Medical marijuana is an increasingly popular alternative to traditional pain-relieving medications, including opioids. Marijuana may ease certain types of chronic pain, including pain resulting from nerve damage and inflammation. Processed variations of the cannabis plant are designed for those consumers who don’t necessarily want to smoke to achieve the desired effect. But when it comes to which method of consumption is best for patients suffering from chronic pain, a new study suggests that loading a bowl full of flower is still the most effective path to getting back to good.

How does marijuana work for pain?

Throughout this time, the cannabis plant has been exalted as miraculous and cursed as a danger to the fabric of society. Yet, throughout this varied past, one thing has remained the same:

Cannabis has been used as a plant medicine for the treatment of an impressively wide array of diseases.

Marijuana, or cannabis, contains compounds that may relieve pain, nausea, and other symptoms. The components of marijuana that most studies focus on for pain relief are cannabidiol (CBD) and tetrahydrocannabinol (THC).

THC is the psychotropic phytocannabinoid that is to thank for the “high” effect users get when they smoke weed. It has been found to have a variety of health-related benefits for the user.

CBD is the second most well-known cannabinoid found in cannabis, and like most of the other phytocannabinoids, it is non-psychotropic.

These are the two most abundant and well-studied cannabinoids in marijuana, and both have been found in numerous published studies to have pain-relieving properties in humans. While they may be the most abundant, THC and CBD are certainly not the only compounds found in cannabis that are known to exert positive effects on human health.

When you compare Western medicine to traditional medicine the world over, one of the most striking differences is the need in the West to pinpoint one specific molecule that is responsible for treating a disease or symptom. This viewpoint stands contrary to the idea of holistic medicine, where you take something in its entirety for medicinal purposes.

The ‘entourage effect’ is a new term coined to describe the idea that all compounds found in the cannabis plant work synergistically, providing more benefit together than the individual compounds would provide alone.

What the research says

In recent years, many studies have looked at the effects of marijuana for chronic pain. Some studies used parts of the marijuana plant and some have used the entire plant so more research is needed. Using parts of the marijuana plant (like CBD oil) helps study specific actions of that ingredient, but when the whole plant is used there is what is called an entourage effect, where the parts work together to have more effect.

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Smoking marijuana flower is the most popular method of ingesting cannabinoids. It’s a simple, time-honored, and quick method of delivery. Within minutes after ingesting smoked marijuana the user can feel the desired effect. At least that’s the case for people who want to get high.

It also seems to be the case for people who use it to manage their pain — according to the results of a new study published in the journal Complementary Therapies in Medicine.

Researchers from the University of New Mexico found that, “Whole cannabis flower was associated with greater pain relief than were other types of products, and higher tetrahydrocannabinol (THC) levels were the strongest predictors of analgesia and side effects prevalence across the five pain categories.”

These results are especially interesting considering that cannabidiol (CBD), the non-intoxicating compound of the cannabis plant, is now being praised as a rockstar at taming pain. Even the folks pushing the hemp-derived version of this medicine, which is much weaker than the oils made from marijuana, swear that this sometimes truck stop novelty is the key to living pain-free. However, researchers beg to differ. They have concluded that the presence of THC, which produces the stoned effects we all know and love, is also essential if the user expects any discernible pain-relief results.

“Cannabis flower with moderate to high levels of (THC) is an effective mid-level analgesic,” the study reads.

But it just isn’t the existence of THC that makes smoking marijuana the best approach to pain management.

Despite the rush to isolate the non-psychoactive compound CBD as the popular extract of marijuana, this study supports two counterpoints. One is that THC, the psychoactive compound, may be the more effective pain treatment, and the other is that whole flower with all the cannabinoids, terpenes, and flavonoids is the more effective form. The rush to isolate compounds in cannabis gives short shrift to the synergistic properties of the whole plant.

“Overwhelmingly, when the whole plant is used rather than isolating one compound of the plant inevitably it’s more effective,” says Mark Passerini, cofounder of the Om of Medicine provisioning center in Ann Arbor. The Om and the University of Michigan cooperated in an International Review Board sanctioned research survey on cannabis and opioid use.

While people are using THC and CBD to treat cancer, it seems that other parts of the plant are helping. Researchers at the Harvard University Dana-Farber Cancer Institute recently reported that cannabis flavonoids had potential for treating pancreatic cancer. Flavonoids are compounds found in all plants that help give them their color and can function as antioxidants. The report concluded that, “a flavonoid derivative of cannabis demonstrates significant therapy potential in the treatment of pancreatic cancer.”

The whole flower is a powerful thing.

The latest study out of New Mexico, however, provides some guidance for an America looking for answers as to whether marijuana can relieve pain or not.

A separate study published earlier this week from the American Society of Anesthesiologists (ASA) shows that 75% of the U.S. population, most of them millennials, has a genuine interest in learning more about how pot can combat pain conditions. These folks, presumably those fed up with all of the anecdotal reports and the conflicting studies that emerge every other week, want to see the federal government finally roll up their sleeves on the cannabis issue and deliver real results.

The Best Cannabis Strains for Pain

There is limited research available on the use of specific marijuana strains for pain and other symptoms. As a result, strain-specific recommendations are not medically proven.

The results of an online survey, comprising 95 participants, featured in the Journal of Alternative and Complementary Medicine in 2014.

The researchers found that participants preferred indica strains for pain management, sedation, and sleep while they would opt for sativa strains to improve energy and mood.

Regarding pain management, participants reported a statistically significant effect when using indica for:

non-migraine headaches

neuropathy

spasticity

joint pain

Benefits of high-CBD strains for treating pain

CBD has been found to exhibit enhancements in treating pain both when used on its own and when used in combination with THC. When used alone, CBD is largely best for inflammatory pain, such as that caused by arthritis or injuries.

In one animal study on arthritis pain, it was found that the topical application of CBD led to a reduction in inflammation and pain. Another animal study found that CBD helps to reduce neuropathic pain through the suppression of chronic inflammation.

CBD does not directly bind to the receptors found in the endocannabinoid system but rather works to modulate the effects of the endocannabinoids (the cannabinoids found naturally in our bodies) as well as working as a CB1 receptor antagonist.

The main mechanism by which CBD is thought to help mediate pain is by reducing inflammation, largely by blocking inflammatory mediators. It is also believed to potentiate glycine receptors, which help to regulate pain at the spinal level. This suppresses both neuropathic and inflammatory pain.

Benefits of high-THC strains for treating pain

THC is used clinically for the treatment of pain and studies find it helps relieve central and neuropathic pain. It is also used to help reduce pain in cancer, AIDS, and fibromyalgia patients, for which resistance to other pain treatments have been found.

The mode of action for THC is as a partial CB1 receptor agonist, which means that it will bind to these receptors but not fully which leads to the variability in effects documented when THC is present with other CB1 agonists, antagonists or both. It has been found to impact the serotonergic, dopaminergic, and glutamatergic systems – an action which may contribute to its pain-relieving benefits. Additionally, THC has been found to act as an anti-inflammatory agent.

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