This article was quite an eye-opener for me. I never considered that there are actually different types of pain. That might explain why some new medical cannabis patients are unable to experience long-term relief with certain cannabis strains; they are not using products designed to alleviate their type of pain. The key is knowing which combination of cannabinoids successfully treats your pain. This article examines the different types of pain with recommendations for the best cannabinoid profile for each one.
There are different general categories of pain:
Nociceptive pain, divided into visceral and somatic, is the common discomfort we have all experienced as a result of a physical injury to tissue — a paper cut, a broken bone, or a muscle tear. Symptoms include sharp, aching or throbbing pain. It is typically responsive to anti-inflammatory agents and opioids. Postoperative and posttraumatic pain fall into this category.
- Somatic pain is musculoskeletal in nature and often well localized.
- Visceral pain is felt in hollow organs and smooth muscle and is referred. Referred pain is felt in areas other than where it originates.
Neuropathic pain is caused by damage to the neurons that are involved in the pain signaling pathways in the nervous system. Symptoms include tingling, numbness, electrical sensations and phantom pain. It is typically chronic. It responds poorly to anti-inflammatory agents and opioids. Recent studies suggest that with neuropathic pain, anatomical and physiological changes occur in the spinal cord and even the brain. This can result in neuropathic pain being hardwired into the nervous system. This may explain why anti-inflammatories agents and opioids are ineffective in controlling neuropathic pain.
These are pain disorders where the underlying mechanism is not very well understood. These include Fibromyalgia, Cancer Pain and Migraines.
Now that the different types of pain have been identified, finding the most effective cannabis product for your type of pain is the next step.
Cannabis and Nociceptive Pain
With nociceptive pain, when you get injured, your immune system sends millions of inflammatory and immune cells to repair the damaged tissue. These cells release proteins and chemicals that activate nerve receptors that travel through the spinal cord to the brain, causing pain. The physiological process of weakening the nociceptive pain sensation is to block the inflammatory process or its signals at the injury site. Reducing the pain signals as they travel up your spinal cord is another process to weaken pain.
Both THC and CBD, which are both powerful anti-inflammatories, can reduce pain at the injury site.
- THC activates CB2 receptors on immune cells which mitigates the pain response to the injury. THC also controls pain in the spinal cord and brain by activating CB1 receptors directly.
- CBD blocks the inflammatory mediators by shifting the macrophage repair cells from pro-inflammatory to anti-inflammatory. CBD blocks pain signals by increasing levels of anandamide, the naturally occurring endocannabinoid which acts like THC, to active CB1 receptors. CBD also improves the capability of receptors to increase the primary inhibitory neurotransmitter known as GABA which decreases pain signals on their way to the brain.
In order to successfully manage nociceptive pain while reducing your risk of tolerance, the recommendation is using balanced THC:CBD products.
Cannabis and Neuropathic Pain
Neuropathic pain is much more difficult to treat because it does not result from inflammation. It is the result of nerve damage which includes diseases such as Parkinson’s Disease, MS, HIV, Diabetes, and chemotherapy treatments.
CBD-rich cannabis fights chemotherapy-induced pain by activating serotonin receptors. Serotonin is a neurotransmitter which regulates mood and social behavior, appetite and digestion, sleep, memory, and sexual desire and function. In addition, cannabis enhances the effectiveness of chemotherapy drugs which makes it a promising therapy for cancer patients.
Cannabis and Non-Classifiable Pain
The origin of Fibromyalgia is largely unknown and fits this catch-all category of pain. It is hard to treat as little is understood about how the pain signals are sent to the brain and processed by it. Those who have tried prescription medications know that they provide little if any benefit and many side effects. Cannabis is shown to be the best treatment option.
Studies indicate that high-THC/low-CBD cannabis strains can produce more adverse side effects and increase tolerance levels. While they may be effective as pain relievers, initially, they are not recommended as part of a long-term pain relief treatment option. Balanced THC:CBD or CBD-rich products seem to be a better strategy in managing chronic pain conditions. Of course, there is always trial and error involved in finding the best cannabis product for your unique situation, even for seasoned cannabis users.
Source: Leafly.com, Part 1, How Cannabis Relieves Different Types of Pain, Josh Kaplan, March 28, 2018