CANNABIS FOR CHRONIC PAIN

BY DR. DEBRA KIMLESS

Chronic pain is difficult. The sufferer endeavors to live a normal life but is impeded by pain. It is difficult for their friends and family because they feel powerless, wanting their loved one to feel better and to be an active participant in life. It is just as difficult for their treating physician or health care provider as the current effective FDA approved treatment options are limited.

Traditional therapies are a balancing act of risk versus benefit. We are all very well aware of the opioid epidemic. We are all aware that opioids aren’t FDA approved for chronic pain. But, opioids are still used for chronic pain and to the great peril of patients and their families and friends. Physicians and patients are left with a paucity of options. One such option is the off-label use of prescription medications (technically not FDA approved for the indication of pain) that come with many serious side effects and with unreliable efficacy. Another is the overuse of over-the-counter pain relief medications. Even though they do not require a prescription, these medications also have the risk of serious side effects-like heart attack or stroke. So, what is left?

The answer everyone wants to read is that cannabis is the panacea. Yes, cannabis can be used as a pain reliever, which I will describe shortly. However, nothing is a panacea. Nor should cannabis be the sole treatment. Patients complain they hate it when physicians just throw pills at them. Patients tell me that they hate feeling like a victim. If that is the case, why should patients want cannabis thrown at them? They shouldn’t.

The causes of chronic pain are as varied as the sufferer. Chronic pain itself varies in nature and character--where the symptoms and intensity are in constant flux. However, the common denominator of chronic pain, like many other disease processes, is inflammation. The adequate treatment of pain will be difficult unless the inflammation is quelled. Inflammation is the cause of most of our chronic diseases, including chronic pain. So how do we stop inflammation? It is not simply with a pill, despite what we have been programmed to believe.

TRADITIONAL THERAPIES ARE A BALANCING ACT OF RISK VERSUS BENEFIT

We all have the power to break the inflammation cycle. We need to take an active role in our own healthcare and not be the passive recipients of pills. Our lifestyle choices create or reduce inflammation. Lifestyle choices include the foods we eat, exercise, sleep, and even socialization. I focus on food because marketing and disinformation creates confusion about what is considered healthy eating and eating is an essential part of reducing the inflammation and therefore reducing pain. When we eat processed foods, animal products, and oils (oil is highly processed-think of how many kernels of corn it takes to make a bottle of corn oil), we set up our body for inflammation. When we eat whole food, all-plants, no added oils, no processed foods we transform our internal environment into a healing machine where our immune system is functioning, inflammation is reduced, and pain is reduced. But sometimes lifestyle alone is not enough.

HOW ABOUT CANNABIS? WHERE DOES IT FIT IN?

I think about healthcare as a pyramid, where the base of the pyramid consists of the elements of a healthy lifestyle. When pain becomes chronic, then the next step up the pyramid is to discover the root cause, if possible, and then try less invasive pain healing techniques first, such as physical therapy, acupuncture, meditation, massage. If these modalities aren’t sufficient then the next step up the pyramid is herbal remedies, including cannabis.

According to the 2017 National Academies of Science, Engineering, and Medicine, cannabis may be useful for the treatment of chronic pain and with minimal adverse side effects. I have seen successful pain relief in patients using cannabis as well. In my current position as the chief medical officer for a cannabis company in Michigan, I have the honor and privilege of conducting IRB approved clinical trials using standardized low doses of cannabinoids in a rapidly absorbing tablet that is administered under the tongue. I have gathered patient data (soon to be published) that shows a statistically significant improvement in pain from baseline pain scale scores, and with no reported adverse side effects. The side effects that were reported were a statistically significant reduction in anxiety and an overall improvement in sleep quality. These clinical trials are not a one-off as the results are repeatable. This is exciting stuff!

Patients are always inquiring if smoking is the only way to use cannabis, and will they be able to function while taking cannabis? Cannabis use is not just about smoking, and you don’t have to feel intoxicated or high for it to achieve the desired results. There can be a stepwise approach in its use as well. If a patient has musculo-skeletal pain where the affected area can be touched, then I recommend using a topical application of cannabinoids first. In fact, I call topical cannabis medicines the gateway to understanding cannabis is an effective medicine and without intoxication. If topicals are not enough or the location isn’t accessible to topicals, then I recommend starting with a low dose of cannabis medicine and slowly titrating to effect. Cannabis medicine is different from traditional pharmaceuticals where the pain relief may take a bit longer to take effect, and the reduction of the pain may not be as dense as an opioid. But low dose cannabis allows for full mental functioning as opposed to opioids. Most patients prefer to be functional with their pain reduction and not incapacitated by their medications.

A holistic and comprehensive approach is the best recipe for pain-relieving success. I recommend finding a physician or health care provider who will help guide you in your healing journey with both diet and cannabis medicine.

BE WELL, DR. DEB