Treatment resistent abdominal pain, with unknown etiology can sometimes be treated succesfully by Cannabis. It might be that this chronic pain syndrome has something to do with small fiber neuropathy in the innervation network around the gut. But, whatever its etiology, it is merely a hypothesis and very difficult to substantiate. However, having said that, there are patients suffering from for instance diabetic neuropthy, with severe gasterointestinal complaits, and we feel these pains and complaints can be due to small fiber neuropthy. As Cannabis appeared to be a useful drug for treating treatment resistant neuropathic pain, we sometimes prescribe Cannabis to patients suffering from treatment resistent abdominal pain, and we follow the so called ex juvantibus approach. This means we give the patient the befifit of the doubt, that the pain might be caused by an internal neuropathy, and if so, whether the patients responds favourable on a treatment regime withn Cannabis, orally taken.  

Cannabis and abdominal pain 

Cannabis has been used to treat many different gastrointestinal (GI) conditions, among which inflammatory conditions,  motility disorders, and abdominal pain.

Receptors for Delta(9)-tetrahydrocannabinol are widely distributed throughout the gut, with regional variation and seem to be involved in the regulation of a great many biological functions, among which visceral sensation and intestinal inflammation in the gut. In a recent review the relation between the endocannabinoid system and the gut was described as follows:

Cellular targets have been defined that include the enteric nervous system, epithelial and immune cells. Molecular targets of the endocannabinoid system include, in addition to the cannabinoid receptors, transient receptor potential vanilloid 1 receptors, peroxisome proliferator-activated receptor alpha receptors and the orphan G-protein coupled receptors, GPR55 and GPR119. Pharmacological agents that act on these targets have been shown in preclinical models to have therapeutic potential. ^[1]

This is one of the reasons German doctors from the Johannes Gutenberg-University Mainz wrote:

Under pathophysiological conditions, the endocannabinoid system conveys protection to the GI tract, eg from inflammation and abnormally high gastric and enteric secretion. For such protective activities, the endocannabinoid system may represent a new promising therapeutic target against different GI disorders, including frankly inflammatory bowel diseases (eg, Crohn's disease), functional bowel diseases (eg, irritable bowel syndrome), and secretion- and motility-related disorders.^[2]  

Therefore Cannabis and the gut attracks much attention internationally. ^[3] Already more than 10 years ago the endocannabinoid system was mentioned to be a forgotten target for diseases related to the gut. ^[4]

At the following videoclip I explain how we administer Cannabir orally in order to have the most optimal effect.

July 2010, prof.dr. Jan M. Keppel Hesselink, MD, PhD 

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