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Cannabis for Chronic Pain

Pain is the most common condition for which physicians recommend cannabis and for which patients report using it. The key to effectively using cannabis for pain is finding the optimal dose or "sweet spot" for pain relief.

As cannabis science continues to unfold, many are talking less about being buzzed and more about their anterior cingulate cortex and the sensorimotor cortex—in other words, the portions of the brain that process pain sensations. This is because a hallmark study has confirmed what so many patients will already know: Cannabis appears to reduce pain sensations.

An Israeli study published in Neurology, the journal of the American Academy of Neurology, described a research project conducted on men who experienced nerve pain in the legs. After initially rating their pain from zero to 100, the study participants were divided into groups, with some taking cannabis oil containing tetrahydrocannabinol (THC) and others taking a placebo.

The process was repeated a week later, with participants who received the cannabis oil now taking the placebo. What the study found is that patients taking the cannabis oil reported a significant lessening of their pain.

"Our study results link pain relief from THC with a reduction in the connections between areas of the brain otherwise heavily connected, suggesting that THC may alleviate pain by disrupting signals between these pain processing pathways," said Dr. Haggai Sharon, one of the study’s authors.

Another study, conducted in October 2018 by Canada’s McGill University Health Centre found that low doses of cannabidiol (CBD) given to animals not only alleviate pain, but also reduce anxiety.

And a third report published by an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine found there was “conclusive or substantial evidence that cannabis or cannabinoids are effective in the treatment of chronic pain in adults.”

The authors of the report compiled over 10,000 medical cannabis studies undertaken since 1999, and though not all of their findings pointed to cannabis as a global cure-all, its use for pain relief was found to be definitive.

Why Try Cannabis for Pain Management? Cannabis is a natural plant option with few side effects and minimal addictive qualities. Patients are tired of the side effects associated with traditional painkillers including:

  • Damage to the stomach and liver associated with long-term use of NSAID’s like ibuprofen

  • Excruciating constipation that those taking opiates may suffer with on a daily basis

  • Muscle relaxants that can render a person useless for anything but lying in bed

  • The downward spiral associated with opioid addiction, which has become a global public health emergency

Is it any wonder that patients would look for healthier, more natural alternatives?

Cannabis Can Be a Safe, Gentle Complement to Opioid Pain Medications Despite the fact that research is still ongoing in terms of the efficacy of cannabis and pain relief, there’s one very important statistic to consider: States where medical marijuana has been legalized have a staggering 25% fewer deaths linked to opioid abuse.

Some patients report life-changing results when they add medical marijuana to their pain-relief regimen. And with no recorded death ever from a cannabis overdose, more and more states are voting to allow medical cannabis in their jurisdictions.

Regardless of the strain or form of cannabis, the key is the amount of THC and CBD in the final product, according to David Bearman, MD, a physician in private practice who specializes in pain management and has more than 40 years of experience in managing substance abuse.

For patients with concerns about the psychogenic effects, he recommends starting with a one-to-one ratio of THC to CBD for chronic pain. “I usually suggest that people start with 7.5 mg [which, using a standard unit converter amounts to 0.003 oz.] of THC and 7.5 mg of CBD, three or four times a day, I tell them that the most likely effect is that (a) it’s not going to make their pain go away, and (b) they’re not going to get high.”

For pain relief, he recommends a dose of 15mg THC (0.0005 oz) to 15 mg CBD. In his experience, doses of THC less than 15 mg generally don’t provide pain relief. Doses may be increased if necessary, best guided under a doctor’s orders, to achieve pain relief without unacceptable side effects.

The key to prescribing medical cannabis for pain is two-fold. A personalized approach is needed. Each patient is different, and many adjustments may be needed to zero in on the dose that controls pain with minimal side effects. It’s also important to start patients on a low dose of THC and CBD and titrate slowly, explained Dr. Bearman.

How Do I Begin Adding Cannabis to My Pain Program?
 Educate yourself: There are so many ways to take cannabis for pain relief, so do your homework.

Understand that medical cannabis therapy looks different for every individual. There’s no one- size-fits-all approach for medical marijuana, as everyone responds differently to the plant.

Start slowly: If you’re brand new to cannabis, consider using a topical cream or oil containing non-psychoactive CBD for starters. Some patients derive immense pain relief from CBD products, while others need the psychoactive components found in THC to alleviate pain. Whatever cannabis product you try, start with a very small amount and wait to see how it affects you before you take more.

Eat cannabis edibles with caution: If you want to medicate with marijuana edibles, start with very small amounts, also known as microdosing. For most, around 2–5 milligrams of THC per dose is a good place to start until you know your unique response to the product. Wait a couple of hours before eating more, if you feel like you need it.

Journal your cannabis experience: Use your journal to adjust your doses and to help document what worked best for you. Things to write down are:

  • The name and type of product you tried

  • How much you used

  • When you used it

  • How you felt after taking it

Combine & conquer: Once you’ve familiarized yourself with the many types of cannabis pain-relief options available, you may want to try layering. This is a technique where you take medicinal cannabis by different consumption methods through the day to layer the different effects of the products. Some pain patients begin their day by smoking or vaping a cerebral, sativa- dominant cannabis strain. Then, as their pain spikes, they may turn to concentrates with a more sedative effect or a topical if they’re out and about. Finally, to help with sleep, some folks wind down with a cannabis-infused bath bomb, or a marijuana edible to promote relaxation and a good night’s rest.

Be a patient patient: Sometimes, enthusiastic cannabis consumers may give people the impression that marijuana is the answer to all of your medical woes. When we’re suffering, we all want relief, but as with any medication, cannabis may work miraculously for some and not at all for others. Learning to manage pain using cannabis takes time, and what works for one person may not work for another. Sometimes it takes a little experimentation to find what works for you.

Often, with a little tenacity and some adjustments to your regime, you’ll discover how to create your cannabis sweet spot, which will hopefully result in reduced pain, an enhanced quality of life and a marked improvement in your ability to manage your aches and pains.

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