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Pain – Introduction to Pain Treatments

There are many different types of pain, and they can be caused by different mechanisms in the body and the brain. Due to this wide variety, each type of pain has to be treated differently. Cannabis can be used to treat pain caused by numerous conditions: Pain associated with Multiple Sclerosis, Nerve pain associated with Diabetes or HIV, and Chronic pain due to Cancer and other causes. However, cannabis has not been shown to help acute pain, for example the post-operative pain. In clinical practice, however, cannabis is usually not part of the typical guidelines for treating pain. In the table, we give you an overview of common pain treatments and compare them to each other and to cannabis. In the following sections, we go into more detail about the effects of cannabis on different types of pain.
Medicine Generic name (Brand name) First-line Indicationsee comment 1 Major Side-effects
Classic pain treatments
Over the Counter Pain Relievers Acetaminophen (Tylenol)[also known as paracetamol] Pain relief Fever Reducer Liver Toxicity
Ibuprofen (Advil) [Non-steroidal Anti-Inflammatory Drugs (NSAIDs)] Pain relief Fever Reducer Anti-inflammatory Kidney Problems
Aspirin (Acetylsalicylic Acid) (Ecotrin) Pain Relief Fever Reducer Anti-inflammatory Bleeding risk
Opiates Hydromorphone (Dilaudid) Morphine (MS Contin) Oxycodone (Percocet) Hydrocodone (Vicodin) Tramadol (Ultram) Codeine {call-out, text:typically combined with other substances such as acetaminophen or an NSAID} Pain Relief Sedation, constipation, breathing problems
Local Anesthetic Lidocaine (Xylocaine) Local anesthetic Heart irregularities (if used in excess)
Anti-epileptic Gabapentin (Neurotin)see comment 2 Pregabalin (Lyrica)see comment 2 Anticonvulsant Neuropathic Pain Sexual dysfunction, suicide
Other medications
General Anesthetic Ketamine (Ketalar) Anesthetic (Neuropathic pain)1 Hallucinations, panic attacks
Corticosteroids Prednisone (Deltasone)Dexamethasone (Decadron) Anti-inflammatory High blood glucose levels, fluid retention
Anti-epileptic Carbamazepine (Tegratol) Anti-epileptic4 Serious skin reactions
Anti-depressive agents Amitriptyline (Elavil) Anti-depression (Neuropathic pain)2 Cardiovascular side effects
Cannabis, THC (analogue), and CBD Various varieties of Cannabis sativa L. There are no varieties that are FDA approved for any indication, even though there are varieties that are produced using a Pharmaceutical-level of Good Manufacturing Practices (GMP) Psychiatric effects, such as feeling high, altered time perception, and drowsiness
Marinol (Dronabinol, synthetic THC) Relief from chemotherapy-induced nausea and vomiting Abdominal pain, and psychiatric effects, such as dizziness, euphoria (feeling high), paranoid reaction
Cesamet (Nabilone, synthetic THC analogue) Relief from chemotherapy-induced nausea and vomitingsee comment 3 Drowsiness, vertigo, dry mouth, euphoria (feeling high)
Sativex (Nabiximols, THC+CBD extract) Neuropathic Pain in Multiple Sclerosissee comment 4 Dizziness, tiredness, depression, confusion
  • Comment 1
    A first-line indication is the primary use of this class of medication based on the FDA Label and what they were approved to treat. Some medicines have been found to be useful in conditions other than what they were approved for.
  • Comment 2
    Used to treat neuropathic pain as third line therapy
  • Comment 3
    The Canadian Pain Society recommends cannabinoids as a third-line treatment in neuropathic pain.3
  • Comment 4
    Sativex is approved for neuropathic pain in Multiple Sclerosis in variouss countries (not in the United States).
References:
  1. Hocking, G.; Cousins, M. J. (2003). Ketamine in chronic pain management: an evidence-based review.
  2. Mehta, Swati; Guy, Stacey; Lam, Tracey; Teasell, Robert; Loh, Eldon (2015). Antidepressants Are Effective in Decreasing Neuropathic Pain After SCI: A Meta-Analysis (166-173).
  3. Moulin, D.; Boulanger, A.; Clark, A. J.; Clarke, H.; Dao, T.; Finley, G. A.; Furlan, A.; Gilron, I.; Gordon, A.; Morley-Forster, Patricia K.; Sessle, Barry J.; Squire, P.; Stinson, J.; Taenzer, P.; Velly, A.; Ware, M. A.; Weinberg, E. L.; Williamson, O. D. (2014). Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain research & management, 19(6), 328--35.