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Cannabis for Chronic Pain

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Chronic pain is difficult. The sufferer endeavors to live a normal life but is impeded by pain. It is difficult for their friends and family because they feel powerless, wanting their loved one to feel better and to be an active participant in life. It is just as difficult for their treating physician or health care provider as the current effective FDA approved treatment options are limited. 

Traditional therapies are a balancing act of risk versus benefit. We are all very well aware of the opioid epidemic. We are all aware that opioids aren’t FDA approved for chronic pain. But, opioids are still used for chronic pain and to the great peril of patients and their families and friends. Physicians and patients are left with a paucity of options. One such option is the off-label use of prescription medications (technically not FDA approved for the indication of pain) that come with many serious side effects and with unreliable efficacy. Another is the overuse of over-the-counter pain relief medications. Even though they do not require a prescription, these medications also have the risk of serious side effects-like heart attack or stroke. So, what is left?

The answer everyone wants to read is that cannabis is the panacea. Yes, cannabis can be used as a pain reliever, which I will describe shortly. However, nothing is a panacea. Nor should cannabis be the sole treatment. Patients complain they hate it when physicians just throw pills at them. Patients tell me that they hate feeling like a victim. If that is the case, why should patients want cannabis thrown at them? They shouldn’t.

The causes of chronic pain are as varied as the sufferer. Chronic pain itself varies in nature and character–where the symptoms and intensity are in constant flux. However, the common denominator of chronic pain, like many other disease processes, is inflammation. The adequate treatment of pain will be difficult unless the inflammation is quelled. Inflammation is the cause of most of our chronic diseases, including chronic pain. So how do we stop inflammation? It is not simply with a pill, despite what we have been programmed to believe. 

Traditional therapies are a balancing act of risk versus benefit.

We all have the power to break the inflammation cycle. We need to take an active role in our own healthcare and not be the passive recipients of pills. Our lifestyle choices create or reduce inflammation. Lifestyle choices include the foods we eat, exercise, sleep, and even socialization. I focus on food because marketing and disinformation creates confusion about what is considered healthy eating and eating is an essential part of reducing the inflammation and therefore reducing pain. When we eat processed foods, animal products, and oils (oil is highly processed-think of how many kernels of corn it takes to make a bottle of corn oil), we set up our body for inflammation. When we eat whole food, all-plants, no added oils, no processed foods we transform our internal environment into a healing machine where our immune system is functioning, inflammation is reduced, and pain is reduced. But sometimes lifestyle alone is not enough. 

How about cannabis? Where does it fit in?

I think about healthcare as a pyramid, where the base of the pyramid consists of the elements of a healthy lifestyle. When pain becomes chronic, then the next step up the pyramid is to discover the root cause, if possible, and then try less invasive pain healing techniques first, such as physical therapy, acupuncture, meditation, massage. If these modalities aren’t sufficient then the next step up the pyramid is herbal remedies, including cannabis. 

According to the 2017 National Academies of Science, Engineering, and Medicine, cannabis may be useful for the treatment of chronic pain and with minimal adverse side effects. I have seen successful pain relief in patients using cannabis as well. In my current position as the chief medical officer for a cannabis company in Michigan, I have the honor and privilege of conducting IRB approved clinical trials using standardized low doses of cannabinoids in a rapidly absorbing tablet that is administered under the tongue. I have gathered patient data (soon to be published) that shows a statistically significant improvement in pain from baseline pain scale scores, and with no reported adverse side effects. The side effects that were reported were a statistically significant reduction in anxiety and an overall improvement in sleep quality. These clinical trials are not a one-off as the results are repeatable. This is exciting stuff! 

Patients are always inquiring if smoking is the only way to use cannabis, and will they be able to function while taking cannabis? Cannabis use is not just about smoking, and you don’t have to feel intoxicated or high for it to achieve the desired results. There can be a stepwise approach in its use as well. If a patient has musculo-skeletal pain where the affected area can be touched, then I recommend using a topical application of cannabinoids first. In fact, I call topical cannabis medicines the gateway to understanding cannabis is an effective medicine and without intoxication. If topicals are not enough or the location isn’t accessible to topicals, then I recommend starting with a low dose of cannabis medicine and slowly titrating to effect. Cannabis medicine is different from traditional pharmaceuticals where the pain relief may take a bit longer to take effect, and the reduction of the pain may not be as dense as an opioid. But low dose cannabis allows for full mental functioning as opposed to opioids. Most patients prefer to be functional with their pain reduction and not incapacitated by their medications.

A holistic and comprehensive approach is the best recipe for pain-relieving success. I recommend finding a physician or health care provider who will help guide you in your healing journey with both diet and cannabis medicine.


Be Well,
Dr. Deb

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GRAM Mag Sets NOW AVAILABLE!

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GIVE THE GIFT OF GRAM

You can now order sets of our
printed magazines. Give the gift of
knowledge this year to your friends,
family, or yourself and only pay
the shipping and handling.

What a deal!

Set includes 9 vintage GRAM Mags
(2019-2020)

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Turmeric

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Turmeric is a root vegetable commonly used as a spice in various Indian and other cultures’ dishes. Turmeric is in the zingiberaceae family, as is ginger. The turmeric plant is native to the southeastern region of Asia and commonly harvested in places like India, Sri Lanka, China, Indonesia, and Taiwan. It is responsible for curry’s signature orange color, and its vibrant pigment will give essentially any meal an orange hue. 

Turmeric contains a substance called curcumin, and curcumin has been shown through research to offer anti-inflammatory and other therapeutic benefits. The scientific name for the turmeric plant is Curcuma Longa, and likely where the name curcumin comes from. When people are talking about the health benefits of turmeric, they are referencing curcumin so you may hear the two names used interchangeably. Curcumin is part of a group called curcuminoids, with curcumin being the most active and the most beneficial for health. Flavonoids are another substance found in various plants and give these plants their color. Curcumin is a flavonoid and is responsible for providing that bright orange color to turmeric. In addition to providing aesthetic value, flavonoids are also strong antioxidants with anti-inflammatory and immune-boosting properties.

The Journal of Biological Chemistry published a study done by Sanjaya Singh and Bharat B. Aggarwal of the Cytokine Research Laboratory at the world-renowned cancer hospital, M.D. Anderson. The study found that curcumin suppressed NF-κB, a protein complex responsible for controlling inflammatory responses. In other words, turmeric shuts off the body’s inflammatory response. Anti-inflammatories can be beneficial for many different ailments, including chronic pain and digestive disorders. A lot of CBD companies even put curcumin in their products because of its benefits. It is believed to be a synergistic pair with complementary therapeutic properties. The thought is that the two plant medicines are powerful on their own; as a combination, they can deliver even more anti-inflammatory and medicinal benefits. 

Many people simply add turmeric to their dishes as a way to easily incorporate it into their daily routine. It is pretty mild in flavor and can be added to many dishes without changing the overall taste too drastically. Some say that turmeric isn’t strong enough on its own to receive the anti-inflammatory properties that curcumin provides, and therefore recommend a curcumin supplement. Research varies on that, so in the end it is just up to personal preference and your doctor’s approval. Curcumin supplements come most available in capsules. Pregnant women can safely use turmeric as an addition to their food, but should avoid taking high-dosage supplements. Those who are interested in supplementing with curcumin products should talk with their doctor first. 

M.D. Anderson Cancer Center did another study in 2007 exploring curcumin for cancer treatment. The study found that curcumin inhibits ovarian cancer growth and angiogenesis (the development of new blood vessels). It does this by targeting and manipulating the NF-κB pathway, the same protein complex responsible for controlling inflammatory response. According to a report published by the National Center for Biotechnology Information, “The nuclear factor NF-κB pathway has long been considered a prototypical proinflammatory signaling pathway, largely based on the role of NF-κB in the expression of proinflammatory genes including cytokines, chemokines, and adhesion molecules.”  

The trend with curcumin seems to be it’s ability to control inflammatory responses in the body. It does this by multiple pathways, but a commonly researched one is the NF-κB protein complex. Because this pathway is able to be manipulated by curcumin to encourage anti-inflammatory expressions, its potential for successfully treating various ailments is there.

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Psilocybin + Magic Mushrooms

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When many think of plant medicine, specifically those plants with psychoactive effects, they think of “magic mushrooms,” or fungi containing psilocybin and psilocin that can cause hallucinations depending on the dosage consumed. In many states, there are active efforts to decriminalize these otherwise scheduled substances, lowering penalties for their use and possession. But what value do psilocybin-containing mushrooms offer? New research suggests a range of therapeutic and psychological value ranging from the treatment of substance abuse to anxiety and depression management.  

What are Magic Mushrooms?

Magic Mushroom use dates back to 10,000 BCE and references continue throughout the era. Their modern popularity began when the term “magic mushroom” was coined by two etnomycologists who learned of a Harvard study on local doctors in Mexico using these substances, noting the substance’s ability to affect the nervous system. These findings were eventually published in Life magazine in 1957, and the term became the universal reference for psychoactive fungi and truffles, specifically those containing high concentrations of psilocybin and psilocin.

Psilocybin & Psilocin: The “Magic” in Magic Mushrooms

Psilocybin and psilocin are part of a family of psychedelic compounds found in magic mushrooms. Psilocin is pharmacologically active, and psilocybin is converted into psilocin when consumed or activated. Similar in structure to serotonin, there are more than 50 species of mushrooms and a variety of truffles that produce both the precursor, psilocybin, and the psychoactive compound, psilocin. Unlike LSD, magic mushrooms do not affect dopamine receptors, solely targeting serotonin sites

How are Magic Mushrooms used?

Magic mushrooms are often used for recreational, therapeutic and medicinal reasons. “Effects range from mild feelings of relaxation, giddiness, euphoria, visual enhancement (seeing colors brighter), visual disturbances (moving surfaces, waves), to delusions, altered perception of real events, images and faces, or real hallucinations.” Recreationally, this is often known as “tripping.” As an alternative health option, these fungi are being used for anxiety, depression, PTSD, and trauma, as well as psychological disorders such as substance abuse disorders, and science is beginning to back the potential for these applications.

Research on Mushrooms

Evaluations of currently available scientific studies suggest a growing number of therapeutic benefits and treatment options. “In the past few years, a growing number of studies using human volunteers have begun to explore the possible therapeutic benefits of drugs such as psilocybin…looking at psilocybin and other hallucinogens to treat a number of otherwise intractable psychiatric disorders, including chronic depression, post-traumatic stress disorder, and drug or alcohol dependency.”

Magic mushrooms have been respected as a “safe & natural healing sacrament for millennia throughout Mexico, Central America and the world,” and are known to be beneficial for depression, recidivism (the tendency to repeat past transgressions), and encourages openness, creativity, as well as personal and spiritual growth. UCLA and NYC have done studies on the applications of magic mushrooms in the treatment of end-of-life anxiety and other studies have backed up the use of psilocybin and psilocin in the treatment of substance use disorders, depression (especially in cases of terminal conditions like cancer as well as treatment-resistant depression), and reducing depression and anxiety overall.

Best way for people to consume?

When it comes to the consumption of mushrooms, advice on dosage is about as specific as it was with cannabis under prohibition. Consumers must purchase on the black market and are subject to whatever may be available. 

“Recreational doses range from 1–5 grams of dry mushrooms depending on the species and individual strength of the specimens… After ingestion, the psilocybin is enzymatically converted to psilocin. Absorbed from the gastro-intestinal tract, hallucinogenic effects usually occur within 30 minutes of ingestion with a duration of effect of 4–6 hours.” 

My recommendation as someone who has used magic mushrooms both for recreational and therapeutic purposes, is to grind the mushrooms into a fine powder and either encapsulate them in small increments and/or combine with lemon juice. Capsules will allow you to titrate your dosage as needed with a recognizable increment, while lemon juice will expedite onset time.  

The Legality of Magic Mushrooms

In the United States, psilocybin is a Schedule I controlled substance, with no accepted medicinal value and a high potential for abuse. In contrast, the Drug Policy Alliance states that “Physically, psilocybin mushrooms are considered to be one of the least toxic drugs known.” With that being said, local efforts such as Decriminalize Nature – Oakland and Decriminalize Denver have pushed for and successfully passed initiatives and legislation to reduce penalties and make enforcement a low priority, as was done in the early days of cannabis activism. This has spurred multiple local and international efforts to “Decriminalize Nature,” efforts that we learn more about in this month’s feature.

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