Which Cannabis Cultivar Is Best for Certain Pains?

Marijuana as a pharmacological tool has been manipulated into varietals that have differing properties based mainly on the levels of tetrahydrocannabinoid (THC) and cannabidiol (CBD) found in the plant flower. Cultivators have designed marijuana types purposefully to create different subsets of cannabis that have particular medical properties as well as related effects on cerebral and pain sensory receptors. It is crucial to recognize how these can be applied to specific pain symptoms in order to be able to recognize a preferred strain as a match for pain sufferers.    

Three categories of pain

Though there are many ways pain can be defined by a patient, there are three distinct categories to consider when assessing which cannabis varietal is recommended as part of a patient’s treatment.

• Nociceptive pain — usually a result of physical harm to the body. This is pain that comes from bodily injury that often abates with the natural healing process of the body. It is typified by aches, sharp or throbbing pain. Harm to tissue triggers signals carried by fine C- and A-gamma peripheral nerves. These travel the dorsal root ganglia through the spinothalamic track to the thalamus where they then reach the cortical area. This is pain that has warning as well as defensive properties for the body.
• Neuropathic pain — often caused by issues with the central nervous system sending false pain receptor signals to the patient’s body (this could be episodic, or it could wax and wane). Often this is related to chronic pain and can be associated with neuropathy caused by illness such as diabetes or spinal stenosis as well as brain or spinal cord injury. Taking the example of diabetic neuropathy (neuropathic pain in the foot), this is not due to damage in the tissue of the foot itself; instead, the feeling of pain is an effect of the disease on peripheral nerves which results in incorrect signaling to the brain.
• Central pain — is caused by damage to the central nervous system that can result in an amplification of peripheral nerve signalling. This triggers chronic pain.   

When considering pain symptoms, it is crucial to realize that pain is a subjective experience for patients and there are a number of physical and mental factors involved in assessment. In his paper: Individual Differences in the Subjective Experience of Pain: New Insights into Mechanisms and Models, Dr. Robert Coghill points to genetic, sociological, psychological, and neural mechanisms that have differing effects on pain. 

“Development of a full understanding of individual differences in pain remains challenging, due to the myriad of genetic, environmental, psychological, and cognitive variables that can shape such differences,” says Dr. Coghill.

He compares pain assessment to the factors that surround taste, and how one person may enjoy chocolate while it might be abhorrent to another. There is no objective reason for this, it has to do with subjective approaches. 

Because of this, it is useful for medical professionals and patients to understand pain assessment tools in order to properly report pain and understand what pharmacology is best for relief. 

Indica and sativa strains of cannabis

Before looking at strains that are relevant for specific pain relief, there is a need to understand the differences between the main categories of marijuana.

Indica: results in an effect related to sedation. This strain produces a “full-body” high that is useful for treatment of intense physical pain. These generally should not be used prior to physical activity (are recommended for before sleep). In a 2016 study published in the Journal of Studies in Drugs and Alcohol, high grade pain sufferers reported a preference for indica strains.

Sativa: These strains create more of a stimulating experience and are more useful for working to get through daily tasks while suppressing low grade pain like arthritis. 

Hybrid: Cannabis strains known as hybrids are attempts to blend the full-body and cerebral highs of sativa and indica strains. By combining these elements, the concept is that a patient can achieve both the sedative effects that come with indica and the stimulation of sativa. 

It should be noted that levels of THC and CBD vary dramatically in sativa and indica strains, and for this reason it is crucial to consider specific varietals for pain control.  

While there are many strains to choose from, Marijuana Doctors has created an infographic and informative article that clearly indicates some more popular varietals that can be found at most dispensaries and how these relate to pain management. 

The basic notions of their assessment include: 

Strains preferred for headache or migraine relief

• Blue Dream: With a high THC and low CBD content it is a stress reliever for low grade pain like headache and for more intensive migraines. 
• Granddaddy Purple: A full-body high, this strain features 20 percent THC and low CBD. It is best for intensive headache sufferers and results in a sedative state. 

Strains preferred for muscle soreness or cramping

• White Widow: A well-known hybrid strain, this is another full-body high with THC between 18-25 percent. Good for severe pain symptoms that require a feeling of sedation. 
• Redwood Kush: A calming hybrid strain that is useful to relieve muscle tension. Again, the sedative effect means it is best just before sleep. 

Strains preferred for arthritis and inflammation

• Harlequin: The anti-inflammatory properties of CBD make varietals that are comparatively high in CBD useful for arthritis sufferers. This strain has 12 percent CBD and creates a feeling of pain relief that does not sedate the user, allowing for a patient to go about daily tasks. 
• ACDC: Again, the high CBD content in relation to THC (19 percent CBD to 3 percent THC) results in almost no cerebral numbing effect. It will still relieve low levels of body pain. 

Strains preferred for severe pain

• Purple Arrow: This strain is recommended for immediate relief from high levels of pain. It has a sedative effect and is also useful for migraine relief. 
• OG Kush: An intense level of THC (24 percent) makes this strain popular with those suffering from severe and chronic pain. It is recommended for more experienced users, as it can be a rather pervasive full-body high. 

Strains preferred for chronic pain

• Jack Herer: A hybrid strain that skilfully combines the effects of sativa and indica cannabis. Because it features THC and CBD, it can be used both as an effective anti-inflammatory and as a pain reliever. 
• Blackberry Kush: This indica strain is known for creating a euphoric state of sedation. While excellent for chronic pain, it is to be used before sleep and not when trying to accomplish tasks. 
• Sour Diesel: The uplifting sativa hybrid works quickly to combat chronic pain. Because it creates an energetic high it is possible to use during active daytime hours*. 

While the effectiveness of marijuana for treating pain is still being fully assessed, many of the questions surrounding its use are due to the complex and subjective nature of pain itself. Studies have resulted in many positive outcomes, and include the following: 

• In a research study in the Journal of Pain and Symptom Management of over 17,000 cancer sufferers, 70 percent reported that marijuana use led to pain relief and improved well-being. 
• Patients prone to chronic migraines reported decreases in symptoms after marijuana use. 
  
  

While Marijuana Doctors have provided a useful reference, likely the best way to assess which variety is right for specific pain treatment is to contact knowledgeable administrators that work at dispensaries. They may have suggestions of varietals and be able to pull up metrics as well as anecdotal evidence that points to recommendations of strains for particular kinds of pain sufferers.  

For a quick reference to how specific strains apply to pain management see this infographic.

*While cannabis can be extremely useful for daily, chronic pain, one should never drive or operate machinery while under the influence of THC.