Cannabis as medicine, aura and valebo - a new perspective on self-medication and medical support for chronic diseases

Abstract

It is known from medical practise that patients and physicians can have positive experiences with little-researched and unapproved interventions. Under certain circumstances, effects even go beyond the placebo effect. Based on casuistics of chronic pain patients, the question of whether self-medication in the context of a good doctor-patient relationship can optimize the efficacy of cannabinoids and reduce dose and undesirable side effects is investigated. Using medicinal cannabis as an example, a new view on self-medication and medical support is proposed. The casuistics show that daily requirements (average of approximately 75 mg) for Δ9tetrahydocannabinol (THC) doses can be reduced. An unaccompanied and risky self-medication can be transformed into an effective therapy with significantly less medical cannabis. The approach consists of tracing the self-medication that has taken place to date and picking up the patient where he has "discovered" something for himself. The specific mode of action of cannabis in chronic diseases can be explained by mechanisms in the endocannabinoid system. Cannabinoids relieve patients in the context of stress, anxiety and depression, which are always involved in chronic diseases. In their physical as well as psychological sensations, patients are strengthened and eventually guided into self-efficacy. If the patient has "discovered" cannabis as medicine for himself and can draw on positive experiences, something very powerful can emerge. In addition to the specific effects demonstrated by studies, there are non-specific effects or contextual factors at work that tend to be neglected in evidence-based medicine. These non-specific effects include, above all, those factors through which a patient gives a (subjective) meaning to a specific intervention. A new view on self-medication and medical support in chronic diseases is needed.