Harvard Health Publishing ran a piece in early December 2022 from Julie Corliss, the executive editor of Harvard Heart Letter. The piece posed a question those of us in the Medical Cannabis community have been asking for quite some time: how does cannabis actually relieve pain? Research cited by Corliss suggests the answer may be in studying what is known as the placebo effect.
The research in question, though small-scale, demonstrated no notable difference in pain relief between Medical Cannabis and placebo. But rather than jumping to the conclusion that Medical Cannabis doesn’t actually work, the research points to our understanding of the placebo effect and its effect on pain perception. The research suggests that cannabis may relieve pain through a similar mechanism.
You may be familiar with the placebo effect in principle. In essence, it is observed when people in clinical trials report positive results after receiving placebos – in contrast to a test group that was provided the real medication. The effect is explained as an effect of the mind. In other words, patients expect to feel better; their expectations become self-fulfilling.
We know the placebo effect is real. It has been demonstrated time and again. But is there anything physiological behind it? According to at least one of the experts interviewed by Corliss for her piece, there is. Ted Kaptchuk, of the Beth Israel Deaconess Medical Center, says the physiological mechanism is related to endocannabinoids.
Kaptchuk says that medical science has known since the 1970s that giving patients a placebo they are thoroughly convinced will work leads to the release of endocannabinoids in the brain. Remember that endocannabinoids are naturally occurring in human biology. They are very similar to the phytocannabinoids, such as CBD and THC, found in Medical Cannabis.
Although science is not clear as to what causes the release of endocannabinoids via the placebo effect, there is little doubt that the human endocannabinoid system helps regulate a variety of physiological functions. It influences appetite, memory, mood, cognition, and more. That’s why cannabis consumption affects many of the same things.
Assuming the placebo effect releases endocannabinoids that are somehow related to pain regulation, patients who sincerely believe a given placebo will relieve their pain are likely to experience some measure of relief. Their sincere expectations contribute to the release of endocannabinoids which bind to pain receptors to provide relief.
Medical Cannabis’ therapeutic benefits lie in the cannabinoids patients consume. Like naturally occurring endocannabinoids, Medical Cannabis cannabinoids bind to those same receptors throughout the body. Therein lies the pain relief. At least that’s the theory. The research cited by Corliss seems to add significant weight to that theory.
If the theory is proved correct, it would ultimately lead to a very important question: if the placebo effect works, what would be the point of recommending Medical Cannabis as a pain treatment? The answer is as simple as understanding human expectations.
The placebo effect relies on a sincere expectation of relief. In other words, patients need to believe a medication will help for the placebo effect to kick in. If it doesn’t kick in, those endocannabinoids don’t get released. Where there is no endocannabinoid release, there is no pain relief.
On the other hand, consuming Medical Cannabis will introduce cannabinoids to the system by default. There is no guessing. There is no sincere expectation required. Medical Cannabis should provide pain relief irrespective of a patient’s expectations. Of course, all of this is dependent on a correct understanding of how the endocannabinoid system regulates pain.