America Slowly Wakes Up to the Good News on Cannabis and Chronic Pain

Whether it’s applied as a topical to sore muscles or used as a direct medication for nociceptive complaints, cannabinoids such as THC and CBD have long enjoyed a strong anecdotal reputation for treating nagging pains throughout the body. They don’t have the same addictive profile as opioids, and there’s pretty much no way you can fatally overdose on them, either. However, the plant that uniquely generates both of these compounds can’t seem to catch a break on the federal level. For those keeping score, some new vindication came through in the release of two papers, both of which extolled the abilities of several pharmaceuticals, either THC/CBD blends or CBD isolates, to reduce pain significantly. One of these studies caught the attention of former President Bill Clinton, who lent his own reserved optimism to the possibilities of CBD in a press release. For those who remember the hostility his administration showed California as it moved forward to legalize medical cannabis in the ‘90s, it’s quite a shift.

As a recent review of papers looking into the data determined, it’s a matter of what sort of pain you’re trying to treat with cannabis. And it’s not specifically the bud itself — we’re talking either isolates of THC and CBD, or pharmaceutical combinations like Sativex. It’s still going to take a while before we see the plant itself studied for its effects, if it ever does occur. But even the National Institute of Health’s National Center of Complementary and Integrative Health acknowledges the studies on their own website. So it’s getting harder and harder for recalcitrant federal lawmakers to ignore the writing on the wall.

The Studies So Far

In 2017, the National Academy of Sciences (NAS) published what was considered the most significant survey of clinical research to date on the cannabis plant’s applications to physical and mental health. In it, the NAS’s panel found substantial evidence for the clinical effectiveness of any cannabis-based medicine in chronic pain treatment. Of course, it’s five years later, and there’s plenty of research that’s happened since then. What does it say now?

A recent paper in Inflammopharmacology looked into the specific types of pain that either THC/CBD-based medicine or CBD-only medicine can treat. Again, the only medicines studied in this treatment were FDA-approved substances like the THC formulation Nabilone and Dronabinol, the CBD formulation Epidiolex and the THC/CBD blend Nabiximols. In a 2019 study derived from data recorded in the German pain registry, Nabiximols in particular accounted for a greater than 30% reduction in neuropathic pain sensitivity, but none whatsoever for nociceptive pain (To clarify, nociceptive pain is usually felt after an external injury, such as a broken leg or stubbed toe; neuropathic pain is felt as a disease of the somatosensory system which registers touch or heat, and is less easily treated and therefore more chronic.) A 2021 panel of 20 experts with clinical experience in managing medical cannabis care for chronic pain patients recommended cannabis, however, for both nociceptive and neuropathic pain as well as mixed and nociplastic.

Recent research also continues to drill down into dosing regimens. While the 2021 study acknowledges that there is as of yet no studies testing CBD-only medicines for chronic pain, it does recommend starting with CBD first, about 5 mg twice daily, and then titrating by 10 mg every two or three days until pain is lifted for the individual patient. In this model, 2.5 mg of THC can also be added should the physician deem it best. Oro-buccal administration is best, and diet and other medicines taken by the patient can stand in the way of either THC or CBD’s effectiveness.

Clinton's Chronic Pain Research Review

However, perhaps the most impactful paper on chronic pain currently being considered derives its importance from support it receives from an unexpected source. The randomized clinical trial examined pain reduction reported by 99 patients recovering after a rotator cuff injury, some of which took a CBD medication called ORAVEXX and a control group that didn’t. Pain reduction in the ORAVEXX group was significant, which drew praise from Mr. Clinton. “The results of the trial conducted by NYU Langone, with TRP’s (TR Processing) CBD ingredient, are very encouraging and I’m eager to see the results of the next round.”

The quote from Mr. Clinton is not his only connection to TR Processing, which supplied the CBD for ORAVEXX. Former Clinton Administration deputy drug czar Andrea Barthwell now sits on its board as well. It shows a general sea change, from former House Speaker John Boehner’s work with Acreage Holdings to former Trump Administration Health and Human Services Secretary Tom Price, position on the board of medical cannabis company Botanical Sciences, which show former politicos jumping into the cannabis industry. Perhaps they too have some chronic pain issues that need resolving after their time in office.