Pain is a widely-defined expressing tool of the body that represents an unfavorable sensory experience. Acute pain occurs when the onset of pain is sudden and lasts for short duration. On the other hand, chronic pain remains for a long period of time and is relatively resistant to the pain-relieving medications. Cannabinoids have recently been introduced as potential therapeutic approaches for several human disorders. In particular, the application of cannabis and cannabinoids in the management of both acute and chronic pain has been investigated, especially in comparison to other potent analgesics, such as opioids. However, it is difficult to retrieve a definite conclusion of the effects of cannabinoids in the treatment of pain as it takes place in a heterogenous group of diseases with great differences in the patterns of presentation. The present study reviewed the relevant clinical trials concerned with investigating the efficacy of cannabinoids in pain management.
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Cannabinoids for acute pain treatment
Smoked cannabis caused a significant, but weak pain-alleviating effect in healthy users following specifically-designed acute pain tests. Such effects were not reversed by using anti-opioid medications. When compared to morphine analgesics, orally-administered tetrahydrocannabinol (THC) produced minimal analgesic effects during the pain tests and it was associated with some adverse effects, including euphoria and hallucinations. The lack of notable effects was also observed in a small group of women suffering from postoperative pain although they received only small doses of oral THC. In general, the anti-inflammatory action of cannabinoids was not investigated in order to compare their efficacy to the non-steroidal anti-inflammatory drugs for acute pain management. Evidence suggested that the cannabinoids may be utilized as modifying substances in a combination with opioids to enhance their analgesic effects. This could be typically useful also to reduce the potential side effects of both analgesic medications.
Cannabinoids for chronic pain treatment
The use of cannabinoids in the treatment of neuropathic chronic pain is promising. Sublingual administration of cannabis extracts, containing THC and cannabidiol (CBD), led to a marked analgesic effect in patients with brachial plexus injury, multiple sclerosis, spinal cord injury, and amputation. The observed side effects were generally acceptable when compared to other pain medications. Although the effects of ajulemic acid, a synthetic THC, were not as potent as the sublingual preparations for the treatment of the multiple sclerosis-associated pain, another synthetic THC preparation (namely dronabinol) resulted in a significant reduction in the pain parameters of the same disease with a marked improvement in the performance of daily activities. Therefore, cannabinoids may constitute a novel pain-reliving drug category for the symptoms that last for long periods.
The use of cannabinoids for the treatment of acute pain has been apparently efficacious when it is only given in combination with opioids. Further cannabinoids studies should be warranted, considering acute pain management using large numbers of participants and for long periods. For chronic neuropathic pain, cannabinoids can be effectively prescribed with an acceptable safety pattern when compared to the analgesic counterparts.