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Russo EB, Hohmann AG. 
“Role of Cannabinoids in Pain Management”. 
Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches. 2013;p181-197.
Chapter from book.

It is a curious fact that we owe a great deal of our insight into pharmacological treatment of pain to the plant world [ 1 ] . Willow bark from Salix spp. led to development of aspirin and eventual elucidation of the analgesic effects of prostaglandins and their role in in fl ammation. The opium poppy Papaver somniferum provided the prototypic narcotic analgesic morphine, the fi rst alkaloid discovered, and stimulated the much later discovery of the endorphin and enkephalin systems. Similarly, the pharmacological properties of cannabis Cannabis sativa prompted the isolation of D 9 -tetrahydrocannabinol THC, the major psychoactive ingredient in cannabis, in 1964 [ 2 ] . It is this breakthrough that subsequently prompted the more recent discovery of the body’s own cannabis-like system, the endocannabinoid system ECS, which modulates pain under physiological conditions. Pro-nociceptive mechanisms of the endovanilloid system were similarly revealed by phytochemistry of capsaicin, the pungent ingredient in hot chile peppers Capsicum annuum etc., which activates transient receptor potential vanilloid receptor-1 TRPV1. Additional plant products such as the mints and mustards activate other TRP channels to produce their physiological effects.

Key Points:

* Cannabinoids are pharmacological agents of endogenous endocannabinoids, botanical phytocannabinoids, or synthetic origin.

* Cannabinoids alleviate pain through a variety of receptor and non-receptor mechanisms including direct analgesic and anti-in fl ammatory effects, modulatory actions on neurotransmitters, and interactions with endogenous and administered opioids.

* Cannabinoid agents are currently available in various countries for pain treatment, and even cannabinoids of botanical origin may be approvable by FDA, although this is distinctly unlikely for smoked cannabis.

* An impressive body of literature supports cannabinoid analgesia, and recently, this has been supplemented by an increasing number of phase I–III clinical trials.
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