by Dr. Stacy Matthews Branch
There is a growing number and variety of cannabis products available to address a diversity of medical and health issues from conditions such as epilepsy and cardiovascular conditions to pain and inflammation. However, the knowledge of the use of medical cannabis is hardly a new phenomenon. For example, earlier than 2000 years B.C., cannabis was used in China as a tea for the treatment of malaria, rheumatism, gout, and beriberi (1). During the medieval period, it was used to treat tumors, respiratory ailments, and liver conditions. Oil prepared from cannabis leaves were used in the past in Indian and Arabic countries to relieve neuropathic pain, earaches, and hemorrhoids (2).
In various countries, people continue to recognize the long known and ancient uses of cannabis (CBD) for pain relief. Many people soak cannabis in alcohol, and use the mixture as a topical treatment for inflammation and pain of muscles and joints. Results of informal reports and surveys of patients with arthritis and other types of pain indicate that there may be a benefit of cannabis use for reducing pain in these patients (3,4). Information available from a naturopathic pain clinic in the state of Washington indicates that many patients with chronic and exercise-induced pain benefit from toxic-free relief (5). Overall, many people are very much aware of the medicinal benefits of cannabis and often seek this method of pain control as an alternative to opioids, which have many adverse effects including the high risk of drug dependence.
One variety of cannabis, hemp, was also used extensively and continues to be a very versatile plant for medical and nonmedical use. Hemp has a much lower tetrahydrocannabinol (THC, the mind-altering component) content and higher cannabidiol (CBD) content then the variety known as marijuana. Although THC has medical uses including as an analgesic (pain reliever), CBD is a highly studied compound for its wide-ranging medical uses and lack of mind-altering properties. Medical research studies have demonstrated its effectiveness as an anticonvulsant, anti-inflammatory agent, and analgesic.
THC and CBD are plant cannabinoids that cause their medical effects by acting on the body’s natural endocannabinoid system, which is made up of natural endocannabinoid neurotransmitters, their receptors (CB1 and CB2), and other molecules involved in the production and control of these components. Activation of endocannabinoid receptors in pain pathways of the spinal cord and brain inhibits the release of other neurotransmitters. In essence, the transmission of pain signals is modified when cannabinoids such as THC and CBD activate endocannabinoid receptors.
The very restrictive federal regulations for the use of cannabis products has made it difficult for scientist to conduct clinical studies regarding its medical effects. However, changes in the laws at the state level have provided access to cannabis use for medical and even recreational purposes. More data is now emerging from US and international researchers regarding the medical use of cannabis products including CBD. Some of the studies focused on pain reduction involve oral dosing with CBD; however, a few scientific studies have been published regarding its effect on pain when given topically.
Topical cannabis was studied in patients as a new treatment for wound pain (6). The results of the study showed that patients with a skin condition called pyoderma grangrenosum (chronic ulcerous wounds) experienced significant relief with a topical cannabis extract. A study looking at the effects of CBD for muscle and joint pain was conducted in rats with knee joint arthritis. CBD gel was applied to the skin of rats for 4 days, and various signs of inflammation were measured. The rats receiving the CBD gel showed significantly less joint inflammation than those that did not receive it (7).
Historical evidence and recent studies provide the basis for newly developed topical CBD creams and ointments used to relieve various types of pain including of joints, the skin, and muscle aches. Properly formulated creams and ointments can aid the absorption of CBD through the skin so that it could have great effects for pain relief. There is a growing selection of topical cannabis products available in the US, including the Whoopi and Maya line of products sold in California and Colorado. Their topical product, Medical Cannabis Rub (Medical Cannabis Body Balm), is primarily intended for menstrual pain relief.
Wellspring markets CBD lotions and creams such as Highland Pharms Therapy Plus Hemp Lotion, Real Scientific Hemp Oil (RSHO) Salve, and more. There is also Nature’s Best CBD Pain Cream, which is a hemp based topical cream intended for various types of pain relief. Another cream sold to relieve muscle aches is Biotech CBD Cream. This is just a small sampling of the growing arsenal of topical CBD products available to relieve various types of pain in people.
The uses and availability of even more cannabis products is expected as more states legalize its use. The current legal status of cannabis in California and Colorado, for example, has provided a strong market for cannabis products and is responsible for the growing information available from actual users of the products. Thus far, there are very consistent reports of the positive effects of cannabis use in people with chronic and other types of pain. Future lifting of the heavy restrictions at the federal level will lead to better and specific controlled clinical trials that can further demonstrate the medicinal effects and actual effectiveness of topical cannabis (CBD) for pain relief and other conditions.
References:
1. Earleywine, Mitchell. Understanding Marijuana: A New Look at the Scientific Evidence. Oxford: Oxford University Press, 2002. Print.
2. Ratsch C 2001, Marijuana Medicine. Healing Arts Press, Vermont. Pp. 26,34,39,53.
3. Ko GD, Bober SL, Mindra S, Moreau JM. Medical cannabis – the Canadian perspective. Journal of Pain Research. 2016;9:735-744.
4. Ste-Marie PA, Shir Y, Rampakakis E, Sampalis JS, Karellis A, Cohen M, Starr M,
Ware MA, Fitzcharles MA. Survey of herbal cannabis (marijuana) use in
rheumatology clinic attenders with a rheumatologist confirmed diagnosis. Pain.
2016 Dec;157(12):2792-2797.
5. Topical cannabis: low-toxic pain relief without a head-high. Online. Available at https://www.drjakefelice.com/2013/11/30/topical-cannabis-low-toxic-pain-relief-without-a-head-high/
6. Maida V, Corban J. Topical medical cannabis: A new treatment for wound pain-three cases of pyoderma gangrenosum. J Pain Symptom Manage. 2017 Nov;54(5):732-736.
7. Hammell DC, Zhang LP, Ma F, et al. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European journal of pain (London, England). 2016;20(6):936-948.
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