Definition of medical cannabis
Therapeutic cannabis is the use of different cannabis plants containing dozens of different molecules with multiple properties that can be used in certain human pathologies.
In view of the growing number of questions being asked about the use of cannabidiol in chronic pain, this summary attempts to explain the role and the known and predictable effects of cannabis derivatives in the treatment of chronic pain. This article is a snapshot of current practice as of June 2021, as the research and studies in progress are numerous and unpublished.
There are 480 different compounds in cannabis plants:
- There are 130 different phytocannabinoid compounds, the three main ones being THC (delta-9-tetrahydrocannabinol), CBD (cannabidiol) and CBG (cannabinol).
- Terpene derivatives responsible for the smell of the plant (+ 120). These derivatives, which are natural hydrocarbons, can also have therapeutic properties (example of taxanes from which anti-cancer treatments derive), they are widely used in phytotherapy treatments (essential oils). They are also able to modify the absorption of phytocannabinoids.
Des traces d’utilisation du chanvre sont retrouvés des le néolithiques notamment en Asie. C’est probablement une des premières familles de plantes domestiquée par l’homme pour ses trois propriétés: ses fibres solides, ses graines oléagineuses nourrissantes et les propriétés médicinales de sa résine.
Dans l’antiquité, le chanvre est utilisé pour la confection de vêtements et de cordes. Son utilisation médicinal se développe également (en Chine, le plus ancien traité de matière médicale (Shennong bencao jing), mentionne le cannabis dans les drogues de catégorie supérieure destinées à prolonger la vie).
Depuis cet ère, le chanvre à été utilisé essentiellement pour les propriétés de sa fibre ( vêtements, cordes, papier) et pour ces propriétés médicinales (fumigation dans le cadre de traitement antalgique, ou dans le cadre de cérémonie rituelle, ou pour son effet euphorisant).
Plus récemment, le cannabis à été utilisé dans les années “SIDA” pour prévenir la perte de poids des patients, les douleurs neuropathiques liées à cette pathologie étaient également améliorées. Le traitement était alors sous forme de marijuana inhalée.
Medical effects of cannabis
The various effects of cannabis described below are mostly related to part of the composition of marijuana and are therefore not in favor of its consumption. Most of the time the positive effects of one of the components of this herb are completely outweighed by the overall effects of its consumption.
Some forms of severe epilepsy are markedly improved by therapeutic cannabis. Studies with CBD (cannabidiol) are underway for Dravet syndrome and Lenoox-Gastaut syndrome.
Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence.
It should be noted, first of all, that the use of cannabis in adolescents and young adults favors the development of a psychotic pathology (delusional puffs, schizophrenia). The use of cannabidiol seems to improve the situation in some people with psychotic disorders, particularly in the context of addiction (alcohol, cannabis)
Pharmacological properties of cannabidiol in the treatment of psychiatric disorders: a critical overview.
Cannabidiol derivatives have shown their interest in nausea and vomiting induced by chemotherapy.
Nabilone: a potent antiemetic cannabiniol with minimal euphoria.
As described in the history of THC derivatives improves appetite in AIDS-related pathologies (which has disappeared in developed countries)
Cannabis use is linked to the onset of psychiatric disorders in young adults, particularly depression.
One of its isolated components cannabidiol seems to improve these symptoms.
Cannabidiol Induces Rapid and Sustained Antidepressant-Like Effects Through Increased BDNF Signaling and Synaptogenesis in the Prefrontal Cortex.
Studies on the cannabinoid receptor system are underway to improve the management of certain cancers. Especially in breast, prostate and bone cancer
Positive effects on abnormal movements and spasticity
New treatments combining a mixture of 50% THC and 50% CBD improve pain related to the spasticity of multiple sclerosis (the only indication for therapeutic cannabis in France). Studies are ongoing in Parkinson’s disease.
Analgesic effect on chronic pain
The various studies on the treatment of chronic pain with therapeutic cannabis find a moderately effective effect with moderate side effects….
Most of the studies showing effectiveness are related to the use of a mixture of THC and CBD with ratios of 1:1 or close.
Studies on the use of CBD alone are very few and show moderate effectiveness of this therapy with doses of 50 to 150 mg per day.
Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort.
Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases.
Review of the neurological benefits of phytocannabinoids.
NSW Cannabis Medicines Advisory Service preliminary survey results: enquirer perceptions and patient outcomes – PMC (nih.gov)
This recent study does not alter the elements previously described on the effects of medical cannabis. Research is still ongoing. it appears that this therapy improves the quality of life of patients in the pathologies described.
A more recent study describes the effects of Cannabiniol in different pathologies: Cannabidiol: Pharmacology and Therapeutic Targets. The positive effects are found in certain degenerative diseases (Parkinson), Certain forms of epilepsy. The effects on chronic pain are weak, but there is an overall reduction in anxiety disorders.
Conclusion on the use of cannabidiol in chronic pain
Cannabidiol has a moderate direct effect on chronic pain, but its anxyolytic effect can bring certain well-being to some patients.
Studies showing an effect on chronic pain are linked to a mixture of THC and CBD.
Current CBD is sold as a dietary supplement….
We will remind here that chronic pain is complex (chronic pain) and that a dietary supplement is unlikely to cure you. It is not excluded that, in some, an improvement is possible.
There is, however, little danger in taking these dietary supplements.
The analgesic virtues of therapeutic cannabis are still in the study phase and new molecules or compositions will probably be proposed for better efficiency. In the current state of research, cannabidiol (CBD) alone does not seem to be an answer to the expectations of chronic pain patients. However in some cases (especially when anxiety is predominant) we can note an improvement in patients.
Therapeutic cannabis is still under evaluation and published studies seem to show an improvement in the quality of life in a certain number of patients.