Cannabidiol (CBD) and the treatment of chronic pain
Published on
August 28, 2024
Introduction
Chronic pain is the common but often ignored scourge of modern medicine. It affects between one-third and one-half of the population in the UK, or just under 28 million adults. Its impact is common across genders and ages, although more often felt by women (38%) than men (30%), and with higher prevalence in those over 75 years (62%) than those aged 18-25 (14.3%). Of those living with chronic pain, over 10% have been found to have moderate-to-severe disabling chronic pain.[1]
Many of us have either endured a chronic pain condition ourselves or watched a friend or family member suffer. Chronic pain conditions can limit the lives of sufferers by reducing mobility and are often associated with mental health issues including anxiety, depression and sleep disorders. Chronic pain affects quality of life and in the worst cases, can lead to mental and physical disabilities.
There are a range of challenges associated with the current management and treatment of chronic pain. In this article we assess those challenges and outline the role that CBD could play as an emerging potential treatment for chronic pain conditions.
What is chronic pain?
While acute pain conditions – sudden or urgent pain caused by something specific like a broken bone or a cut – are well known and treatment methods well established, chronic pain is less understood.
The technical definition of chronic pain is pain lasting more than three months and is categorised as primary or secondary pain.[2] Primary chronic pain often arises from a confluence of factors and may have no clear underlying condition. Examples include:
- fibromyalgia
- chronic musculoskeletal pain
- chronic migraine.
Secondary chronic pain can be caused by or associated with other medical conditions or co-existing mental health conditions. Examples include:
- endometriosis
- tuberculosis
- irritable bowel syndrome
- rheumatoid arthritis
- lower back pain and sciatica
- osteoarthritis.
In many instances chronic pain is linked with inflammation, part of the body’s response to defend itself against infectious or non-infectious assaults.[3] When functioning correctly this response is beneficial and protects the body. When there is dysfunction or dysregulation of the inflammatory ‘cascade’, and the body fails to resolve the initial threat adequately or to return the immune system to a stable state, chronic inflammation can develop.[4] This inflammation can be a major contributor to, or exist alongside, chronic pain.[5]
How is chronic pain currently treated?
“Chronic pain is common—but it isn’t sexy.” – Henry McQuay[6]
Many chronic pain conditions have historically been put in the ‘too hard’ basket by the medical fraternity and pharmaceutical companies. Today chronic pain remains a significant unmet healthcare need.
Current treatments for chronic pain are based on individual assessments of the type of chronic pain (primary or secondary), as well as a range of other factors including biological, emotional, lifestyle and social. The success and quality of existing treatments could at best be described as inadequate and at worst non-existent. The elimination of pain is rare, with estimates suggesting that pain is only reduced by around 30% on average, and patients continue to experience reduced function and quality of life over the long-term.[7]
Drugs used in the treatment of chronic pain are often associated with side effects, or in the case of opioids have high abuse potential. Non-pharmacological approaches such as exercise, psychological therapy or acupuncture are also used to manage pain, rather than resolve it.
The current lack of effective therapies with fewer side effects means that individuals suffering from chronic pain have significantly reduced quality of life and health spans. These negative health outcomes for the individuals affected also come at a huge economic expense to the UK Government and taxpayers, not to mention the vast societal cost incurred as a result of productivity losses, poor mental health outcomes, and impacts on family life and leisure. The treatment of musculoskeletal pain conditions alone cost the NHS around £5 billion every year and is the third largest area of NHS spending.[8]
As a company, MRX Medical is resolved to tackling these challenges head on and delivering better outcomes for patients; as McQuay also observed, “People who through no fault of their own have their lives demolished by pain deserve our help.”
CBD and chronic pain
In the absence of effective, safe and affordable medications to treat and/or manage chronic pain, researchers, clinicians and patients have sought out suitable alternatives. CBD – a substance that is derived from cannabis but does not contain any of the psychoactive properties of other derivatives such as Δ9-tetrahydrocannabinol (THC) – has been identified as one such potential alternative.
Anecdotal, pre-clinical, observational and limited clinical evidence highlight CBD as a potential treatment for chronic pain, particularly when it results from chronic inflammation. CBD is a particularly good candidate because there is no risk of drug abuse and it is accepted to have a favourable safety profile with minimal side effects.[9] CBD has already been approved by the FDA in one formulation, Epidiolex®, for the treatment of seizures associated with Lennox-Gastaut syndrome, Dravet syndrome and tuberous sclerosis complex.
CBD is thought to help with chronic pain through its interaction with the endocannabinoid system (ECS) in the body. The ECS plays a role in regulating various physiological processes, including pain perception, immune response and inflammation. Through this interaction and a range of other actions, CBD exhibits a range of clinical effects including anti-inflammatory, analgesic, antioxidant, anticonvulsant, anxiolytic antipsychotic, antidepressant, sedative and neuroprotective properties.[10]
This range of effects make CBD a prime candidate for clinical research into its therapeutic potential for chronic pain management. However, despite existing research there remains a lack of clinical evidence demonstrated through randomised controlled trials to establish the efficacy of CBD in patients experiencing chronic pain. This has been identified by the National Institute for Health and Care Excellence (NICE), which provides guidance and advice to the UK Government to improve health and social care. NICE has highlighted several key areas that require further investigation, including pain intensity, pain relief and functional impairment.[11]
The need for further clinical evidence to allow widespread prescription of cannabis-based medicines has also been recognised at the political level, particularly in relation to epilepsy. A series of recent questions in the UK Parliament have broached the issue, with the UK Government typically responding along the lines of “clinical guidelines from NICE demonstrate a clear need for more evidence to support routine prescribing and funding decisions for unlicensed cannabis-based medicines.” [12]
Proponents of cannabis-based medicines for the treatment of intractable epilepsy in children were a driving force behind legalisation in 2018, and they continue to advocate for relaxation of restrictions around prescription and increased access through the NHS. However, bound by the existing legal framework for authorisation of medicines, the UK Government and regulatory bodies appear resolute in their position that clinical evidence in the form of randomised controlled trials that prove efficacy and safety for certain conditions is required before widespread prescription can occur.
What role is MRX Medical playing?
MRX is motivated to deliver proven, effective, and safe cannabinoid medicines to treat chronic pain conditions and most importantly, make them available to those that need them. To do this we are focussed on delivering the clinical evidence that clinicians, regulators and patients require to be confident in our medicines.
We are responding directly to the NICE guidelines and UK Government calls for further clinical evidence by undertaking gold standard randomised controlled trials using our cannabinoid medicines. Our patent pending MRX1 cannabidiol oil is being used in two Phase II clinical trials being undertaken by the University of Edinburgh.
One of these trials will use MRX1 to target the pelvic pain associated with endometriosis. Endometriosis is a debilitating condition that has been hugely underfunded in terms of research, despite currently affecting over 1.5 million women in the UK.
The other trial will use MRX1 in a double-blind, placebo-controlled crossover RCT to target CIPN. CIPN is a nerve-related condition characterised by tingling, numbness, and extremity pain. CIPN not only affects patients' physical well-being, but also profoundly impacts their overall quality of life and daily activities. Approximately 160,000 new CIPN cases emerge in the UK each year.
We continue to seek further clinical studies in other conditions, with a strong focus on those that are poorly treated, have large addressable markets and display promising pre-clinical or clinical evidence.
Our goal is to prove our medicines are efficacious and safe for the treatment of specific chronic pain conditions, and then have them licensed and made available on the NHS for those who need them.
Thank you for your interest in what we do and our ambition to improve the treatment of complex, chronic inflammatory pain conditions. Stay tuned for more updates and insights from MRX Medical News.
If you are interested in learning more, joining our mailing list or would like to talk to us, please don't hesitate to reach out to us at info@mrxmedical.com, or via our parent company, Ananda Developments, using the links below.
MRX Medical is an Ananda Developments plc company. Ananda is a company quoted on the Aquis Stock Exchange (AQSE: ANA) Growth Market. To find out more visit the Ananda Investor Hub or follow us on social media:
[1] Mills et al., 2019; Fayaz et al., 2016
[2] National Institute for Health and Care Excellence, 2021a
[3] Placha & Jampilek, 2021
[4] Netea et al., 2017; Furman etal., 2019
[5] Ji et al., 2014; Ji et al.,2018; De Logu et al., 2021
[6] McQuay, 2008
[7] Dydyk & Conermann, 2023
[8] Public Health England, 2022
[9] WHO, 2018
[10] Vitale et al., 2021; Aziz et al., 2023; Yau et al., 2023
[11] NICE 2021b
[12] Quince, 2023a; Quince, 2023b; Stephenson, 2024a; Stephenson, 2024b; Stephenson, 2023a; Stephenson, 2023b
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