Cannabis Withdrawal and Body Pain
Yes, quitting marijuana can lead to body pain as a recognized symptom of cannabis withdrawal syndrome (CWS). Body pain is an established physical manifestation of cannabis withdrawal, occurring alongside other characteristic symptoms when heavy or prolonged cannabis use is abruptly stopped.
Physical Pain as a Withdrawal Symptom
Body pain is explicitly recognized as part of the DSM-5 diagnostic criteria for cannabis withdrawal syndrome. The diagnostic criteria require three or more symptoms including "a physical symptom causing significant discomfort (such as abdominal pain, tremors, sweating, fever, chill, or headache)" 1. These physical discomfort symptoms are well-documented manifestations of withdrawal 2.
Additional physical symptoms that may occur include:
- Headaches 1, 2
- Abdominal pain or stomach discomfort 1, 2, 3
- Tremors 1, 2
- Physical tension 4
- Muscle pain or stiffness 1
- Sweating, fever, or chills 1, 2
Timeline and Severity of Withdrawal Pain
Withdrawal symptoms typically begin 24-72 hours after cannabis cessation, peak during the first week, and can last 1-2 weeks, though some symptoms may persist up to 3 weeks or longer in heavy users 1, 4. More specifically, symptom onset occurs at 24-48 hours, with peak intensity at days 2-6 4.
The severity of withdrawal symptoms, including body pain, correlates directly with the amount of cannabis consumed before cessation 2, 5. Withdrawal is more likely to occur in patients consuming:
- More than 1.5 g/day of inhaled cannabis 1, 2
- More than 300 mg/day of CBD-dominant oil 1, 2
- More than 20 mg/day of THC-dominant cannabis oil 1, 2
- Cannabis products with unknown CBD/THC content more than 2-3 times daily 1, 2
Conversely, withdrawal symptoms are unlikely in patients consuming 300 mg/day or less of smoked CBD-dominant cannabis (approximately one cigarette) 1, 2.
Clinical Significance and Impact
Cannabis withdrawal can theoretically contribute to increased pain perception and decreased pain tolerance in the postoperative or clinical setting 1. This is particularly relevant because:
- Withdrawal from an analgesic or anxiolytic cannabis regimen may contribute to increased postoperative pain perception 1
- The removal of cannabis as a coping mechanism can increase distress and decrease tolerance of pain 1
- Cannabis users may have developed tolerance to certain NSAIDs and opioids, complicating pain management 1
Women report stronger cannabis withdrawal symptoms than men, including more prominent physical symptoms such as nausea and stomach pain 6. Younger age predicts greater severity and worsening of withdrawal symptoms over time 5.
Neurobiological Basis
Regular cannabis use causes downregulation and desensitization of cortical and subcortical CB1 receptors, which begin to reverse after 48 hours of abstinence and return to normal in approximately 4 weeks 1, 6. This neurobiological timeframe corresponds with the duration of withdrawal symptoms and provides the physiological basis for the physical discomfort experienced during cessation 6.
Management Considerations
For patients experiencing significant withdrawal symptoms including body pain, supportive counseling and psychoeducation are first-line approaches 4. When symptoms are severe:
- Consider nabilone or nabiximols substitution for patients with CWS symptoms, particularly those who were consuming high amounts of THC-dominant cannabis 1
- Referral to psychiatry or addiction medicine services is appropriate for suspected CWS 1
- Medications may be used to manage short-term symptoms, though no medications are currently approved specifically for cannabis withdrawal 4
- Mirtazapine can be beneficial for treating withdrawal-related insomnia 6
- Gabapentin and THC analogs show promising results in treating CWS 6
Important Clinical Pitfalls
Cannabis withdrawal must be distinguished from cannabinoid hyperemesis syndrome (CHS), as both can present with abdominal pain and physical discomfort but require different management approaches 3. CHS involves cyclical vomiting episodes relieved by hot showers, while CWS occurs after cessation and includes a broader constellation of withdrawal symptoms 1, 3.
Cannabis users with concurrent opioid dependence are less likely to experience CWS overall, but when they do, they report more frequent sleep disturbances 1, 7. This population requires special consideration in withdrawal management 7.