Cannabis and placebo may provide similar pain relief. But that's not the only story.You're not alone if you've used medical marijuana (marijuana), in the hopes of relieving chronic pain. Millions of Americans use cannabis to treat pain.A new review published in JAMA Open, found that there is good evidence to support the claim that a cannabis "placebo" -- a substance created to mimic the real product in appearance, scent, taste and feel -- can provide pain relief similar to a cannabis-based drug. But why?
What was the focus of this research?
This meta-analysis, which included 20 controlled randomized studies, examined the impact of positive media coverage on patients' expectations of pain relief with cannabis products. These studies involved a total 1,459 participants, the majority of whom suffered from neuropathic or multiple sclerosis pain.The active treatments used in these studies included two main cannabinoids in marijuana, delta-9-tetrahydrocannabinol (THC) or cannabidiol (CBD), and the prescription drugs nabilone (Cesamet), dronabinol (Marinol, Syndros), and nabiximols (Sativex). Both the active products and placebos were administered as pills, sprays, oils, smokes or vapors. Researchers found that both participants who received active treatment and those who received placebos reported similar levels pain relief.Ted J. Kaptchuk is the director of Program in Placebo Studies at Beth Israel Deaconess Medical Center. He says that the results from this well-conducted study are not surprising. He says that most pain-relieving drugs are only marginally better than placebos.In clinical trials, placebos provided about the same pain relief as actual drugs in common pain medications like aspirin and Ibuprofen. It's not that active medications do not have physiological effects. The effects of a 'placebo' are similar or identical to those of the active medication. Kaptchuk says that they just use different neurobiological pathways.
Has media coverage raised expectations about medical cannabis?
According to the authors, the positive media coverage may have contributed to expectations and explained their results. They found in a separate study of 136 articles from traditional media and blogs that cannabis studies were given more attention by the media than other published research, regardless of how much the placebo effect or therapeutic effect of marijuana was. Kaptchuk notes that while media hype may be involved, unhyped medications like ibuprofen can also produce strong placebo effects.It can also happen when patients receive treatment from a doctor, and they feel that the care and attention is going to make them feel better. The placebo effect is more pronounced with treatments that are more ritualistic, such as getting an injection or smoking.
What does it mean to you?
What should you think of these findings if you are using a cannabis-based pain product or thinking about it? Kaptchuk says that a doctor who follows the strict orthodoxy in modern medicine would tell you that cannabis products are no more effective than placebos.It's a puzzle because a clinical study isn't real life. Chronic pain is notoriously hard to treat. The more effective the drug in treating pain is, the higher the risk of unwanted side effects, including dependence and addiction. He says, "If it helps you relieve pain and does not cause significant harm, then I'd say use it."