Your body has an endocannabinoid system (ECS), which helps regulate functions like pain, inflammation, and mood. The main compounds in cannabis, THC and CBD, interact with this system to reduce pain.

THC (Tetrahydrocannabinol): Directly binds to pain receptors in the brain and immune system, which can lessen the perception of pain and reduce inflammation. It is also the compound that causes the euphoric "high".
CBD (Cannabidiol): Does not produce a high. It works by enhancing your body's natural endocannabinoids and anti-inflammatory responses. CBD can also help reduce the intoxicating effects of THC.
Teamwork: THC provides direct pain relief, while CBD offers indirect pain and anti-inflammatory benefits.

When Cannabis Is (and Isn't) a Good Choice for Pain

Cannabis is most effective for treating chronic pain. A significant review by the National Academies found that adults with chronic pain who were treated with cannabis were more likely to see a notable reduction in their symptoms.

Cannabis may be effective for:

Chronic Pain: Conditions like chronic back pain, fibromyalgia, and arthritis often respond well, with patients reporting moderate pain reduction and improved sleep.
Neuropathic (Nerve) Pain: Cannabis is well-supported for nerve-related pain from conditions like multiple sclerosis or nerve injuries, often providing relief when other medications don't work.
Inflammatory Pain: The anti-inflammatory properties of both THC and CBD can help with pain from conditions like rheumatoid and osteoarthritis.
Cancer-Related Pain: Cannabis is increasingly used as a complementary therapy to manage cancer pain and the side effects of chemotherapy, such as nausea. It can sometimes help patients reduce their use of opioids.

Cannabis is less effective for:

Acute Pain: For sudden, short-term pain like a broken bone or post-surgical pain, studies show cannabis generally does not outperform a placebo or standard analgesics.

Who should be cautious or avoid cannabis:

Individuals under 25, due to potential effects on brain development.
Anyone with a personal or strong family history of psychosis or schizophrenia.
Those with a history of substance abuse.
Pregnant women, as THC can cross the placenta and has been linked to developmental issues in children.

How to Use Cannabis for Pain Safely

Finding the right approach is key to using cannabis effectively while minimizing risks.

1. Start Low and Go Slow

This is the most important rule for new users.
Begin with a very small dose (e.g., 2.5 mg of THC in an edible) and wait to see how you feel before taking more.
With inhalation, take one or two small puffs and wait 10-15 minutes.

2. Choose Your Method Wisely

How you consume cannabis affects how quickly it works and for how long.

3. Be Mindful and Keep a Journal

Your mindset and environment can shape your experience.
Use cannabis in a safe, comfortable setting with a clear intention, such as "I'm using this to relieve my back pain so I can sleep."
Using ALTERD to track the product, dose, and its effects on your pain and mood can help you identify what works best for you over time.

4. Know the Risks and Interactions

Medication Interactions: Cannabis, especially CBD, can affect how your body processes other drugs like blood thinners or anti-seizure medications. Always check with a doctor.
Impairment: Never drive or operate heavy machinery while under the influence of cannabis.
Heart Conditions: High doses of THC can temporarily increase heart rate and blood pressure.
Safe Storage: Keep all cannabis products, especially edibles that can look like candy, safely stored and out of reach of children and pets.

Choosing the Right Type of Cannabis

THC vs. CBD Ratio:

For many people, a combination of THC and CBD is most effective.
A 1:1 ratio (equal parts CBD and THC) is a popular starting point for balanced pain relief.
If you want less of a high, choose a product with more CBD than THC, such as a 5:1 or 10:1 ratio.
While you can use CBD-only products, research suggests they are not very effective for pain without at least a small amount of THC.

Indica vs. Sativa vs. Hybrid:

Indica: Strains are generally known for being relaxing and sedating, producing a "body high." They are often preferred for pain relief, especially at night to help with sleep.
Sativa: Strains tend to be more energizing and uplifting, producing a "mind high." They are less common for severe pain but may be used in small doses during the day to stay functional.
Hybrid: Most strains are hybrids that combine traits. Many people use a sativa-dominant hybrid during the day and an indica-dominant one at night.

Key Benefits of Cannabis for Pain

Meaningful Pain Relief: Cannabis has a broad mechanism that can dull different types of pain, even when other drugs fail.
Improved Sleep and Mood: The relaxing properties of cannabis can help restore healthy sleep patterns and reduce the anxiety and stress associated with chronic pain.
Opioid-Sparing Effect: Adding cannabis to a pain management plan may help patients reduce their reliance on opioid painkillers.
Fewer Serious Side Effects: Compared to opioids, cannabis has a milder side effect profile and does not carry the risk of a fatal overdose from respiratory depression.
Holistic Symptom Management: Cannabis can address multiple issues at once, such as pain, nausea, and appetite loss in cancer patients.

Challenges and Risks to Consider

Dependency and Tolerance: About 1 in 10 adult users may develop a cannabis use disorder. Over time, you may need higher doses to get the same effect, which can be managed by taking periodic "tolerance breaks."
Side Effects: Common side effects are often linked to the THC dose and can include drowsiness, short-term memory lapses, dry mouth, and increased appetite. High doses may cause anxiety or paranoia in some individuals.
Legal and Workplace Risks: Cannabis remains illegal at the federal level in the U.S., and local laws vary. You could fail a workplace drug test even if you use cannabis legally for a medical condition.

Integrating Cannabis into a Holistic Plan

Cannabis works best when combined with other strategies.
Continue to follow medical advice for any underlying conditions and use cannabis to help you participate more fully in treatments like physical therapy.
Maintain a healthy lifestyle with proper nutrition, exercise, and stress management techniques like meditation.
Always keep an open dialogue with your healthcare providers about your cannabis use.

Sources

1. Cannabinoids for Chronic Pain – PMC

2. Medical Cannabis to Reduce Opioid Use – Frontiers

3. Cannabis Use and Opiate Reduction – The Journal of Pain

4. Cannabis and Chronic Pain – BMJ Review

Cannabis for Pain Relief