Treating Pain With Medical Cannabis

In part one of this article, you saw how pain patients can trade opioids (and also aspirin) for medical cannabis, and why it can be safer to do so. 

In Part 2, we’ll examine more aspects of using medical cannabis for pain, including different delivery methods, what you should look for on product labels. But first, let’s review just a couple of the dozens of specific and common pain conditions you can treat with medical cannabis — Carpal Tunnel Syndrome, and chronic back pain.

Treating Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome1,2 is a condition that causes painful nerve pain in the hand, wrist, and arm. It’s known as a repetitive motion disorder3, or repetitive stress injury (RSI). This means that this painful condition can occur as a result of long-term, repeated motions of the hand, especially involving the wrist. Its name comes from the area inside the wrist called “the carpal tunnel”, which houses ligaments, bones, tendons, and the meridian nerve.

According to Canadian Center for Occupational Health and Safety, “Cashiers, hairdressers, or knitters or sewers are examples of people whose work-related tasks involve the repetitive wrist movements associated with carpal tunnel syndrome. Bakers who flex or extend the wrist while kneading dough, and people who flex the fingers and wrist in tasks such as milking cows, using a spray paint gun, and hand-weeding are other examples. Excessive use of vibrating hand tools may also be related to carpal tunnel syndrome.

There have been studies surrounding computer use and carpal tunnel, but nothing is conclusive2. However, there is strong evidence that extended computer use does lead to other injuries requiring pain treatment.

Besides pain, other symptoms of carpal tunnel syndrome include:

• Tingling
• Numbness
• Reduction in grip strength
• Loss of hot/cold sensitivity

Traditional treatments

An initial diagnosis of CTS often begins with rest, NSAIDs, and wearing a brace or splint on the wrist at night to prevent movement while you’re  sleeping.

If these measures don’t reduce the pain and other symptoms, your practitioner may suggest a corticosteroid injection in the carpal tunnel itself. However, these injections4 carry their own risks including: damage to the nerve, infections, weakening of the bones, and a temporary increase in pain during the first 24 hours following the injection.

Because of these side effects, practitioners try to limit the number of procedures a patient can have to three or four per year.

If symptoms get worse or don't improve, your medical provider may refer you to a surgeon5 to relieve the pressure on the nerve manually.

How Can Cannabis Help?

Medical cannabis can be very effective at reducing nerve pain. A 2012 study6 published in volume 14, issue 2, of the Journal of Pain found that low doses of vaporized cannabis reduced the nerve pain of patients with minimal side effects.

A more recent, 20187 study in the Current Pain and Headaches Report found patients had significantly less pain with a cannabis treatment. The research also shows that doses varied by patient, pain level, the method of delivery, and the ratio of THC in each dose.

We discuss this often debilitating condition in our new digital book, Medical Cannabis For Pain: A Patient’s Guide.

Chronic Back Pain

If you've experienced back pain, you're not alone. A 20078 report by the American Chiropractic Association estimates that 80 percent of Americans will endure back pain in their lifetime. Most back pain9 will resolve on its own in a few days to a few weeks depending on the source.

However, as explained in part one, practitioners define anything that doesn't go away after three months a chronic condition. Although most people won't experience chronic back pain, 20 percent10 of patients with short-term back pain develop a chronic pain condition.

Traditional treatments

Treating chronic back pain varies by the cause. For example, patients with a specific condition, such as a lumbar disc disorder have a few options to find relief. But, this ailment is degenerative, which means it will slowly worsen over time11.

Your practitioner can work to decrease the pain and slow the progression of the disease. However, it’s unlikely they will be able to they won't be able to stop in many cases it’s not possible to completely stop the progression. On top of this, reducing the diminishing pain can take several attempts to find the right combination of treatments.

Examples of traditional pain management include:

• Anti-inflammatory medicines
• Epidural cortisone injections
• Narcotics
• Surgery

Patients should keep in mind that surgical procedures are usually the last option given, and that they can consider getting a second opinion before making a final decision on this serious procedure.

How can cannabis help?

Cannabis is a proven12 treatment for chronic pain — one that doesn't require needles, narcotics, or surgical tools. Patients can apply a whole plant topical application of THC and CBD to reduce pain. Another topical option includes the transdermal patch. (For more information on topicals and transdermal applications, continue reading.)

How to Use Medical Cannabis for Pain Relief

One of the myths about medical cannabis is that you have to smoke it to receive its healing benefits.

Smoking is not only one way to take this medicine. And in most cases, smoking is not the dosing method preferred by medical professionals, because all smoke can be harmful to the lungs.

Another reason medical cannabis practitioners prefer different modes of delivery of cannabis for pain, is accuracy of dosing. You can't accurately measure or track your dose when you smoke the medicine compared to other methods.

"One of the myths about medical cannabis is that you have to smoke it to receive its healing benefits."

Other ways you can take medical cannabis for pain include:

Sublingual Tincture – The sublingual tincture13 is a fast-acting method that absorbs through the blood vessels under the tongue. These are made by extracting cannabis with a high volume grain alcohol. To use a tincture, measure out the dose your practitioner recommends with the dropper and place it under your tongue. Don't drink or eat anything for 15-30 minutes after taking it and you will likely begin to feel the effects after 15 minutes.

Cannabis Oil – Cannabis oils resemble tinctures, but, they the are made with carrier oils such as grapeseed and coconut. These can be taken orally or added to different foods and drinks. It's common14 for patients to place a dropper full of oil in their tea or a similar drink.

Keep in mind these take longer to work than the sublingual. Patients should allow 45 to 90 minutes for symptom relief, and discuss appropriate ratios of THC and CBD.

Smoking – As mentioned, smoking is the most commonly known method, but, it's not the safest.15 The near-instant onset and relatively low price of this form of delivery are what makes it attractive to patients. If you have any breathing problems, such as a reduced lung function from lung cancer or chronic obstructive pulmonary disease (COPD), speak to your pulmonologist before starting treatment with medical cannabis.

Vaporization – Vaporization offers the same onset as smoking – nearly instant. This method delivers the medicine via steam rather than smoke which is safer16 for your lungs. Patients need to use a vaporizer with this method of cannabis for pain relief. These are available as portable or desktop devices. You can vaporize oils and dry flowers.

Edibles – Edibles can be a great option for taking medical cannabis for pain if you don't need the fast-onset. Like cannabis oils, they take about 45-90 minutes for your body to digest and start reducing pain.

However, practitioners usually the Sacred Plant likes to caution patients about using an edible for your first dose. The delicious taste that comes with many of these products along with the delay in onset can lead to patients taking too large of a dose. Work with your practitioner on types of edibles for pain, and doses.

Capsules – You can get cannabis medicine in capsules with exact ratios of CBD and THC. These are the closest to traditional17 pharmaceuticals and are available in regular or extended-release pills depending on your needs. Similar to edibles and cannabis oils, as pain relief cannabis capsules can take between 45 and 90 minutes to provide symptom relief.

Transdermal – Although more research is still necessary for transdermal products, these may be a good are a great option for patients that need a steady delivery of pain medicine over an eight to twelve hour period. Transdermal products work similar to nicotine and lidocaine patches — you place them over an area on the body, and the medicine absorbs through the skin and into the bloodstream.

Topical lotions and salves – A topical application is similar to the muscle rubs you can purchase over-the-counter, with the medicinal benefits of cannabis in a cream or lotion form. Patients apply these creams directly to the area where they're experiencing pain.

According to anesthesiologist Debra Kimless, MD, who specializes in cannabis and pain management, “Topical preparations have insignificant systemic absorption and are not known to cause psychoactive effects.”19  This localized pain relief from medical cannabis can start with this method in 30 to 45 minutes.

Understanding the Product Label and Dosage Instructions – Labels can vary19 by product and state regulations. However, there are a few items you will find on most labels:

• Company/Brand name
• Testing lab name
• Date the product's batch was tested by the lab for safety
• Name of farm or grower
• An expiration date for edibles
• Quantity/Weight
• Number of servings
• Ratio of CBD/THC

The ratio is important because it shows patients the percentage of CBD and THC in the product. This information should be available for all products, including: dry flowers, tinctures, oils, vaporization cartridges, capsules, edibles, and transdermal patches.

The ratio percentage20 will either be CBD-dominant (ex. 2:1), THC-dominant (ex. 1:2), or an even ratio (1:1).

Where Can You Find More Answers?

Many experts agree that medical cannabis is one of the safest options for reducing pain without the dangers that come with opioids and other strong narcotics. You may have seen this for yourself in season one or two of our docuseries, with touching interviews with patients who were debilitated, then transformed by using medical cannabis for their pain.

More recently we teamed up with medical cannabis practitioner and expert, Dr. David Bearman, in order to bring you more specifics about how medical cannabis can help you and your loved ones with more than a dozen different conditions including:

• Chronic neck, back, and knee pain
• Pain conditions specific to women
• Migraines, cluster, and tension-type headaches
• Painful autoimmune conditions
• … and Surgical recovery

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1. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet

2. https://www.ccohs.ca/oshanswers/diseases/carpal.html

3. https://www.ncbi.nlm.nih.gov/pubmed/9646750

4. https://www.mayoclinic.org/tests-procedures/cortisone-shots/about/pac-20384794

5. https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/diagnosis-treatment/drc-20355608

6. https://www.sciencedirect.com/science/article/pii/S1526590012008644

7. https://www.ncbi.nlm.nih.gov/pubmed/29388063

8. https://www.acatoday.org/Patients/Health-Wellness-Information/Back-Pain-Facts-and-Statistics

9. https://medlineplus.gov/backpain.html

10. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

11. https://www.spine-health.com/conditions/degenerative-disc-disease/lumbar-degenerative-disc-disease-ddd

12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845915/

13. https://www.ncsm.nl/english/diy/make-cannabis-tincture-recipes

14. https://www.ncsm.nl/english/information-for-patients/using-cannabis-tea

15. https://www.lung.org/stop-smoking/smoking-facts/marijuana-and-lung-health.html

16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456813/

17. https://weedmaps.com/learn/dictionary/capsule/

18. https://www.elle.com/beauty/a42274/higher-power-marijuana-beauty-products/

19. https://www.cdph.ca.gov/Programs/CEH/DFDCS/MCSB/CDPH%20Document%20Library/Labeling-CannabisProducts.pdf

20. https://www.projectcbd.org/guidance/cannabis-dosing

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