The dilemma of chronic pain. Shoot, as though the agony isn’t enough, there’s the remedy. And my heart goes out to those who’ve had to turn to opioids, especially for the long-haul. But maybe there’s another option, one that produces true and lasting relief. Let’s talk about cannabinoids...
The cannabinoids, particularly cannabidiol (CBD), are being praised as non-addictive alternatives to using escalating doses of opioids to treat chronic pain.
It’s actually a research update for psychiatrists, psychologists, and other healthcare professionals written by Thomas R. Kosten, MD and Coreen B. Domingo, DrPH. Both are professors at the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.
Hey, much to review, so let’s get right into it. As usual, I’m skipping all of the “Drs. Kosten/Domingo said…” formality. What you’re about to read is my summary of their work. Okay?
Chronic Pain Management Realities & Cannabidiol (CBD)
Psychiatrists and other addiction specialists are well aware of the challenges of chronic pain management. Fact is, according to a recent JAMA Network Open survey, almost half of primary care providers are refusing to treat chronic pain.
This reality has presented a new challenge: assessing the use of cannabinoids for the relief of “chronic benign pain.” What’s that? It’s pain generated by inflammation, stress or damage to organs, or other physiological processes not associated with the spread of disease (such as cancer).
The cannabinoids, particularly cannabidiol (CBD), are being praised as non-addictive alternatives to using escalating doses of opioids to treat chronic pain. But there’s one little kink: 10% of the population who use tetrahydrocannabinol (THC), which is not in CBD, become addicted to it.
Cannabidiol (CBD): Facts
Just about two years ago I posted “CANNABIDIOL: What Is It? Why Should a MOOD or ANXIETY DISORDER Sufferer Care?.” I’m referring you to that article for lots of foundational information (link at the end). Still, we need to go over a few things here.
CBD is derived directly from the hemp and marijuana plants. And though CBD is one of approximately 100 cannabinoids found in the marijuana plant, it doesn’t cause a “high.” Indeed, CBD exhibits no effects that would indicate any abuse or dependence potential. All 50 states have laws that legalize CBD with varying degrees of restriction.
Cannabidiol (CBD): Dosing
It’s important to note that FDA (US) action pertaining to CBD began earlier this summer. The work includes legislative hearings concerning regulation.
With the exception of two rare seizure disorders, the most effective CBD therapeutic dose for medical conditions, including pain, is unknown. However, some preliminary estimates are available, such as the 5 mg/kg twice-daily dose of Epidiolex (prescription CBD, more in a bit) to treat those two seizure disorders.
But there’s more. In comparing pain-relieving effects in a variety of medications a metric known as number needed to treat (NNT) is used. Tricyclic antidepressants and opioids have the lowest NNT (2.6 and 2.1, respectively) for treating neuropathic pain. That means that for every one patient showing a therapeutic response to the treatment agent, the NNT is the number of patients who need to be treated. In other words, for every two patients treated with opioids, one will have satisfactory relief from chronic neuropathic pain.
Bringing all of this to CBD, the oral CBD spray used in studies has an NNT of 5.0. Here’s what we find when comparing this to other meds for neuropathic pain: opioids 2.1, SSRI antidepressants 5.0, gabapentin 6.4. You can see that this particular CBD formulation, though not as powerful as the opioids, brings results.
Cannabidiol (CBD): The Foreseeable Future
Oh, you can be sure the pharmaceutical industry is ready to make CBD widely available, under state regulation, with and without prescriptions.
Epidiolex, an oral solution developed by Greenwich Biosciences, is available in the US for the management of refractory epilepsy. It may offer relief for chronic pain conditions, as well. Also, recent data shows that heroin cue-induced craving was significantly reduced in subjects given an oral CBD solution once daily for three consecutive days.
GW Pharmaceuticals markets nabiximols (Sativex), a marijuana extract approved in the UK for the treatment of neuropathic pain. overactive bladder, and other symptoms associated with multiple sclerosis. A plan to conduct Phase 3 trials in the US is in the works.
Finally, Cara Therapeutics and Zynerba Pharmaceuticals are developing investigative synthetic cannabinoids that are showing promise for the treatment of specific psychiatric disorders and chronic pain symptoms.
Obviously, the cannabinoids, including cannabidiol, are getting a ton of well-deserved attention. Within the context of this article it’s about pushing away from opioids for pain relief. And there’s a lot going-on in the mood and anxiety disorder neck of the woods.
Much more research and development to be done, but I really believe we’re onto to something.
From Psychiatric Times: “Cannabinoids for Chronic Pain: An Opioid Alternative?”
And if you’re in the mood for more reading, scan through the Chipur titles.