We are in the midst of an opioid overdose epidemic.
As the laws on prescribing narcotics become stricter, the millions of people who suffer from chronic and debilitating pain are left to fend for themselves. Denied access to pain-relieving medication, those with excruciating conditions are suffering, searching for alternative forms of relief.
It is in this light that I asked neuromuscular specialist, Dr. Greg Carter, chief medical officer of St. Luke’s Rehabilitation Institute and clinical professor at Washington State University’s College of Medicine about his research on cannabis as it relates to neuropathic pain in CMT.
By Greg Carter, MD
Humans have used cannabis (marijuana) as a safe and useful pain reliever for thousands of years. With appropriate patient screening and physician oversight, it can be used to treat chronic pain, particularly neuropathic pain, which causes people with CMT much grief and suffering.
Originally delta-9-tetrahydrocannabinol (THC) THC was felt to be the main active ingredient in cannabis. However, over the past several decades, other compounds unique to cannabis (“cannabinoids”) were isolated and characterized. Cannabis is now estimated to contain over 100 such compounds, many of which are not psychoactive but have potential medicinal benefits. This includes compounds like cannabidiol (CBD) and cannabinol (CBN).
We now know there is an internal cannabinoid system in our bodies that is intricately involved in the control of movement, pain, memory, mood, motor tone, and appetite, among others. Activation of this internal “endocannabinoid system” is what produces the runners high, among countless other physiological effects.
Overall evidence indicates that cannabinoids are safe and effective if used properly and may relieve pain without serious adverse effects. You do not need to be “high” to get pain relief. Strains that have higher CBD content and lower THC strains are the best. Patients should not smoke cannabis but rather use concentrated tinctures, putting several drops under the tongue. Vaporizers can also be used, which allows for inhalation of active hot mist, without the smoke. For dosing, patients should “start low and go slow.” They can take two or three inhalations, stop, and wait 10 minutes to see what the effects are. Ingestion takes about an hour to get effects so it’s harder to dose but lasts longer. Cannabis is absorbed through the skin and may be used in a liniment for localized pain. Patients should not drive or do anything that requires full cognitive and motor function while medicated with cannabis.
Patients with CMT need to be aware of the laws in their particular state or country. Even in states that allow for medicinal use, there may be laws that require that all standard means of treating pain be tried and failed before cannabis can be offered. Arguably, any decision to offer medicinal cannabis as a treatment option will depend on the severity of the underlying pain condition and the extent to which other approaches have been tried. Patients also need to be aware that the use of cannabis for any reason remains illegal under federal law in the United States.
Here are a few of his sources, including one of his research papers:
Br J Clin Pharmacol. 2011 Nov
Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials.
Abstract
Effective therapeutic options for patients living with chronic pain are limited. The pain relieving effect of cannabinoids remains unclear. A systematic review of randomized controlled trials (RCTs) examining cannabinoids in the treatment of chronic non-cancer pain was conducted according to the PRISMA statement update on the QUORUM guidelines for reporting systematic reviews that evaluate health care interventions. Cannabinoids studied included smoked cannabis, oromucosal extracts of cannabis based medicine, nabilone, dronabinol and a novel THC analogue. Chronic non-cancer pain conditions included neuropathic pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Overall the quality of trials was excellent. Fifteen of the eighteen trials that met the inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared with placebo and several reported significant improvements in sleep. There were no serious adverse effects. Adverse effects most commonly reported were generally well tolerated, mild to moderate in severity and led to withdrawal from the studies in only a few cases. Overall there is evidence that cannabinoids are safe and modestly effective in neuropathic pain with preliminary evidence of efficacy in fibromyalgia and rheumatoid arthritis. The context of the need for additional treatments for chronic pain is reviewed. Further large studies of longer duration examining specific cannabinoids in homogeneous populations are required.
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J Neuroimmune Pharmacol. 2015 Jun;10(2):293-301.
Cannabinoids for the Treatment of Chronic Non-Cancer Pain: An Updated Systematic Review of Randomized Controlled Trials.
1
Departments of Anesthesiology, Pain Medicine and Perioperative Care, Psychiatry and Pharmacology Dalhousie University, Halifax, Nova Scotia, Canada, mary.lynch@dal.ca.
Abstract
An updated systematic review of randomized controlled trials examining cannabinoids in the treatment of chronic non-cancer pain was conducted according to PRISMA guidelines for systematic reviews reporting on health care outcomes. Eleven trials published since our last review met inclusion criteria. The quality of the trials was excellent. Seven of the trials demonstrated a significant analgesic effect. Several trials also demonstrated improvement in secondary outcomes (e.g., sleep, muscle stiffness and spasticity). Adverse effects most frequently reported such as fatigue and dizziness were mild to moderate in severity and generally well tolerated. This review adds further support that currently available cannabinoids are safe, modestly effective analgesics that provide a reasonable therapeutic option in the management of chronic non-cancer pain.
Pain Manag. 2015;5(1):13-21. doi: 10.2217/pmt.14.49.
Re-branding cannabis: the next generation of chronic pain medicine?
Carter GT1, Javaher SP, Nguyen MH, Garret S, Carlini BH.
St Luke’s Rehabilitation Institute, Spokane, WA 99202, USA.
Abstract
The field of pain medicine is at a crossroads given the epidemic of addiction and overdose deaths from prescription opioids. Cannabis and its active ingredients, cannabinoids, are a much safer therapeutic option. Despite being slowed by legal restrictions and stigma, research continues to show that when used appropriately, cannabis is safe and effective for many forms of chronic pain and other conditions, and has no overdose levels. Current literature indicates many chronic pain patients could be treated with cannabis alone or with lower doses of opioids. To make progress, cannabis needs to be re-branded as a legitimate medicine and rescheduled to a more pharmacologically justifiable class of compounds. This paper discusses the data supporting re-branding and rescheduling of cannabis.
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Very timely blog!! I have been considering taking non-THC or low THC CBD oil so that I can slowly wean off Gabapentin for pain management. There are so many CBD oils that are out there and they are costly. Since the CBD industry isn’t well regulated, how do you know which ones are legit and pure? I would love to hear from users of CBD oil that have CMT to hear which ones are good for CMT pain management.
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Very informative as usual. Thanks for sharing and I hope that treatment for anyone with chronic pain will be able to use Cannabis and it will be readily available for those unfortunate people liveing a life of pain because traditional medicine has failed to help them.
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In alot of cases it’s not that modern medicine failed it’s modern medicine has been aborted , those optional guidelines from the CDC have done a number on many formerly stable patients who’s physicians have abandoned evidence based medicine involving opioid medication and arbitrarily have cut back or cut off patients entirely.
I will say there was a problem with mismanaged pain patients and the B’s big pharma was claiming and convinced physicians to forget about the lessons learned from the first opioid epidemic in the early 1900, when heroin and syringes were legally purchased from the Sears catalog (our first addicts were primarily women and children ,because in those days women were domestic goddess and men worked) I tried raising the alarm on Oxcycontin with Dr’s, phatmacists,rehabs, police around ’94-95 and got no traction got told by one rehab its not a drug of abuse or addiction, “your wifes only problem is her crazy husband who thinks she has a problem, you should divorce him” I told the woman she was full of crap and don’t remeber me remember you were warned this is going to blow up in your face!And indeed it has but most of the patients who went ” bad” are dead and gone , today’s problems are the conflating of pain patients , street drugs ,and addiction as one issue it’s not and anyone who tries to say other wise needs a reality check . lack of common sense and lack of care got us here the lessons of heroin were completely disregarded by those who new , the same reps that got physicians to forget because it was profitable ,fast and easy . But once again it’s lack of care that is keeping the problem burning and leaving many patients to turn to readily available street drugs that are cheap however they are also laced with Sublimaze or as its called today fentanyl & carfentanyl death on the head of a pin, we haven’t in my county had an honest heroin overdose death in about 2 years, on post and tox it’s been Fentanyl & carfentanyl has to be 4 or 5 hundred deaths and we get at least 9 or 10 drug related cardiac arrests a day with resuscitation and signing out AMA to go try again 3 or 4 hours later it’s not uncommon to resusitated the same person twice on a shift.
Back in the 90’s I was just a fireman no degree in pharmacology ,no doctorate, just a guy who nobody believed when i called Bs on a drug company wonder pill that had a unique 12 hour pain relief indication thats the only reason it was approved .
Opioids are not the monster, they are safe and effective for treating pain when used prudently and with care ,but physicians got screwed dragged over the coals for prescribing them , it was E.D physicians , then it was Dentists , then chain pharmacies , then patients , then pharmacists and back to doctors and the evil no good patients , in fact they all had a part to play (except it’s been proven over and again it was not E.D physicians or Dentists singularly responseable)but finally the needle has swung squarely back on the manufatuers malfeasonse, Perdue pharma who started this with its bogus claims because MScontin patent was running out and they needed a blockbuster to keep them on top that was Oxcycontin all 34 billion(when it came on the market a months supply was $18,000.but with rescheduling drugs, optional guidelines, “federal” declarations ,and demonizing opioid medications and playing blame somebody quickly has gotten Us here , trumps leader to combat the epidemic has no idea what she’s doing like everyone else in this administration , trumps declaration sat collecting dust until it expired , Medicaid is the #1 reimbursement for drug rehab its budget and health and human services budgets are being sliced diced and cut to funnel money to nuclear weapons and the failed trump wall that Mexico isn’t paying for.
And even though i have seen the problems , witnessed it ,and buried my wife over it , no one will care about what I have said or seen or why ,because along the way I developed a rare very rare painfull disease and tried all kinds of straight and mixed medications working my way up to my last resort opioid’s ,so I have a horse in this race so I am biased ,but i have fascinating conversation with my pain manager who has never had a patient as clear headed and cautious as I am , my epic trips to her office have been rewarding for both of us ,I officially moved to palliative care a few years ago ,and what’s happening shouldn’t be we went a little to far in throwing caution to the wind and people died and now we are choking off the legal regulated usage and its going to cost more lives ,unless and until we come up with a leader on drug use and drug control policy who is familiar with both the facts and fallacies of this cycle who stops demonizing the medications use we will get worse and never help the people who use street drugs or the innocent pain patient.
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I live in a state where I cannot use cannabis legally. I have found that Young Living Copaiba Oil is a great alternative and has helped me so much.
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Thank you for this article. Being a recent transplant from the western part of the US to the eastern part, I have to say there’s still a big stigma in regards to cannabis (medical or otherwise) in the eastern part of the US (east of Illinois – excepting Michigan). In the western part (west of Kansas), numerous doctors I’ve talked to understood efficacy, prescribing, side-effects, etc. Now that I’m in the east, it’s hard to get a doctor to even have an open conversation about cannabis. Indeed, the common reaction is cynicism and disregard. I’m happy that things are slowly changing but it’s interesting how location drastically changes perceptions!
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