Cannabis: Placebo or Pain Reliever

​Does Cannabis actually relieve pain – or is something else going on?
 
Treating pain is by far the most common reason many millions of Americans use Cannabis.  Often, the Cannabis is used instead of opiates or other prescription medicine.  The therapeutic benefit is implicit.   Most patients seeking medical Cannabis have pain.  This is real world evidence. 
 
Is it belief or faith in Cannabis?  The placebo effect is the suggestion or belief in a substance resulting in therapeutic benefit.  Research suggests Cannabis and placebos provide similar pain relief, but that may not be the whole story.  Many drugs have similar effects to placebo.  These drugs are sold in the marketplace because they improve lives.  In the end, does it matter how they work if they are safe and effective?
 
Traditional studies are meant to be models of the real world.  They are controlled studies, and, therefore, not ideal for studying variable, multi-agent botanicals.  A recent study published in the Journal of the American Medical Association proposes that Cannabis is no better at relieving pain than placebos.  The authors suggest that “positive expectations may contribute to the improvements” of pain.  The conclusion was based on a literature review with selection bias in searching only published studies where single agent drugs are used. And in the real world, It’s clear that the plant’s broad spectrum of active ingredients is more desirable for pain. Cannabis products used by community consumers are not single agents.
 
Harvard neuroscientists believe that the placebo effect is triggered through specific nerve pathways involving neurotransmitters, including endocannabinoids.  According to Dr. Ted Kaptchuk, director of the Program in Placebo Studies, the effects of a placebo rival or mimic the physiological effects of certain active medications.  An additional consideration is that some people are predisposed to having a placebo effect.  That may explain why some Cannabis users respond to lower doses of Cannabis and others require higher doses. 
 
The FDA requires the “gold standard” trial to regulate the pharmaceutical industry. The studies are developed to identify safe and effective pharmaceutical drugs. Health care professionals are accustomed to assessing the effectiveness of a single agent pharmaceutical with the gold standard in research, a double blind, randomized, controlled trial.  In that regard, they are not accustomed to assessing the benefits of botanicals
 
Real world evidence is the best scientific path to understanding Cannabis.  Cannabis is a plant that has been used for thousands of years.  Its components are influenced by cultivator, season, and location.  Despite the variability, real world evidence demonstrates a safety profile that rivals or beats pharmaceuticals.   Many pharmaceuticals approved by traditional studies have side effects and adverse events despite blinded controlled trials.