Cannabis may ease the pain, but it increases the psychosis!

This is evident from a recent study published in the journal Case reports on psychiatric research, researchers present the case of a 27-year-old African American woman with a history of schizoaffective disorder who suffers from fibromyalgia, a neurological disorder characterized by chronic pain. The woman reported self-medicating with potent, pharmacy-obtained cannabis in gradually increasing doses to suppress her pain, but with the side effects of cognitive dysfunction, profound fatigue, sleep disturbances and drastic mood swings in addition to suicidal tendencies.

Case study: A gentle reminder of the potential risk of psychosis when cannabis is used as a treatment for chronic pain. Image credits: Sasun Bughdaryan / Shutterstock

Encouragingly, dietary interventions aimed at lowering the patient’s free glutamate intake reduced her pain to such an extent that she voluntarily stopped cannabis use just one month after the dietary intervention. This in turn appeared to result in a reduction in the patient’s psychiatric symptoms and substantial improvements in her quality of life, suggesting that cannabis may have exacerbated her pre-existing psychosis.

This case study serves as a warning to cannabis consumers, especially those who self-medicate despite a family or medical history of psychosis or similar mental health conditions, of our limited current information on the side effects of cannabis consumption and to physicians on the dangers of cannabis use, especially high-potency cannabis sources or in high doses.

Cannabis: blessing or curse in the war against pain?

Fibromyalgia is a multi-symptom neurological disorder characterized by widespread muscle and body pain, chronic fatigue, severe headaches, sleep disturbances, gastrointestinal symptoms, and sporadic mood swings, including depression, suicidality, and anxiety. In addition to depression and anxiety, recent research has linked excessive glutamatergic neurotransmission and N-methyl-D-aspartate glutamate receptor (NMDAR) antagonist to the manifestation and progressive escalation of fibromyalgia and its symptoms, respectively.

Unfortunately, despite studies elucidating the mechanisms underlying the association of fibromyalgia with glutamate dysregulation, no pharmacological treatments for the condition have remained to date. This leads countless pain sufferers worldwide to seek alternative painkillers, often resulting in self-medication with cannabis and its derivatives. This in turn has made pain management the most commonly cited reason for cannabis use, with more than 82.6% of cannabis users in California, 87% of those in Michigan and 80% of users in the United Kingdom (UK) reporting that pain relief as their primary use of the drug.

Alarmingly, association-based observational studies in humans and animal psychosis model systems have shown that high concentrations or amounts of the drug can result in the manifestation or enhancement of psychosis, especially in individuals with a medical or family history of neurological disorders such as schizophrenia.

“While some research has suggested that medical cannabis has potential long-term analgesic and quality of life benefits, it is not yet clear which populations are at risk for adverse side effects, making it more difficult to make recommendations. about the use of cannabis as treatment.”

About the study

In the current study, researchers present and discuss the case of a 27-year-old African American woman suffering from fibromyalgia and comorbid schizoaffective disorder. Data collection took place via a questionnaire. It included a detailed symptom history, medical records of failed interventions, and the potency and frequency of the patient’s current cannabis use. The dietary intervention included in-depth patient training on the fibromyalgia benefits of low-glutamate diets, as well as the recommendations on food products that naturally contain high levels of free glutamate (soy sauce, Parmesan cheese and flavor-enhancing food additives) and would therefore be avoided. Physical activity and caloric interventions were not recommended, despite the patient being slightly overweight at the start of treatment.

The intervention lasted one month, after which a follow-up health assessment (weight) and questionnaire evaluation (for the number of symptoms associated with fibromyalgia or schizoaffective disorder) were conducted.

Findings of the study

The patient reported 97% adherence to the recommended dietary intervention during the one-month study. The glutamate intervention proved to be very effective in reducing the patient’s pain quotient – ​​the case reported a significant reduction in the number of reported symptoms associated with fibromyalgia or schizoaffective disorders (19 symptoms reported at baseline reduced to just five after the intervention) , in addition to substantial improvements in their mental health (anxiety and depression). Encouragingly, the intervention had such a profound effect on the patient’s pain and mood that she voluntarily stopped using cannabis after the intervention.

Notably, quitting cannabis further improved the patient’s neurological conditions, resulting in reduced junk food cravings, substantial weight loss, and reductions in her fears and hallucinations (the latter of which decreased from extremely frequent to “rare and minor”). This suggests that cannabis may directly contribute to the worsening of pre-existing neurological and mental health diseases.

Conclusions

A growing body of literature clarifies the potential role of cannabis, a cocktail of numerous psychoactive substances, in exacerbating mental illness. In particular, cannabis has been shown to have agonistic effects on 5-hydroxytryptamine receptors (5-HTRs), vanillin subtype transient receptor potential channels (TRPV), and G protein-coupled receptors (GPRs), while also interacting with NMDA receptors. These interactions have been shown to significantly reduce pain tolerance in mouse Parkinson’s disease (PD) models. Cannabis and its derivatives are further involved in glutamatergic synaptic signaling, indirectly contributing to increased glutamate uptake, creating a snowball effect when used as a self-prescribed painkiller.

“Before I changed my diet, my life revolved around how I felt both mentally and physically. I was unaware that the foods I was consuming were contributing to my lack of focus, worsening my poor mental health, gastrointestinal disorders and caused fibromyalgia attacks, among others… once I finally fully committed to the new regimen, my symptoms improved dramatically. I noticed that my sleep and concentration were better, my fibromyalgia became manageable, and I had more energy depression/anxiety to a point where I could function in my daily life.”

The current study serves as both a warning to patients currently consuming (or planning to consume) cannabis for pain relief, and a reminder to physicians of the limited scientific knowledge that supports claims about the benefits of cannabis in chronic pain therapy.

“Cannabis appears to reduce glutamatergic neurotransmission, resulting in reduced excitotoxicity and the onset of pain; however, higher doses and more frequent use may result in NMDA hypofunction, which may lead to psychosis and other psychiatric symptoms in susceptible individuals. Psychiatrists may be best suited to identify these new psychiatric symptoms in patients with chronic pain who self-treat with cannabis.”