Daily Cannabis Use Associated With Decreased Pain Tolerance
Medical cannabis use is commonly viewed as a reasonable pain management solution by the public, but the current evidence reflects conflicting results. This retrospective cohort study compared pain tolerance thresholds in participants who reported daily cannabis use with individuals who reported daily inhaled nicotine use, daily cannabis and inhaled nicotine use, and no cannabis/nicotine use (control group). All participants received a painful stimulus (the cold pressor test [CPT]), with time-to-reported pain as the primary outcome measure.
- Individuals with daily cannabis use demonstrated a significant reduction in pain tolerance with a median CPT time of 46 seconds, compared with the control group median CPT time of 105 seconds.
- Participants with daily inhaled nicotine use demonstrated a similar result to those with daily cannabis use with median CPT time of 45 seconds, but this result had marginal statistical significance.
- Overall, participants with both daily cannabis and nicotine use demonstrated a significant reduction in pain tolerance with the lowest median CPT time (26 seconds).
Comments: This study contributes to a growing body of evidence that daily cannabis use may result in increased pain sensitivity and chronic pain (or central sensitization). The authors postulate that opponent processing (desensitization of CB1 and CB2 receptors resulting in the brain’s dysphoric complementary mechanism to function in overdrive) may play a role in cannabis-induced hyperalgesia. In turn, patients may be driven to escalate their use and risk developing cannabis use disorder. Given the implications, medical cannabis use should be approached with caution. The relationship between individuals with inherently decreased pain tolerance and subsequent cannabis use deserves further inquiry.
Emily Nields, DO
Reference: Zhang-James Y, Wyon E, Grapsas D, Johnson B. Daily cannabis use may cause cannabis-induced hyperalgesia. Am J Addict. 2023;32(6):532–538.