More than 3.2 million Australians live with chronic pain according to Pain Australia statistics from 2018. Chronic pain is usually defined as pain that persists beyond the expected healing time or in excess of three months. Chronic pain can arise from pre-existing conditions, as a result of physical injury, surgery or psychological trauma. Chronic pain can present as headache, muscle, neuropathic, visceral, arthritic or cancer pain.
Common conditions where Australian patients can also experience persistent pain as a co-morbidity include, but aren’t limited to; Multiple Sclerosis, arthritic or radiculopathy manifestations, fibromyalgia, cancer and from chemotherapy treatments. And sometimes chronic pain is further complicated by mental health conditions such as PTSD, schizophrenia or depression.
GPs report that patients presenting with chronic pain have increased by >65% in the past decade. Given the health and addiction risk factors associated with many pharmaceutical pain killers, such as opioids, doctors and patients are seeking information on how medical cannabis may help in reducing chronic pain.
Medical cannabis has strong evidence to support its use in treating cancer-related pain. In 2018 the Journal of Pain and Symptom Management published trial where 177 cancer patients with intractable pain were given medical cannabis in the form of THC:CBD spray, THC spray or placebo. 43% of individuals experienced a 30% reduction in pain scores, while this may not seem a lot, it is classed as clinically significant in terms of pain management options and can make a huge difference to patients.
Fibromyalgia patients report significant benefits to their pain, sleep and quality of life when being treated with medical cannabis. A small study from 2018 showed 50% of fibromyalgia patients were able to cease taking pharmaceutical medications to manage their condition. A systematic review of 13 randomised placebo-controlled trials (the gold standard of medical research) concluded medicinal cannabis may provide effective pain relief, especially in presentations where other medications have failed.
CBD oil only prescriptions are great for those individuals seeking to avoid the intoxicating effects of THC. But for those whom THC is indicated, it is believed the entourage effect, created by having a combination of THC and CBD, can lead to greater pain relief than to isolated cannabinoids.
There is limited research for CBD oil alone treating chronic pain and yet in Australia, around 85% of prescriptions of medical cannabis relate to chronic pain presentations, of that 30% are CBD oil or other CBD-only products. Traditionally THC is thought of as the main cannabinoid to relieve pain, now we know CBD has analgesic properties in its own right. CBD attaches to and desensitises receptors that respond to heat, pain and inflammation. Small studies in humans suggest CBD oil is effective in treating peripheral neuropathic pain (nerve pain occurring outside the brain or spinal cord) which can arise from injuries, infections and conditions like diabetes.
A recent self-reporting study conducted in New Zealand showed statistically significant reductions in pain and anxiety, as well as improvements in mobility for non-cancer-pain patients.
Side effects of CBD oil were reported by 9% of individuals, mostly commonly drowsiness and vivid dreams. Much like any other pharmaceutical drug, side effects are common in patients prescribed CBD oil. General side effects of cannabis CBD oil include drowsiness, gastrointestinal upset and nausea. In most clinical trials and anecdotal reports involving CBD oil individuals note these side effects to be tolerable and mild, especially in light of the positive benefits they are receiving.
When it comes to the evidence behind medical cannabis for chronic pain, the science is mixed, yet anecdotes abound. The Therapeutic Goods Administration lists chronic pain under its medical cannabis guidance documents and offers information on its evidence, recommended dosing and prescription.
Given how few conditions are acknowledged by the TGA, it is interesting to note that this governing body is providing guidance on its use, and can be read as an affirmation of the evidence supporting medical cannabis’ efficacy in chronic pain.
Australian patients have shared their outcomes with prescribed medical cannabis for pain with the ABC in 2019. One patient, Beth McDougall, diagnosed with advanced lung cancer was experiencing chest pain that caused her to wake and take potent painkillers every two hours throughout the night.
Beth who never had, nor thought she would try cannabis shared that while medical cannabis hasn’t been a miracle cure, it reduced pain enough to aid her sleep and therefore improved her engagement with life. Others such as Christian Read who suffers from Multiple Sclerosis, found that medical cannabis oil has improved his sleep and pain levels, reducing his need for opioids and more generally allowing him to have a positive outlook on life.
For Australian patients experiencing chronic pain, the symptoms can be not only physically debilitating but also take a toll on one’s mental health. According to Pain Australia, 44.6% of chronic pain sufferers also present with mental health conditions. When pain extends past months and into years, with little aid from conventional treatments, it can be a struggle for patients to keep a positive attitude when the one constant in life is pain. In that case, patients should talk to their doctor about exploring alternative therapy options such as medical cannabis.
As with most aspects of the medical cannabis industry, more research is warranted. In the meantime, there is sufficient evidence supporting the use of medicinal cannabis preparations to relieve chronic pain that it is being prescribed with increasing prevalence around the world and in Australia.
Using a Telehealth model, our 15 minute screening appointments provide a quick and convenient way to assess the suitability of a patient’s condition for treatment prior to discussing options with their own doctor.