Chronic Pain In New Zealand
According to the Ministry of Health, chronic pain is common, with 20.2% of New Zealanders reported to be affected by it.
Chronic pain refers to persistent and ongoing pain that doesn’t simply disappear after the cause is treated, as opposed to acute pain that has a sudden onset and resolves itself after the cause is dealt with. Chronic pain can be extremely debilitating and devastating for patients, with anxiety, depression, sleep disorders, and overall reduced quality of life all being closely associated with chronic pain.
The treatment response needed for patients with chronic pain is typically complex and requires investigating different medication combinations, procedures, and rehabilitation to hopefully find the right analgesic effect for patients. But this is generally no easy task, especially for chronic musculoskeletal pain, which is considered to be one of the most difficult pain-related medical issues to treat.
Increased Chronic Pain Risk In The Elderly
One group of Kiwis particularly at risk for developing chronic pain are ageing or elderly patients. The Ministry of Health reports that chronic pain-like symptoms are on the rise in New Zealand and that pain is a more common symptom in elderly patients.
There is also a direct correlation between ageing and chronic pain diagnosis, with the Ministry of Health reporting in 2018 that the number of New Zealanders diagnosed with chronic pain rises with age. For example, only 9.8% of women aged 15-24 received a chronic pain diagnosis, this percentage rises to 22.8% in the 45-54 age group and rises again to 36% for female patients aged 75 and older.
Alternative Treatment Options
Due to the complex nature of chronic pain treatment, patients often receive inadequate pain care, hence the urgent need for alternative treatment options. Thanks to the upcoming 2020 cannabis referendum, another treatment option may become more easily accessible for those suffering from chronic pain in New Zealand.
Does Cannabis Cure Chronic Pain?
Cannabis is quickly gaining a reputation for its therapeutic potential and as legalisation and scientific research continues to escalate around the world, more is learnt about this once much-maligned drug.
One of cannabis’ most talked about therapeutic benefits is its ability to reduce pain, but is this really true?
A systematic review and meta-analysis explored the efficacy of cannabis-based treatments for pain management. 43 randomised controlled trials were examined (2,437 patients in total). The results were mixed with some studies showing improvements, with others not showing improvements for chronic pain. Overall, clinically significant reductions in pain were favourable to cannabis-based treatments compared to placebo treatments, especially for neuropathic pain (NP).
How Might Cannabis Reduce Pain?
Much of cannabis’ therapeutic potential is thanks to cannabinoids, active compounds which act on the endocannabinoid system to induce a range of effects on the body.
The two main cannabinoids to be concerned with are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is a psychoactive cannabinoid and is responsible for the ‘high’ that comes with consuming cannabis. CBD, on the other hand, is not psychoactive, but both CBD and THC have demonstrated strong pain-relieving properties.
CBD’s potential analgesic effect is thought to occur by increasing serotonin levels. Serotonin is a chemical found in the body that is typically associated with feelings of happiness but has also been linked to pain reduction, especially for chronic pain.
CBD has demonstrated an ability to activate serotonin receptors and increase the potential chronic pain-reducing neurotransmitter serotonin. One study even showed that CBD managed to activate serotonin receptors which lead to a cellular response that resulted in the reduction of pain perception.
The other main cannabinoid THC has also demonstrated strong pain-relieving abilities. Cannabinoid receptors are found throughout the body and THC binds to these receptors, causing a range of effects, including analgesia.
The activation of one cannabinoid, in particular, is thought to be responsible for much of THC’s pain-relieving effects. CB1 is a cannabinoid receptor and when activated by THC it can cause an increase in both opioids and serotonin. We know that serotonin has been linked to pain relief and opioids are commonly used as a pain-relief medication. Common opioids include morphine and codeine.
With ageing populations being particularly at risk for developing chronic pain symptoms, the safety of cannabis and cannabinoid use by ageing patients is an important factor to consider.
A 2018 study investigated this exact issue, examining 2,736 patients aged 65 and above after cannabis treatment. The study found that 66.6% of the participants had taken cannabis for pain relief and after 6 months reported improved symptoms and an impressive overall pain reduction from an 8 to a 4 on a scale of 10. The most common side effects experienced by these participants were dizziness and dry mouth.
Importantly, the study found that cannabis treatment is not only a safe and effective pain treatment for elderly patients, but also demonstrates an ability to help patients reduce their reliance on other prescription pain medications. 18.1% of the study participants reported that they either stopped using opioid pain medications or reduced their use.
Current research has made it clear that cannabis is effective in treating chronic pain. The increased availability and use of medical cannabis in New Zealand could help to reduce the unnecessary harm caused by current pain-relief medications such as opioids, which have significantly more side effects than cannabis and carry greater risk for abuse.