Cannabis and Chronic Pain: A Comprehensive Guide

Types of Pain

1. Nerve Pain: Arising from damage or disease affecting the nervous system, nerve pain often feels like a burning or stabbing sensation. Examples include conditions like trigeminal neuralgia or post-herpetic neuralgia.
2. Muscle Pain: Usually associated with tension, overuse, or muscle injury from exercise, muscle pain can be widespread or localized, presenting as a deep, aching sensation.
3. Nociceptive Pain: This pain results from actual or potential damage to non-neural tissues and is due to the activation of nociceptors, which are pain sensors. It often presents as a sharp, aching, or throbbing pain.
4. Radicular Pain: A type of pain that radiates into the lower extremities due to irritation of nerve roots. Sciatica is a common example, often resulting from a herniated disc.
5. Neuropathic Pain: Caused by damage to the nervous system itself, such as from diabetes, chemotherapy, or injury. It often feels like a burning or shooting pain.
6. Cancer Pain: This arises due to the tumor pressing on other organs or nerves, as well as from treatments like chemotherapy or radiation.

Timing of Pain

• Acute Pain: A direct response to tissue damage, often sudden and sharp. It can be a precursor to chronic pain.
• Chronic Pain: Persists beyond the natural healing time of an injury, usually longer than 12 weeks. It may or may not have a known cause.
• Intermittent Pains: These are sporadic flare-ups of sharp or dull aches that come and go.

Current Scope of Treatment Options

Popular Over-The-Counter Options:

1. Ibuprofen
2. Aspirin
3. Naproxen
4. Acetaminophen
5. Topical analgesics (like Bengay or Icy Hot)
6. Capsaicin
7. Lidocaine patches
8. Menthol gels
9. Salicylates
10. Magnesium salicylate

Popular Prescription Pharmaceuticals:

1. Opioids (like Morphine, Codeine, Oxycodone)
2. Tramadol
3. Gabapentin
4. Pregabalin
5. TCA antidepressants
6. SSRI & SNRI antidepressants
7. COX-2 inhibitors
8. Muscle relaxants
9. Topical NSAIDs
10. Steroids

Alternative Medicine Options:

• Acupuncture
• Massage
• Nutrition
• Exercise
• Chiropractic treatments
• Yoga
• Biofeedback
• Psychotherapy

Cannabinoid Therapies: Current Evidence

Cannabis has emerged as a multi-faceted tool in pain management. Studies reveal that cannabinoids, the active components in cannabis, can modulate pain by inhibiting neuronal transmission in pain pathways. This mechanism is particularly influential in reducing chronic pain. Furthermore, the pain relief offered by cannabis does not have the same risk profile as opioids, which have a high risk of dependency and adverse side effects. Cannabis, particularly when used under guided therapy, has shown promise in treating various pain types. Whether acting as a primary treatment or an adjunct to other modalities, its efficacy, especially in conditions refractory to other treatments, is noteworthy.

How Cannabis is Different

The realm of cannabinoid therapies offers patients an empowering approach to pain management. With cannabis, individuals gain the autonomy to select, adapt, and personalize their treatments. The products can be adjusted to address real-life, daily challenges. At CED Clinic, we’ve seen as many as 70% of patients report significant pain improvement under guided cannabinoid therapy. Beyond pain relief, certain cannabinoid products provide euphoria, while others are non-intoxicating, giving patients the power to choose their experience.

Comparative Chart on Treatment Options for Chronic Pain

Treatment Type	Cost	Effectiveness	Local vs. Systemic	Risks and Limitations	Onset & Duration
Over-The-Counter Options
Ibuprofen	$	Good	Systemic	Gastric ulcers, kidney issues	15-30 min; 4-6 hours
Acetaminophen	$	Good	Systemic	Liver toxicity	30 min; 4-6 hours
Aspirin	$	Good	Systemic	Gastric ulcers, bleeding risk	15-30 min; 4-6 hours
Naproxen	$	Good	Systemic	Gastric ulcers, heart risk	30 min; 8-12 hours
Topical Menthol	$	Fair	Local	Skin irritation	5-10 min; 2-3 hours
Prescription Pharmaceuticals
Opioids	$$	Very good	Systemic	Dependency, overdose risk	30 min; 4-12 hours
Gabapentin	$$	Good for neuropathic pain	Systemic	Drowsiness, dizziness	1-2 hours; 8-12 hours
Pregabalin	$$$	Good for neuropathic pain	Systemic	Drowsiness, weight gain	1-2 hours; 12 hours
Tramadol	$$	Good	Systemic	Dependency, seizure risk	1 hour; 6-8 hours
COX-2 inhibitors	$$	Good	Systemic	Heart risk, gastric ulcers	30 min; 12-24 hours
Alternative Medicine Options
Acupuncture	$$-$$$	Varies	Local	Minimal if done by a professional	Varies; Days to weeks
Massage	$$-$$$	Good for muscle pain	Local	Slight soreness post-massage	Immediate; Days to weeks
Chiropractic	$$-$$$	Varies	Local	Risk varies by procedure	Immediate; Days to weeks
Biofeedback	$$$	Varies	N/A	Time intensive	Varies; Days to weeks
Yoga	$-$$	Good for muscle pain	Systemic	Injury risk if not done properly	Varies; Days to weeks
Cannabinoid Therapies
Smoking	$$	Varies	Systemic	Respiratory concerns	Immediate; 1-3 hours
Edibles	$$	Varies	Systemic	Delayed onset, long duration	30 min-2 hours; 4-12 hours
Tinctures	$$-$$$	Varies	Systemic	Dosage precision required	15-45 min; 4-8 hours
Topicals	$$	Varies	Local	Minimal	5-10 min; 2-4 hours
Vaporization	$$-$$$	Varies	Systemic	Respiratory concerns less than smoking	Immediate; 1-4 hours

Unhappy with Your Doctor?

Unhappy with Your Doctor? Reflecting on one’s dissatisfaction with a healthcare provider can be an introspective journey into our values and expectations regarding medical care. The modern healthcare system often promotes efficiency, with clinicians sometimes defaulting to pharmaceutical solutions as quick remedies to complex problems. While evidence-based medicine, which is built upon the foundation of meta-analyses, randomized controlled trials (RCTs), and peer-reviewed publications, underscores the importance and efficacy of many pharmaceutical treatments, the art of medicine requires more than just dispensing a pill. Tailored patient care, a cornerstone of effective medical practice, emphasizes understanding the individual behind the symptoms. Each patient carries a unique narrative – a blend of cultural, psychological, physiological, and environmental factors that shape their health and wellness. In an era where a 15-minute consultation has become the norm, the nuances of a patient’s life story can easily be overshadowed by the pressing need to diagnose and treat. A healthcare provider who takes the time to genuinely listen, to unravel the intricacies of a patient’s life, is not just offering a service; they are building a therapeutic alliance. This alliance is grounded in trust, understanding, and mutual respect. It allows for the co-creation of treatment plans that are not just clinically sound but also resonate with a patient’s values and life circumstances. When such an alliance is lacking, patients may feel unheard, their concerns minimized, and their holistic well-being neglected. Their dissatisfaction isn’t just about the absence of a pill or a prescription; it’s about the absence of recognition as a unique individual with specific needs and aspirations. Therefore, if one finds themselves unhappy with their doctor, it might be a moment to reflect on the nature of the doctor-patient relationship they desire. Is it one that rushes towards symptomatic relief, or one that dives deep into the heart of individualized care? In the world of medicine, where evidence-based practices, as showcased in esteemed journals like The New England Journal of Medicine, guide clinical decisions, the humane aspect of patient care – the art of truly seeing and understanding a patient – remains paramount.

What Makes a Good Doctor?

Good Doctors	Bad Doctors
1. Actively listen to patients	1. Dismiss patient concerns
2. Stay updated with latest research and medical advances	2. Rely on outdated practices
3. Exhibit empathy and compassion	3. Display indifference or impatience
4. Encourage patient participation in decision-making	4. Make decisions without consulting patients
5. Prioritize patient’s well-being	5. Prioritize other factors (e.g., financial) over patient care
6. Transparent about limitations	6. Overstate expertise or hide uncertainties
7. Continuously engage in professional development	7. Neglect ongoing education
8. Collaborate well with other healthcare professionals	8. Work in isolation or display ego in collaborations
9. Provide evidence-based care	9. Base decisions on anecdotal experiences
10. Effective communicator	10. Poor communication skills
11. Respect patient autonomy	11. Push their agenda or beliefs
12. Maintain patient confidentiality	12. Careless with patient information
13. Admit mistakes and take corrective actions	13. Deny or deflect blame
14. Allocate adequate time for each consultation	14. Rush through appointments
15. Focus on preventative care	15. Focus solely on symptomatic relief
16. Cultivate a strong doctor-patient relationship	16. Maintain a distant or transactional relationship
17. Seek feedback to improve services	17. Disregard patient feedback
18. Advocate for patient’s needs both in and out of the clinic	18. Show apathy towards broader patient needs
19. Exhibit cultural sensitivity and awareness	19. Display cultural insensitivity or bias
20. Uphold medical ethics and integrity	20. Exhibit questionable ethical practices

References:

1. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796-804.
2. Haidet P, Dains JE, Paterniti DA, et al. Medical student attitudes toward the doctor-patient relationship. Med Educ. 2002;36(6):568-574.
3. Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267(16):2221-2226.
4. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553-559.

References:

1. Russo, E. B. (2008). Cannabinoids in the management of difficult to treat pain.
2. Martin-Sanchez, E., et al. (2009). Systematic review and meta-analysis of cannabis treatment for chronic pain.
3. Greenhalgh T, Howick J, Maskrey N. Evidence based medicine: a movement in crisis? BMJ. 2014;348:g3725.
4. Beach MC, Inui T. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21(Suppl 1):S3-8.
5. Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Aff (Millwood). 2010;29(7):1310-8.

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