More than one-third of people living with HIV/AIDS suffer from excruciating nerve pain in the hands or feet, frequently in response to the antiretroviral therapies that constitute the first line of treatment for HIV/AIDS. This neuropathic pain is extremely difficult to treat, and as a result, many individuals reduce or discontinue their HIV/AIDS therapy because they cannot tolerate or get adequate relief from the debilitating side effects of the antiretroviral medications. The effectiveness of cannabis and cannabinoids in managing pain has been demonstrated in more than three dozen preclinical and clinical trials, comprising more than 6,000 patient-years of data as of 20121. A 2009 review noted that “a large number of research articles have demonstrated the efficacy of cannabinoids” and concluded that “cannabinoids show promise for treatment of neuropathic pain76.”
A series of clinical studies of HIV/AIDS patients demonstrated that cannabis can reduce neuropathic pain and promote weight gain without compromising the immune system77-79. One randomized, placebo-controlled clinical trial of 50 people who had experienced neuropathic pain for an average of six years showed that smoked cannabis was well-tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy, according to the researchers at the University of California, San Francisco79. Other double-blind, placebo-controlled clinical trials have found that cannabis provides significant pain relief with people living with HIV who experience neuropathic pain that was not adequately controlled by other pain-relievers, including opiates78. Recent randomized clinical trials conducted by the University of California Center for Medicinal Cannabis Research (CMCR) also demonstrated that smoked cannabis is effective in treating neuropathic pain80. Researchers found that over half of patients with painful HIV peripheral neuropathy experienced pain reduction of more than 30% when treated with cannabis, a level of relief pain researchers correlate with improved life quality. That improvement occurred in two CMCR trials of patients with HIV peripheral neuropathy and in a separate trial of patients with mixed neuropathic pain due to peripheral or central dysfunction of the nervous system81-84.
Additional double-blind, placebo-controlled clinical trials indicate cannabis medicines may improve neuropathic pain associated with multiple sclerosis and mixed neuropathies resulting from herpes, trauma and vascular problems1. This research is also important for people with cancer, as many of them also experience neuropathic pain, as do those with diabetes. While at least one study found that the effectiveness of cannabis as an analgesic was dose specific, with lower doses decreasing pain and higher doses increasing pain, many studies have indicated that low- and high-dose cannabis can produce similar levels of pain relief, reducing both the intensity and unpleasantness of unbearable nerve pain1,85. Researchers have found that cannabinoids such as THC work in concert with opiate-based painkillers to increase their effectiveness, particularly in neuropathic pain, allowing patients to reduce their opiate dosage86-89.This synergistic or entourage effect also occurs between the various cannabinoids in cannabis, with multiple studies finding isolated synthetic cannabinoids such as THC (dronabinol) did not provide the same degree of efficacy as a whole-plant preparation90.
References:
Ware, M. A. et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 182, E694–701 (2010).
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