Pain: Today’s essay is on pain, what causes it, how it works, how we treat it. I have concluded that of the three classes of treatments, two are very dangerous and not very efficacious. I have concluded Nonopioid analgesics (NSAIDs) and Opioid analgesics are very dangerous and ineffective. I have concluded only CBD is very safe and very efficacious.
Pain is registered by the brain and nervous system through nociception. It begins with a nociceptor, which is a sensory neuron. It is stimulated by damage or damaging stimuli and sends signals through the spinal cord to the brain. The brain then creates the sensation of pain centered on the specific site of the stimulation.
Where there is pain, there is inflammation. Eicosanoid and endocannabinoid systems (ECS) are also engaged. These mechanisms are all engaged together and are related and interdependent, interacting. Pain is one of three things happening, we need to aid all three.
When there is a pain stimulus caused by a trauma event raising toxic antigens the ECB and eicosanoid systems engage at the same time. All three systems are stimulated to react together with inflammatory eicosanoid biosynthesis. CBD addresses all three systems.
This begins with the release of arachidonic acid (AA) from membrane phospholipids. CBD is a major sustaining agent in making AA available to the eicosanoid system. As pain is signaled, the system reacts with inflammatory signaling eicosanoids, and then later in the resolution phase, with anti-inflammatory signaling eicosanoids. The AA is eventually transformed thereby into cyclooxygenase (COX) and lipoxygenase (LO) pathways to prostaglandins, thromboxane and leukotrienes as typical types of eicosanoids.
These pathways are a major theme in non-opioid treatments for pain and inflammation. CBD in abundance, from the ECS system or taken as a supplement, thereby is intimately and powerfully involved in these events. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase 2 (COX2) thus, decreasing the synthesis of prostaglandins. Some antiepileptic drugs and anesthetics thus inhibit the generation of pain nerve impulses.
The scholarship we are studying lead us to suggest that the optimal treatment for pain, would create also optimal inputs and conditions for the eicosanoid and ECS systems simultaneously.
Three classes of treatments for pain:
1) Inhibit the transmission of nociceptive input from the periphery to the spinal cord,
2) Activate descending inhibitory pathways that modulate transmission in the spinal cord, and
3) Alter limbic system activity and are powerfully and dangerously addictive, killing millions every year.
Some notes to understand the three classes:
Thus, opioids modify sensory and affective aspects of pain. However, CBD seems to address all three systems in a balanced and healthful way. And it may be much safer than the other two.
FDA on danger of Opioids:
It should be noted that the term “opioids” has replaced “narcotics,” and “co-analgesics” is an alternate term for “adjuvant analgesics. Most everyone today is aware of the danger of narcotics. Just last year the FDA drafted this guidance for medical providers with respect to opioids: FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain (May 2017)
HCPs should be knowledgeable about the risks associated with opioid analgesics as they pertain to their patients and from a public health perspective.
extent of the problem. HCPs should understand that most of the opioids available for
misuse and abuse in the community originate from prescriptions for individual patients.
information about safe opioid practices, current federal and state regulations, and
guidelines on opioid prescribing and the use of naloxone.
Some references from the WHO on Safety:
We would also here quote the WHO on the safety of CBD: (WHO Expert Committee on Drug Dependence Thirty-ninth Meeting Geneva, 6-10 November 2017)
Adverse Reactions in Humans:As noted above, CBD does not produce the effects that are typically seen with cannabinoids such as THC. It also failed to produce significant effects in a human study of abuse potential discussed below.  Across a number of controlled and open label trials CBD of the potential therapeutic effects of CBD it is generally well tolerated, with a good safety profile.
Human Studies:While the number of studies is limited, the evidence from well controlled human experimental research indicates that CBD is not associated with abuse potential.
Understanding Pain, Inflammatory reactions, Anti-inflammatory reactions in the context of the pain, ECS and eicosanoid systems and regulations:
One of the things we should to address is the fact that CBD is a promising candidate for so many diseases and afflictions. One would think that the same mechanisms are in play in these many conditions. A theme is to find solutions with nonsteroidal anti-inflammatory drugs (NSAIDs) which aid in the operations of all three system. And to understand how and why CBD modulates pain and inflammation.
If CBD is safe, non-addictive, addresses a broad cross section of our biological operations, if it is safer and more efficacious than opioid and non-opioid treatments, it should be preferred.
For instance, Pisanti et. al. (Cannabidiol: State of the art and new challenges for therapeutic applications. Pharmacology 2017. 175: p. 133-150):
I am reminded of Daniel Rossignol’s article Evidence linking oxidative stress, mitochondrial dysfunction, and inflammation in the brain of individuals with autism(DanielA.Rossignol1* and RichardE.Frye2 REVIEW ARTICLE 22April2014) We quote:
Several case-control studies have reported Lower concentrations of reduced glutathione(GSH), higher levels of oxidized glutathione(GSSG)and a decrease in the GSH/GSSG redox ratio(Jamesetal.,2004,2006,2009b), along with a lower mitochondrial GSH reserve(Jamesetal.,2009a) in individuals with ASD compared to controls. In addition, in some studies, lower GSH levels(Adamsetal.,2009) and markers of increased oxidative stress (Ghezzoetal.,2013) have been correlated with ASD severity.
The reason I find this relevant is that CBD, like astaxanthin and THC, is one of the few large molecules of value that crosses the blood brain barrier. So, it is likely that CBD and astaxanthin, especially in combination with a rich source of DHA, would be a great treatment to prevent or curtail autism, and many other ailments, many involving pain. My conclusions: