Cannabis: An Effective Alternative to Opioids for Chronic Pain
May 25, 2017 05:29PM
by Patricia C. Frye, M.D.Chronic pain is an enormous public health problem. Approximately 85 percent of American adults will experience it at some time in their lives. Medically defined as pain lasting longer than 12 weeks, chronic pain is maladaptive, in that the pain far outlasts the precipitating injury. It is a burden that affects every aspect of the patient’s life—relationships, work, school—effectively diminishing the quality of life for not only the patient but for the patient’s loved ones.
When we look at the pathophysiology of persistent pain, we commonly find one or more of these processes involved: nociception where nerves that respond to tissue damage produce a signal that travels along a chain of nerve fibers via the spinal cord to the brain; inflammation where pro-inflammatory mediators are released from damaged tissue; neuropathy which is caused by damaged nerves, commonly associated with diabetes, vitamin deficiencies, chemotherapy, radiation therapy or injury; and emotional states such as anxiety and depression. Both can signal the release of pro-inflammatory mediators that contribute to persistent pain.
Patients often continue to suffer from pain despite the use of conventional pharmaceuticals which may have harsh and sometimes dangerous side effects. Adverse effects are common—sedation and constipation being the most prevalent.
In 2014, 2 million people in the U.S., or about a quarter of the patients who received prescriptions, were either misusing or were dependent on opiates. They found that methadone, oxycodone and hydrocodone were the drugs most commonly involved in opiate overdoses.
At present, the prescription opiate overdose deaths is rising, except in the states that have legalized medical cannabis where the rate has decreased by almost 25 percent. In 2016, there were almost 1,500 opiate overdose deaths in the state of Maryland, a 62 percent increase from 2015. Because of this, Maryland’s governor recently declared a state-of- emergency.
Our conventional approach to treating chronic pain includes various pharmaceuticals starting with things like COX inhibitors (ibuprofen). We may then move on to SNRI’s (Effexor, Cymbalta), topical anesthetics (lidocaine), tricyclic antidepressants (amitriptyline, cyclobenzaprine) for pain and muscle relaxation, and anticonvulsants (Lyrica, gabapentin, topiramate) for neuropathic pain.
Most chronic pain patients have a medication list that consists of a NSAID which they might alternate with acetaminophen, an antidepressant, a benzodiazepine for anxiety and enhanced pain relief, a muscle relaxer, an anticonvulsant for neuropathy, an opioid, another opioid for breakthrough pain, a sleep medicine, a stool softener or laxative and a proton pump inhibitor for gastritis and reflux
THC and CBD, the major cannabinoids in cannabis, alleviate chronic pain by a variety of mechanisms and also treat anxiety and depression. They signal the nerve to stop firing, inhibit inflammation, protect the nerves from further damage, relax the muscles, decrease anxiety and elevate the mood. THC also has the unique ability to distract patients from their pain so that even if it can’t be eliminated completely, the patient just isn’t bothered by it.
A major benefit to using cannabis is that it potentiates the pain-relieving effects of opiates without increasing the risk of respiratory depression. Patients can achieve better pain relief using cannabis with a much lower opiate dose. Most patients treated with cannabis lower their opiate medication dose by 50 to 75 percent. That, and the regulatory effect of CBD, on the gastrointestinal tract, remedies the constipating effects of opiates. Many chronic pain patients do not sleep well. THC shortens the amount of time it takes to fall asleep and patients sleep through the night, awakening feeling rested and restored.
Cannabis can be administered in a number of different ways that do not involve smoking. There are tinctures that are administered by drops under the tongue, suppositories, capsules and topical salves that relieve pain, inflammation and muscle spasm. When CBD is present, cannabis can be used without causing the patient to be high or stoned.
Other non-pharmaceutical approaches to pain that have been shown to be effective are turmeric for its anti-inflammatory effects, decreasing sugar and processed foods in the diet, stretching, yoga and meditation. Tai chi has been shown to help reduce chronic arthritic knee pain.
So if you are suffering from chronic pain or the side effects of conventional pain therapy, eat right, keep moving, and consider adding cannabis to your regimen. It just might bring you that much needed relief.
Patricia C. Frye, M.D. is the founder of Takoma Alternative Care, located at 6930 Carroll Ave., Ste. 502, Takoma Park, MD. For more information, call 301-328-3045 or visit TakomaCare.com.