Pain Management/Chronic Pain

Pain management (also called pain medicine) is that branch of medicine employing an interdisciplinary approach to easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners. Pain usually resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics. Effective management of long term pain, however, frequently requires the coordinated efforts of the management team.

The pain-reducing effects of cannabis have been well documented, but are limited by psychoactive side effects. In a study in Spain, the evidence that pain states alter the endocannabinoid receptor system at key sites involved in pain processing is discussed, and how the changes may inform the development of cannabinoid-based analgesics. According to this study, "cannabinoid ligands produce well documented analgesic effects mediated by the CB1 and CB2 receptors; however, other receptor systems may also contribute, in particular in inflammatory and neuropathic pain states. The emerging evidence that the levels of cannabinoid receptors, their ligands and biologically active metabolites are altered in a tissue-specific manner under pathological conditions, such as chronic pain states, may support a more targeted approach to the development of cannabinoid-based analgesics."

Another study indicates, "In the brain, cannabinoids can produce analgesic tolerance that is not associated with the loss of surface CB1Rs (Cannabinoid 1 Receptors) or their uncoupling from regulated transduction. Neural specific Gz (G alpha Z) proteins are essential mediators of the analgesic effects of supraspinal CB1R agonists and morphine. These Gz proteins are also responsible for the long-term analgesic tolerance produced by single doses of these agonists, as well as for the cross-tolerance between CB1Rs and MORs."