New research indicates that cannabinoids could be efficacious pain management options
Cannabis and similar substances that interact with the body’s natural cannabinoid receptors could be viable candidates for pain management and treatment, according to new research published in the journal Experimental and Clinical Psychopharmacology.
“Currently, more than 30 states have policies in place that permit medicinal cannabis use; many of these cite pain conditions as inclusionary criteria. However, despite expanding use, what we know about ‘how’ and ‘why’ cannabinoids alleviate pain remains poorly understood,” said study author Julio A. Yanes, a graduate research assistant and National Research Service Award Fellow at Auburn University.
The researchers conducted a meta-analysis of previous research that had examined cannabinoid-induced alterations in pain ratings. They identified 25 peer-reviewed studies that met their criteria, which included 2,248 participants in total.
All of the studies compared either whole-plant cannabis, cannabis extracts, or synthetic cannabinoids to a placebo.
The meta-analysis found that cannabinoid administration was associated with greater pain reduction than placebo administration.
“Although our meta-analysis results suggest that cannabinoids are efficacious pain management options, more research is needed,” Yanes told PsyPost.
“For example, our follow-up meta-regression results revealed that study sample size was associated with observed pain reduction, such that smaller samples were associated with bigger effects. Thus, large (i.e., sufficiently powered) studies are warranted.”
Scientists are learning more about how cannabis interacts with the brain and the body’s endogenous cannabinoid system. But the mechanisms behind cannabis-induced pain reduction are still unclear.
“Our meta-analysis doesn’t address ‘how’ or ‘why’ cannabinoids were more effective than placebos. One important challenge facing the field is to determine the neurobiological mechanisms that may support cannabis-related pain reduction,” Yanes said.
The study, “Effects of Cannabinoid Administration for Pain: A Meta-Analysis and Meta-Regression“, was authored by Julio A. Yanes, Zach E. McKinnell, Meredith A. Reid, Jessica N. Busler, Jesse S. Michel, Melissa M. Pangelinan, Matthew T. Sutherland, Jared W. Younger, Raul Gonzalez, and Jennifer L. Robinson.
Licie_Quip on July 7th, 2019 at 06:12 UTC »
Given this is /r/science, we probably should discuss the actual science here. Firstly this is not "new" research, it's a meta analysis, which literally means they've combined the results of a bunch of previous studies. There are serious drawbacks to this which can be discussed another time, but basically boils down to "garbage in = garbage out". As the article admits, the better effect sizes were shown in studies with smaller numbers, sowing probably greater chances of bias/poor blinding etc. I know it's against the reddit narrative, but generally the evidence for cannabis products is not good. For persistent pain, it's probably on par with opioids - as in poor.
That's the second point. As anyone working in pain management knows, opioids are terrible. We know that, and taper whenever possible. Tolerance is achieved quickly, and opioid hyperalgesia is probably common with chronic use. As a result, literally a glass of water is a better pain management than opioids, as we know for certain its not going to sensitise the system. So comparing anything to opioids, as a lot of people here are doing, is not an accurate reflection of that particular agent's pain relief chops.
That brings on the third point - pain is such a complex, multidimensional experience, that it is subject to all our biases and expectations. As a result, individual anecdotes (like the ones shared here) mean nothing to the general body of evidence. People who have swapped from opioids to THC/CBD/etc and report feeling much better - that's great, I'm happy for you. It doesn't mean that starting the cannabis product made that difference (and based on what we do know, it's more likely just simply a result of stopping the opioids).
Final point, and this is the one that really gets me, there's nothing more 'natural' about endogenous cannabinoid receptors than mu opioid receptors. Opium is a plant product, and it's about as natural as anything cannabis related. At the end of the day cannabis products are, contrary to what this report suggests, really not showing that much promise. Any other medication that had similar unimpressive results would have stopped being developed by now.
*edit paragraphs
musadiqalex on July 7th, 2019 at 01:06 UTC »
Hey, in every post what does the " (n= random number) " mean?
mvea on July 6th, 2019 at 21:20 UTC »
The title of the post is a copy and paste from the title and first paragraph of the linked academic press release here:
Journal Reference:
Yanes, J. A., McKinnell, Z. E., Reid, M. A., Busler, J. N., Michel, J. S., Pangelinan, M. M., . . . Robinson, J. L. (2019).
Effects of cannabinoid administration for pain: A meta-analysis and meta-regression.
Experimental and Clinical Psychopharmacology. 2019
Link: https://psycnet.apa.org/record/2019-28227-001?doi=1
DOI: http://dx.doi.org/10.1037/pha0000281
Abstract
Chronic pain states have resulted in an overreliance on opioid pain relievers, which can carry significant risks when used long term. As such, alternative pain treatments are increasingly desired. Although emerging research suggests that cannabinoids have therapeutic potential regarding pain, results from studies across pain populations have been inconsistent. To provide meta-analytic clarification regarding cannabis’s impact on subjective pain, we identified studies that assessed drug-induced pain modulations under cannabinoid and corresponding placebo conditions. A literature search yielded 25 peer-reviewed records that underwent data extraction. Baseline and end-point data were used to compute standardized effect size estimates (Cohen’s d) across cannabinoid administrations (k = 39) and placebo administrations (k = 26). Standardized effects were inverse-variance weighted and pooled across studies for meta-analytic comparison. Results revealed that cannabinoid administration produced a medium-to-large effect across included studies, Cohen’s d = −0.58, 95% confidence interval (CI) [−0.74, −0.43], while placebo administration produced a small-to-medium effect, Cohen’s d = −0.39, 95% CI [−0.52, −0.26]. Meta-regression revealed that cannabinoids, β = −0.43, 95% CI [−0.62, −0.24], p < .05, synthetic cannabinoids, β = −0.39, 95% CI [−0.65, −0.14], p < .05, and sample size, β = 0.01, 95% CI [0.00, 0.01], p < .05, were associated with marked pain reduction. These outcomes suggest that cannabinoid-based pharmacotherapies may serve as effective replacement/adjunctive options regarding pain, however, additional research is warranted. Additionally, given demonstrated neurocognitive side effects associated with some constituent cannabinoids (i.e., THC), subsequent work may consider developing novel therapeutic agents that capitalize on cannabis’s analgesic properties without producing adverse effects.