Notes from a class from Green Flower Media
Cannabis For Back Pain, Chronic Pain, & Nerve Damage: Guest speaker - Mara Gordon
A Little Background
What we know:
* Pain of the back and neck is the chief reason that people miss work.
* The chief western medicine response has been opioids.
* Cannabis is a better choice. It won't destroy your organs.
The causes of this epidemic of pain we created for ourselves are many, mostly defined by genetic conditions like arthritis, injury, and the crazy habit we have of sitting behind desks, in schools, and at our jobs. From childhood on we squash our bodies into positions they weren't meant to hold for any real length of time and we keep doing that over and over again. Our proclivity to SIT ALL DAY LONG causes ongoing nerve pain.
Believe it or not you weren't evolved to be sitting on our tailbones all day with our arms hunched over, working at a laptop.
Some gentle solutions to the problem:
- Stand and work (can your work surface be raised?)
- Move as much as you can.
We could all stand to move more and move in a more thoughtful manner.
80% of all Americans will experience back pain at some point in their lives. When you look beyond our shores to the rest of the world that number drops to a shocking 10%. Women experience 8% more back pain than men, but surprisingly, men miss more work for back pain than women - 50% more than women, to be exact. Apparently, women have a higher tolerance level for pain.
More seek help for back pain than any other pain. A full 7-10% will develop chronic pain - when pain is no longer the symptom, but has become the disease. At this point there is so much inflammation and memory in the nerves that you can't not feel it.
Pain is a warning sign. As such, it's easy to appreciate that the lack of pain is dangerous to survival. But pain is meant to be temporary, something the body can deal with and adjust to as it heals.
Only a small percentage of the 80% of those with back or neck pain find relief with traditional pharmaceuticals or OTC solutions. The pharmaceutical options come with delightful side effects like mood swings and constipation, and that wonderful tendency they have to eventually cause more pain than they were meant to relieve. In a very real way opioid drugs can turn on you.
Consider that constipation causes inflammation in the gut. Because of the way the gut is wired into the system at large inflammation easily gets spread around the body, so now you have inflammation showing up in other places. The ECS is now even more stressed,many you have more pain to deal with.
One of the chief arguments against cannabis as a pain management medication is the fear of euphoria. When people express concern about the psychoactivity with cannabis, ask them if it's the feeling good that concerns them?
Opioids cause psychoactivity too, it's just that it's a depressing type of psychoactivity.
The economic impact of this pain epidemic is huge. It's estimated to be costing us around $50 BILLION a year in direct costs and upwards to $100 Billion in indirect costs.
Work is missed. Disability is used as a safety net. Self worth begins to degrade. Income limitations begin to effect dietary choices, and quality of life suffers from more directions than simply pain. It creates its own downward spiral if left unchecked.
Most people would rather be working than home in pain and on Disability. People say things like "How lucky you are to be on Disability. You don't have to go to work."
There's no such thing as back pain and lucky in any logical sentence.
By definition chronic pain is chronic.
The double-edged sword about pain is that you need to move to find relief, but pain and the opiods make it difficult to do. Cannabis, used correctly, allows you to be somewhat self-sufficient. You'll be able to get up. You'll be able to move about and be involved with life. Movement and staying away of poor dietary choices are called for.
Gluten-free diets reduce inflammation and level the emotional tone. It might be worth your while to explore gluten-free eating if you deal with inflammation. Chronic inflammation in your body is your body asking you to make better choices.
A Closer Look At Chronic Pain
Chronic pain serves no protective biological function. If anything it will self-perpetuate. As pain levels persist pain behavior begins to limit movement. This reduced movement increases systemic degradation, and before you know it social supports begin to fall away.
The disability system discourages wellness. If you begin to heal, or even to do things that make you feel better, you run the risk of losing the medical coverage and income that are keeping you from falling through the cracks. This is not a scenario conducive to stress-free healing.
Cannabis is a preferred medication for pain. Cannabis won't simply mask symptoms, it will cause physiological change at a cellular level. Healing will commence with a cannabinoid therapy. When disease has set in and pain is involved you can be sure the endocannabinoid system isn't producing enough endocannabinoids, so we bring in the reserve troops of phytocannabinoids.
How Cannabis Helps
There are 5 mechanisms with CB1 and CB2 receptors (attachment points found on the surface of cells that are activated by the cannabinoids) in response to cannabinoid therapy.
Activation of the CB1 receptors (primarily in the CNS)
1. THC will retard the electrochemical reaction at the peripheral pain receptor.
2. THC interrupts the pain signal at the dorsal root ganglion.
3. THC interrupts the pain signal at the neuron.
4. Activation of the CB2 receptors (more prevalent in the immune system and in the peripheral organs) results in reduces inflammation. Immune response triggers inflammation, a great part of chronic pain
5. The psychoactive effects of cannabis will help you get beyond the pain perception. This also interrupts the short-term memory. Although short-term memory loss is not always a preferred situation, in this circumstance it breaks the stress response and give you a respite from the pain.
CBD is 30-50 times more powerful than steroids, which typically cause adrenal damage when used long-term. CBD has been proven to be a neural protector.
When the cannabinoids become active in attachment pain doesn't occur because the signal is stopped by THC while CBD gets busy reducing inflammation.
Any nerve ending is potentially a place to feel pain.
When you activate the CB1 receptors with THC you stop the pain transmission in three different places. You're reducing and eliminating the sensation of pain by healing the problem.
In legal states Medicare tracked opioid prescriptions and found physicians were writing fewer daily prescriptions in response to pain, to the tune of
- 1826 less prescriptions for daily doses of opiates
- 362 less doses for sleep aids
- 265 less doses per day for depression
These improvements are magnified by the lack of secondary conditions. Since many pharmaceuticals come with pesky side effects there will usually be a number of prescriptions to treat those, as well as all the accompanying conditions that follow pain response.
Cannabis saves us the secondary issues brought on by side effects, and offers relief by blocking pain, reducing inflammation, and offering the blissful relief of euphoria.
Dosing Guidelines
Start by assuring yourself that you can't go wrong. If you're getting cannabinoids into the system they're healing you on some level.
Clinical information has shown that for many patients, a balanced ratio of THC:CBD is your best bet for managing chronic pain.
Having said that, I'd like to share the thoughts of one of our members who speaks from experience.
Begin with a ratio that the patient is comfortable with and increase the levels of both components to get the THC levels to where they are most effective. This is a trial and error process, so be kind to yourself and prepare to experiment. Cannabis expresses in individual ways patient to patient.
Some of the more valuable components of cannabis that will help you deal more effectively as a pain patient are:
CBGa, which can be found in higher concentrations in young cannabis plants, before they begin to flower. CBGA is a potent anti inflammatory and analgesic.
THCa for the anti-spasmodic effects. This can be very helpful for the patient with muscle spasms.
THCV for diabetes and weight loss.
THC will protect neurons and directly effect pain modification.
CBN will help you sleep and is also an anti-inflammatory. It expresses a slightly less secure attachment to the receptor.
CBG can offer anti depressive relief.
CBD relieves inflammation.
Patients will respond to CBD in one of three ways:
1. They'll get really really sleepy.
2. They'll become really active.
3. They'll have no response at all. Many times you won't feel the effects of CBD until you stop taking it.
How much to take?
The guidelines for starting a new regimine are always the same - every patient needs to start low. You begin at a sub therapeutic dose and slowly titrate up until you reach an optimal therapeutic dose. Here's a handy link to the guidelines for starting a new patient on cannabinoid therapy. Starting a new patient on cannabis
Weight of the patient will not give you any indication as to dose. Two patients with identical body makeup and identical diagnoses can require wildly disparate doses.
A good daytime dose would be 5-10 mg THC, with 25 mg of CBD (CBD in 2 doses). Start the THC at 3-5 mg and work up.
A good bedtime dose would be 10- 25 mg THC at bedtime.
The magical formula of terpenes for pain
We know that the action of the cannabinoids is driven in large part by the terpenes. Well, it turns out there's a terpene profile that will enhance pain management.
B-Caryophyllene is anti inflammatory
Limonene is uplifting (daytime use)
Linalool is relaxing
Myrcene helps cannabinoids cross the BBB (nighttime use - will cause drowsiness)
Learn how the terpenes react in your body. If you're using cannabis and becoming anxious change the terpene profile. Experiment.
To increase bioavailability, take a dose of some fatty food (as in a tablespoon of coconut oil) about 30 minutes before the dose. We have a process for further increasing bioavailibity that can be found here.
Topicals will focus relief to tense muscles. The nice thing with a topical is that you can use it whenever you feel the need. The rules here are simple: if you need it, use it. You won't hurt yourself at all. You'll just gain relief from the stiff muscles squeezing the nerve endings.
Guidelines for Topicals
- Arnica and frankincense will ease pain.
- Essential oils should not be to mask the smell, but for medicinal values.
- If it smells weedy it isn't well processed.
- THC strong will work best for relief (it hits the pain by relaxing muscles).
- CBD strong will reduce inflammation but not offer immediate relief. It works from within, over time.
The Importance of Sleep
It's lonely at night when you're in pain. Sleep removes this isolation and keeps you from feeling lost.
You need to get sleep under control first. Treat sleep first, incorporating relaxation techniques and dietary awareness. Sleep allows to to feel less pain and deal with the pain you have more effectively. A good night's sleep will allow the patient to function on a low dose of THC and more CBD during day.
For most people a 15-25 mg dose is an optimal dose for sleep. This isn't a starting dose. A starting dose begins at 3-5 and works up to the optimal dose. There are many ways to administers hat dose, keeping in mind that at bedtime you're looking for the longest-lasting effects, and that would be a good edible.
It's advisable to keep a vaporizer near the bed for any breakthrough pain that may wake the patient. A sublingual dose offers 6-8 hours of relief but won't hit for 30-90 min, making it a poor choice for middle of the night distress.
Most people use too much cannabis. Using less can save you money. Using less as a society can also reduce prices by reducing strain in the market.
Tolerance buildup is a real concern for the cannabis patient. To avoid tolerance buildup change up the profiles on a regular basis. Switch strains every now and then. You have the terpene profile you're looking for. Find more than one source for that basic profile and toggle between them. This simple trick can keep your tolerance levels in check.
When you hit your therapeutic dose you'll typically level off on need. Your expectation when using cannabis as a medicine should always be that at some point the ECS will become heartier and will begin to pick up more and more of the workload, requiring less reserve troops to be introduced.
If you've about three months without leveling off it's recommended to take a holiday and reset the optimal dose. There's a link to an effective protocol for doing this. It's never fun to have to go through desensitization, but it works very well.
The correct dose is the level of euphoria the patient is comfortable with. As an aside, citicoline will help with pain reduction and may reduce euphoria, but NOT FOR CANCER PATIENTS!!!
Most CBD comes from sativa plants, which are less robust, skimpier, and more difficult to grow. This is by way of explaining the higher cost of CBD products. Try growing your own and eliminating all the middle men.
Hemp-derived CBD lacks the entourage you get from cannabis sativa, and you won't get the same variety or volume of terpenes you'd get from cannabis sativa.
An Important Note About Your Opioids
Always use cannabis with your opiates. You should never let an opioid pass your lips without some THC ahead of it. Prepare to adjust their opiod dose down. It isn't the cannabis making you higher. It's the opioid being potentiated. Alert your pain physician, changes will have to be made.
Cannabis doesn't touch level 10 pain. Neither do opioids. How do you know if your pain is beyond cannabis? You aren't having a conversation when you're in level 10 pain. At this level of pain the patient needs to be knocked out so the body can heal in sleep.
Cannabis will hit all the other levels and have you able to get up and get around.
Opiods won't let you function, or if you do, you may be dangerous to yourself and others.
Cannabis can increase your sense of well-being and productivity.
Special considerations
The biggest mistake with cannabis that patients make is to become impatient and take too much too soon. Be prepared for it not to work for a couple tries - experiment. A good rule to remember with cannabis that more is not always better. If you need more and can't wait, vape a small amount that will only have a small effect to get you to the next dose.
As long as cannabis is illegal federally employers have the right to discriminate against us with drug testing. It's more than a little disconcerting that the company that sells the test kits is running this show. We let that happen, and now we'll have to undo it over time.
Chronic sciatic : try topicals that contain THCa, THC, CBD.
Degenerative bone disease, choose cannabinoids that have bone-stimulating properties.
Isolates (i.e. CBGa) can be best used to boost the profiles in a specialized medication.
Cannabis can improve neuropathy. Try Using a topical and vaporize for discomfort.
Cannabis use for migraine can be as simple as a topical, but for long-term relief choose a balanced ratio plant and process some capsules with an infused oil. This approach gets the cannabinoids in for deeper, systemic care.
Some closing thoughts
We would benefit from learning to dose properly. It's going to be up to us to educate our doctors to the truth of cannabis. Be patient and keep trying. As our numbers grow the evidence becomes impossible to deny.
Pick healthy products. You're using them as medication for a patient that likely has a compromised immune response. The purer the medication the better you support healing.
THE BIG TAKE-AWAY
There's hope.
You can get out of the spiral of pain.
Take your opportunity.
Step out of the box and find your solution.
CANNABIS CAN HELP.
There's hope.
You can get out of the spiral of pain.
Take your opportunity.
Step out of the box and find your solution.
CANNABIS CAN HELP.
