Medicinal Cannabis: A new path for chronic pain management in Arthritis

Please be aware that Arthritis NSW is not providing clinical advice on the individual use of Medicinal Cannabis. The information presented below is for education purposes only.

Medicinal cannabis has caught the attention of medical professionals & arthritis patients alike. In 2016, it was introduced in Australia, and since then there have been developments in how it is prescribed and who is able to prescribe it. With growing acceptance and scientific evidence, Medicinal Cannabis is emerging as a promising option for those seeking relief from arthritis-related pain.

Arthritis is a condition characterized by inflammation and stiffness. It is a leading cause of disability worldwide, limiting individuals’ ability to perform daily activities. Conventional treatments for arthritis include: Analgesics, NSAIDS, physical therapies, and in severe cases, joint surgery. These approaches often come with limitations, side effects, or inadequate relief, prompting researchers to explore alternative therapies such as medicinal cannabis.

The Science behind Medicinal Cannabis

The science behind medicinal cannabis refers to the use of the cannabis plant or its chemical components, specifically cannabinoids, for therapeutic purposes. The two primary cannabinoids of interest include: Tetrahydrocannabinol (THC) and Cannabidiol (CBD).

THC – The main constituent of cannabis that induces psychoactive effects

CBD – The active ingredient able to induce therapeutic effects

Both THC and CBD interact with the body’s biological – endocannabinoid system, which plays a crucial role in regulating pain, inflammation and immune responses. Whilst it’s mode of action remains fairly elusive, some research suggests in Rheumatoid Arthritis, it may be able to effectively target the receptors in the synovia to attenuate disease activity & progression of arthritis; some other research, focusing on Osteoarthritis, suggests the mechanism of action relates to the analgesic effect that comes from reducing the excitability of the spinal cord cells that transmit pain signals to the brain, and acting on other pathways that are responsible for perceiving pain, amplifying pain, and creating pro-inflammatory substances.

Promising research & clinical studies

Several recent studies have examined the use of medicinal cannabis in managing arthritis pain yielding promising results. A 2022 Randomized Controlled Trial, published in the Journal of pain, demonstrated that a THC/CBD oral mucosal spray significantly reduced pain and improved sleep quality.

Another study published in the journal of pain medicine in 2021, revealed that CBD- based tropical creams were able to reduce joint swelling and tenderness in thumbs of people living with Osteoarthritis in the hand & thumbs. Furthermore, Medicinal Cannabis has shown potential in reducing the need for opioid medications, which have adverse effects and addictive properties.

In 2019, data revealed that some states in the US with legalized medicinal cannabis, experienced a slight decrease in opioid prescriptions, which could be a promising step towards improving the critical impacts we see associated with opioid use and misuse in Australia.

Challenges in Medicinal Cannabis

Despite promising findings and growing research, Medicinal Cannabis faces challenges in its widespread acceptance & implementation. Regulatory frameworks and social stigmas surrounding cannabis use have limited access for patients.

In Australia, the process of prescribing medicinal cannabis is highly bureaucratic. In each state there are different eligibility jurisdictions.

In NSW, it is part of the TGA’s special access scheme, and is only used in cases where there is evidence to support its therapeutic effects. At the moment, specialists, and select General Practitioners with specialist support, are allowed to prescribe Medicinal Cannabis.

In NSW, Medicinal cannabis may be suitable for:

  • chronic non-cancer pain
  • epilepsy
  • nausea and vomiting
  • palliative (end-of-life) care
  • multiple sclerosis due to chemotherapy.

Changing attitudes and evolving legislation in many countries are gradually opening doors for people living with Osteoarthritis and Rheumatoid Arthritis to explore this alternative therapy under medical supervision.

It is essential for arthritis patients considering medicinal cannabis to consult with healthcare professionals experienced in its usage. They can provide guidance on strain selection, dosage, and potential interactions & contraindications. Continued research is crucial to better understanding the long term effects, optimal formulations & delivery methods.

With cannabis emerging as an alternative therapy that can provide relief from pain, and improve quality of life for those living with arthritis, this offers a glimmer of hope for individuals grappling with the debilitating effects of arthritis, especially in its more severe forms.

It’s likely that medicinal cannabis will continue to gain recognition as a valuable tool in the fight against arthritis-related discomfort bringing newfound joint relief, despite clinical trial evidence remaining incomplete.

If you are interested in following the research just like we are, you can access some of the many articles available just below;

  1. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015;313(24):2456–2473. https://doi:10.1001/jama.2015.6358
  2. Langford, R., et al., A double-blind, randomized, placebo-controlled, parallel-group study of THC/ CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis. Journal of neurology, 2013. 260: 984-997.
  3. Blake, D. R., Robson, P., Ho, M., Jubb, R. W., & McCabe, C. S. (2006). Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology (Oxford, England), 45(1), 50–52.
  4. Frane, N., Stapleton, E., Iturriaga, C., Ganz, M., Rasquinha, V., & Duarte, R. (2022). Cannabidiol as a treatment for arthritis and joint pain: an exploratory cross-sectional study. Journal of cannabis research, 4(1), 47.

RACGP Guidelines

Next Tuesday – 7.30pm 23 May, Join us for a deep dive into the use of medicinal cannabis for the treatment of arthritis related pain. We will provide up to date information about studies and trials, benefits of use and where you may find such products. You can also watch the webinar recording after the event.

Mary Zagotsis
Health Educator 
Arthritis NSW