To alleviate your chronic pain, you may have tried one of the many forms of medical cannabis (marijuana). Cannabinoids are the primary active ingredients in marijuana, and the vast majority of the millions of Americans who use products containing them report doing so for pain relief.
A new review in JAMA Network Open says that there is good evidence that a cannabis placebo, which is a substance made to look, smell, taste, and feel like the real thing, gives very similar pain relief as a cannabis-based product. Why is that, though?
What did this study try to find out?
In this meta-analysis of 20 randomised controlled studies, the effect of positive media coverage on patients' hopes that cannabis products will help with pain was looked at. There were a total of 1,459 people in the studies, and most of them had neuropathic pain or pain from multiple sclerosis.
Delta-9-tetrahydrocannabinol (THC) or cannabidiol (CBD), the two main cannabinoids in marijuana, as well as the prescription drugs nabilone (Cesamet), dronabinol (Marinol, Syndros), and nabiximols, were used in these studies as active treatments (Sativex). Both the real drugs and the fake ones were given as pills, sprays, oils, smoked, or vaped. Researchers found that both groups of patients—those who got real treatment and those who got a fake one—felt about the same amount of pain relief.
Ted J. Kaptchuk, who runs the Program in Placebo Studies and The Therapeutic Encounter at the Harvard-affiliated Beth Israel Deaconess Medical Center, says that the study's results are not shocking. He says that, with the exception of opioids, most painkillers are only slightly more effective than a sugar pill.
In fact, clinical trials of common painkillers like aspirin and ibuprofen have shown that placebos relieve pain about as well as the real drugs. But this doesn't change the fact that the drugs have effects on the body. Instead, a placebo has the same effects or effects that look like the real thing. Kaptchuk says that they just use different neurobiological pathways to work.
What does a placebo do to the brain?
Kaptchuk says, "Since the late 1970s, we have known that when you give someone a placebo, different neurotransmitters are released in the brain, and certain parts of the brain are turned on." Some of these neurotransmitters are endocannabinoids, which have the same structure as the active ingredients in cannabis. But it's still not clear what makes these chemicals come out into the air.
The traditional explanation for the placebo effect, according to Kaptchuk and colleagues' review of placebos in chronic pain published in the BMJ in 2020, is expectation. You think the treatment you're getting will make you feel better, and this belief becomes self-fulfilling.
Is there more demand for medical marijuana because of the media?
The authors of the new meta-analysis say that expectations were raised by a lot of good news coverage, which may help explain their findings. In a separate analysis of 136 news stories and blogs, they found that cannabis studies got more attention from the media than other published studies, no matter how big the placebo effect was or how well cannabis worked as a medicine. Even though media hype may be at play here, it's important to remember that unhyped medicines like ibuprofen can also have strong placebo effects.
The placebo effect can also happen when people receive care and attention from a doctor during treatment, which makes them feel both consciously and unconsciously like they will feel better. Getting an injection or smoking are also more likely to make the placebo effect stronger than just taking a pill.
What does it mean for you?
What should you think about these results if you take or are thinking about taking a painkiller made from cannabis? Kaptchuk says, "A doctor would say that cannabis products don't work." Kaptchuk says that a doctor would say that cannabis products don't work and are no better than a placebo. The strict rules of modern medicine say this is true.
But the problem is that a clinical trial doesn't show what life is really like. Chronic pain is known for being hard to treat. Also, the better a drug is at treating pain, the more likely it is to have side effects and other negative effects, such as dependence and addiction. He says, "I would say use it if it helps relieve your pain and doesn't hurt you too much." But first, talk to your doctor and listen to this advice about medical marijuana.