The Endocannabinoid System, Cannabinoids, and Pain

cannabis_sativa_koehler_drawingI was raised by hippies.

So I have lots of anecdotal evidence on the effects of chronic marijuana smoking. I came to the conclusion (at a young age) that marijuana is often part of the problem, rather than a cure-all solution.

But there is mounting evidence that Cannabinoids deserve our serious attention, including a survey of research presented in the paper The Endocannabinoid System, Cannabinoids, and Pain by Perry G. Fine and Mark J. Rosenfeld, who both sit on the Board of Directors for the American Academy of Pain.

I am interested in pain because my husband, Matthew, has spent years trying to manage severe chronic pain associated with Psoriatic Arthritis.

Chronic pain has been like an abusive 3rd spouse in our marriage & a destructive presence in our family life.

Image from The Endocannabinoid System, Cannabinoids, and Pain

Chart 1 from The Endocannabinoid System, Cannabinoids, and Pain

We can vouch for the effects depicted in the two charts from Fine & Rosenfeld’s paper that I’ve included in this summary. They illustrate that chronic pain effectively wrecks lives.

Matthew’s pain is substantially reduced after 12+ months on the Autoimmune Protocol, without the use of Cannabinoidsbut pain-management is still part of his daily reality.

Cannabinoids, in the form of ‘CBD’, has been prescribed by his Functional Medicine Doctor for pain, and also as an experimental treatment for his extreme, mysterious nausea.

Matthew hasn’t tried CBD yet. He is currently trying Folinic Acid for nausea, to see if it can assist in repair of his gastrointestinal mucosa cells, after long-term use of Methotrexate that was prescribed for Psoriatic Arthritis.

We’ve learned that he needs to try one thing at a time, and often requires recovery time in between, if a particular experiment doesn’t go well.

CBD is his next experiment, after Folinic Acid, and this paper is part of my research on the subject. I thought it was worth sharing.

We keep trying things. Sometimes we find something that works. If it’s not Folinic Acid or CBD, we’ll try something else.

The following are excerpts from Fine and Rosenfeld’s paper The Endocannabinoid System, Cannabinoids, and Pain.

The Endocannabinoid System, Cannabinoids & Pain

Starting at the beginning:

What Is Pain?

“Pain is an unpleasant, commonly occurring, and universal human experience; it is also a very complex phenomenon. The experience of pain and the resultant emotional state depends as much or perhaps more on the contextual circumstances (how, when, where, and why) of the pain-inciting event as the intensity of the noxious stimulus. And a seemingly similar pain-producing event may be experienced (and communicated) quite differently from person to person, situation to situation, and among various cultures” (p. 2).

Image from The Endocannabinoid System, Cannabinoids, and Pain

Chart 2 from The Endocannabinoid System, Cannabinoids, and Pain

“Fortunately, most occurrences of pain are self-limited, resolving quickly with discontinuation of the noxious stimulus or in tandem with tissue healing or resolution of the insult to somatic or visceral structures. But pain that continues relentlessly… serves little purpose. In contrast to acute pain, unresolved pain leads to subliminal and conscious reflex responses that are often maladaptive. It imparts a tremendous burden on the pain sufferer’s health, social interactions, occupational performance, emotional state, and finances. In turn, chronic pain incurs a significant direct and indirect financial toll on society” (p. 2).

“The prevalence of persistent, debilitating pain is increasing” in the population (p. 2).

“Currently available analgesic medications and pain-modulating procedures are severely limited by combinations of low efficacy, excessive toxicity/risk/safety concerns, insufficient access to care, or unbearable cost” (p. 3).

How effective are currently-available pharmaceutical pain-management strategies? “In randomized clinical trials of analgesics for neuropathic pain, no more than half of patients experience clinically meaningful pain relief from pharmacotherapy” (p. 3).


“Cannabinoid refers to a pharmacological class of about 60 naturally occurring compounds (phytocannabinoids) found in plants of the genus Cannabis (i.e. marijuana and hemp)” (p. 4).

“Evidence continues to accumulate suggesting that cannabinoids can impact normal inhibitory pathways and pathophysiological processes influencing nociception in humans… Clinical trials lasting from days to months, involving more than 1,000 patients, have shown efficacy in different categories of chronic pain conditions” (p. 7).

“The phytocannabinoids have efficacy in the treatment of various chronic pain conditions with greatest promise as a therapeutic adjunct in treating peripheral and central neuropathic pain and inflammation-mediated chronic pain” (p. 11).

The Endocannabinoid System & Inflammation

“It appears that the endocannabinoid system [in the body] is intimately involved in tissue healing in the face of inflammatory conditions, correlating clinically with prevention and treatment of inflammation-mediated pain” (p. 6).

The cannabinoid system is described as “an ancient lipid signaling network which in mammals modulates neuronal functions, inflammatory processes, and is involved in the etiology of certain human lifestyle diseases… The system is able to downregulate stress-related signals that lead to chronic inflammation and certain types of pain, but it is also involved in causing inflammation-associated symptoms” (p. 5).

In short, “the endocannabinoid system is involved in a host of homeostatic and physiologic functions, including modulation of pain and inflammation” (p. 1).


Marijuana is smoked. It’s the tetrahydrocannabinol (THC) that gets you stoned. Cannabidiol (CBD) is a non-psychotropic (doesn’t get you stoned) component of Cannibis: “Cannabidiol is a major constituent of Cannabis. It has virtually no psychoactivity compared against THC” (p. 9).

Negative attitudes toward marijuana are impacting the adoption of Cannabinoids: “The health hazards of smoking coupled with the cognitive-behavioral effects of Cannabis have created political and regulatory obstacles worldwide, with regard to evaluating cannabinoids as medicines and mainstream health care professionals’ acceptance of Cannabis as a legitimate therapeutic agent” (p. 5). I understand these negative attitudes, as I’ve harboured some of them myself!

Find the full paper here.

Find CBD here (this is the company recommended by our Functional Medicine Doctor).

As mentioned, Matthew hasn’t tried CBD yet.

As always, consult with your Health Practitioner before engaging in any new  therapy~.

8 thoughts on “The Endocannabinoid System, Cannabinoids, and Pain

  1. I took CBD for my extreme nausea (caused by auto immune brain stem swelling pressing on my vagus nerve, at that time cause unknown). Sadly I did not experience any relief from nausea and did experience a mild high. That said, I know a lot of other AI pain sufferers who very successfully use it for pain management. I also experienced chronic joint pain and got much relief from supplements listed in this crazy looking book.

    I took green lipped mussel extract and the other supplement she mentions (name escaping me now) and after about 2-3 weeks the pain just melted away. This after months of daily crying from the pain, taking elevators instead of stairs, struggling to get in and out of cars, perform normal tasks like gripping, etc. Kind of a miracle for me.

    I wish you guys the best and thank you for documenting your journey, because of you I attended the bio hacking conference in Pasadena, which was fascinating, and am spreading the good word of bio hacking. It makes perfect sense to me. Thanks again.

  2. Hello!
    I have used a high CBD, low THC medicinal weed called Bediol in Holland for neuropathic pain in my legs. Even though you dont get stoned it didnt work well for me on the long term… I stopped using it. I will start LDN at the end of this month, hope that does some good! I am on the AIP for 12 months now too BTW 🙂

  3. Medical Marijuana is a hot topic here in NSW at the moment, Petra.

    I was very interested in your unresolved pain chart – how it affects so much of our lives. I’m so happy that Matthew is finding improvement on his current regime. I’m looking forward to when you come to Sydney to celebrate!

  4. I grew up thinking marijuana was to blame for a lot of things going on with my father. I only wish he were still here so I could talk to him openly and add his side of the story to my skewed adolescent perception. My mind has opened over the years regarding cannabis use, and I’m thankful for that. But I am left with many unanswered questions at the same time. I now wonder if the main reason for him smoking marijuana was for pain relief. :/

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