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Isn't cannabis better than placebo for pain relief?

by Ties Inc.

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Recently, the green world was shaken by a study that found that a cannabis placebo provides very similar pain relief to a cannabis-based product. However, this also applies to medicines such as ibuprofen and aspirin. Below is explained how this works.

A meta-analysis of 20 randomized controlled trials examined the effect of positive media coverage on patients' expectations for pain relief from cannabis products. The studies included a total of 1.459 people, most of them neuropathic pain or had pain from multiple sclerosis. Science has proven that chronic, low-grade inflammation can become a silent killer contributing to cardiovascular disease, cancer, type 2 diabetes and other conditions.

Cannabis versus placebo

The active treatments used in these studies included two major cannabinoids in marijuana, delta-9-tetrahydrocannabinol (THC) or cannabidiol (CBD), and the prescription drugs nabilone (Cesamet), dronabinol (Marinol, Syndros), and nabiximols (Sativex ). The products – and the placebos – were given as a pill, spray, oil or smoke/vapour. The researchers found that participants who received active treatment and participants who received placebo reported similar levels of pain relief.

Ted J. Kaptchuk, director of the Program in Placebo Studies and The Therapeutic Encounter at Harvard-affiliated Beth Israel Deaconess Medical Center, says the findings of this well-conducted study are not surprising. “With the exception of opioids, most pain-relieving drugs are barely better than a placebo,” he says. In fact, in clinical trials of common pain relievers like aspirin and ibuprofen, placebos provide about as much pain relief as the actual drugs. That is not to say that the active drugs have no physiological effects. Rather, the effects of a placebo mimic those effects. They just work through different neurobiological pathways, Kaptchuk explains.

How does a placebo affect the brain?

“We've known since the late XNUMXs that when you give someone a placebo, different neurotransmitters are released in the brain and specific parts of the brain are activated,” says Kaptchuk. These neurotransmitters include endocannabinoids, which are similar in structure to the active compounds in cannabis. However, what exactly causes the release of these chemicals remains a mystery.

As Kaptchuk and colleagues wrote in a 2020 review in TheBMJ about placebos in chronic pain, the classic theory for explaining the placebo effect is expectation: You believe the treatment you're getting will make you feel better, and it becomes a self -fulfilling prophecy.

Does media attention raise expectations for medical cannabis?

According to the authors of the new meta-analysis, a wealth of positive media coverage likely contributed to the expectation. In a separate analysis of 136 news items in traditional media and blogs, they found that cannabis studies received more media attention than other published studies, regardless of the size of the placebo response or the therapeutic effect of cannabis. But while media hype may be playing a role here, it's worth remembering that unhyped drugs like ibuprofen also elicit strong placebo responses, says Kaptchuk.

The placebo response can also arise when people receive care and attention from a medical professional as part of a treatment, which evokes conscious and unconscious feelings that they are going to feel better. Treatments that involve more rituals, such as getting an injection or smoking, also tend to enhance the placebo effect more than just taking a pill.

What Can Cannabis Products Do?

If you use a cannabis-based product for pain or are considering trying one, how about these findings? “According to the strict orthodoxy of modern medicine, a doctor would say that cannabis products don't work — they are no better than a placebo,” says Kaptchuk.

However, a clinical trial is not real life. Chronic pain is notoriously difficult to treat. And the more effective a drug is at treating pain, the greater the chance of side effects and other unwanted consequences, such as dependence and addiction. "If something—another alternative remedy—helps relieve pain and doesn't cause significant harm, I'd say use it." It is smart to consult a doctor.

Source: www.health.harvard.edu (EN)

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