Chronic pain, which is often associated with conditions such as arthritis, neuropathy or inflammatory diseases, poses a major challenge to the quality of life of those affected. Research suggests that cannabis-derived compounds, particularly tetrahydrocannabinol (THC) and cannabidiol (CBD), can provide relief.

Study on the treatment of chronic pain with medicinal cannabis

A study published in 2024, based on a series of interviews, now sheds light on the preferences of people with chronic pain when using medical cannabis to treat this pain. The data is intended to support the development of guidelines and shared decision-making in clinical practice. The study was conducted in the Canadian context, i.e. both the use of medical cannabis and recreational use are legalized. Therefore, participants (of the user group) who use cannabis for recreational use were also included. Almost 44% of respondents have a license for the use of medical cannabis, but 45% do not have insurance that financially covers such therapy.

A total of 52 people living with chronic pain were interviewed. Almost 77% (number: 40) of the participants were using cannabis for their pain at the time of the survey, ten of the participants had previously used cannabis for their pain and two of the participants were non-users. Most participants (63%) stated that they had been living with chronic pain for more than ten years. About 94% of respondents suffer from these symptoms on a daily basis. Final decisions to treat with medical cannabis for chronic pain relief were based on participants’ differing values and preferences.

Results

The majority of users surveyed stated that they need to try out which cannabis products (including ingestion and dosage) prove most helpful for them personally. The opinions of current cannabis users overlapped in terms of the following clear benefits derived from using cannabis:

• Pain relief
• Improved sleep
• Improved mental health

When taken orally, longer lasting but slower onset pain relief was noted, while when inhaled, a faster onset but shorter duration of effect was documented.

Some respondents cited the lack of or insufficient pain relief and unwanted side effects as disadvantages of treatment with medicinal cannabis. However, consumers reported that CBD-containing products had minimal adverse effects (physical or psychological) compared to THC-containing products.
Social acceptability, availability and access, cost and knowledge of healthcare providers had a significant impact on the decision to use cannabis therapy and were seen as both a barrier and in some cases an impetus/encouragement.

Adequate education and consideration of pros and cons, barriers and facilitators, and patient values and preferences are increasingly important in facilitating appropriate cannabis therapy for those affected.

Reference:

Since 2017, doctors in Germany have been able to prescribe cannabis flowers and extracts as well as synthetic cannabinoids to patients for the treatment of various serious illnesses. However, according to the current state of knowledge, such treatment is only covered by health insurance companies in rare cases. The prerequisite is a sensible use of the treatment as well as the condition that “a generally recognized treatment corresponding to the medical standard is not available, cannot be used in the individual case […] after weighing up the expected side effects and taking into account the clinical picture […] and there is a not entirely remote prospect of a noticeable positive effect on the course of the disease or on serious symptoms”. (1).

Neurological diseases for which medical cannabis is already approved for treatment in Germany include epilepsy, Dravet syndrome, pharmacotherapy-resistant epilepsy syndromes and multiple sclerosis (2).

In principle, any doctor in Germany can prescribe cannabinoids (THC). However, for final reimbursement by the health insurance company, prior authorization for the prescription must be obtained from the respective health insurance company. Around 40 % of these applications are not approved.

Study situation

In the treatment of neurological diseases, the study situation on the long-term effects is particularly important, as one-off or short-term use in such cases would only bring a short-term improvement/relief of symptoms for those affected. To date, there is little information on the long-term effects of medical cannabis use. A meta-analysis of non-cancer chronic pain suggests that long-term use is likely to be safe. However, the studies included in the analysis were based on a maximum observation period of 12 months. The different studies also show different results with regard to the use of cannabinoids in multiple sclerosis.

Two large national patient surveys on the use of cannabinoids in Parkinson’s disease show that the treatment may be particularly useful for treatment-resistant non-motor symptoms such as pain, sleep disturbances or anxiety, as well as for improving motor symptoms.

Overall, there is only limited, clear evidence of a “general, safe” mode of action of cannabinoids in neurology (2).

Conclusion

In principle, it should be noted that all effects of medical cannabis use are influenced by several factors. The frequency of use, the THC content, the age of the user and individual susceptibility must therefore be taken into account when making general statements about possible effects/side effects. In the treatment of neurological disorders, there is a fundamental risk of cognitive impairment, especially in younger people. Although THC-containing cannabinoids also appear to be generally well tolerated in the above-mentioned patient survey, further high-quality studies are urgently required in order to create a valid database.

In principle, however, patients with severe symptoms should not be denied access to this therapeutic option if other therapeutic approaches have proven to be inadequate, especially since the response to treatment varies from case to case and there is already growing evidence that medicinal cannabis can have a positive effect on the symptoms of neurological diseases.

References:

Mucositis

One of the side effects of conventional cancer treatment with chemotherapy is damage to healthy tissue, which often leads to a breakdown of the mucosal barrier of the gastrointestinal tract, known as mucositis. This is due to rapid and extensive DNA damage in highly proliferative stem cells throughout the gastrointestinal mucosa. The resulting cell death and inflammation leads to the breakdown of the mucosa and the formation of lesions in the mouth, esophagus, intestines and rectum. This leads to changes in taste, dysphagia, pain and malabsorption, which in turn leads to anorexia, malnutrition and dehydration. The resulting gaps in the protective mucosa create an unfavorable environment for the resident intestinal bacteria. This leads to a further weakening of the mucosal barrier. Fever, cognitive impairment and fatigue can be the result.

The role of the endocannabinoid system

Medicinal cannabis contains compounds such as cannabinoids, including cannabidiol (CBD) and tetrahydrocannabinol (THC), which interact with the body’s endocannabinoid system. This regulates a number of functions known to be negatively affected by chemotherapy, including mood, anxiety, cognition, appetite, sleep and pain. Gastrointestinal inflammation, mucosal defense and gastric motility, including diarrhea and constipation, also play a role. Given the immunomodulatory ability of the ECS, many symptoms and side effects of chemotherapy can be influenced by the ECS.

Previous use of medicinal cannabis in cancer

There are already numerous studies on the use of medicinal cannabis in cancer treatment. Pain is the most commonly reported symptom. Nausea, vomiting, loss of appetite, sleep disturbances and psychological symptoms (depression, anxiety) also play a major role. New findings show the possible role of cannabis in these side effects caused by chemotherapy. CBD and THC in particular are being studied intensively for their ability to influence the function of the gastrointestinal tract. This is due to the fact that the endocannabinoid system (ECS) controls gastrointestinal homeostasis to a significant degree. CNR1 and CNR2, G-protein-coupled receptors present in the gastrointestinal tract, are responsible for this. This network of ECS receptors controls gastric motility.

Medicinal cannabis – use during active cancer treatment

According to the study reviewed for this article [1], medical cannabis should be used during active chemotherapy to minimize both the depth and duration of mucositis. It is important to point out that much of the evidence for the use of medicinal cannabis in cancer has only been studied in vitro or in preclinical (animal) models.

However, there are also human clinical trials investigating the role of cannabinoids in the active treatment of cancer. The results of these studies show that in the standard treatment of recurrent high-grade glioma, the addition of medical cannabis resulted in an improvement in quality of life and imaging-indicated tumor response in 11% of patients, while in 34% of patients, disease progression remained stable compared to previous controls. These clinical trials make it clear that some patients may benefit from treatment with cannabinoids.
However, there are currently no predictive biomarkers to identify responders and non-responders.

Although the use of medicinal cannabis during active chemotherapy still presents some challenges, including drug interactions, there are also potential benefits and opportunities that have been highlighted in these studies. The focus of medical cannabis adjunctive therapy is on combating the development of some symptoms or controlling these symptoms at an early stage.

Targeted adjunctive treatment with medicinal cannabis for mucositis may have the following benefits:

• Medicinal cannabis can influence eating behavior in weight loss due to reduced oral food intake (anorexia) through taste changes and pain (appetite stimulant) in a way that can have a positive effect on weight maintenance and nutritional status.
• Sleep disturbances due to diarrhea and pain. Due to the pain-relieving properties of medicinal cannabis, targeted treatment has the potential to improve patients’ quality of life.
• Anti-inflammatory properties of medicinal cannabis.

For mucositis, the use of CBD and THC (along with other cannabinoids and compounds such as terpenes) is probably best suited to provide meaningful benefits due to their synergistic effects. CBD has been shown to counteract the (undesirable) psychotropic effects of THC, while THC can, for example, help with anxiety or promote food intake/appetite and sleep quality.

Conclusion

Given the numerous symptoms that occur as a secondary consequence of mucosal barrier impairment in mucositis, the use of medical cannabis as an adjunctive therapy has the potential to alleviate certain symptoms and improve quality of life for individuals during active cancer treatment.
Further studies are needed to better understand the specific effects of medical cannabis on gut health in people with advanced cancer and to validate the efficacy and safety of this treatment option.

Reference:

Reference:

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental illness that can occur as a result of trauma caused by stressful events or particularly threatening situations. War, sexual abuse or even serious accidents play a major role here (1).
If the event is not dealt with and processed, a post-traumatic stress disorder can develop from the (co-)experience of such a trauma – in other words, the stressful memories return and are “lived through” again and again. Intense anxiety, flashbacks and sleep disorders can dominate the daily lives of those affected (1).

PTSD can often be treated well with cognitive behavioral therapy or the administration of medication (usually psychotropic drugs: antidepressants) (1). In recent years, the use of medicinal cannabis has also emerged as a possible treatment option.

Current study data

A pilot study from Florida in 2023 shows that the severity of PTSD symptoms in the study participants improved significantly after 30 and 70-day follow-up examinations due to the use of medicinal cannabis. In particular, a statistically significant reduction in nightmares was observed, as well as longer sleep duration, better sleep quality and higher sleep efficiency. General mental health improved significantly (2).

The results of the Florida study underscore the potential of medical cannabis to improve outcomes in patients with PTSD, particularly those with sleep disorders that do not respond to currently available treatments (2).

Cannabinoids

THC, the psychoactive component of cannabis, may help reduce anxiety and modulate emotional responses to traumatic memories. CBD, on the other hand, the non-psychoactive part of cannabis, shows anti-inflammatory and anti-anxiety properties, which could contribute to a possible improvement of sleep disorders and stress symptoms.

News of the world – Ukraine

Already last year, activists and advocates of medical cannabis in Ukraine pleaded for access to this treatment method, especially with the aim of helping millions of people, including soldiers wounded in the Ukrainian war. In December last year, the Ukrainian parliament passed a first draft law on the legalization of medical cannabis.

The aim of legalization is to help cancer patients in particular, but also people with PTSD, and to offer an additional treatment therapy for the respective symptoms.

According to Mariia Mezentseva, who spoke out in favour of legalization in parliament, medicinal cannabis is needed by up to 6 million Ukrainians, including civilians with post-traumatic stress disorder (PTSD) and wounded soldiers (3).

Legalization, which is expected to take place in the second half of 2024, is to take place under the strictest conditions. “Only approved facilities with the necessary licenses and GMP certificates will be allowed to grow cannabis. For security reasons, there will be constant video surveillance by the national police. Each plant will be given a unique code so that its path to the patient can be precisely tracked. The cannabis-based medicines will only be available with an electronic prescription. This would be issued by a doctor according to the patient’s condition.” (3). Recreational use remains illegal by law. 

References:

ADHD

ADHD is a neurological disorder that can affect people at different stages of life. The disorder manifests itself primarily in hyperactivity (excessive urge to move), inattention (impaired ability to concentrate) and impulsivity (rash behavior) and affects an estimated 5% of all children and 2.5% of all adults worldwide (1,3). In addition to behavioral therapy, other approaches are often based on stimulants or other medications (2). These methods are considered relatively safe and effective, but are often associated with decreased appetite, insomnia, emotional dysregulation, irritability and an increased risk of adverse cardiovascular events (1). 
There is evidence that cannabinoids may play a promising role in the symptom management of ADHD due to their neuroprotective and anti-inflammatory properties.

Endocannabinoidsystem (ECS)

The endocannabinoid system (ECS) can be described as a signaling network of the body that consists of cannabinoid receptors (type 1 and type 2), among others. CB1 receptors are widely distributed throughout the central nervous system, with high concentrations detected in regions associated with cognitive function and processing. Therefore, activation of CB1 receptors directly or by increasing AEA, an endogenous ligand of CB1 receptors whose activation leads to modulation of neurotransmitter release, is thought to be a potential target for the treatment of ADHD (1).   

ADHD study

In a study conducted by the British Medicinal Cannabis Registry in 2023, a total of 68 participants diagnosed with ADHD were treated with medicinal cannabis over a period of 12 months. Inhaled preparations of dried flowers and sublingual oil preparations were prescribed individually and in combination. The results of the study show that, among other things, the severity of anxiety and sleep quality as well as the general health-related quality of life could be improved.

These findings may open up new avenues for personalized treatment approaches that are better tailored to the individual needs of people with ADHD.  

Further studies are needed to understand the long-term effects and optimal mode of action. Nevertheless, the discovery of new treatment options has the potential to support conventional therapeutic approaches and improve the lives of those affected through symptom relief.   

References:

Understanding Cannabinoids 

Cannabinoids, including THC (tetrahydrocannabinol) and CBD (cannabidiol), interact with the endocannabinoid system in the human body. This system plays a crucial role in regulating various physiological processes, including the perception of pain [2]. The potential therapeutic effects of cannabinoids on gynecological pain have sparked interest in their use as an adjunct to conventional treatments. 

Chronic Pelvic Pain Conditions, focus on Endometriosis 

Chronic abdominal pain, such as endometriosis, is a major challenge for women’s health. Widespread pain, especially in the lower abdomen, as well as fatigue, sleep disturbances and cognitive disorders accompany those affected [3]. Endometriosis patients often express dissatisfaction with current treatment approaches, with only 25% considering their symptom control to be satisfactory. There are studies suggesting that cannabinoids have anti-inflammatory and pain-relieving properties that could benefit people suffering from endometriosis [1]. The phytocannabinoids from cannabis not only interact with the CB1 and CB2 receptors to exert an analgesic effect but can also indirectly relieve pain by triggering anxiolytic and antidepressant effects. Further analgesic effects of cannabinoids are also suspected, particularly in endometriosis, which are induced by antiangiogenic, immunomodulatory and antiproliferative processes [1]. 

Potential Benefits of cannabinoids  

Potential benefits of cannabinoids in gynecologic pain management include a favorable side effect profile compared to some conventional medications [1,4]. However, challenges such as standardization of dosing, long-term safety and regulatory considerations highlight the need for further research, particularly with regard to specific use in endometriosis. 

References:

1 – Sinclair, J., Abbott, J., Proudfoot, A., & Armour, M. (2023). The Place of Cannabinoids in the Treatment of Gynecological Pain. Drugs, 83(17), 1571–1579. https://doi.org/10.1007/s40265-023-01951-z 

2 – Dingermann T. (2021). Grundlagen der Pharmakologie von Cannabinoiden. Schmerzmedizin, 37(Suppl 1), 8–13. https://doi.org/10.1007/s00940-021-3139-9  

3 – Kaltsas, G., & Tsiveriotis, K. (2023). Fibromyalgia. In K. R. Feingold (Eds.) et. al., Endotext. MDText.com, Inc.  

4 – Armour, M., Sinclair, J., Chalmers, K. J., & Smith, C. A. (2019). Cannabis use, a self-management strategy among Australian women with Endometriosis: Results From a National Online Survey. Journal of Obstetrics and Gynaecology Canada. https://www.jogc.com/article/S1701-2163(19)30808-4/fulltext