical Trial," presented at the International Assocation for Cannabis as Medicine (IACM) 3rd Conference on Cannabinoids in Medicine:
"There is significant evidence that cannabinoids may be involved in the modulation of pain, especially of neuropathic origin. HIV-related painful peripheral neuropathy is a significant medical problem with unsatisfactory treatment options. Based on the effects of cannabinoids in preclinical models of neuropathic pain and anecdotal case reports, a controlled trial of smoked cannabis was conducted...
Thirteen of the 25 patients who were randomized to marijuana cigarettes reported greater then 30% reduction in pain during the intervention phase, compared with 6 of the 25 patients receiving placebo cigarettes...
Smoked marijuana is effective in reducing chronic ongoing neuropathic pain as well as acute pain in the experimental pain model. The magnitude of the response of the neuropathic pain is similar to what is seen with gabapentin, a widely used therapeutic intervention for HIV neuropathy."
Sep. 9-10, 2005 - Donald Abrams, MD
Cheryl A. Jay, MD
David Hadorn, MD, PhD, Medical Consultant for GW Pharmaceuticals, Ltd., wrote in his July 17, 2003 document titled "Use of Cannabis Medicines in Clinical Practice," published on his personal website www.davidhadorn.com (website no longer available; Feb. 17, 2009):
"Scientists have known for many years that cannabinoids (the major active ingredients in cannabis medicines) are potent pain relievers, and that they act synergistically with opiates to increase the degree of pain relief. The addition of cannabis medicines to therapeutic regimens can reduce the need for opiates by 50 percent or more in many patients (while also reducing side effects such as constipation that opiates commonly produce)."
Feb. 17, 2009 - David Hadorn, MD, PhD
Denis Petro, MD, Board of Directors for Patients Out of Time, wrote in his paper titled "Spasticity and Chronic Pain" published in the 1997 book Cannabis in Medical Practice - A Legal, Historical and Pharmacological Overview of the Therapeutic Use of Marijuana:
"The evidence in support of cannabis as a treatment for pain exists both in preclinical animal studies and in a small number of clinical trials. Since cannabis contains many active cannabinoids in varying amounts in differing plants, a coherent recommendation concerning use against pain symptoms is lacking...
Considering the alternative of addicting drugs such as the opiate analgesics, patients may opt for the relative safety of cannabis."
1997 - Denis Petro, MD
Americans for Safe Access stated in its online brochure "Medical Marijuana and Chronic Pain" (accessed May 4, 2006):
"Cannabis can serve at least two important roles in safe, effective pain management. It can provide relief from the pain itself (either alone or in combination with other analgesics), and it can control the nausea associated with taking opiod drugs, as well as the nausea, vomiting and dizziness that often accompany severe, prolonged pain."
May 4, 2006 - Americans for Safe Access (ASA)
Aaron Weiner, Director of Addiction Services for Linden Oaks Behavioral Health stated the following as quoted in a Nov. 17, 2017 article written by Robert McCoppin and titled "Illinois Doctors Campaign for Medical Marijuana as Alternative to Opioids," available at chicagotribune.com:
"Like opioids, marijuana is a dead-end for pain — you'll develop a tolerance, need to go up in the amount you smoke and will have to smoke and be high all the time to achieve pain relief. In my opinion, we need actual sustainable solutions to chronic pain, not just other addictive substances."
Nov. 17, 2017 - Aaron Weiner, PhD
Jessie Podolak, DPT, physical therapist and owner of Phileo Health, LLC, stated the following in her Jan. 20, 2017 article titled "Pot for Pain: The Good, the Bad, and the Down-Right Scary," available at evidenceinmotion.com:
"[W]e see smoking marijuana as a behavioral issue, similar to smoking, illicit or prescription drug abuse, alcohol abuse and surgery: medical marijuana is yet another passive way to treat pain... In addition, we know there is a proliferation of [cannabinoid] receptors, and that tolerances, like opioids, can increase over time, leaving us with many long-term questions.
We know it's the active approaches that work best in the treatment of chronic pain: understanding how pain works, getting regular cardiovascular exercise, practicing good sleep hygiene, setting goals, cognitive behavioral therapy, establishing a plan, etc. Trying to foster these practices through the haze of marijuana seems challenging at best, nonsensical at worst...
The new face of marijuana is not Cheech and Chong. It is executives in three-piece suits looking to make a fortune at the expense of the brain cells of our youth, people in pain, and an unsuspecting nation."
Jan. 20, 2017 - Jessie Podolak, DPT
Daniel Clauw, MD, Director of the Chronic Pain and Fatigue Research Center at the University of Michigan, stated the following in his June 23, 2016 article titled "Why U.S. Doctors Love Opioids and Hate Marijuana for Chronic Pain," published on the University of Michigan Health Lab blog:
"Although the lay public has moved rapidly toward accepting cannabis decriminalization or legalization, the medical community does not generally share this enthusiasm for cannabinoids... Even if we could prescribe cannabis, we have no idea what strength or dose to use, or which route of administration is most effective...
[N]either opioids nor cannabinoids should be used as first-, second- or third-line therapies for pain, as there are almost always many much more effective and safer drug and nondrug therapies. We can and should do better for our patients."
June 23, 2016 - Daniel Clauw, MD
Gregory Bunt, MD, Medical Director at Daytop Village, stated the following in his response titled "Marijuana Is Not Good Medicine," published in an article titled "Medical Marijuana: A Viable Tool in the Armamentaria of Physicians Treating Chronic Pain? A Case Study and Commentary," in the May 2013 issue of Pain Medicine:
"There is no scientific evidence that the effect of marijuana in diminishing pain is related to any specifically identified analgesic effect. That it unequivocally does produce a short-term CNS [central nervous system] euphoria, which alleviates some pain centrally, best explains its mechanism for both reducing pain short-term during the period of influence as well as causing the euphoria associated with addictive drugs of abuse. Additionally, there is no scientific evidence that long-term use of medicinal marijuana is either effective or safe for the treatment of chronic pain... [T]here are many analgesic medications available to patients and physicians that have been proven and established in the practice of medicine, through sound scientific clinical research, to be more effective and safer for the treatment of chronic pain than medical marijuana."
May 2013 - Gregory Bunt, MD
Birgit Kraft, MD, Anesthesiologist in the Department of Special Anesthesia and Pain Therapy at the Medical University of Vienna, et al., concluded in their study titled "Lack of Analgesia by Oral Standardized Cannabis Extract on Acute Inflammatory Pain and Hyperalgesia in Volunteers," published July 2008 in the journal Anesthesiology:
"The surprising result of our study was the absence of any kind of analgesic [pain relieving] activity of THC-standardized cannabis extract on experimentally induced pain using well-established human model procedures. Our results also seem to support the impression that high doses of cannabinoids may even cause increased sensitivity in certain pain conditions."
July 2008 - Birgit Kraft, MD
Paul Chelminski, MD, MPH, Assistant Professor of Medicine at the University of North Carolina at Chapel Hill, stated in a Jan. 2, 2008 video titled "Is Marijuana Good for Pain Relief?" posted on the ABC News website:
"Several well-designed clinical trials have failed to show any direct benefit of marijuana in relieving pain. It's important to remember, though, that chronic pain is complicated by mental health issues such as depression and anxiety, and I suspect that many patients with chronic pain are trying to self-treat and alleviate the depression and anxiety that accompany their pain.
However, if a patient were to ask me whether or not they should use marijuana to treat their pain, I would have to respond that it's impossible for me as a physician to endorse a therapy that is illegal, of no proven medical benefit, and possibly also dangerous. I would propose, rather, that we use well-established therapies for the treatment of depression and anxiety that are already available to us."
Jan. 2, 2008 - Paul Chelminski, MD, MPH
Fiona Campbell, MD, Assistant Professor in the Department of Anesthesia at the University of Toronto, et al., concluded in their study titled "Are Cannabinoids an Effective and Safe Treatment Option in the Management of Pain? A Qualitative Systematic Review," published July 7, 2001 in the British Medical Journal:
"Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use. Their widespread introduction into clinical practice for pain management is therefore undesirable. In acute postoperative pain they should not be used...
The best that can be achieved with single dose cannabis in nociceptive pain [pain resulting from tissue damage] is analgesia equivalent to single dose codeine 60 mg, which rates poorly on relative efficacy compared with nonsteroidal antiinflammatory drugs or simple analgesics. Increasing the cannabinoid dose to increase the analgesia will increase adverse effects...
We found insufficient evidence to support the introduction of cannabinoids into widespread clinical practice for pain management."
July 7, 2001 - Fiona Campbell, MD
John Walters, Director of the US Office of National Drug Control Policy (ONDCP) at the time of the quote, stated in an Apr. 21, 2006 press release:
"Too many of our citizens suffer from pain and chronic illnesses. Smoking illegal drugs may make some people 'feel better.' However, civilized societies and modern day medical practices differentiate between inebriation and the safe, supervised delivery of proven medicine by legitimate doctors."
Apr. 21, 2006 - John P. Walters
The US Food and Drug Administration (FDA) stated in an Apr. 1, 2004 testimony before the U.S. House of Representatives Subcommittee on Criminal Justice, Drug Policy, and Human Resources Committee on Government Reform by Robert J. Meyer, MD, Director of the FDA's Office of Drug Evaluation II:
"FDA has not approved marijuana for medical use in the United States. Despite its status as an unapproved new drug, there has been considerable interest in its use for the treatment of a number of conditions, including glaucoma, AIDS wasting, neuropathic pain, treatment of spasticity associated with multiple sclerosis, and chemotherapy-induced nausea...
Having access to a drug or medical treatment, without knowing how to use it or even if it is effective, does not benefit anyone. Simply having access, without having safety, efficacy, and adequate use information does not help patients. FDA has and will continue to use its IND and other expanded access programs to provide patients freedom to choose investigational medical treatments while reasonably ensuring safety, informed choice, and systematic data collection that allows us to review drug applications.
FDA will continue to be receptive to sound, scientifically based research into the medicinal uses of botanical marijuana and other cannabinoids."
Apr. 1, 2004 - US Food and Drug Administration (FDA)