Overview of Research on Cannabis for Chronic Pain

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Chronic pain can be a symptom for many patients with various illnesses. On their website, Johns Hopkins Medicine defines chronic pain as long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition. Otha Smith’s Tetragram mobile app allows users to anonymously track cannabis products as well as the conditions or symptoms they are using it for. In their most recent collection of data, users reported muscle pain, joint paint, nerve pain, muscle spasms, injury pain, headache, migraine, abdominal pain, chronic back pain, surgical pain, and more. Here, Tetragam allows us to share an overview of some of the top four areas patients reported on related to pain to see what type of products they are finding useful to help manage their pain, how they are consuming it, and more. This data relates to patients that reported muscle pain, joint pain, nerve pain, and injury pain. Some data highlights from this set include:

Inhalation is still the most popular consumption method among consumers with an average of 83.35% across all four symptoms reported here.

The average consumer is still not completely satisfied or experiencing symptom relief with an average of 35.58% of users responding with a score of 5 for the overall rating in these four symptom categories.

Patients who selected muscle pain as their primary symptom equaled 1729 sessions. Of those sessions, 32.79 reported using THC, 17.13 reported THCA, 8 reported CBD, 4.83 reported THCV, 2.9 reported CBDA, and 0.13 reported CBDV in their product.

Patients who selected joint pain as their primary symptom equaled 1503 sessions. Of those sessions, 32.5 reported using THC, 16.67 reported THCA, 8.62 reported CBD, 3.99 reported THCV, 2.84 reported CBDA, and 0.06 reported CBDV in their product.

Patients who selected nerve pain as their primary symptom equaled 977 sessions. Of those sessions, 32.9 reported using THC, 16.21 reported THCA, 9.72 reported CBD, 5.02 reported THCV, 2.79 reported CBDA, and 0.03 reported CBDV in their product.

Patients who selected injury pain as their primary symptom equaled 688 sessions. Of those sessions, 33.79 reported using THC, 14.98 reported THCA, 7.19 reported CBD, 3.06 reported THCV, 1.7 reported CBDA, and 0.15 reported CBDV in their product.

Here, Tetragram shares an overview of some of the top four areas users reported on related to pain to see what type of products they are finding useful, how they are consuming it, and more.

Chronic Pain: Data Snapshot

In his 1999 address to The American Society of Anesthesiologists, Michael Cousins stated that “chronic pain will be regarded as the disease of the 21st century” (1). Indeed, it is: pain is “a significant public health problem,” afflicting some 11% to 40% of the US population (2). While people talk about pain as if it’s a relatively homogeneous problem, in reality, it’s fantastically diverse, both in what causes it and in how people experience it.

There are many different classification schemes for pain. One way to classify pain is by duration, either acute or chronic. 

 generally comes on suddenly, has a specific cause–often tissue damage–and lasts for a limited period, until the wound has healed. In contrast, 

 lasts for a much longer period–more than six months in duration–and may be due to any variety of underlying causes (3-5). Notably, chronic pain “is totally different from acute pain because of its pathologic psychobehavioral manifestations” (6), such as social isolation and avoidance.

Cancer pain is often multidimensional and may be either acute (for example, associated with tests or treatments undertaken to address the cancer) or chronic (such as associated with the cancer itself) in nature. Likewise, fibromyalgia and other pain syndromes may be either acute or chronic in nature. And as with cancer, pain syndromes tend to be quite multidimensional and not well-understood (3-5).

Another way to classify pain is by source, either nociceptive or neuropathic. 

 is caused by a specific sensory stimulus: extreme heat or cold (burns or frostbite), toxic chemicals, or tissue damage, while 

 is caused by damage to or disease of the nervous system (3–5).

Based on these two sets of classifications (duration and cause), there are four overlapping categories of pain: acute nociceptive, chronic nociceptive, acute neuropathic, and chronic neuropathic (see 

Cannabis has been used throughout history to treat pain (7), and studies of people who use medical cannabis consistently report pain as being the most common target of cannabis relief (8–10). Scientific research on cannabis for pain was ignited when cannabis was reintroduced into society in the early 1990s with the discovery of the endocannabinoid system (ECS), and the research subsequently caught fire over the past 30 years (see 

While cannabis has shown little ability to address acute pain (11), there is a vast pre-clinical body of research examining the mechanisms of action (MoA) of cannabis for addressing different types of chronic pain. Additionally, there is also a substantial collection of clinical trials conducted to test the efficacy of cannabis for different types of chronic pain.

Direct MoAs of cannabis for reducing chronic pain include reducing chronic inflammation, acting on pathways of chronic pain signaling, and acting on acute and chronic cognitive perceptions of pain. Other indirect MoAs for cannabis to address chronic pain include improving sleep and enhancing the effect of other treatments for addressing pain.

Cannabis can reduce chronic pain by decreasing inflammation that causes pain.

Typically, our immune system is triggered whenever our body senses trauma or toxins. Both tissue damage (nociceptive) and nerve damage (neuropathic) induce the same type of inflammatory response: nearby blood vessels dilate—causing heat and swelling—and become permeable, enabling various types of immune system cells to flood the site and managethe threat. Some of the substances released in the process “irritate nerves and cause pain signals to be sent to the brain.” By inducing pain, your body is telling you to protect the affected region (12).

Of course, acute inflammation is generally a productive response by your body to very real threats. However, for many people, inflammation transitions from being a productive, acute response to a short-term problem into becoming an ongoing, noxious problem. In these cases of chronic inflammation in which the process is no longer serving a useful response, cannabis can be used to inhibit the inflammatory process. More specifically, the immune system cells responsible for triggering cascades of activity that target perceived threats contain cannabinoid receptors (CBs), which mediate those cascades. As a result, cannabis can be used to act on these immune system cells to disengage the noxious immune response, thereby reducing inflammation, together with any associated pain (13–15).

Cannabis can reduce chronic pain by inhibiting pain signals at different points along pain signaling pathways to and from the brain.

, stimulus in the body that triggers a noxious response (say, in an injured finger) sends information signals along peripheral nerves and through the spine, where it is relayed as ascending input up to the brain. The brain then processes those signals and sends pain signals as descending signals back down to the spinal cord, which, in turn, relays the pain signals through the periphery to the site (16).

Cannabinoid receptors are “strategically located” along the pathways of both the central and peripheral nervous system “where pain signaling is intricately controlled” (14). The ECS mediates pain signals as they ascend and descend pain pathways by acting on cannabinoid receptors located on peripheral nerves, within the spine, and within the brain (13–16). Cannabis can thus be used to mitigate overactive pain activity along the body’s pain signaling pathways.

Cannabis can reduce chronic pain by changing how we perceive and experience pain in several respects.

First, independently of the strength of the stimulus, negative emotional states, including anxiety and depression, can exacerbate pain experiences. Cannabis’s ability to reduce both anxiety and depression have been well-documented (17). Cannabis thus reduces pain by mitigating negative emotional states that exacerbate sensations of pain.

Second, cannabis can reduce chronic pain experiences by helping to distract us from focusing our attention on pain (18,19).

And third, while cannabis may not decrease the intensity of pain, it has been found to decrease the perceived unpleasantness of pain (20–22).

In addition to its direct mechanisms for addressing pain, cannabis also indirectly aids in reducing pain through indirect mechanisms, including improving sleep, and reducing the need for other pain medications.

Lack of sleep exacerbates perceptions of pain directly as well as indirectly, by exacerbating mood disorders (anxiety and depression) and attention problems, which themselves exacerbate pain

Manyresearchers have thus noted the benefits of using cannabis to “normalize” patients’ sleep, which, in turn, helps decrease pain (24–26).

One of the increasingly celebrated benefits of cannabis is the associated reduction in use of other pain medications, notably opioids. A substantial body of research describes how opiates and cannabinoids complement each other. The two substances “use overlapping signaling systems in the body having to do with drug tolerance, pain, and dependence” (27). As a result, supplementation of opioid use with cannabis can decrease, if not eliminate, the need for opioids (27–30). In fact, studies have shown that Medicare reimbursements for opioids significantly decrease after states legalize medical cannabis (31).

There have been many clinical studies performed to assess to efficacy of cannabis for treating pain.

One way to summarize the findings is by study type. A good number of surveys—several of them are surveys of hundreds or thousands of patients—consistently report that most medical cannabis patients use cannabis to treat pain, depression or anxiety, and sleep. Furthermore, survey participants generally report cannabis as being effective for these uses. Additionally, there have been a fair number of placebo-controlled studies of cannabis for pain. Some three and a half dozen randomized controlled trials and an additional three dozen (non-randomized) placebo-controlled trials have been performed to assess cannabis efficacy for pain. Most of these studies include only a few dozen participants, but some do include a few hundred. More than half find statistically significant benefits of cannabis for reducing chronic pain.

Alternatively, we can summarize finding by type of pain. Several studies have been conducted on cannabis for postoperative (that is, acute) pain. As mentioned earlier, these studies tend to find that cannabis is not effective for addressing acute pain. Next, several dozen studies test the efficacy of cannabis for chronic nociceptive and neuropathic pain, and many of these studies find cannabis effective for reducing chronic pain. Third, a dozen studies find cannabis to be an effective substitute for opioids. The last area with a bit more than a handful of studies is that of cannabis for helping pain patients improve sleep, and these studies do find cannabis to be effective for sleep.

This evidence does not constitute the good set of large-scale, randomized, controlled trials that the medical community generally turns to as validating a treatment’s efficacy. Yet, it does provide some assurance that cannabis seems quite promising for addressing chronic pain.

Chronic pain is one of the more heavily studied therapeutic applications for cannabis. Preclinical studies have established several clear mechanisms of action of cannabis for addressing chronic pain: reduction of inflammation, mitigation of pain signaling, modification of pain perception, enhancement of sleep, and complement of other traditional therapeutics used to treat pain. A large body of survey data establishes the prevalence and efficacy of cannabis use by patients to treat chronic pain. Finally, a large body of clinical trials also confirms the promise of cannabis for addressing chronic pain.

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, PhD, is a systems design researcher and analyst. She analyzes markets to determine how environments shape outcomes. She is co-founder of CannDynamics, Inc., and author of The Medical Cannabis Primer and Winning the Hardware-Software Game: Using Game Theory to Optimize the Pace of New Technology Adoption. Dr. Fisher has worked in the technology and healthcare sectors on behalf of technology companies, early-stage researchers, physicians, and technology start-ups.

In this article, Ruth Fisher explores the prominence of cannabis being used to treat chronic pain patients and data from studies detailing how beneficial it can be.

Dr. Michelle Weiner, DO, MPH, is a pain management physician and partner at Spine and Wellness Centers of America based in South Florida, and was the chair of Florida’s Medical Cannabis Advisory Committee (1). Cannabis helped change many of her patient’s lives. Her patient’s experiences with cannabis furthered her understanding of how to use cannabis effectively for chronic pain. After she finished her residency and fellowship, Dr. Weiner had a large amount of patients that had chronic pain who were taking opioids.

“Honestly, that wasn’t what I expected after I had finished my training, because I really went into medicine to help people and empower patients to promote wellness,” Dr. Weiner said. “I found that there was a big problem with addiction and opioid dependence and chronic pain that wasn’t being treated properly.”

When cannabis became legal in Florida in 2016 (2), she thought it would be a great option to offer to her patients who had pain and wanted a substitute to help them decrease their opioid medication. Here, Dr. Weiner shares her journey to learning and practicing cannabis medicine.

Dr. Weiner wasn’t taught anything about cannabis or the endocannabinoid system (3) in her medical training, so she started learning on her own. “I started researching, talking to different physicians in other states, as well as going to the dispensaries and trying to learn as much as I could about the different routes of administration, the different cannabinoids, and learn as much as I could about the endocannabinoid system,” she said. “I was very curious about the plant.”

As she found out more about cannabis, she was amazed that her training had not prepared her for the importance of the human endocannabinoid system. “It’s like saying we’ve never learned about the sympathetic nervous system or the cardiovascular system,” she said.

She started integrating cannabis into her treatment programs for patients, offering the patient cannabidiol (CBD) or trying to help them with medical cannabis. “At that time, we had to wait three months for the patients to be able to actually purchase cannabis, which was really a ridiculous rule that has since changed,” she explained.

Her research revealed that there was a 40% reduction in overall opioid use (4) when cannabis was added to a patient’s treatment regimen. “I saw that not only were they decreasing their opioids, but they were also sleeping better,” said Dr. Weiner. “They had a reduction in their anxiety medications and antidepressants as well. So, I saw this huge substitution effect and I realized that this one botanical medicine could potentially be used for so many indications. For me, it really offered people hope, and it was this catalyst to say, okay, take your health in your own hands as opposed to just waiting for the answer or the magic pill.”

Over time, as she got more positive results from patients, she began using cannabis for different conditions such as neurodegenerative and psychiatric conditions. “It’s really just a wonderful tool to have in my toolbox,” she said.

Dr. Weiner explained that there are certain questions she will ask initially just to get a baseline so that she and her patient know where to start with cannabis treatment. “One question would be if they’ve ever used cannabis before and what their reaction was, and if they know the product and the dose that they were using,” she said.

“The other question is what conditions we are treating and what time of day they would want to use the medicine. You can give someone tetrahydrocannabinol (THC) while they’re sleeping and perhaps that’s not going to cause much fear, as opposed to maybe someone who can’t use any form of THC with the potential of psychoactivity during the day while they’re at work,” Dr. Weiner explained.

It’s a personalized treatment based on the condition they want to treat, like nausea or increasing their appetite, and their past experience with cannabis. “What I really like to learn is their tolerance to THC,” she said. “Some people take 5 milligrams of THC, and they don’t need any CBD to counteract that high. Other people need a 5:1 ratio of CBD to THC. So, it really is personalized,” she said.

Dr. Weiner normally has a patient write down in a journal what products they’re starting with. “I always give them an algorithm to start with. For example, I tell them to use a tincture during the day, or perhaps half an edible at night, and then we go from there,” said Dr. Weiner. “We go back and forth with email a lot. And then the nice thing is a lot of patients like the fact that they can personalize this, and they can understand and listen to their body, and see what’s working for them, and then make changes from there.”

But other people need more hand-holding, she said. In any case, it’s amazing how people respond differently to THC. “It’s not just about age or weight, but many other factors; hence personalized medicine,” she said. “I’ve had patients who are 80 years old, who can take THC and have never felt any intoxication. And then I have other ones who may be very young, who use cannabis often and still feel that intoxication.”

Dr. Weiner said that she treats chronic pain (5) by looking at the whole person. “We’re not just treating where their actual pain is, but also the emotional component behind that, and that’s really the benefit of cannabis,” she said. “Our cannabinoid receptors are in our central nervous system. They’re in multiple organs and muscles throughout our body. So, when you use it, you have more of this mind–body connection where people are really able to not just take care of the physical pain but understand that they are not their diagnosis. They are not their pain. It gives them a little bit of a tool to say, let’s change my perspective on how I’m living, and how can I relate to my pain.”

She has found that not just cannabis, but psychedelics come into play when dealing with chronic pain. “I think that the psychedelic renaissance that we’re starting on now is opening people’s eyes to understanding the connection between chronic pain and mental health,” she said. “I think we’re seeing that using ketamine (6), for example, which is a dissociative anesthetic. It’s used for pain management, but it also has this ability for the patient to dissociate.”

The problem is that different medical specialties are not seeing this as a way to help their patients, whether its cannabis or psychedelics. “A psychiatrist will address only emotional pain for example, depression, and a pain physician will discuss physical pain and not mental health,” she said. “So there has to be more of a collaboration going on among specialties.”

Patients who use cannabis as medicine are listening to their body, she said, and can also treat a lot of the physical pain that gets stored in their body by using other medications that open their mind and even alter their consciousness. “I have seen these medications transform people’s lives through the power of connection. It gives them a new perspective on how to look at themselves, their lives, and conditions,” she said.

Dr. Weiner pointed out that there are different considerations for older patients in treating their chronic pain. “Because the cannabinoid receptors are not in our brain stem, there’s no chance of respiratory suppression,” she said. “It’s very nontoxic. It’s a very safe plant. Age doesn’t really matter.”

However, there are some significant differences to consider between younger and older patients. “When we’re younger, we’re healthy. Our endocannabinoid system is functioning in an optimal way, assuming that our lifestyle choices are healthy,” Dr. Weiner said. “As we age, we make less of these naturally occurring cannabinoids, so we can’t regulate our endocannabinoid system in the same way. Also as we age, it becomes more difficult to maintain homeostasis or balance. We don’t know how to test the cannabinoid recaptor density and the endogenous cannabinoid levels. These values are also likely to vary based on stress, lack of sleep, or our diet.”

But either way, because they’re elderly, she always uses a high CBD dose first because of the risk of a fall or confusion in an older patient. “I’ll generally start them off on a high CBD product and then titrate them up on their dose and then switch them over to a 1:1 ratio so that the CBD can still negate some of the high from the THC,” she said. “But I’ve been very surprised. I had an 80-year-old patient the other day who came in and she was very frustrated because she tried CBD for two months and it did nothing. Then she just started using THC alone, and she got great results. So, every person’s a little different.”

“Older patients are at the point where everything that they’ve done to improve their condition has failed,” Dr. Weiner said. “They’re just so frustrated with their pain or their lack of restorative sleep or their tremor from Parkinson’s or their depression that they just want hope and an answer. So usually, they’ll come in with a daughter or son who is much more inquisitive and nervous for their mother or father.”

She said, given the history of cannabis, for some elderly patients it’s something they can’t really relate to. “You have to understand what their previous opinion is about cannabis culturally, and what the stigma is, and then give them a lot of education.”

Patients with chronic pain want answers and solutions now, she said. “But the evidence is slow to follow,” Dr. Weiner explained. “Most of that has to do with the fact that cannabis is a Schedule I drug (7). Because it’s a Schedule I drug, it makes it difficult to do research. Other countries are much further along than we are.”

The interesting part of cannabis as medicine for chronic pain treatment is that patients are teaching the physicians now, she noted. “They are using cannabis and then telling the doctors, ‘Well, I’ve decreased my medication. I’m sleeping better. My pain is more controlled.’ So, it really means that we’re probably missing the root cause of most people’s pain. Not just to give a Band-Aid and to numb the pain or to numb the person’s emotions or feelings, but to help them become aware of what’s happening and give them hope. That’s the biggest issue. A lot of times patients are just hopeless, and that’s not a way to live, either,” she said.

Dr. Weiner is working on a study with Florida Atlantic University (FAU) on chronic pain and cannabis with Dr. David Newman at FAU (8). They received $75,000 from the Consortium for Medical Marijuana Clinical Outcomes from the State of Florida to conduct a study looking at the elderly population with chronic pain and the use of medical cannabis. “What we were looking at was safety, if there’s any patterns, the efficacy and then the education the patients received,” said Dr. Weiner.

There were 131 patients in this study, with their pain score measured on a scale from one to 100. “There was a 52% reduction in the pain scores, which is definitely a statistically significant decrease in the patient’s pain.”

The most common side effects that patients reported was increased appetite, lethargy, and improvement in mood. The other thing that they said was that the physician spent less than 20 minutes educating them. “That was something else that we took from the study was the fact that we probably need physicians to be more knowledgeable and improve the exam that the physicians have to take to be qualified to recommend cannabis,” Dr. Weiner said.

She and Dr. Newman just finished the study and will be publishing results soon. They are considering continuing that research. “We would really love to do a study where we’re looking specifically at products as opposed to just overall use of cannabis, but really identifying what products they’re taking, the milligrams, the ratios, the route of administration, and getting a little bit more detail,” said Dr. Weiner.

Dr. Weiner also has two ketamine studies right now that are approved through the University of Miami (9) comparing two different routes of administration of ketamine—intramuscular route versus sublingual route. “We have patients that are having six sessions of ketamine and seven sessions of therapy for the different routes of administration,” she said. “Patients are having a microdose (of ketamine) during therapy, which is actually ketamine-assisted psychotherapy, comparing it to higher intramuscular ketamine doses with the therapy after. The point is really to show how chronic pain patients need therapy. It’s not just the fact that the ketamine is causing pain relief, but the fact that they need help dealing with how they’re relating to their pain.”

She has found out that when someone uses ketamine and they’re able to reconsolidate a memory, or have an experience, and no longer have the emotion attached to it, then the trauma is able to leave their body. “It shows up like less pain,” she said. “So, there’s such a connection going on here. I’m sure the endocannabinoid system plays a role in that in terms of glutamate being a neurotransmitter that’s hyper excitatory in this population.”

Her other ketamine study is a nano-botanical formulation that she worked on with therapist, Shari Kaplan, designed to mitigate the negative side effects of ketamine, which is usually nausea, dizziness, and fatigue. “Shari made a botanical formulation that can be poured into water. It’s water soluble,” Dr. Weiner said. “We give it to the patients after ketamine so that they don’t have any negative side effects when they’re going home.”

They did the study in group sessions. “We had six people in four different groups, and we looked at 24 people,” Dr. Weiner said. “One time, they got the placebo. And then one time, they got this nano-formulation.”

She and Kaplan are analyzing the data now.

Dr. Weiner had a female patient diagnosed with fibromyalgia who had been treated by another pain physician. She was on high doses of fentanyl, given as a transdermal opioid, and Percocet (10). She was also on Ambien (11) for sleep and medication as a muscle relaxant.

“She came to me and had the stigma about cannabis,” Dr. Weiner said. “But she was just on all these meds. For me, I look at someone who has something like fibromyalgia, which is a chronic pain condition. Opioids treat acute pain. So, when she goes back to the doctor every time, he just increases her medication, but that’s not really helping her at all.”

The woman was functioning completely fine, Dr. Weiner noted, but had the same pain issues. “It took me about three months to wean her off of her opioids,” she said. “As I started to use cannabis with her, I used it like a short-acting tincture to be comparable to her short acting opioid. Then we used long-acting forms of cannabis, like a capsule or an edible, to represent more of the long-acting opioid.”

Dr. Weiner was able to wean her off all her opioids. “The interesting thing is that she had no pain. Then she was able to significantly reduce her cannabis,” she said. “So, I think that’s an interesting concept, the fact that they don’t even realize that they have this opioid-induced hyperalgesia where the pain medications are actually making her more sensitive to pain. It’s like a wind-up phenomenon where once the pain starts, it’s not able to calm down. Cannabis really puts the body into this parasympathetic mode, but it also is treating this wind-up phenomenon.”

Dr. Weiner thinks that her clinic has changed in the sense that she no longer treats the patient in that patriarchal way—here’s a medication for the condition that you have—but becomes more of a conversation of understanding what’s going on in the patient’s life and treating the whole person.

“My clinic is very different now because I actually want to get to know the patient a little bit because there’s a lot of things that they’re not sharing,” she said. “Or if it’s a situational thing, perhaps they’re not going to improve. I think the algorithm for how I treat pain and how I look at the patient has changed. I talk to them about sleep hygiene. That’s an important one. I think people don’t put enough influence on getting a good night’s sleep. I talk about resilience to stress. All of that, I think, really has to do with lifestyle changes because I don’t want the cannabis to fail because other parts of their lifestyle are not really going in the right direction.”

She wants her patients to understand who they are. “I think that’s really the most special thing about cannabis is that it does have the ability to alter our consciousness and it can transform how we view ourselves,” she said.

Her experience with cannabis as a treatment option has led her to believe that medical professionals need to get away from this daily pill, pharmaceutical type of mentality. “We need to focus a little bit more and put evidence into looking at lifestyle changes, talking more about nutrition and movement. Also, really just to have physicians have a little bit more of an open mind. If they see that things are not working, don’t just increase the dose. If we don’t have good treatment options, then we need to go find better options and we need to be honest with the patient,” she said.

Dr. Weiner believes in the next five years a lot is going to change with mental health and chronic pain. “I think we’re going to really get away from the opioids to treat chronic pain and only give that for like three to seven days after an acute trauma or surgery. Patients are going to start to understand how to use botanical medicine and rely less on physicians,” she said. “I think as we modulate the endocannabinoid system, we’ll be able to decrease chronic conditions, which is really the goal.”

https://ballotpedia.org/Florida_Medical_Marijuana_Legalization,_Amendment_2_(2016)

https://www.health.harvard.edu/blog/the-endocannabinoid-system-essential-and-mysterious-202108112569

https://nida.nih.gov/drug-topics/opioids/opioid-summaries-by-state/florida-opioid-involved-deaths-related-harms

https://journals.lww.com/pain/Abstract/2022/02000/Prevalence_of_chronic_pain_among_adults_in_the.31.aspx

https://www.webmd.com/depression/features/what-does-ketamine-do-your-brain

https://www.dea.gov/drug-information/drug-scheduling

https://nursing.fau.edu/news/newman_marijuana.php

https://spinewellnessamerica.com/dr-michelle-weiner/

 has written for many cannabis publications, and organized or moderated sessions at national and international cannabis trade shows. He was voted the 2018 Journalist of the Year by Americans for Safe Access, the world’s largest medical cannabis advocacy organization.

Here, Dr. Michelle Weiner shares her journey to learning and practicing cannabis medicine.

“People who live with pain all of the time, day in and day out, can find help and support.” That is the message that Ellen Lenox Smith hopes to spread through her activism. Her goal is to help spread awareness so that people in pain can possibly get back some improvement on their quality of life. “People in constant pain often are reluctant to talk about it and to seek help for fear they will be perceived as weak by others,” said Lenox Smith.

But no one knows better than Lenox Smith, that there can be relief.

At 42 years old, Lenox Smith began to feel that something was wrong. Still teaching at the time, she could barely remember the names of her students—many of whom she had known for years—because she was so distracted by pain.

Lenox Smith suffers from two rare, incurable conditions, Ehlers-Danlos Syndrome and sarcoidosis. 

 is a degenerative collagen disorder and is a crippling disease that allows her joints to become easily subluxed or even dislocated. This condition has confined her to a wheelchair for four years of her life in the past and is the cause for 26 surgeries. 

 has caused enlarged lymph nodes and granulomas in her lungs.

In 2007, Lenox Smith decided she couldn’t take the pain anymore. While preparing to leave for yet another surgery with a specialist, she asked her primary care physician for a referral to a pain clinic. It was at this pain clinic that she first learned about the possibility that cannabis could help.

Lenox Smith was a resident of Rhode Island, and the state had just enacted a medical cannabis law the year before. However, the very-limited law did not then allow for any method of production or retail of medical cannabis, other than home cultivation. Although illegal, Lenox Smith’s doctor suggested she find some cannabis on the illicit market and try it to see if it helped and if it did, he would sign her up for the state program. Because she had developed sarcoidosis in her lungs, smoking anything was out of the question, so she had to go with an oral cannabis extract. A friend of her son helped her obtain some plant material and convert it to an oil. The first night she took some oil she was deeply afraid of how she would react or feel. But she was more than surprised when she woke up the next morning having slept through the entire night for the first time in as long as she could remember. This was something previously unheard of with the level of pain she was having. Since then, she has been taking medicine at night to help her sleep. Which in turn, helps her have a peaceful day.

“It’s unbelievable what sleep does for anybody. It just begins to help turn your life around. No matter what chronic problem I have, I am dealing with it with dignity because I am getting restful sleep and it’s pretty magical,” she said.

From that moment on, she knew she needed to share this information with others and help people walk through the same fears she experienced in the hopes it would provide them with relief as well. With the help of her pain specialist, she enrolled in the Rhode Island medical cannabis program. Since then, Lenox Smith, together with her husband of over 48 years, Stu, has become a leading voice for patients living with pain. Experiencing what a change cannabis has made in her life, Lenox Smith became committed to advocating for it, not just in her home state of Rhode Island, but across the country. Her efforts to raise awareness have included everything from testifying at hearings to holding in-service events for doctors and nurses at area hospitals. Lenox Smith has appeared before the Food and Drug Administration (FDA), spoken to new medical students, and presented at conferences, including Americans for Safe Access (ASA)’s National Unity Conference. She is committed to doing anything and everything to help spread awareness so that others can find relief.

“We want to help spread awareness because you, too, could get back your quality of life,” she said.

Lenox Smith is very limited to what she can put into her body. Due to Ehlers-Danlos, she has a lot of food and medication sensitivities. While in the hospital for surgery, she had a deoxyribonucleic acid (DNA) drug sensitivity testing, which showed her body does not properly metabolize medications such as aspirin, Tylenol, Benadryl, or any opioids. So, for her, cannabis is the only medicine she can use for pain relief.

Since Lenox Smith is incredibly reactive to certain foods and medications, and labeling issues still do not include everything that she may need to know, it is extremely important for her to grow her own cannabis so that she can create an oil that works best for her. She can 100% guarantee her own cannabis is safe for her to consume.

While she is now a legal patient in the state of Rhode Island, her biggest struggle to this day is that although she cannot take other medications, she is also not legally allowed to take cannabis in a hospital or across state lines. “We need national access to medical cannabis,” said Lenox Smith. “You shouldn’t be denied relief just because you live in the wrong state or because the government still has it listed as Schedule I.”

“Cannabis gave me some dignity back,” said Lenox Smith, who is now 72. “It activated my life again… I was able to do things and smile again. People see the smile and assume I’m okay. I’m not, but cannabis helps me to be able to be positive.”

Ellen is a proud member of Americans for Safe Access, a Rhode Island ambassador for the US Pain Foundation as both a board member and co-director for Cannabis Advocacy, was on the board of the Rhode Island Patient Advocacy Coalition (RIPAC) as secretary before it closed down, appointed by the governor to both the ATEL Program, (Adaptive Telephone Equipment Loan Program) and the Compassion Center Oversight Committee, helps run the RI EDS Support group finding speakers to educate and empower others, is a former staff writer for Pain News Network and was a staff writer for both National Pain Report and 1000 WATTS Magazine until the shut down for good during the pandemic. She speaks and presents webinars about Cannabis, Ehlers-Danlos advantages of service dogs, and living with chronic pain.

A proud mother of four adult children, three grandsons, and two granddaughters, Ellen is also an organic gardener, and prior to her disability was a master swimmer and high school swim coach.

 is the Executive Director of Americans for Safe Access (ASA), a medical cannabis patient advocacy non-profit whose mission is to ensure safe and legal access to cannabis (marijuana) for therapeutic use and research. Debbie oversees all organizational and program operations in regards to education, training, policy, research, product safety and business compliance. Current projects include national campaigns such as ASA’s End Pain, Not Lives campaign and No Patient Left Behind campaign and programs such as ASA’s Patient Focused Certification (PFC) program and the Cannabis Care Certification (CCC) program. She serves as a writer and final editor on ASA publications including the State of the States Report, the Patients Guide to CBD, and the Medical Cannabis Access for Pain Treatment report.

Patient Ellen Lennox Smith shares her chronic pain story and how cannabis allowed her to live her life again.

Finding Relief with Cannabis

Medical writer, author of three books on medical cannabis, and co-founder/chief science officer of CannaKeys, Dr. Uwe Blesching provides insight into the exploration of cannabis as a supplement for chronic pain treatment, opioid addiction mitigation, and the mind-body balance. Informed by his years-long compilation of research and personal experience, he also offers suggestions regarding the challenges and benefits patients and doctors could encounter in their own journey into cannabis research and understanding.

Dr. Uwe Blesching started a 20 year long career as a paramedic and fireman for the San Francisco Department of Public Health during the height of the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) epidemic. He quickly noticed a large patient population that used cannabis for various medical reasons. “It really started with observing and witnessing patients firsthand in the back of my ambulance,” he said.

He explained that initially he was naïve about drugs, particularly cannabis. “I began to notice differences between, let’s say, a person that was challenged by HIV and AIDS, for example, who presented with peripheral neuropathies and who utilized cannabis and those who didn’t,” he said. “The difference between patient presentation and the way they presented themselves, in the larger context, was quite dramatic.”

Dr. Blesching also witnessed patients using medical cannabis who were experiencing chemotherapy-induced nausea and vomiting, or the pains from radiation treatments for specific types of cancer, or even people who were heroin users and who utilized cannabis to mitigate their withdrawal symptoms. “Fairly quickly, I began to look at cannabis and not so much with the black and white perspective that came from the narrative on the war on drugs that I was raised with,” he said. “It added nuance and it added a sense of curiosity to what’s going on here truly.”

During this time, he was also in touch with several physicians who were looking into and trying new treatments, such as cannabis, for HIV. This led him to find “a dozen or so researchers and physicians who were open to looking at cannabis and who were the pioneers in a lot of the research that has since transpired over the past 30 years or so.” He felt that this environment “was a welcoming of kindred spirits opening their minds,” but the stigma that came from the war on drugs hampered progress. “In general, the medical community like myself, initially, are socialized by the narrative on the war on drugs and as such, if we’re not completely averse to it, we’re very skeptical,” Dr. Blesching explained.

The amount of research conducted in the past 30 years has greatly increased, though, and continues to do so. “To give you a couple of numbers, last year, nearly 4000 studies related to cannabis and specific patient populations were published, which translates to roughly about 10 trials being published on a daily basis that can be utilized to learn more about if cannabis is posited to work for a particular condition or not,” he added.

Adding to his firsthand experience with patients, Dr. Blesching’s friends and relatives began to ask his opinion on cannabis as an effective treatment for various ailments such as chronic pain, glaucoma, or high blood pressure. Eager to help and to provide an informed opinion, he began researching and taking down notes, and was surprised to find how many studies had been conducted on cannabis as treatment for chronic pain. Over time those notes became a collection and compilation that turned into his first book, 

, and later its online equivalent, CannaKeys (1,2). “

 looks at the state of the science for about a hundred different conditions with the question in mind such as, does cannabis work for this particular condition or not? And if it is posited to work, what type of cannabis is thought to work best,” noted Dr. Blesching.

, published in 2015, contained 100 chronic condition and by the third edition, published in March 2022, grew to contain more than 200 conditions. Over time, Dr. Blesching explained, some initial skepticism about cannabis has given way in part “because of the sheer volume of endocannabinoid-related studies that have really laid the groundwork of a new field of science, the cannabinoid health sciences, or endocannabinology as some people refer to it.”

By the time the third edition was started, Dr. Blesching realized that because of the number of new studies, it became imperative to have an electronic version, which is what led to the creation of CannaKeys, so that people who need the very latest research can have access to it. The written and online versions of the studies and data provide a balance for those who need the most updated information and those who need written material. According to Dr. Blesching, the purpose of CannaKeys, which has been created over the past four years, is to “demystify the science of the endocannabinoid system and to make that science available for patients, caretakers, and physicians alike to make this process as streamlined, easy, and elegant as possible.” Rather than having to wade through tens of thousands of unfiltered studies, a significant obstacle that researchers and doctors face, the online databank distills the data into what is useful and relevant in a practical way. This allows users to access a solid foundation on which to make more informed decisions.

Both the book and the online databank contain annotated information and synopses of the most important elements of the texts while also providing the opportunity to access the science itself if a user wanted to perform their own deep dive of the material. Dr. Blesching noted that even with this intentional organization of the material, “we’re very careful to not inject bias or our subjective opinions into the process of making the research as easily digestible in the clinical setting as possible.” While the printed book and the online material are accessible for both doctors and patients, a more patient-focused version of the information is in progress to make the information easier to digest. For now, the online version has accessibility options such as a glossary so that users can learn unfamiliar terms and be prepared to see it in later research.

Cannabis as Pain Management Supplement, Withdrawal Symptom Mitigation, and its Therapeutic Benefits

One major takeaway from his research that Dr. Blesching would like doctors to understand is not to be afraid of looking at cannabinoid-based therapeutics as a potential treatment, especially for the chronic pain patient population. “Look at the data, look at the state of the science and reach out to other cannabis educated physicians and try to learn from their experience because many times they have very specific answers that are relevant to very specific patient populations that may not even be reflected in the science because the state of the science hasn’t caught up to it yet,” he said.

He further explained that most meta-analyses on cannabis studies suggest that cannabis or cannabinoid-based therapeutics absolutely present a valid and viable option in the treatment of chronic pain. “Now, that doesn’t mean that it is a cure-all for chronic pain. There’s a lot of individual circumstances that need to be taken into account,” he added. “But the data is out there for many chronic pain populations, and the science clearly leans in favor of utilizing cannabis for these patient populations.”

Similarly, on the patient side, he suggested that when patients are looking for treatment options, such as for chronic pain, they should make an informed choice about what type of cannabis, what form, and what dosage to use for their situation. “Patients can do this with two goals in mind: first, to mitigate any potential adverse effects and second, to maximize the therapeutic impact that can be possible to mitigate the chronic pain that they’re dealing with,” he said. “If you’re open to it, look at the potential mind-body component of any chronic pain and see if you can widen the net to catch positive therapeutic effects that are not just based on taking a remedy, but taking a broader, wider regimen into account. I found that those folks that do that tend to have their healing experience go broader and go deeper and longer lasting, all the while having to use less and less of whatever physical substances they rely on.”

Dr. Uwe Blesching provides insight into the exploration of cannabis as a supplement for chronic pain treatment, opioid addiction mitigation, and the mind-body balance.

Read the Research: What One Medical Writer Can Tell Us from Years of Compiling Data on Medical Cannabis Use for Chronic Pain Treatment, Opioid Addiction Management, and Enhancing Mindfulness