Selective Cannabinoids for Chronic Neuropathic Pain


Marijuana use for recreation and medical care has broadened across the USA, along with the legalization in many states. Still, the debates about its use, side effects, and addiction problem continue. The analysis of the research abstracts published during the last three years shows that the concerns of the scholars relate to two main scopes – positive treatment effect and a negative influence on the brain and overall health.

Despite the efficiency of THC (tetrahydrocannabinol) and CBD (cannabidiol) intervention for pain mitigation, reduction of nausea and vomiting, or spasticity treatment, long-term use of marijuana is related to a risk of brain damage and lung injury. Thus, the recommendations about the dose and the necessity of such treatment should be improved based on the cross-sectional studies of heterogeneous populations.

The Debate over the Legalization of Marijuana

The policies that legalize marijuana and, at the same time, regulate its use have been issued in many states during the last decades. However, the question still causes controversy, and further research is needed to assess the effect of such policies. The analysis conducted by Barry and Glantz includes data from “four states where medical marijuana has been legalized” (914). The study reveals that “only between 34% and 51% of policies followed best practices” (Barry and Glantz 914).

The authors also noted a lack of proper investigation in other states as it is mostly based on inconclusive and unsystematic scientific evidence. Problems occur due to the limitations of many studies caused by different timing, population, and methodology. Recent publications address mostly the interventional medical effect, despite the lack of research focusing on social and behavioral changes. The impact of marijuana laws on the population should be studied to evaluate the risks of increasing addiction and misuse and regulate the way how it is marketed and dosed.

The Use of Marijuana for Medical Treatment

THC-based medications have received approval of the FDA as the effective treatment for chronic disease or for those who undergo chemotherapy. Purified extracts are considered safer and clinically more effective than traditional marijuana plants. However, a risk of the destructive effect of THC treatment causes heated scientific discussion. Medical marijuana is today prescribed in the cases without any alternative treatment or when there is an evident benefit that overcomes potential danger.

The latter situation can be observed in many cases in palliative medicine. Palliative care aims at improving quality of life of patients with severe chronic or life-threatening illnesses. Its primary purpose is to reduce suffering, so THC (tetrahydrocannabinol) and CBD (cannabidiol) are frequently used here. In such cases, the pain that patients regularly suffer impacts their quality of life more than the potential side effects of the treatment.

Patients undergoing palliative treatment or perioperative care often require cannabinoids to reduce pain, spasticity, and nausea. However, the thoughts of scholars differ regarding the efficiency of such treatment. Liu et al. studied the population of patients who are on the early postoperative to analyze the “impact of preoperative cannabinoid use on postoperative pain scores and pain-related outcomes” (874). One hundred fifty-five patients undergoing marijuana-related treatment were compared with 155 patients, not on cannabinoids. The results found a connection between THC intervention and increased pain scorers, along with lower sleep quality (Liu et al. 874). Moreover, the medical staff notes that the lack of dosing recommendations and proper research on the potential danger creates barriers to the maximum efficiency of such care.

Treatment based on marijuana-originated medications has become a common practice in dealing with symptoms of neurological disorders, such as multiple sclerosis, Alzheimer’s disease, or dementia. Multiple sclerosis (MS) is a severe illness in which the spinal cord and the brain are damaged. It causes such symptoms as spasticity, vision problems, and reduced motion control that substantially reduce the quality of life. Sustaining symptomatic treatment is focused on eliminating those symptoms to the maximum extent. Meng et al. have studied the efficiency of selective cannabinoids for pain mitigation of patients with different neurological disorders (1638).

The group of patients under nabiximols (marijuana-derived oromucosal spray) and other THC medications was compared to the control group undergoing conventional treatments. The results of the study revealed significant analgesic efficacy, which still showed lower rates than traditional treatment (Meng et al. 1638). However, the improvements in health-related quality of life and reduction in spasticity were observed in the patients under cannabinoids.

THC and CBD are widely used as recreational intervention after surgery or for the patients undergoing chemotherapy. They are often prescribed as a symptomatic treatment of cancer-related conditions with the purpose of pain mitigation or reduction of nausea. Saadeh and Rustem conducted comparative research of the patients with early-stage and advanced cancer to study the effect of symptomatic cannabinoid treatment (e556).

The incidence of marijuana-derived medication use was similar in both groups – 18,3% (Saadeh and Rustem e556). The patients under THC treatment reported increased pain and anxiety rates along with reduced appetite, so the authors conclude that the “risks versus benefits should be discussed with all patients who use marijuana” (Saadeh and Rustem e556). They also suggest that these methods of treatment should undergo further research.

Negative Influence of Marijuana on Health

The opponents of marijuana legalization address the danger this medication poses to human health. Advocates of marijuana prohibition express their concern about such factors as the increased accessibility of drugs, possible misuse of prescribed medication, and the effect of long-term treatment on brain function. The recent outbreak of lung injury is another issue that has been increased due to the popularization of vaping products based on cannabis. Many scholars connect this tendency to the fact that the production and distribution of marijuana are less restricted today, spreading beyond medical institutions. However, there is a lack of precise data and evidence-based research on the issue.

Another argument against the use of marijuana-based medication is its potential danger to brain function. Carr and Schatman have reviewed the current state of knowledge regarding the potential threat of THC to human health (50). The authors relate long-term use of marijuana to such risks as “lung disease, cardiovascular disease, and… diminution of gray matter in the brain” (Carr and Schatman 50). The research proved that analgesic efficiency is connected to the dosing of THC, yet higher dosing poses an elevated danger to health. Still, further research is needed as the information on what doses and treatment periods are relatively safe is missing. Treatment recommendations and protocols should be developed on the basis of evidence-based investigations.

Conclusion

The present state of research on marijuana legalization requires complex evidence-based study as data on several controversial issues is lacking. Although marijuana-originated medications are believed to be for the treatment of many severe conditions, they are still potentially dangerous to the neurological system. As there is little or no effective alternative to such therapy, especially in palliative care, the protocols should be developed that regulate dosing and duration of treatment. Other tendencies connected to marijuana legalization, such as illegal use or a growing number of lung injuries, should be studied to develop regulatory policies.

Works Cited

Barry, Rachel A., and Stanton A. Glantz. “Marijuana Regulatory Frameworks in Four US States: An Analysis Against a Public Health Standard.” American Journal of Public Health, vol. 108, no. 7, 2018, pp. 914-923. Web.

Carr, Daniel, and Michael Schatman. “Cannabis for Chronic Pain: Not Ready for Prime Time.” American Journal of Public Health, vol. 109, no. 1, 2019, pp. 50-51. Web.

Liu, Christopher W., et al. “Weeding Out the Problem: The Impact of Preoperative Cannabinoid Use on Pain in the Perioperative Period” Anesthesia & Analgesia, vol. 129, no. 3, 2019, pp. 874-881. Web.

Meng, Howard, et al. “Selective Cannabinoids for Chronic Neuropathic Pain.” Anesthesia & Analgesia, vol. 125, no. 5, 2017, pp. 1638-1652. Web.

Saadeh, Claire E., and Danielle R. Rustem. “Medical Marijuana Use in a Community Cancer Center.” Journal of Oncology Practice, vol. 14, no. 9, 2018, pp. e556-e578. Web.