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Medical Marijuana for Acute Pain What is the Hype About?

by Sarah Walker

July 1, 2023 03:20 pm ET Estimated Read Time: 10 Minutes

Medically reviewed by Dr. Abraham Benavides Fact checked by Kymberly Drapcho

Pain is an unpleasant experience, despite the fact that acute pain is actually beneficial to us at times. When someone is running and gets an injury, or experiences a fall, the pain actually serves as a warning sign that something is wrong with the body and that it’s time to stop and assess the situation. Medical cannabis is known for its ability to decrease chronic pain, inflammation, and neuropathy, but can it help with acute pain? 

Inside our bodies, we have a bodily system known as the endocannabinoidome (eCBome). This system is activated by medical cannabis and its cannabinoids, including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). When cannabinoids are ingested, they enter the bloodstream and make contact with a variety of receptors located in different parts of the body. These receptors including cannabinoid receptors CB1 & CB2, peroxisome proliferator-activated receptors, and transient receptor potential (TRP) receptors increase or decrease the levels of endocannabinoids in our body. 

Endocannabinoids are fat-based neurotransmitters that tell the body how to do certain essential tasks. The body naturally produces and uses endocannabinoids, but they can be modulated with medical-use cannabis. The eCBome plays a role in everyday functions of the body, influencing appetite, inflammation, and pain perception.

What’s the Deal with Acute Pain?

Acute pain happens suddenly and can result from a physical injury or a sudden illness. This type of pain can start out as sharp or intense, serving as a warning to the body that there is a physical threat or as a sign of an underlying medical issue (2). Acute pain also occurs after surgeries, dental work, burns, broken bones, and blunt trauma. It can involve the following pain and nerve sensations (2):

• Throbbing
• Burning
• Stabbing pain
• Weakness
• Numbness
• Tingling

Sometimes it can feel more convenient to ignore acute pain in hopes that it will go away. Sometimes the pain goes away, or it might simply need treatment with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. The reality is that acute pain can become more severe or turn into chronic pain if it is not treated appropriately (45). 

It can sometimes be difficult to get adequate pain treatments for acute pain. Sometimes this can be because patients simply are not able to access stronger pain medications due to physician concerns over opioid dependence. Narcotics, including opioids such as oxycodone, can also cause unwanted side effects such as nausea, constipation, sedation, and other adverse effects. 

Other times patients may not report that their medications do not provide a significant difference in pain relief, or they simply forget to take medications as prescribed (45). 

Several medical conditions cause acute or short-term pain. These causes are not limited to but include:

• Back pain
• Joint pain
• Tendinitis 
• Phantom limb pain
• Sickle cell disease
• Spasmodic torticollis 
• Muscle cramps & spasms
• Multiple sclerosis
• Spinal cord injuries
• Carpal tunnel syndrome
• Sciatica 
• Spasticity

Types of Pain Relieved by Medical Cannabis

In addition to acute pain, there are several other types of pain conditions. Understanding the differences between these types is important when describing the pain you are experiencing to your doctor. Different types of pain stem from different pain mechanisms in the body, which is why there is no one specific treatment (14).

Medical cannabis and CBD have been shown to be effective analgesics in helping pain management when it interacts with CB1 and CB2 receptors in the body’s endocannabinoid system. The effects of cannabis within the endocannabinoid system can impact the perception of pain.

Chronic Pain

Chronic pain occurs when a patient has been experiencing the same pain for over 3 to 6 months (16). Pain turns chronic when the damaged or affected tissue repeatedly undergoes an inflammatory process (14). This process can lead to arthritis and other complex pain disorders.

The immune system is responsible for healing damaged portions of the body by sending immune cells to the location of the injury in order to heal it. Unfortunately, sometimes the immune cells are unable to heal the injury, and chronic pain may result. Other times, the immune cells get confused and attack healthy tissues instead of healing them. 

A 2022 review of cannabis and chronic, noncancer, musculoskeletal orthopedic pain supports the possible benefits of cannabis and its analgesic effects (21). It found that cannabis reduces pain, improves mental and physical health, and improves the quality of life in this patient set. The benefits appear within three months of regular cannabis use and then plateau. Patients may also be able to reduce opioid and benzodiazepine prescriptions, even at non-intoxicating levels of cannabis.

Please check out our chronic pain page for more information on how to use medical cannabis to manage it. 

Neuropathic Pain

Neuropathy or nerve pain is caused by an injury or damage to nerves in the body. When the nerves are damaged or simply pinched, the nerves spontaneously fire or become altered to how pain is perceived (14). There are different types and causes of nerve pain, but it often results in pain that feels like burning, tingling, or numbness (52). 

This type of pain is very commonly seen in patients with advanced diabetes. THC has shown efficacy in clinical randomized controlled trials with diabetic patients using THC in both low and high doses (8). 

Check out our neuropathy page for more information.

Nociceptive Pain

This type of pain is caused by injury to the tissues of our body, which include the skin and organs (52). Acute pain is considered a type of nociceptive pain (16). It can be further divided into somatic and visceral pain. Somatic pain can occur as a result of an acute or chronic injury (14). Somatic pain can cause sharp or burning pain when the skin is damaged or it can cause throbbing or aching pain when deeper tissues such as the joints, tendons, or muscles are affected. 

Visceral pain comes from damage to deeper tissues such as the gastrointestinal tract or other organs (14). 

Recommendations for Relieving Pain

The guidelines for treating pain released during 2020 PAINWeek also serve well for patients with acute pain. These guidelines include (9):

• Patients are recommended to begin CBD-only treatments at twice daily 5 mg doses. 
• THC doses for pain begin at 2.5mg doses a day.
• Patients who are elderly, have comorbid conditions, or are taking several different medications are advised to start at 1mg of THC daily and slowly increase doses.
• Patients with severe pain or prior medical cannabis use are recommended to begin with a 1:1 CBD to THC balanced dose between 2.5 mg and 5mg once or twice daily.

It is important to note that while these doses may appear to be small, medical cannabis can still help relieve your pain in lieu of opioid use or other pain medicines. Feeling the psychoactive effects of THC is not necessary to get relief from pain with marijuana use.

Medical cannabis and CBD-only products are also available in several different forms to fit your needs. It is available in full-spectrum flower, edibles, tinctures, oils, and topical products. 

Patients who are suffering from menstrual pain or endometriosis for example, often choose to use suppositories containing CBD and THC.

What Does the Science Say About Cannabinoids & Acute Pain?

A 2020 review published in Cannabis and Cannabinoid Research reviewed the results from six different clinical trials examining cannabinoid use for acute pain (20). Five of the studies focused on the use of oral cannabinoids versus placebo. The remaining study examined the use of intramuscular cannabinoid injections for acute pain. 

The review found small, but statistically significant results showing favoring the use of orally administered cannabinoids for reducing acute pain (20). The study focusing on intramuscular cannabinoids found a significant reduction in pain scores over the placebo. 

It is important to note that these studies are typically small-scale studies that occur over a short period of time. Larger-scale and longer-term research is still needed in order to accurately assess the effectiveness of cannabinoids for patients with acute pain. Many of these studies did not measure effectiveness past 24 hours (20). 

Cannabinoids for Surgical Pain

Because of its effects on chronic pain, many patients and researchers are hoping to learn more about if medical marijuana is an effective option for acute pain that occurs after surgical procedures. Unfortunately, the results of studies focusing on post-surgical pain and cannabinoids are still mixed. 

Research presented at the American Academy of Orthopaedic Surgeons (AAOS) 2022 annual conference, showed that patients may benefit from the use of CBD after surgery (47). This systematic review focused on the use of a sublingual, dissolving pill called Oravexx, a CBD-based pharmaceutical prescription that is orally absorbed and is still being studied for use in the United States. This study had 99 rotator cuff surgery participants who received a low dose of Percocet and Oravexx or a placebo after the procedure.

Participants did not know if they received a placebo or the Oravexx and were prescribed to take their assigned medication 3 times a day for 14 days after the surgery (47). Patients who received Oravexx reported 23% lower visual analog scale (VAS) pain scores and up to 25% more satisfaction with their post-surgical pain control.

In 2006, a double-blind and placebo-controlled study set out to answer the question of if using nabilone could be effective in postoperative pain (7). Nabilone is a synthetic cannabis-based medicine available for treating nausea in HIV patients and patients receiving chemotherapy as a cancer treatment. The study recruited 40 patients who received either ketoprofen, 1mg or 2 mg doses of nabilone, or a placebo. 

Researchers in this study were unable to prove their hypothesis that nabilone would decrease postoperative pain and instead found that pain levels were significantly higher in the patients who received the 2 mg nabilone doses in comparison to the other groups (7). 

A study presented at the 2022 annual meeting of the American Society of Anesthesiologists analyzed the medical records of 34,521 patients in regard to their post-surgical pain (13). There were 1,681 marijuana users in this group who reported using cannabis in the 30 days prior to the surgery. These patients experienced 14% more pain in the first 24 hours after surgery than non-cannabis users. They also consumed 7% more opioids after surgery, which is likely related, but not clinically relevant.

The results of this study regarding cannabis use and post-surgical pain are significant. Though we do not know how much cannabis the 1,681 patients were taking during the month leading up to surgery, the results are significant because this study used a large set of patients and many studies do not encompass such a large data set (13). 

The use of medical cannabis for pain after surgery requires more research for doctors in order to give quality recommendations to their patients. The results from the post-surgical review above are interesting because several studies support the use of cannabis and opioids together because they can provide complete pain relief (48). 

Important Notes on Cannabis Use & Surgery

Regardless of how much cannabis a patient has used, it is extremely important to let your clinician, surgeon, and anesthesiologist know about it before the surgery. This is for several reasons including that many patients who use cannabis will need more anesthetics to put them under for the procedure (49). 

It may also take longer for your stomach to empty before the surgery, increasing the risk of inhaling stomach contents into the lungs during the procedure. Additionally, there is an increased risk of a heart attack in patients with cardiovascular diseases who have consumed cannabis within an hour of receiving anesthesia (49).

Note: Veriheal does not intend to give this as professional medical advice. Do not attempt to self-diagnose, or prescribe treatment based on the information provided on this page. Always consult a physician before making any decision on the treatment of a medical condition.