Pain Tolerance Among Cannabis Users

A recent study examining pain among cannabis users suggests that - unlike long-term opioid use - regular cannabis use does not appear to increase pain sensitivity.

PhD student Michelle St. Pierre, who conducts research in the psychology department at UBC Okanagan, recently published a study looking for differences in pain tolerance between frequent cannabis users and those who do not use it.

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“In recent years, there has been an increase in the adoption of cannabinoid medications, which have shown effectiveness in treating chronic pain,” says St. Pierre. “However, the extent to which frequent cannabis use influences acute pain sensitivity has not been systematically examined.”

Interest in using cannabinoids to help with chronic pain relief has accelerated in the last decade, St. Pierre explains, noting that a recent survey of medical cannabis patients reported that more than half used cannabis for pain relief. This is despite recent reviews suggesting that the effectiveness of cannabinoid therapies for chronic pain is mixed.

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"This study should be good news for patients who are already using cannabis to treat pain," says co-author Zach Walsh, who leads the UBC Recreational and Problematic Substance Use Lab, which hosted the study. “Increases in pain sensitivity with opioids can really complicate an already difficult situation; given the growing intake of cannabis-based analgesics, it is a relief that we have not identified a similar pattern with cannabinoids.”

St. Pierre's study explored differences in pain intensity and tolerance measures. The authors speculated that people who report frequent cannabis use would demonstrate greater sensitivity to experimental pain, but instead found no differences.

"There is a different effect from opioid users; long-term opioid use can make people more reactive to pain. We wanted to determine if there was a similar trend for people who use cannabis frequently," says St. Pierre. "Cannabis and opioids share some of the same pain relief pathways and have been associated with increases in pain sensitivity after acute use."

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The risk of addiction, overdose, and opioid-induced hyperalgesia - when someone becomes more sensitive to pain - are major concerns when it comes to using opioids to manage chronic pain, says St. Pierre. A patient with hyperalgesia may then increase the opioid dosage to control pain, further increasing the risk of dependence.

The analgesic effects of cannabis have been proposed to involve some of the brainstem circuits similar to those of opioids. However, the extent to which cannabinoids induce hyperalgesia has not been determined.

For her study, St. Pierre recruited volunteers who used cannabis more than three times a week and people who had never used it. Study participants underwent a cold pressor task, where they submerged their hand and forearm in ice-cold water for an extended period of time.

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What they determined was that cannabis use does not carry the same risk of hyperalgesia as opioid use, she adds.

"Our results suggest that frequent cannabis use does not appear to be associated with heightened sensitivity to experimental pain in a way that may occur with opioid therapy," she says. "This is an important distinction that healthcare professionals and patients should consider when selecting options for pain treatment. These findings are particularly relevant in light of recent reports of excessive opioid prescribing and high pain rates in the population, as they suggest that cannabis may not carry the same risk of hyperalgesia as opioids."

Source: information from Science Daily