On June 4, 2024, the German Pain Society's 13th "Day of Action against Pain" will draw attention to chronic pain, which affects twelve million people in Germany. 60 percent of Germans occasionally suffer from back pain. Pain patient Michael L. explains how cannabis has helped him.

Shortly after the partial legalization of cannabis, newspapers ran the headline: "Will cannabis be the new ibuprofen 600?" What was meant was that the plant had long been used to treat pain. It was available in pharmacies in Germany until the 1930s. It was only with the Opium Act (1929) and the subsequent prohibition that cannabis disappeared from German medicine cabinets. It has been permitted again since April; medicinal cannabis on prescription since 2017. According to a companion survey, 73 percent of prescriptions have been for pain therapy since then - for example for tension pain, back pain, menstrual pain, headaches or endometriosis pain (Grünhorn reported).

Pain patient feels safe since legalization

For 30-year-old pain patient Michael L. from Munich, the partial legalization of cannabis is a major step forward. Since his youth and a multiple slipped disc, the pharmaceutical-commercial employee has suffered from back pain, like around 60 percent of Germans. He had to give up his hobby of playing handball: "I tried everything from tilidine to other opiates. Cannabis on prescription helped me in 2018, but only because I had a doctor who knew a lot about it. I have no side effects". Michael L. combines flowers, which he vaporizes in a vaporizer, and cannabis extracts. In contrast to inhaling the dried flowers, these have a longer effect, similar to sustained-release medication, and get pain patients like him through the night better. In addition, the patient did not want to stand out due to the smell of cannabis in Bavaria, where the ban on cannabis was particularly restrictive: "It was a burden, as you were quickly put in the wrong light," he says. "I felt badly treated when I used cannabis as part of my pain therapy - even though I wasn't doing anything illegal. I'm glad that time is over now and I can feel safe." Today, he can return to his job as a pharmacist in the pharmacy without any major problems: "I'm only occasionally tired or slightly sedated, I'm now well adjusted and generally feeling much better," he says. This means he can meet up with friends again and take part in social life. He now hopes that more doctors will open up to cannabis therapy than was the case before legalization.

Pain doctor sees clear advantages in cannabis therapy

Valuable insights are also provided by everyday treatment in cannabis therapy, as experienced by Dr. Horst Bettstetter on a daily basis. The pain therapist works at the Inn-Salzach Pain Centre, an interdisciplinary facility for holistic pain therapy: "I have now successfully treated thousands of people with medical cannabis for pain with hardly any side effects," says Dr. Horst Bettstetter. "For chronic pain, especially back pain, medicinal cannabis can alleviate symptoms and improve quality of life - with significantly fewer side effects compared to opiates." In his own survey of fibromyalgia patients suffering from chronic pain all over the body, Dr. Bettstetter recorded a significant reduction in the pain experienced. However, there is a crucial difference between cannabis and pills: There are around 200 cannabis flowers - and each one can have a different effect depending on the individual CBD, THC and terpene content. It also depends on the right dosage. For this reason, not every doctor will have immediate success. They need to familiarize themselves sufficiently with medicinal cannabis and find the ideal therapy: "It is important to take other medication and previous illnesses into account in order to ensure the best possible effect and minimize side effects," says Dr. Bettstetter. He therefore attaches great importance to a good exchange with his patients and recommends that they try out several varieties if necessary. There are also online advisors such as the Grünhorn pharmacy's flower finder, which recommends the right flowers depending on the treatment goal.

Moderate to strong evidence for medical cannabis for chronic pain

Researchers Mary Lnych and Penny Whiting evaluated numerous studies and came to the conclusion that cannabis can be effective and comparatively safe in pain therapy. Dr. Nadine Herwig, Head of the Grünhorn Academy, explains: "Studies show moderate to strong evidence for the efficacy of medicinal cannabis in chronic pain and the potential to reduce opioids. The cannabinoids dock onto the endocannabinoid system in the body, where, among other things, the sensation of pain is regulated. The anti-inflammatory properties can also help to alleviate pain and improve the quality of life for millions of people." As cannabis can have a slightly different effect on each person and there are still gaps in the studies due to the long period of prohibition, the German Pain Society is cautious in its recommendations: "Possible areas of application for cannabis-based medicines currently include chronic nerve pain (neuropathic pain), spasticity (prolonged muscle cramps) in multiple sclerosis and loss of appetite, nausea and vomiting in cancer patients undergoing chemotherapy." In addition to dried flowers, which are inhaled, there are extracts and capsules for ingestion, which the German Pain Society prefers due to the current study situation on efficacy (ibid.).

Grünhorn Apotheke is the leading provider of medicinal cannabis in Germany. Every third prescription is submitted to the Leipzig pharmacy. The reclassification as a non-narcotic means significantly fewer bureaucratic hurdles, as narcotic prescriptions are no longer required. As with other medicines, an e-prescription is now sufficient: "As a result, we have seen a doubling of incoming prescriptions," says Stefan Fritsch, founder and CEO of the Grünhorn Group. Before legalization and easier online prescribing, many patients used the black market because doctors refused to treat them. "Simplified access helps to dry up the black market and provide patients with pure, pharmaceutical-grade medical cannabis that has not been contaminated with mold, lead or hairspray, as is often the case on the street," adds Fritsch.

For further information, we recommend the Grünhorn Academy's specialist article on "Cannabis therapy for pain" and the Grünhorn Academy podcast with Dr. Nadine Herwig and Dr. Bettstetter. For interview requests, please contact Corporate Communications.

Sources::

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932947/
• https://rdcu.be/dd6xn
• Whiting, P. F., Wolff, R. F., Deshpande, S., Di Nisio, M., Duffy, S., Hernandez, A. V., Keurentjes, J. C., Lang, S., Misso, K., Ryder, S., Schmidlkofer, S., Westwood, M., & Kleijnen, J. (2015). Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA, 313(24), 2456–2473.
• Lynch ME, Campbell F. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Br J Clin Pharmacol. 2011 Nov;72(5):735-44.