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BJA Advance Access originally published online on May 29, 2008
British Journal of Anaesthesia 2008 101(1):59-68; doi:10.1093/bja/aen119
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Therapeutic potential of cannabis in pain medicine{dagger}

R. D. Hosking and J. P. Zajicek*

Neurology Research Group, Peninsula Medical School, Plymouth, UK

* Corresponding author. E-mail: john.zajicek{at}phnt.swest.nhs.uk

Advances in cannabis research have paralleled developments in opioid pharmacology whereby a psychoactive plant extract has elucidated novel endogenous signalling systems with therapeutic significance. Cannabinoids (CBs) are chemical compounds derived from cannabis. The major psychotropic CB delta-9-tetrahydrocannabinol ({Delta}9-THC) was isolated in 1964 and the first CB receptor (CB1R) was cloned in 1990. CB signalling occurs via G-protein-coupled receptors distributed throughout the body. Endocannabinoids are derivatives of arachidonic acid that function in diverse physiological systems. Neuronal CB1Rs modulate synaptic transmission and mediate psychoactivity. Immune-cell CB2 receptors (CB2R) may down-regulate neuroinflammation and influence cyclooxygenase-dependent pathways. Animal models demonstrate that CBRs play a fundamental role in peripheral, spinal, and supraspinal nociception and that CBs are effective analgesics. Clinical trials of CBs in multiple sclerosis have suggested a benefit in neuropathic pain. However, human studies of CB-mediated analgesia have been limited by study size, heterogeneous patient populations, and subjective outcome measures. Furthermore, CBs have variable pharmacokinetics and can manifest psychotropism. They are currently licensed as antiemetics in chemotherapy and can be prescribed on a named-patient basis for neuropathic pain. Future selective peripheral CB1R and CB2R agonists will minimize central psychoactivity and may synergize opioid anti-nociception. This review discusses the basic science and clinical aspects of CB pharmacology with a focus on pain medicine.

Keywords: analgesics non-opioid, cannabis; pain, experimental; pain, neuropathic; pharmacology, neurotransmission effects; receptors, transmembrane

{dagger} Declaration of interest. The authors have received funding from the Medical Research Council and the South West Regional Development Agency.


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