Does Cannabis Actually Relieve Pain, or Is Something Else at Play?

Cannabis has become a popular choice for managing chronic pain, with millions of Americans turning to its various formulations for relief. However, recent research suggests that the perceived effectiveness of cannabis for pain relief might be influenced by factors beyond its chemical properties. A new review published in JAMA Network Open highlights intriguing findings: placebo treatments often provide pain relief comparable to cannabis-based products. So, what’s really going on?

What the Research Found

The recent meta-analysis examined 20 randomized controlled trials, involving 1,459 participants with conditions like neuropathic pain or pain from multiple sclerosis. These studies tested the effects of cannabinoids (such as THC and CBD) and cannabis-based prescription drugs (like nabilone, dronabinol, and nabiximols) against placebo treatments that mimicked these products in appearance, smell, taste, and feel.

The analysis revealed that both cannabis and placebo treatments led to similar levels of pain relief. This outcome prompts a deeper investigation into why this might be the case.

Understanding the Placebo Effect

Ted J. Kaptchuk, Director of the Program in Placebo Studies at Harvard-affiliated Beth Israel Deaconess Medical Center, explains that the placebo effect is not unusual. Most pain-relieving medications, except opioids, show marginal improvements over placebos. Clinical trials for common pain medications like aspirin and ibuprofen often show that placebos can deliver comparable relief.

Placebos and the Brain: The classic theory of the placebo effect involves expectation. When patients believe that a treatment will alleviate their pain, this belief can trigger physiological changes in the brain. Research has shown that placebos can activate certain brain regions and release neurotransmitters, including endocannabinoids—chemicals similar to those found in cannabis. The precise mechanisms behind this process are still not fully understood, but it suggests that the brain’s response to placebos can mimic or rival the effects of active treatments.

The Role of Media and Expectations

The new meta-analysis also points to the role of media attention in shaping patient expectations. Cannabis studies receive substantial coverage in both traditional media and blogs, which may enhance expectations and contribute to perceived efficacy. The authors found that cannabis research garners more media attention compared to other therapeutic studies, potentially inflating expectations for pain relief.

Media Hype and Expectations: Positive media portrayals can heighten patient expectations, which, in turn, may amplify the placebo response. While media hype can influence how effective a treatment appears, Kaptchuk notes that even less-publicized drugs, like ibuprofen, can elicit strong placebo responses.

Rituals and Placebo Effects: Treatments that involve more rituals—such as injections or smoking—can also enhance the placebo effect. The act of administering a treatment, along with the ritualistic aspects, can influence the patient’s perception of its effectiveness.

What Does This Mean for You?

So, if you’re using or considering using a cannabis-based product for pain relief, how should you interpret these findings?

Practical Advice: From a clinical perspective, if a cannabis-based product seems to relieve your pain and does not cause significant harm, it may be worth continuing, despite the possibility of a placebo effect. Chronic pain management is complex, and finding an effective treatment can be challenging. Kaptchuk advises that if a treatment works for you without adverse effects, it can still be a valid option. However, consulting with a healthcare provider before starting or continuing any treatment is crucial.

Balancing Efficacy and Safety: While the research might suggest that cannabis products are no more effective than placebos, the reality is that pain management often involves a balance between efficacy and side effects. Cannabis may offer benefits for some individuals, particularly if conventional treatments are ineffective or lead to undesirable side effects.

The notion that cannabis provides relief similar to a placebo underscores the intricate relationship between expectation, media influence, and actual pharmacological effects. While the placebo effect plays a significant role, the decision to use cannabis for pain management should be made in consultation with a healthcare provider, considering both its potential benefits and limitations.