The world of medicine is turning towards using cannabis for treating a number of medical conditions in patients. It has been used for soothing symptoms of cancer, Alzheimer’s, glaucoma, IBD, and most prominently chronic pain. According to a research carried out by University of Michigan, about two-thirds of all medical cannabis patients are those that need support to combat chronic-pain. Recently, an international task force has shared some newly issued guidelines for dosing and administering cannabis to manage chronic pain in patients.
What is Chronic Pain?
Almost everyone experiences pain in some form during their lifetime. In fact, sudden pain acts as a tip off for the nervous system that a possible injury can occur. This is what typical pain looks and feels like to the body. Its severity reduces slowly as the site of injury repairs itself.
Chronic pain however, is different from a typical form of pain. Any pain that lasts for more than twelve weeks can be classified under this category. The period of pain can range from weeks to even years in patients, reducing their physical capacity to perform tasks. It limits their endurance and flexibility, causes irritability, anxiety and sometimes depression.
Data collected from 15 states of United States showed that chronic pain is the most common reason for patients use of medicinal marijuana.
Science behind cannabis use and pain relief
Cannabinoids receptors are located through out the human body and play an important role in controlling a number of physiological responses. These include appetite regulation, pain-detection, mood, memory and anxiety among many other bodily functions.
The chemical structure of cannabinoid receptors is very similar to the phytocannabinoids produced by strains of the cannabis plant. This chemical propensity of cannabis plants makes it easier for them to attach with the brain’s receptors and bring about changes in the everyday functions of the human body.
The most convincing depiction of the therapeutic properties of cannabis was seen in the clinical studies of cancer patients.
Cancer causes chronic pain in a variety of ways. It causes severe nerve damage, inflammation and grows tumors by invading bone and other sensitive tissues.
Dr.Ilana Braun is a cancer psychiatrist at the Dana-Farber Cancer Institute of Boston. She is the lead author of a study published in the Journal of Clinical Oncology. According to the findings of the study, nearly half of all oncologists recommend medical cannabis to their patients.
New guidelines on cannabis use for chronic pain management
Despite of the success of cannabis for managing persistent pain, the ‘evidence base’ to support its effectiveness is lacking.
About 80% of oncologists talk with their patients about cannabis as an alternate treatment. In contrast to this, less than 30% of them feel they have sufficient knowledge about its medicinal use.
In the light of these facts, an international task force conducted a virtual PAINWeek meeting last week with the intent to put forward new guidelines for cannabis use by patients suffering from chronic pain.
The task force stressed the need to educate clinicians about the applications of cannabis in chronic pain management. “We as a task force believe it’s extremely important to bring medical cannabis to patients, “said Alan Bell, MD, of the University of Toronto. He further added,”There’s a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen.”
In addition to this, other recommendations made by the members of the task force highlighted the importance of proper dosage and administering of the drug to the patients.
The task force led by Arun Bhaskar MD recommended using a Delphi process for arriving at dosage levels that could work best for patients.
Under this process, experts will voice their opinions on suitable methods and dosages via questionnaires. The final analysis will then be based on these individual opinions for reaching a consensus among the experts.
The 20-clinician Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain led by Arun Bhaskar M.D made the following recommendations:
1- Start with a ‘routine’ measure
This involves giving them 5 mg of CBD two times in a day. Introducing THC should only be considered if there is no response by patients to 40 mg of CBD daily. The staring dose for THC should be 2.5 mg everyday. The dosage should not exceed 40 mg daily.
2- Adopt stringent doses for geriatric patients
Elderly patients or those with multiple chronic diseases should be treated via a conservative route. This will involve starting the THC dosage at 1 mg daily and taking up the dosage by low degrees.
3- Rapid Protocol for severe chronic pain patients
Rapid protocol means giving a balanced dosage of CBD-THC to patients suffering from severe pain. In addition, all those patients who have had previous exposure to cannabis consumption can also be eligible for this protocol. The recommended dosage for these patients can begin with 2.5-5 mg per each compound once or twice daily.