Chronic Pain, Muscle Pain and Other Types of Pain

Medical Cannabis and Chronic Pain

Pain is a common symptom associated with various health problems, and it is essential to determine if an underlying condition might be causing it. Chronic pain, in particular, is one of the primary reasons people turn to medicinal cannabis and medical marijuana. An estimated 51.6 million Americans live with chronic pain daily, with 17.1 million of them experiencing high-impact chronic pain, meaning it severely disrupts their daily life and requires chronic pain management.

Pain can manifest in different forms, including physical (somatic or musculoskeletal), mental, emotional, and even spiritual pain. Pain is deeply personal, with its impact influenced by factors like personality traits, life experiences, and one’s home and social environment. Pain can be classified as acute, meaning it is sudden and short-term, or chronic, meaning it lasts for a long time. Chronic pain is typically defined as pain that persists for longer than three months or beyond the expected healing time.

Although these types of pain are often treated individually, they can overlap and exacerbate one another. Dame Cicely Saunders, known for her work in palliative care, introduced the concept of “total pain” to describe how pain from different sources can interact and intensify.

For instance, arthritis pain may lead to anxiety or depression, which can cause insomnia. The lack of sleep weakens the immune system, which can exacerbate joint problems. Treating the emotional aspect, such as anxiety, can indirectly relieve some of the physical pain, which is why antidepressants are often prescribed for chronic pain. However, people living with chronic pain conditions frequently end up taking multiple pain medications, including prescription opioids, which carry risks of addiction and opioid use disorder.

Medical cannabis and medical marijuana are gaining attention as treatment options for various types of chronic pain, including chronic neuropathic pain and chronic noncancer pain caused by inflammation. Research is also exploring how cannabis can reduce the use of prescription opioids, sedatives, and antidepressants, especially as part of chronic pain relief strategies.

Chronic Pain Causes

Chronic pain can result from illness, injury, or nerve damage. In some cases, even after the initial injury or illness has healed, pain persists for long periods, which makes it chronic. Health conditions like arthritis, autoimmune diseases, or cancer can also lead to ongoing pain. Cancer pain, for example, can be severe and persistent, requiring a combination of treatments, including medicinal cannabis and medical marijuana for chronic pain relief.

Neurodegenerative diseases like multiple sclerosis (MS), Parkinson’s disease (PD), and Alzheimer’s disease (AD) often cause chronic pain by damaging the nervous system. Injuries to the spinal cord or other parts of the nervous system can also lead to severe pain that persists for a long time and interferes with daily activities.

Chronic low back pain is one of the most common forms of persistent pain, often arising from musculoskeletal issues or past injuries. Additionally, conditions like irritable bowel syndrome (IBS) and chronic headache disorders also contribute to chronic pain conditions, impacting a person’s overall quality of life. Medical cannabis use is increasingly being studied as a potential treatment option for these conditions.

Chronic Pain Symptoms & Health Effects

Pain can be described in many ways—sharp, dull, stabbing, or throbbing. Chronic pain can vary in intensity based on its cause. For example, arthritis pain is typically described as a constant ache, while nerve pain often feels like burning or tingling. Regardless of the specific cause, chronic pain tends to have a significant impact on a person’s daily life and mental health.

Pain can consume a person’s focus, leading to emotional distress, mental health issues, and disruption of daily activities. Many chronic pain patients develop depression, anxiety, or irritability, which in turn can affect sleep quality. This lack of rest worsens the physical pain, creating a cycle that further impairs quality of life. This cycle, often referred to as “the terrible triad,” can make it difficult for patients to experience good days where their pain is more manageable.

Chronic pain can also cause physical side effects such as nausea, fatigue, hormonal imbalances, and a weakened immune system. Over time, the constant strain of severe pain can become debilitating, making it difficult for people to perform even simple daily tasks like getting dressed or preparing meals. The longer chronic pain persists, the more it can affect both mental and physical health. Treatment options like medicinal cannabis and medical marijuana may offer chronic pain relief without some of the severe side effects associated with opioids.

Chronic Pain Diagnosis

Diagnosing chronic pain requires a thorough evaluation by a healthcare provider. Doctors will ask patients about the location of their pain, how long it has lasted, and how it feels. For example, they may inquire whether the pain worsens during movement or at rest, or if applying heat or cold offers relief. Diagnosing chronic pain often involves a physical exam, and imaging tests such as X-rays, MRIs, or CT scans may be recommended to identify potential causes like spinal cord issues or joint problems. These tests are especially important when the nervous system is involved.

Additionally, blood tests may help uncover underlying medical conditions, such as infections or autoimmune diseases, that could be contributing to the pain. The patient’s medical history will also be considered to identify previous treatments or health problems that may be affecting their pain levels.

Doctors often use the “5 A’s” approach to assess pain: analgesia (pain relief), activity levels, adverse effects (side effects of treatment), aberrant behaviors (such as medication misuse), and emotional affect (mood). In some cases, a medical cannabis license may be recommended for patients seeking alternative pain management.

Chronic Pain Prognosis

A prognosis is the likely course of a disease or ailment. The prognosis for chronic pain depends largely on its cause and how effectively it is managed. Some people continue to live relatively normal lives despite chronic pain, while others may face reduced mobility and a lower quality of life. Chronic pain, such as lower back pain or arthritis pain, often interferes with daily activities like working, socializing, or caring for oneself, leading to isolation, guilt, and anxiety. These emotional responses can exacerbate physical pain, creating a cycle of suffering.

Conditions like trigeminal neuralgia (Tic Douloureux) and chronic headache disorders can increase the risk of suicide, particularly when pain is inadequately managed. Proper treatment is essential not only for physical relief but also for mental health. Medicinal cannabis and medical marijuana are being researched for their ability to offer chronic pain relief and improve patients’ overall quality of life by reducing dependency on prescription opioids, especially in the context of the opioid epidemic.

Chronic Pain Treatments

There are many ways to treat chronic pain, depending on the underlying cause. Some common treatment options include:

• Over-the-counter (OTC) pain medications such as acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil), aspirin, and naproxen (Aleve)
• Prescription NSAIDs like celecoxib (Celebrex)
• Topical pain relievers for sore muscles, joint pain, and arthritis pain
• Steroids and steroid injections to reduce inflammation
• Antidepressants and anti-anxiety medications to manage the emotional toll of chronic pain
• Anticonvulsants like gabapentin, which can help reduce nerve pain
• Prescription opioids such as codeine, fentanyl, or combinations of oxycodone and acetaminophen (e.g., Percocet) or hydrocodone and acetaminophen (e.g., Vicodin)
• Transcutaneous electrical nerve stimulation (TENS) therapy
• Bioelectric therapy, which blocks pain signals to the brain and triggers the release of endorphins
• Mind-body techniques such as meditation and biofeedback
• Low-impact exercises like walking, stretching, and yoga, which can improve mobility and reduce pain
• Improved diet and sleep habits
• Physical therapy and occupational therapy, often guided by physical therapists to help patients regain function
• Various forms of psychotherapy, including cognitive behavioral therapy (CBT), which can help patients manage the mental health aspects of chronic pain
• Alternative therapies like acupuncture and herbal remedies
• In rare cases, surgery may be required to address structural issues that cause pain

First-Line Treatments

First-line treatments for chronic pain often include common pain medications like acetaminophen and NSAIDs, which can alleviate mild to moderate pain. Health care providers may also suggest lifestyle changes, such as increasing physical activity, improving diet, and reducing or eliminating alcohol or smoking. Physical therapy is frequently recommended for conditions like chronic low back pain or arthritis pain. Physical therapists can design exercise programs to strengthen muscles, improve flexibility, and reduce pain.

What Patients Say About Their Treatment

Other Treatments

If first-line treatments are ineffective, doctors may prescribe stronger medications like anticonvulsants for nerve pain or opioids for more severe pain. However, opioids carry significant risks, including drowsiness, addiction, and potential overdose. As a last resort, surgery may be necessary, especially in cases involving chronic low back pain or injuries to the spinal cord. Medicinal cannabis products or medical marijuana products may also be considered a safer alternative to opioids for chronic pain management.

Adjunctive Therapy and Alternative Treatments

Complementary therapies can be helpful for managing chronic pain. Although more research is needed to confirm the efficacy of some of these treatments, many patients report relief from:

• Acupuncture
• Massage therapy
• Yoga
• Mind-body techniques like meditation and biofeedback
• Herbal remedies, such as lavender, rosemary, black pepper, cloves, capsaicin, and ginger
• Some people turn to plants like kratom to reduce opioid use, although kratom can also be addictive
• Medical cannabis use, under the guidance of a healthcare provider, as an adjunctive treatment option for chronic pain relief

Cannabis for Chronic Pain

Medical cannabis has emerged as a promising treatment option for chronic pain relief. Cannabis contains cannabinoids (mainly tetrahydrocannabinol or THC, cannabidiol or CBD, and beta-caryophyllene), along with terpenes (including terpenoids) and flavonoids (cannflavins A, B, and C), that interact with the body’s endocannabinoid system and pain sensors to help manage pain, inflammation, and mood.

When these compounds work together, they stimulate many systems in the body, including the endocannabinoid system’s (ECS’s) receptors. Many consider cannabis products a more holistic approach to pain management, often reducing the need for multiple medications. Medical cannabis and medical marijuana can act like a combination of acetaminophen, ibuprofen, muscle relaxers, antidepressants, and strong painkillers—all in one treatment. Cannabis works by reducing inflammation, calming the nervous system, and alleviating chronic pain symptoms.

Here is how cannabis works to manage different types of chronic pain:

• Inflammatory pain: Cannabis sativa contains anti-inflammatory compounds like THC, CBD, cannabigerol (CBG), and terpenes such aslimonene, myrcene, and linalool, which can help reduce inflammation and ease conditions like arthritis pain or irritable bowel syndrome (IBS).
• Chronic neuropathic pain: Randomized controlled trials show that medical cannabis can effectively reduce nerve pain and improve quality of life quality of life (QOL) scores.
• Nociceptive pain (tissue damage-related pain): Terpenes like beta-caryophyllene, found in the cannabis plant, have been shown in animal studies to help relieve nociceptive pain, such as pain caused by injuries.
• Functional pain: Cannabis may help address endocannabinoid system imbalances that contribute to conditions like IBS and fibromyalgia.
• Reducing opioid use: Cannabis shows potential for reducing the need for prescription opioids. Patients in states with medical cannabis laws have reported fewer opioid-related deaths and reduced reliance on opioids, especially in light of the ongoing opioid epidemic.
• The endocannabinoid system as a “multi-facet therapeutic target”: As cannabis compounds (cannabinoids, terpenes, flavonoids) can affect multiple receptor systems ( such as opioid, serotonin and dopamine receptors), it’s theoretically possible that medical cannabis could be used to reduce or replace the need for multiple pills (e.g., cannabis for both depression and physical pain, as opposed to antidepressants for depression and opioids for physical pain).
• Acute pain (sudden, sharp pain that lasts less than 3 months): Although cannabis is primarily used for chronic pain relief, one study showed that dronabinol (synthetic THC) reduced opioid use following physical trauma.
• Improved function: A recent guideline published by the British Medical Journal (BMJ) shows that cannabis may reduce pain and improve physical function.

Overall, the evidence suggests that medical cannabis may be beneficial in chronic pain management and an alternative to opioids, sedatives, and/or antidepressants that may be prescribed to control various types and causes of chronic pain.

Additional Information for Patients

There are many resources available for those with chronic pain. There are many disease-specific charities throughout the US. There are also some that focus on pain more generally, including:

• The U.S. Pain Foundation
• The American Chronic Pain Association (ACPA)
• Pain Connection
• National Pain Advocacy Center (NPAC)

Chronic Pain FAQs

How long does it take for pain to be considered “chronic”?

Chronic pain is defined as chronic when it lasts 3 months (12 weeks) or more, or pain that lasts longer than the expected healing time. The pain can be consistent or intermittent (comes and goes).

What are the most common causes of chronic pain?

The most common causes of chronic pain are headaches/migraines, back pain, joint pain (such as that associated with arthritis), and muscle pain.

What are the different types of chronic pain?

Pain can be broken down into broad categories, including:

• • Neuropathic pain: Divided into 2 groups
    • Peripheral neuropathic pain: Postherpetic neuralgia and diabetic neuropathy
    • Central neuropathic pain: Cerebral vascular accident sequella
  • Nociceptive pain
    • Pain due to actual tissue injuries such as burns, contusions, sprains as well as surgical pain

• Musculoskeletal pain

• • • Back pain, including radicular pain, to the appropriate dermatome
    • Myofascial pain

• Inflammatory pain

• • • Autoimmune disorders (rheumatoid arthritis, fibromyalgia, and gout)
    • Infection and cancer pain

• Psychogenic pain

• • Pain caused by psychological factors, such as headaches or abdominal pain caused by emotional, psychological, or behavioral factors
• Mechanical pain
  • Expanding malignancy, benign tumors, advanced ascites, fractures, and retained hardware pain

What about medical cannabis laws and licensing?

Access to medical cannabis varies depending on the state or country. Many regions have established medical cannabis laws to regulate the production, distribution, and use of medical cannabis products.

Patients who qualify for medical cannabis use or to use medical cannabis products in these areas often need a medical cannabis license, which must be obtained through consultation with a healthcare provider.

Understanding local laws and regulations is essential for patients seeking cannabis-based treatment options.

It is also important for healthcare providers to stay informed on potential drug interactions with medical cannabis, especially when treating patients with multiple medical conditions.

References:

1. Arthritis Foundation. (n.d.). Sleep and pain. Arthritis.org. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/fatigue-sleep/sleep-and-pain
2. BMJ. (2021, August 5). Legal cannabis stores linked to fewer opioid deaths in the United States. https://www.bmj.com/company/newsroom/legal-cannabis-stores-linked-to-fewer-opioid-deaths-in-the-united-states/
3. CDC. (2023, April 14). Vital signs: Trends in stimulant overdose deaths—United States, 2015–2022. CDC.gov. https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm
4. Drug Science. (n.d.). Medical cannabis compared to common pain medications. https://www.drugscience.org.uk/medical-cannabis-compared-to-common-pain-medications/
5. Health Affairs. (2018). The effect of opioid prescribing limits on duration of initial opioid analgesic prescriptions: Evidence from the Medicare program. HealthAffairs.org. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05266
6. National Pain Foundation. (n.d.). National Pain Foundation. https://nationalpain.org/
7. PubMed. (2003). Functional expression and characterization of the cannabinoid receptor CB2 in the mouse pancreas. https://pubmed.ncbi.nlm.nih.gov/12587692/
8. PubMed. (2016). The cannabinoid CB2 receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic effects in mouse models of inflammatory and neuropathic pain. https://pubmed.ncbi.nlm.nih.gov/27086601/
9. PubMed. (2017). Inflammatory pathways in atherosclerosis: The role of CB2 receptors. https://pubmed.ncbi.nlm.nih.gov/29388063/
10. PubMed. (2020). Cannabis use in patients with fibromyalgia: Effect on symptoms relief and health-related quality of life. https://pubmed.ncbi.nlm.nih.gov/33998900/
11. PubMed. (2020). Use of cannabidiol for treatment-resistant epilepsy in a 30-year-old patient with focal impaired awareness seizures. https://pubmed.ncbi.nlm.nih.gov/32091871/
12. PubMed. (2020). Cannabis use in older adults: Effects on cognition and safety issues. https://pubmed.ncbi.nlm.nih.gov/25622554/
13. ResearchGate. (2014). The cannabinoid CB2 receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic effects in mouse models of inflammatory and neuropathic pain. https://www.researchgate.net/publication/258427503_The_cannabinoid_CB2_receptor-selective_phytocannabinoid_beta-caryophyllene_exerts_analgesic_effects_in_mouse_models_of_inflammatory_and_neuropathic_pain
14. TSACO. (2020). Patterns of cannabis use among patients undergoing total hip arthroplasty: A retrospective cohort study. https://tsaco.bmj.com/content/5/1/e000391
15. U.S. Pain Foundation. (n.d.). U.S. Pain Foundation. https://uspainfoundation.org/
16. Wiley Online Library. (2008). Understanding of the concept of “Total Pain”: A prerequisite for pain control. Journal of Hospice and Palliative Nursing, 10(1). https://journals.lww.com/jhpn/Abstract/2008/01000/Understanding_of_the_Concept_of__Total_Pain___A.8.aspx
17. World Health Organization. (2020). Exploring the therapeutic potential of cannabinoids: An expert review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309661/
18. World Health Organization. (2020). Neuropathic pain: A therapeutic challenge. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576607/
19. Harm Reduction Journal. (2021). Cannabis substitution for opioids: A harm reduction strategy to address the overdose crisis. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00520-5
20. BMJ. (2021). Legal cannabis stores linked to fewer opioid deaths in the United States. https://www.bmj.com/content/374/bmj.n2040

Pain Connection. (n.d.). Pain Connection. https://painconnection.org/Related Articles

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Note: the information in this article does not constitute medical advice.

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