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Medical cannabis and chronic pain – everything you need to know

It’s no secret that cannabis has been an important part of natural medicine for countless societies and peoples around the world for thousands of years. Evidence suggests that the plant may have been used medicinally for over 4,000 years. Despite our long relationship with cannabis, a relatively brief period of prohibition implemented in the 20th century has skewed our understanding of the plant. As a result, clinical research into the medicinal potential of cannabis has fallen behind, limiting patient access to cannabis-based medicines. 

On the bright side, however, the situation is gradually beginning to improve. Medical cannabis has now been legalised in a significant number of countries, globally – including the UK. While the situation is still far from ideal, patients can now – in theory, at least – access medical cannabis for the treatment of several conditions, including epilepsy, multiple sclerosis, and chronic pain.

What is chronic pain?

Chronic pain is a common condition that refers to persistent pain that carries on for more than 12 weeks. In some cases, the pain may be linked to an injury or operation; however, chronic pain may also affect people who have had a traumatic experience, such as childbirth, abuse, or the breakdown of a relationship. Chronic pain is resistant to treatment and medication, with many patients struggling to find an effective management strategy.

The persistent nature of chronic pain often leads to co-occurring conditions such as anxiety and depression, as well as a reduction in quality of life. Evidence suggests that the occurrence of mental health conditions may make chronic pain worse, leaving many patients in a cycle that is difficult to break. It may have a significant impact on a patient’s ability to complete everyday tasks and activities, social commitments, and ability to take care of themselves and others. 

According to a 2016 systematic review, between one-third and one-half of the UK population are affected by chronic pain. This high prevalence makes the development of effective treatment options an extremely important area of research. Current therapies for chronic pain include the use of several medications, including anticonvulsants, antidepressants, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. However, the efficacy of these products is often questionable and many carry the risk of unwanted and unacceptable risks and side effects. 

As a result, a growing number of chronic pain patients are becoming interested in alternative therapies – including medical cannabis.

Medical cannabis and chronic pain

In November 2018, the UK government rescheduled cannabis to allow for the prescription of cannabis-based medicines following a long campaign run by patients and advocates. The campaign was largely focused on the experiences of children with rare forms of treatment-resistant epilepsy whose conditions had improved with the help of medical cannabis. However, four years after the law change, chronic pain is the most common reason for medical cannabis prescriptions in the UK. This pattern is echoed in other countries that permit the use of medical cannabis, including the USA and Canada. 

The use of cannabis for pain and inflammatory conditions is believed to date back thousands of years. In fact, there is evidence that Ancient Egyptian, Chinese, and Indian societies used cannabis preparations for various methods of pain management. There is an abundance of anecdotal evidence from patients that supports the potential of medical cannabis for chronic pain; however, clinical evidence is lacking. This is due to a general lack of research on the subject, as well as a lack of understanding of the causes of chronic pain.

Nonetheless, there is a growing body of literature on the topic. One 2016 study that aimed to determine the long-term effect of medical cannabis on pain and functional outcomes in patients with chronic pain demonstrated that medical cannabis was associated with improvements in pain and functional outcomes, as well as a reduction in opioid use. The results of other studies suggest similar outcomes, in addition to improvements in depression, anxiety and other quality-of-life measures in chronic pain patients.

How does it work?

Cannabinoids are a type of cannabis compound that is most commonly utilised in the development of medical cannabis products. The most common and well-known of these compounds are CBD and THC. These compounds have been found to interact with a vast receptor system in our bodies known as the Endocannabinoid System (ECS). 

The ECS plays an important role in various physiological and cognitive functions, including mood, inflammation, and pain signalling. As such, the ECS is increasingly considered a potential target for pain conditions, including chronic pain. Furthermore, growing evidence suggests that medical cannabis may be beneficial for reducing anxiety and depression and improving sleep – all of which commonly affect patients with chronic pain. 

How to access medical cannabis for chronic pain

Despite the lack of clinical evidence, recent poll evidence suggests that around 1.4 million adults in the UK currently use recreational cannabis products for chronic pain management. This high use of unregulated cannabis products is a worrying figure that is significantly influenced by ongoing barriers to legal access.

On November 1st 2018, cannabis was officially moved to Schedule 2 of the Misuse of Drugs Act, allowing for its medicinal use in the UK; however, the law change came with several caveats. First of all, while medical cannabis can now technically be prescribed for any condition for which there is evidence that it could be useful, only specialist clinicians can approve these prescriptions. Secondly, official recommendations have contributed to a deadlock for access through the NHS. 

Recommendations by the National Institute of Health and Care Excellence (NICE) state that clinicians should not offer THC-containing medical cannabis products to patients with chronic pain. Furthermore, it is only recommended that CBD be prescribed as part of a clinical trial. This has left many patients to choose between potentially expensive private prescriptions or unregulated cannabis products sold on the black market. 

Luckily, though, there are ways to access medical cannabis for chronic pain in the UK. Private medical cannabis clinics routinely prescribe medical cannabis products to patients with chronic pain conditions. While many patients may struggle to afford private prescriptions, there are initiatives to reduce the impacts of these costs. Many clinics have joined the Project Twenty21 initiative to offer reduced-cost prescription fees while gathering evidence of patient outcomes.

If you would like to learn more about the process of obtaining a UK medical cannabis prescription, either for you or a loved one, take a look at leafie’s extensive guide.

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