Minnesota on the Eve of Medical Marijuana

June 29, 2015 / Thomas Cohn, MD

Recently there have been excellent reviews on the state of the science of medical marijuana. Minnesota is about to start its program, but only a handful of people have been approved for the program and there are not many providers interested in participating. So why is medical marijuana off to such a slow start in Minnesota?

Medical cannabis is a complex subject, after attending many lectures on the subject, and reviewing significant amounts of literature, the one main conclusion is that the science behind cannabinoids is only in its infancy. For the average reader, the Time Magazine May 14, 2015 and the National Geographic July, 2015 issues have good information. At a higher level for medical science, the June 23/30, 2015 issue of the Journal of the American Medical Association has more data.

US Lags Behind

The United States has not been a leader in the study of marijuana. Since marijuana has been labeled a Schedule 1 compound by the DEA, its scientific analysis in the U.S. has been extremely limited. Some of the best research initially has come out of Israel where many of the cannabinoid compounds have been isolated, and in Spain where some of the cancer research and other studies have been done. The most recent issue of JAMA has reviewed a large number of medical studies with regards to a variety of conditions. For the scientist, it is clear there is a significant shortage of information supporting claims of effectiveness of the compounds for most conditions. Most information is based on a very limited numbers of study participants. Comparing the information to almost all other drugs on the market, these studies would barely qualify for drug approval.

The quality of studies for marijuana and chronic pain has been especially limited. The studies researched include neuropathic pain and cancer pain. Most of the studies just looked at a numeric pain scale to measure success and did not quantify any other objective measure like functional ability. The outcome was a modest improvement in reported pain level, but deeper evaluation did not show any changes in quality of life measures when compared to placebo or standard treatments.

After reading multiple articles on cannabinoids and pain, one clear message is present. First, there are a number of different cannabinoid compounds, probably well over a hundred. Second, the chemistry is poorly understood and the effectiveness to treat a variety of medical conditions is limited. Medicine has become a very science driven field. Physicians are constantly under fire to provide care that is safe and effective. The current status for medical marijuana is truly still in the research phase. We won’t be able to fully embrace medical marijuana as a viable option until we know more about all of its compounds.

Pain Doctors Looking To The Painless For Possible Solutions

June 22, 2015 / Thomas Cohn, MD

If you’re a James Bond fan, you may remember the 1999 film, The World is Not Enough. The movie’s villain is a Russian terrorist named Renard who suffers from a rather unique condition. During an encounter with British agent 009, Renard gets shot in the head. However, like most bad guys in the movies, the oft-would-be kill shot doesn’t end up being a fatal blow. Renard’s doctor saves his life, but he is unable to remove the bullet, as doing so would kill the man. Eventually, the bullet will claim Renard’s life, but until that time, its presence in his medala oblong gata renders him almost senseless, dulling his ability to smell, taste and even feel pain.

Although the events leading up to Renard’s condition are unique, the inability to feel pain is not. Many people are unable to sense pain, which may sound appealing, but it can actually be very dangerous. After all, pain is one of the quickest ways our body tells us that something is wrong.

Inability to Feel Pain

The inability to feel pain is known in the medical community as congential insensitivity to pain. It is part of a larger set of disorders known as hereditary sensory and autonomic neuropathy.

As we mentioned above, it may sound cool to feel “invincible,” but it can leave you open to injury. For example, let’s say you have the condition and you set your hand on a hot stove. You’ll still suffer the burns, but you won’t realize you’re being burned. See how this could be an issue?

Interestingly, it’s the pain-free that the pain community are turning to to address the problem of chronic pain. Researchers at Cambridge University have recently pinpointed the exact gene responsible for the pain-free condition, and they’re trying to replicate its expression to help find new pain management avenues.

According to researchers, knowing the underlying mechanisms of pain sensations are critical to controlling and reducing pain, especially because some current methods are ineffective or addictive.

“We are very hopeful that this new gene could be an excellent candidate for drug development, particularly given recent successes with drugs targeting chromatin regulators in human disease,” said Dr. Ya-Chun Chen, the study’s first author.

Obviously the treatment strategy is in the beginning stages, but it’s encouraging for the future of pain management. The key here will be to find a delicate balance between helping people achieve chronic pain relief without dulling the senses so much that the individual is in danger.

Related Source: Medical Daily

Chronic Nerve Pain Can Impact Mood and Motivation

June 10, 2015June 10, 2015 / Thomas Cohn, MD

Chronic nerve pain doesn’t just make it painful to go through your daily routine, it may actually make it psychologically harder for your brain to get motivated to complete certain tasks, according to California researchers.

Researchers at UC-Irving and UCLA say their findings suggest that brain inflammation caused by chronic nerve pain can have significant psychological effects. In a lab study, researchers uncovered that rodents with brain inflammation exhibited “accelerated growth and activation” of immune cells known as microglia. These microglia cells cause chemical signals that restrict the release of dopamine, a chemical that helps control our brain’s reward and pleasure centers.

New Approaches To Chronic Pain Care

What’s more, the researchers may have uncovered new evidence in the battle to control and conquer chronic pain. Researchers found that certain opioids designed to spur the release of morphine may actually be ineffective in certain cases. One such case occurred with these rats. In rodents with brain inflammation, these opioids did not stimulate dopamine release as designed.

Instead, when the same rodents were treated with an opioid designed to inhibit the release of the microglial cells, dopamine levels returned to normal.

“For over 20 years, scientists have been trying to unlock the mechanisms at work that connect opioid use, pain relief, depression and addiction,” said Catherine Cahill, an associate professor of anesthesiology & perioperative care at UCI. “Our findings represent a paradigm shift which has broad implications that are not restricted to the problem of pain and may translate to other disorders.”

Cahill and her team hope to recreate the study in humans in order to combat mood swings, depressive attitudes and behavioral disorders.

“We have a drug compound that has the potential to normalize reward-like behavior,” she said, “and subsequent clinical research could then employ imaging studies to identify how the same disruption in reward circuity found in rodents occurs in chronic pain patients.”

The First Phase of Legal Marijuana

June 8, 2015June 10, 2015 / Thomas Cohn, MD

The start of legalizing medical marijuana in Minnesota began last Monday. The initial step for patients is to be certified that one has a condition approved for treatment by this medication. Pain is not a condition approved for marijuana in Minnesota. Once certified as having an appropriate condition, the process in Minnesota applying for the medication can begin, and then obtaining the approved medication can occur. One can assume, the medical marijuana oils obtained in Minnesota, will be far different from recreational use marijuana.

In June, 2015, the lead National Geographic article is titled “Weed, The New Science of Marijuana”. It is an excellent review of the knowledge and science of cannabis. The use of marijuana dates back to at least to 3000 B.C.E., but did not become demonized until 1970 when it became a Schedule 1 drug, meaning it had no valid medical purpose. The truth about marijuana is much more complex. The study of marijuana really began only in the early 1960’s compared to the early 1800’s when opium and cocaine became known. Those drugs, which were once taboo, led us to the discovery of morphine and coco leaves. Will marijuana follow a similar path?

The Science Behind Marijuana

In 1963, a young organic chemist by the name of Raphael Mechoulam began experimenting with the compounds in marijuana. After isolating a number of compounds, Mechoulam tested the compounds on monkeys. Only one compound produced a significant effect. As Mechoulam wrote, “normally the rhesus monkey is quite an aggressive individual,” but when injected with this compound, the monkeys became quite calm.

Flash forward a few years, and Mechoulam’s research is helping 20,000 patients get treatment in his home country of Israel for a variety of conditions, including Crohn’s Disease, glaucoma, Tourette’s Syndrome and asthma. Mechoulman says he doesn’t believe the substance should be legalized for recreational use, but he hopes the stigma of studying the compounds for medical research fades now that more people seeing the medical benefits it possesses.

“We have just scratched the surface,” he says, “and I greatly regret that I don’t have another lifetime to devote to this field, for we may well discover that cannabinoids are involved in some way in all human diseases.”

In fact, researchers are using marijuana to combat cancers as we speak. Research in Spain found that some rats with brain tumors were cured of their condition after being injected with THC. The results are quite encouraging, but as biochemist Manuel Guzmán noted, “the problem is, mice are not humans. We do not know if this can be extrapolated to humans at all.”

Think about that for a second. We may have found another potential ally in the war on cancer, but there’s still so much hate for the drug that it’s impeding medical progress. We need to study these compounds in order to provide the best care possible for our patients.

Related source: National Geographic

Exercises Can Alleviate Fibromyalgia Pain

May 20, 2015 / Thomas Cohn, MD

Research out of Spain confirmed the belief that exercise and physical fitness can help relieve symptoms due to chronic pain and fibromyalgia.

To conduct their experiment, researchers asked participants to refrain from using pain medications for at least 24 hours, then they measured their pain levels using a number of different scales, including the Visual Analog Scale (VAS), the Pain Catastrophizing Scale (PCS) and the Chronic Pain Self-Efficacy Scale. After pain was measured, researchers surveyed patients about their exercise habits. Although the findings don’t prove causation, researchers uncovered:

Patients with higher physical activity exhibited lower levels of pain.

Those who exercised more had a lower psychological overreaction to pain.

Fitness appeared to decrease negative thoughts about chronic pain.

“These results might have implications for future intervention studies in this population,” the investigators wrote in Arthritis Care and Research. “In general, there was a linear (dose-response) relationship so that higher levels of fitness were associated with lower levels of pain and catastrophizing and higher self-efficacy.”

The team concluded that fitness helped improve overall agility, flexibility and mobility. They believe strength conditioning can help increase pain tolerance, while aerobic exercises can help a person with some of the mental aspects of chronic pain and fibromyalgia.

“Our exploratory analyses suggest that muscle strength and flexibility could be the fitness components most strongly associated with pain levels, while aerobic fitness and flexibility could be the fitness components most strongly associated with the psychological experience (i.e. catastrophizing and self-efficacy) of pain,” wrote the authors.

Dr. Cohn Comments

The benefits of exercise for chronic pain have been well documented, so it should come as no surprise that regular exercise can help alleviate problems associated with fibromyalgia.

I’ve even written about how exercise has helped me control my pain condition. If you’re suffering from chronic pain, try to squeeze in some regular exercise. Even 15 minutes of walking can do wonders for your mind and body. If some exercises are too trying, try to find an activity that works for your condition. Whether it’s running, walking or swimming find an activity that works for you!