Does Marijuana Help Severe Back Pain

International Task Force Shares Recommendations For Dosing Administering

byRyan Basen, Enterprise & Investigative Writer, MedPage Today September 13, 2020

Chronic pain patients can be treated with medical cannabis following one of three protocols based on patient characteristics, according to an international task force at the virtual PAINWeek meeting.

Citing limited clinician knowledge about medical cannabis treatment and the opioid crisis, one task force member said the recommendations are timely.

“We as a task force believe it’s extremely important to bring to patients,” Alan Bell, MD, of the University of Toronto, told MedPage Today. “Our main focus was to provide directions to clinicians.”

Medical cannabis has been suggested to treat chronic pain, the task force noted, but too many providers still do not utilize it because there has not been accepted guidelines about dosing and administration. Others prescribe medical cannabis without knowing how patients can properly dose.

“There’s a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen,” Bell said.

Led by Arun Bhaskar, MD, of Imperial College Healthcare NHS Trust Pain Management Centre in London, the 20-clinician Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain used a modified Delphi process. Among their recommendations:

“Tailoring medical cannabis treatment to the individual is a critical component of successful treatment,” according to the group’s poster presentation at PAINWeek.

Disclosures

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Cannabis For Pain Relief

Concerns about side effects and dependence particularly with opioid painkillers has led many people to consider cannabis as a treatment for their chronic pain. There are reportedly many benefits to cannabis, and one of them is its ability to provide relief for those who suffer from a variety of painful conditions.

One of the loudest voices in the fight for patients right to use marijuana for chronic pain is NFL running back Mike James. In 2013, James injured his ankle and was prescribed opioid painkillers. He quickly developed a dependance on them. Alarmed, he turned to marijuana for pain relief in an attempt to avoid a dangerous addiction. The marijuana worked and for the past few years, James has been in a battle with the NFL for the right to use marijuana for his chronic pain. Cannabis is a banned substance in the league and so far, James hasnt succeeded in getting his treatment approved by NFL officials.

Concern about side effects and dependence has led many people to consider using cannabis for pain.

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What Is Medical Marijuana

Medical marijuana, also referred to as Cannabidiol, is extracted from the dried Cannabis sativa plant. It is a leading cash crop in the US and is used as an herbal remedy for several diseases and symptoms. Medical marijuana is a non-psychoactive chemical compound and thus, has no altering effect on the mind.

There are several solid medical evidences that prove this compound to have effective therapeutic attributes. People use it to treat several disabilities and disorders, some uncommon, others quite common.

The good news however, is that chronic pain like neck and back pain, together with spine conditions, are some of the reasons for which .

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Is Medical Marijuana Helpful And Safe

Medical use of marijuana has been studied for decades. But experts still don’t agree on how safe it is or how well it works.

Some experts don’t recommend marijuana because:

• It’s not approved by the U.S. Food and Drug Administration.
• It may impair your memory, judgment, and coordination. It can increase your risk of being in a car crash.
• There are legal drugs that may work just as well, like new kinds of pain and nausea medicines.

Other experts recommend marijuana because:

• It can help relieve pain when normal pain medicines have unwanted side effects or don’t work.
• It can improve appetite and relieve nausea in people who have cancer or AIDS.
• It may help relieve symptoms such as pain and muscle stiffness from multiple sclerosis.

Be sure to let your doctor know if you’re using medical marijuana. If you’re pregnant, it’s not safe to use marijuana.

What Is Known About The Safety Of Cbd Products

The FDA admits research about the safety of CBD products is quite limited. To date, Epidiolex is the only FDA-approved prescription drug, and this medication is only indicated for treatment of 2 rare types of epilepsy. Bear in mind that just because a product is FDA-approved doesnt mean its completely safe without potential side effects that could be serious.

The FDA warns consumers about illegal CBD marketing strategies and product promises. They also suggest the potential for liver damage, serious side effects when combined with other medications, such as central nervous system depressants . While CBD products can cause side effects , these symptoms may go away when use is stopped. The FDA raises many unanswered questions about the effects on infants and children, not only adults.

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What Are Side Effects Of Marijuana For Back Pain

While medical marijuana is very effective at treating back pain, there is the potential of experiencing side effects. They are usually mild and go away once your treatment wears off. In any event, itâs good to know what they are, so you can sit down with your doctor to discuss them. There are certain side effects each patient should know about the use of marijuana for back pain, or any other pain. The side effects are usually mild and can go way as a treatment wears off. Patient should discuss the side effects with their doctor. Some of the common side effects are as follows:

• Redness of Eyes: Commonly patients will experience redness of eyes. This is not harmful and can be treated by using eye drops such as Visine.

• Short-term memory loss: This is a temporary side effect and does go away as the treatment wears off. Some patients may be more susceptible to it than the others.

• Heightened sensory perception: This side effect can impact a patient’s site, hearing, sense of taste and smell.

• Fatigue: This side effect is common with high THC strains. One can balance it with the use of low THC strains.

Conventional Treatments For Back Pain

Recommended treatments to relieve back pain depend on how long the pain lasts. These include massage, physical or chiropractic therapy, over-the-counter medications like Tylenol or Advil, and prescription medications, including opioid painkillers.

Exercise, proper diet, and hot and cold packs can also help. Resting in bed is not usually recommended. Surgery is a last resort and depends on the cause of the back pain.

In addition to these treatments, some doctors are now considering medical marijuana for managing symptoms of back pain.

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Pharmaceutical Formulations Of Cannabis

Marijuana has commonly been used to alleviate chronic pain. Routes of administration include oral, inhalation, sublingual, topical, or intravenous . Medical marijuana is synthetically modified cannabis used for symptom management. Cannabis is a general term referring to the products derived from the plant genus Cannabis . The active ingredients in plant-based cannabis, termed cannabinoids, are tetrahydrocannabinol the psychoactive component and cannabidiol . Cannabinoids are widely used in pain relief and may be synthetically modified for use . Dronabinol is a synthetic form of THC with the same psychoactive and pain modulation properties as the plant counterpart . Pharmaceutical cannabinoids include dronabinol nabilone and nabiximols . Globally, most cannabis-based pharmaceuticals are not approved for medical use. Nabilone, Epidiolex, and dronabinol are used in Canada and the USA, while nabiximols are used in Canada, New Zealand, and Europe. Marinol© was recently withdrawn from the Canadian market by the manufacturer for unknown causes . Cannabis also exists as oil and may be used in baked goods resulting in slower THC absorption, a delayed onset and a prolonged period of intoxication compared to inhalation . The utilization of CBD in conditions such as epilepsy, multiple sclerosis , Huntingtons disease, and more, is currently being evaluated.

The Challenge Of Effective Pain Management Medical Marijuana For Pain

For some patients with degenerative disc disease, spinal canal stenosis, other common problems associated with overuse and ageing, or whove had unsuccessful or only partly successful back surgery, the long-term management of their back and nerve pain can be a real challenge.

The major active ingredients of cannabis are called cannabinoids. THC and CBD oil are the best-known cannabinoids. They have been isolated or synthesised to make medicinal cannabis. CBD oil has a known anti-inflammatory affect and is useful in the treatment of nerve pain.

In some pain studies and for some patients, CBD oil seems to work best when combined with a small amount of THC. This kind of formula relieves pain without any of the cognitive side effectsdisorientation, confusionwhich are possible with THC alone. An example of this is sold under the brand name Sativex.

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Having Those Hard Conversations

Rolling a joint at work isnt exactly socially acceptable yet. It can be difficult to explain your medical marijuana use with family members, especially children . The historical propaganda and stigma surrounding marijuana can complicate life for the medical marijuana user. While there is still a dearth of research on medical marijuana, there is no record of anyone overdosing from marijuana. However, the jury is still out on whether one can develop a physical dependence or addiction to the substance.

At the end of the day, your pain is your own experience and how you choose to manage your condition is a personal choice. While the science of marijuana for pain relief is new and evolving, its historical use is more traditional than most people realize. Whatever your choice, it should be about what helps you live your happiest, healthiest, and most pain-free life.

What Is Synthetic Marijuana

Synthetic marijuana is made of dried plant material that is treated with chemicals that produce effects like marijuana’s effects. It is sold in the form of incense under many names, such as K2 or Spice. The labels often claim that these products are “safe” or “natural.” But in fact, the active chemicals are created in a lab. And they have not been tested for safety.

But young people often try these products because they are easy to buy and they may not be detected by drug tests.

People think that using these drugs will make them feel the same as when they use marijuana. But these drugs are stronger than marijuana. And the effects are hard to predict. That’s because the type and strength of the chemicals used are often unknown. Some people have reported severe symptoms, such as:

• Fast heart rate and high blood pressure.
• Vomiting.
• Feeling agitated or confused.
• Feeling like others want to harm them , or seeing or hearing things that aren’t there .

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Treatment Of Spinal Stenosis With Medical Marijuana

The current treatments for spinal stenosis are primarily pain management and surgery. Pain management can include counseling, physical therapy and/or pain medications. Medical marijuana cannot replace counseling, physical therapy or surgery if the need for these remedies presents in a person with spinal stenosis.

However, it can replace, complement and/or act as a pain medication for individuals with chronic pain from spinal stenosis. Research also indicates it may help relieve addiction to opiates in individuals who have been prescribed addictive medications for an extended period due to chronic pain.

North Dakota has approved spinal stenosis as a qualifying condition for the use of medical marijuana, and many other states have approved chronic pain for cannabis.

Enhancing Healthcare Team Outcomes

The treatment of chronic pain requires an interprofessional approach. As with any patient encounter, a thorough history and physical exam are essential when delineating appropriate treatment options for chronic pain patients. The complexity of treating chronic pain patients is attributable to the subjective nature of pain, variability of pain tolerance amongst patients, and the psychosocial impact of chronic pain. Therefore, effective collaboration amongst various disciplines, including physiatrists, physical therapists, psychologists, pain management physicians, neurologists, psychiatrists, social workers, is necessary to ensure the best possible outcome for patients. Questionnaires and other forms can be offered to patients to monitor symptomatic improvement in pain and quality of life after initiating cannabis use. Nonetheless, ongoing research and studies are required to determine the actual effectiveness of medicinal cannabis as a possible alternative treatment for chronic pain.

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Cbd And Thc: Side Effects And Legal Concerns

THC might not be an option for everyone, though. Some people may live in states where THC is illegal while others simply dont want the psychoactive effects of the substance. In those cases, it might be worth trying CBD on its own to see if it offers pain relief for you.

CBD isnt legal everywhere either. And in states where CBD is legal, laws can vary as to how much THC is permissible in CBD products in order for them to be legally sold. Many states in which certain CBD products are legal require them to contain less than 0.3 percent THC.

Before trying either substance, its worth considering potential side effects they may cause. Side effects of CBD include nausea, fatigue, and irritability, according to Harvard Health. CBD can also interact with certain medications and either increase or decrease the concentration of certain drugs in the bloodstream.

THC has its own set of side effects, including sleepiness and lethargy, increased appetite, increased heart rate, coordination problems, dry mouth, red eyes, slower reaction times, memory loss, anxiety, and mood changes.

Its quite likely that individuals will respond to different versions of these cannabinoids, and some may not respond at all, says Dr. Alexander. Theres a tendency for anecdotal evidence to highlight the positives of people who do respond , which is useful, but its difficult to measure the numbers of people who dont get a lasting benefit.

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The Legal Stuff: How Do I Get Medical Marijuana

Depending on which state you live in, marijuana laws will vary. In states like Alaska, Massachusetts, California, Colorado, Maine, Washington and Nevada, all uses of marijuana have been legalized.

In other states, recreational marijuana is illegal but medical use is permitted. These states include: Arizona, Arkansas, Florida, Hawaii, Louisiana, and Michigan.

In five states the THC level of medical marijuana is capped and controlled. Anything over the level of THC outlined by the state is not permitted. South Carolina and Tennessee have most limited THC content permitted, stating that cannabis oil must contain less than 0.9% THC.

As of this writing, only 4 states deem marijuana illegal for medical use. Currently, medical marijuana is still illegal in:

• South Dakota
• Kansas
• Idaho

Note: Heres an updated list with the legality of marijuana across the USA .

The rest of the states allow some form of legal medical marijuana use. However, costs and difficulty associated with obtaining a license or prescription vary. In addition, marijuana is largely not covered by insurance as it is not directly prescribed by providers. A lot of patients independently go to dispensaries to get their medical marijuana and not entirely government-controlled.

District of Columbia has the most expensive price per ounce of high-quality marijuana. Per ounce, it costs nearly three times the average price on Oregon!

Here are the states where medical marijuana is broadly legalized :

• Alabama

Cbd For Chronic Pain: The Science Doesnt Match The Marketing

• By Shafik Boyaji, MD, Contributor

If you ask health care providers about the most challenging condition to treat, chronic pain is mentioned frequently. By its nature, chronic pain is a complex and multidimensional experience. Pain perception is affected by our unique biology, our mood, our social environment, and past experiences. If you or a loved one is suffering from chronic pain, you already know the heavy burden.

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