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Does MMJ help with Chronic Back Pain?

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Chronic pain is one of the most common conditions that medical cannabis is prescribed for. Chronic pain refers to persistent pain that lasts for several months or longer, often resulting from conditions such as arthritis, neuropathy, fibromyalgia, or back injuries. Conventional treatment approaches for chronic pain may include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. However, these treatments can be ineffective for some individuals and may come with undesirable side effects or risks of dependency.

The Endocannabinoid System and Pain
In recent years, research has shown promising evidence regarding the use of medical cannabis for managing chronic pain. Cannabis contains more than 100 active compounds, known as cannabinoids, with two primary cannabinoids being delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). These cannabinoids interact with the body’s endocannabinoid system, which plays a role in pain regulation.

The endocannabinoid system consists of cannabinoid type 1 (CB1) and type 2 receptors (CB2) which play roles in pain perceptions and pain sensation [4]. Here’s a snapshot of how these cannabinoid receptors impact chronic pain:

CB1 is most abundant in the nervous system
CB1 inhibits pain sensation (nociception) by blocking signals in the spinal column
CB1 stimulates the body’s pain-relieving (analgesic) pathways
CB2 is abundant in the immune system
CB2 inhibits the release of inflammatory factors from immune cells (glial cells, neurons)
CB2 inhibits pain sensation by mediation immune cells (neuroprotective)
Cannabinoids like THC and CBD are able to bind to cannabinoid receptors because they are the botanical version of endocannabinoids. The endocannabinoids 2-arachidonoylglycerol (2-AG) and anandamide (AEA) are naturally produced in the body. Both types of cannabinoids can act on biological pathways outside of the endocannabinoid system in addition to, or in conjunction with, their interactions with cannabinoid receptors. Serotonin 3A (5-HT3A), and transient receptor potential subfamily V member 1 (TRPV1) cation channels are an example of this [4].

How Cannabinoids Combat Pain Outside of the Endocannabinoid System
Synaptic junctions are the spaces between nerve cells where signals get passed. One way that CBD can reduce pain is by increasing endocannabinoid concentration at synaptic junctions [4]. It does this by inhibiting the breakdown of fatty acids that transport endocannabinoids to these junctions. Another way that CBD can relieve pain is by inhibiting serotonin 3A (5-HT3A) receptors. These serotonin receptors transmit pain sensation signals, especially the sensation of neuropathic (shooting or burning) pain [3]. They also play a role in hyperalgesia (increased pain sensitivity).

TRP cation channels like TRPV1 are another important target for treating chronic pain with medical cannabis. These channels play a crucial role in pain sensation which involves psychological and physiological aspects [2].THC has been found to inhibit pain sensation by blocking TRP cation channels [4].

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