The rise of hemp as a pain management tool

The Cannabis Sativa plant is considered to be one of the five sacred plants in Ayurveda and has been a part of Indian culture for centuries. Ayurveda points to a variety of uses of the plant; however, the limited knowledge surrounding Cannabis has contributed to several misconceptions. Owing to its low levels (0.3 per cent or less) of Tetrahydrocannabinol (THC) which is the intoxicating cannabinoid responsible for the euphoric effect, hemp has shown to be non-toxic and non-addictive.

Another major cannabinoid extracted from Cannabis Sativa (mostly low-THC hemp) is Cannabidiol (CBD). It is claimed to provide wide-ranging properties useful for health and wellness including anti-anxiety, anti-inflammatory, anti-pain, anti-arthritic and neuroprotective effects. Since CBD does not give off psychotropic effects, the substance is more common for medical treatment and pain management. According to The Asian Cannabis Report published in 2022 by Prohibition Partners, lessening social stigma being attached to cannabis, CBD oil, in particular, is paving the way for more mainstream adoption to treat aches, pain and anxiety.

Cannabis use in traditional Indian medicine, mainly for pain management, has increased among the middle classes since 2020, as per data reviewed by Indian hemp group Bombay Hemp Company (BOHECO). "Pain is a common symptom experienced by millions of people worldwide, and can be caused by various conditions, including arthritis, fibromyalgia, multiple sclerosis, and cancer. It is a challenge to treat symptomatic and chronic pain since pain perception is dependent on an individual's unique biology, mood, lifestyle, and other factors. It can significantly impact a person's quality of life," says Dr. Neeraj K Patel, head of research and development at BOHECO. Below, Patel outlines the impact of hemp on humans, and its usage in pain management to promote holistic well-being.

What is hemp?
Patel: Hemp's role in pain management has recently gained significance amongst the medical fraternity. Derived from the plant Cannabis Sativa (Vijaya), hemp is a powerful remedy and has historically been used to treat a variety of ailments from epilepsy and sleep disorders, to anxiety and pain. It contains compounds called cannabinoids, which have potential pain-relieving properties, the major two being cannabidiol (CBD) and tetrahydrocannabinol (THC). As it contains less than or equal to 0.3 per cent THC, hemp is non-intoxicating, making it legal for industrial and medical use in several countries, including the United States. In India, the seeds, leaves, and fiber are considered non-narcotic under the Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS).

How does hemp work on the human body?
Patel: The Endocannabinoid System (ECS) in the body is responsible for the regulation of many physiological processes like mood and appetite, stress, and pain perception, among others. This system consists of cannabinoid receptors (CB1 and CB2), endocannabinoids (cannabinoids produced by the body), and enzymes involved in the metabolism of endocannabinoids. With age, external injury or trauma, and other ailments, the endocannabinoid levels in the body may go down. Hemp leaf-based medicines introduce phytocannabinoids into the body that support the functioning of the ECS by binding with the receptors and producing effects similar to that produced by the body's endocannabinoids majorly.

Why is hemp gaining prominence in pain management?
Patel: Given the challenges of treating chronic pain through conventional approaches, hemp is emerging as an alternative therapy that is safe and efficacious. Several studies showcase promising results in hemp's effectiveness in managing pain. A 2022 study on hemp leaf-based formulations for pain management published in the Journal of Ayurveda and Integrated Medical Sciences illustrates this. The study found that, out of all the 47 respondents, 6.4 per cent reported complete remission of the pain, 59.5 per cent reported marked improvement, and 31.9 per cent reported moderate improvement.

How effective has hemp been in managing various types of pain?
Patel: In addition to cannabinoids, hemp contains other compounds, such as terpenes (aromatic compounds known for their distinct smells), that have anti-inflammatory and analgesic properties, adding to the plant's many benefits. Being a versatile plant, it can be consumed in a variety of forms, including oils, tinctures, and topicals, depending on the patient's needs for pain management. Although research on hemp's effectiveness in pain relief is still nascent, initial results have been extremely promising, and if taken in regulation under a doctor's guidance, can provide people with a better quality of life.

Chronic pain: Conditions such as fibromyalgia, and multiple sclerosis can lead to chronic pain in patients. Hemp's anti-inflammatory and pain-relieving properties can be beneficial for such patients. In a study (2019) published in PubMed, patients with chronic pain were given a CBD-rich hemp extract, and results showed that their pain levels were significantly reduced. Further, hemp also offers relief from pains induced by muscle spasms, as in the case of multiple sclerosis (MS), an autoimmune disease that affects the entire human body. A 2018 review found that short-term use of CBD oil could reduce the levels of muscle spasms a person encounters with many participants reporting a reduction in symptoms.

Arthritis and joint pain: Arthritis is a broad term for various joint-related conditions. This condition includes symptoms such as swelling, pain, and stiffness in the joints. Hemp is a proven analgesic and works well for arthritis treatment. In an open single-arm study (2019) conducted by Bombay Hemp Company, patients suffering from Osteoarthritis were given hemp extract oil for external application to evaluate its efficacy and safety. The results showcased that patients' pain levels were reduced by 79 per cent and stiffness by 65 per cent after regular use of the topical oil, with minimal side effects.

Neuropathic pain: Neuropathic pain is caused by damage to the nerves and manifests as tingling, numbness, muscle weakness, and a sharp, shooting pain. The condition is often difficult to treat with conventional pain medication. However, hemp has been shown to be effective in managing it. One study published in the Journal of Ayurveda and Integrated Medical Sciences showcases that patients suffering from neuropathic and chronic pain strongly agreed that hemp provided relief from pain, while also enhancing their mood and stimulating their appetite.

Cancer Pain: People living with cancer often go through symptomatic pain, anxiety, lack of appetite, etc. due to the disease. Hemp's role in managing these symptoms has been promising. Studies on cancer-related pain reveal oral sprays of a combination THC-CBD extract were more effective in pain relief as compared to opioids. Further, National Cancer Institute research shows that hemp is effective in reducing chemotherapy side effects and offering relief to patients. Initial animal studies also indicate the plant's effectiveness in shrinking cancerous tumors, an area that requires further research and evidence.

Migraine Pain: There is limited research on migraine-induced acute pain. However, a two-phased study was conducted in 2017 where participants received a combination of CBD and THC in a certain dosage. The results revealed that their acute pain fell by 55 per cent and the frequency of their migraine attacks reduced by 40.4 per cent. Participants with cluster headaches and family histories of migraine also found relief with hemp's usage. Hemp has also proven beneficial in managing acute pain caused by injuries and surgeries.

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