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Medical marijuana increases pain threshold for patients

But researchers said it remains unclear whether cannabidiol, which is not the substance in marijuana that makes users high, actually reduces the intensity of pain.

Drugs derived from an active ingredient in marijuana produced only modest increases in pain threshold and tolerance but no reduction in ongoing intensity, according to an analysis of research.

Researchers examined 18 placebo-controlled studies in determining the effectiveness of cannabidiol, which contains less than 0.1 percent of tetrahydrocannabinol, or THC, the psychoactive substance in marijuana that makes users high. The findings were published Wednesday in the Journal of the American Medical Association.

The researchers concluded that cannabis-induced improvements in pain-related situations "may underlie the widely held belief that cannabis relieves pain."

"Cannabinoid drugs are widely used as analgesics [painkillers], but experimental pain studies have produced mixed findings," Martin De Vita, a doctoral student at Syracuse University who studies interactions between substance use and co-occurring health conditions, said in a press release. "Pain is a complex phenomenon with multiple dimensions that can be affected separately."

Medical marijuana has been approved in 31 states and the District of Columbia, according to ProCon.org. Recreational pot is legal in nine states and D.C.

"Patients have reliably endorsed the belief that cannabis is helpful in alleviating pain," the researchers wrote. "However, the analgesic properties of cannabinoids remain poorly understood."

The most common clinical use of cannibas use is associated with pain relief.

"Cannabinoid analgesia is of increasing clinical interest, and research on this topic has grown exponentially in recent years," the researchers wrote. "Despite substantial legal changes surrounding medical cannabis, consensus is emerging that better quality research is needed to understand the analgesic efficacy of cannabinoids."

De Vita led a review of research with data collected from August through November 2017.

Participants had to be healthy and using an experimentally-controlled cannabinoid preparation in a quantified dose. Participants with chronic pain were excluded.

In the 18 studies, 223 participants were male and 209 were female. The median age was 26.65.

The study analyzed 18 pain threshold comparisons, 22 for intensity, nine for unpleasantness comparisons, 13 for tolerance and nine for mechanical hyperalgesia, which is sensitization caused by exposure to opioids.

The researchers used established pain reactivity outcomes for the categories.

Cannabinoid administration was associated with small increases in pain threshold, small to medium increases in pain tolerance and a small to medium reduction in the unpleasantness of ongoing experimental pain. Cannabinoid administration was not reliably associated with a decrease in experimental pain intensity or mechanical hyperalgesia.

"Cannabinoid drugs may prevent the onset of pain by producing small increases in pain thresholds but may not reduce the intensity of experimental pain already being experienced," the authors wrote. "Instead, cannabinoids may make experimental pain feel less unpleasant and more tolerable, suggesting an influence on affective processes."

People who use medical marijuana often rely on medical and non-medical prescription drug use, including pain relievers.

In a study published in April, researchers at Stanford University and University College Cork in Ireland analyzed more than 57,000 responses to the 2015 National Survey on Drug Use and Health to determine if medical marijuana users also turn to opioids.

About 1.4 percent of all respondents said they used medical marijuana.

Survey participants using medical marijuana were 60 percent more likely to report prescription drug use, for medical reasons or not, than those who didn't use medical pot.

The U.S. Food and Drug Administration wants to know how people are dealing with pain as it continues to tweak recommendations for opioid painkiller prescription and use.

Other methods to reduce pain acupuncture, chiropractic care, hypnosis and meditation.
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