Chronic pain is a silent epidemic. Worldwide 1.5 billion live with it and in the United Kingdom and United States sufferers amount to over a third of the population. It is defined as ‘any pain lasting more than 12 weeks, whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain persists—often for months or even longer’.
Chronic pain is silent because so many of us have it but say nothing about it. For some it’s that constant niggling back pain that provides a low level background noise to daily activities, while for others their life is defined by its excruciating relentlessness.
Like Carola Perez who broke her coccyx as a child, something that has condemned her to a life of almost intolerable pain. ‘It’s like a kind of burning sensation in my legs or sometimes they just go to sleep’ she says. ‘My whole body temperature shoots up and I have to spend days in bed. I have been known to pass out completely with the intensity’.
Different countries have different approaches. If you’re lucky you might be referred to a physio or a pain clinic, but the reality for most is a lifetime of heavy prescription painkillers with varying levels of repercussions on the body.
But when all else fails many doctors bring out the ´big guns´ – opiods like OxyContin, Percocet, Vicodin, Percodan, Tylox, Tramadol and Demerol. In the US 12 million people are reported to be taking them. At 4% of the population that wouldn’t be so shocking if it weren’t for the fact that 78 Americans die every day from an opioid overdose. In fact, according to CNN, ‘overdoses from prescription painkillers, usually involving alcohol, recently overtook car crashes as the number one cause of accidental death in the United States. And despite making up less than 5% of the world’s population, U.S. patients consume about 80% of all prescription pain medication’.
Even Bill Clinton has spoken out about some people close to him dying from accidental opiod overdoses. CNN doctor Sangay Gupta remembers a conversation he had with the former President who had seen two close friends’ sons lose their lives. He told Gupta ‘”Look, no one thinks having a few beers and an Oxycontin is a good idea, but you also don’t expect to die.”
In the UK figures from the Office for National Statistics show that deaths from the abuse of strong painkillers have been rising steadily with more Britons dying from them than from taking heroin or cocaine.
So if the doctors keep prescribing them for chronic pain, it must be because they work, right? Well think again. Opiod medication was designed for acute pain following surgery, an accident or during cancer treatment. As well as the side effects of long term use such as addiction, drowsiness, constipation, kidney damage and suppressed immune function, studies show that opiods over time can actually make the pain feel worse. This is due to something called ‘opioid-induced hyperalgesia’ which according to Roger Knaggs, associate professor of pharmacy at Nottingham University and a council member of the British Pain Society, is because ‘Opioids “up-regulate” the body’s pain system so natural painkilling chemicals, such as endorphins, become less sensitive and effective and make some people more sensitive to pain – so your pain gets worse.’
In the UK approximately 1 of the 28 million estimated to suffer from chronic pain do not find relief from the pharmaceutical solution and are turning to Cannabis. Cases such as Callum who while serving in the British Army lost both his legs in an explosion in Afghanistan aged 22. According to the pro-medical cannabis campaign group End Our Pain he was ‘left in the terrible dilemma of having to suffer in silence or to break the law to access his medical cannabis’. Or Faye who after being diagnosed with rheumatoid arthritis at 27, started taking cannabis to control the pain, nausea and inflammation. She says ‘the doctors prescribed me a whole host of medication that didn’t do much for my symptoms but did make me very sick. I discovered that medical cannabis was a much better option. I don’t see why I should be criminalized for seeking a medicine that works for me’.
You see there’s the rub. In the UK Cannabis has a Schedule 1 status and is considered to have no therapeutic benefit, condemning chronic pain sufferers to breaking the law. Something End Our Pain is campaigning to change.
‘People who are in pain are either missing out on an effective treatment, or risking criminal prosecution’ they state. ‘We need to act now to put control back into the hands of doctors, and to allow further medical trials to proceed unhindered’.
Across the pond in the United States medical cannabis is available in 23 states despite it too being classed as Schedule 1 under federal law. So if you happen to live in the right state a doctor can write a prescription for medical cannabis which can be collected from one of the many dispensaries. If not, tough luck.
In fact a recent study from a team of researchers from the University of Georgia found that in states where medical cannabis was legal, prescriptions for painkillers and other classes of drugs fell sharply compared with states that did not have a pro-medical cannabis law, with on average 1,826 fewer doses of painkillers being prescribed in a given year.
This of course isn’t conclusive proof that cannabis is effective, but it does suggest that doctors are choosing to prescribe it over conventional pain medication.
However other studies that do point to its efficacy include a 2015 review in the Journal of the American Medical Association that found “30% or greater improvement in pain with cannabinoids compared with placebo,” across the 79 studies it surveyed. It concluded that there is “moderate-quality evidence” for medical marijuana treating chronic pain.
As does the study carried out by the Department of Orthopedics in the Hasharon Hospital, Israel, assessing the outcome of treating patients suffering from chronic low back pain with medical cannabis alongside existing pain medication. Presented recently at the 2016 International Cannabinoid Research Society, encouraging results were reported whereby ‘short term usage of smoked medicinal cannabis appear to improve both physical and mental function while decreasing pain levels of chronic low back pain sufferers’.
So why does cannabis seem to be so effective for people experiencing chronic pain? The answer lies in the endocannabinoid system; the body’s network of chemical compounds and receptors that work to maintain its homeostasis or equilibrium. Key to this process are endocannabinoids (compounds produced in the body) such as Anandamide and 2AG, that when binding to the CB1 receptors in the Central Nervous System and CB2 in the periphery, can influence the immune system, the inflammatory response, pain modulation and cell death.
The Cannabis plant itself contains phytocannabinoids, with the headline grabbers THC and CBD being just two of over 80. And it’s these plant based cannabinoids that scientists believe explain what people have been reporting for years – that cannabis helps with chronic pain, neuropathy and other conditions such as epilepsy and MS.
For instance, inflammation, a contributing factor to many cases of chronic pain is modulated by the CB2 receptor. Cannabinoids such as THC and CBD bind to cannabinoid receptors to produce analgesic and anti-inflammatory effects. Cannabinoid compounds, particularly the acidic versions found in the raw plant (THCA and CBDA), also bring about anti-inflammatory effects by inhibiting the enzymes that produce the pro-inflammatory molecules, prostaglandins. It has also been reported that THC, the main psychoactive component in cannabis, has twenty times the anti-inflammatory capacity of aspirin and up to twice that of hydrocortisone. And then there’s beta-carophyllene, a substance found in cannabis and other foods such as cloves and black pepper, that when binding to the CB2 receptor has been shown to reduce pain.
So with anecdotal evidence in abundance and increasingly scientific studies pointing to cannabis as an alternative to current prescription medicine protocol, why are many governments resisting a move towards the legalisation of medical cannabis?
According to Peter Reynolds from campaign group Clear Cannabis Law Reform, in the UK Cannabis cannot currently be considered a medical drug because of its complex molecular structure. The regulatory body for medicines and healthcare the MHRA is designed around pharmaceutical medicines containing only one or two molecules whereas Cannabis has over 400. He says ‘it’s about finding the political will to find a different way of regulating cannabis, like they have done in countries like Holland and the United States’.
Others consider the relatively small amount of clinical research to be a stumbling block, attributed to a lack of interest from pharmaceutical companies that see Cannabis as difficult to patent and therefore not worth investing money in. Although the US government’s patent taken out on cannabinoids as neuroprotectants and antioxidants somewhat flies in the face of this theory.
Either way, the current situation for many chronic pain sufferers remains the same. Suck it up, take hardcore, potentially dangerous pain meds, or break the law and use cannabis.