The Benefits and Drawbacks Of Medical Marijuana

Minnesota Medical Marijuana BenefitsRecently, the National Academies of Sciences, Engineering, and Medicine did a comprehensive review of the information available on the use of marijuana. The study looked at research published since 1999, and they came up with a number of conclusions. One of the most important findings is the current lack of good scientific information on marijuana. There is a clear need for good scientific research to guide healthcare professionals on the risks and benefits associated with marijuana use. Currently, to study marijuana or any of its derivatives, the federal bureaucratic hoops one must go through makes it extremely difficult to perform. The information available and the quality of the research at this point are limited. The conclusions are based mostly upon case report studies with limited controls.

The Complexity of THC and Marijuana

In Minnesota, medical marijuana is available to treat several specific conditions, and this year chronic pain was added to the list of approved conditions. The recent study also supports the idea that marijuana may be helpful to treat some people with chronic pain. For some it seems the non-THC (THC is the component that is responsible for the “high”) may help for pain. Since there are multiple causes of pain, it definitely is not indicated for everyone. Further, no studies have been done to determine what types of pain may be helped by components of marijuana, and it is not clear which of the 80 or more different compounds in marijuana are helpful. It is also known to be helpful for nausea from chemotherapy, and spasticity in multiple sclerosis. Marijuana may help in appetite with HIV, and there is limited evidence for help with bowel disorders, epilepsy, and Parkinson’s disease.

Potential Drawbacks

There are multiple potential harms that may be caused by marijuana. There is strong evidence that its use can lead to schizophrenia and psychosis, especially among young and frequent users. It may also lead to depressive disorders. The claim that it can make you a better driver is simply false, as statistics have shown that it leads to inattentive driving, a main contributor to traffic accidents. In pregnancy, use can lead to low birth weight in infants. Smoking pot can also cause and worsen any respiratory condition. There is weak evidence that smoking marijuana can increase the risk of heart attacks. One can also develop an addiction to marijuana. Conclusions cannot be drawn with regards to school achievement, unemployment, or social function and marijuana use.

Understanding It All

The overall scientific conclusion so far is that marijuana may have some reasonable medical uses. However, the scientific research on the compound is extremely limited at the moment. In the United States, it has been classified as a compound with no medical value and harmful to society. What needs to happen is that national legislation is needed to reclassify marijuana as a controlled substance, then good medical research can be done to determine what compounds in this plant are helpful or harmful. Once good research is done, then the use of compounds can occur with everyone understanding appropriate risks and benefits like with any other drug now available.

Shared Reading Helpful For Chronic Pain Patients

Shared Reading Chronic PainNew research suggests that shared reading may help ease discomfort and provide cognitive benefits for individuals battling chronic pain.

Shared reading, as the researchers defined, was the act of of gathering with others and reading short stories, poetry or other literature out loud. Researchers said by reading literature that triggers memories of experiences throughout life, like happy childhood memories or relationships, patients can experience benefits similar to or that outweigh the effectiveness of cognitive behavioral therapy for chronic pain.

Shared Reading And Chronic Pain

There are hundreds of different treatment options for chronic pain, because chronic pain is unique to the individual. Some people experience pulsing pain in their lower back, others battle waves and waves of headaches, while others have nerve damage that sends pain signals to the brain when their is no painful stimulus present. What works for one person will not always work for another, and unfortunately that’s the problem that many pain sufferers are running in to. In turn, they are looking into alternative options, one of which is shared reading.

For their study, researchers compared the benefits of shared reading to cognitive behavioral therapy, which is a technique that aims to change the way people think and behave in order to better manage physical and mental issues related to chronic pain. To do this, patients with severe chronic pain were asked to participate in either five weeks of CBT or 22 weeks of shared reading. At the conclusion of the five weeks of CBT, individuals in that group joined the shared reading group for the remainder of the 22 weeks. The shared reading sessions incorporated literature that was designed to prompt memories of family, relationship, work experiences or other happy memories throughout their lifetime. Participants were required to report their pain severity and emotions before and after each session, and they were asked to record their pain and emotions twice a day in a personal journal.

Study Results

At the end of the study, researchers wrote:

  • While CBT helped to manage a person’s emotions, shared reading appeared to help patients address the painful emotions that might be contributing to chronic pain.
  • Pain severity and mood improved for up to two days after shared reading sessions.

“Our study indicated that shared reading could potentially be an alternative to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by chronic pain patients,” researchers wrote. “The encouragement of greater confrontation and tolerance of emotional difficulty that sharing reading provides makes it valuable as a longer-term follow-up or adjunct to CBT’s concentration on short-term management of emotion.”

Researchers want to conduct future studies with larger sample sizes, but it’s an interesting approach to treating chronic pain. We’ll certainly keep tabs on shared reading as a potential treatment option.

New Low Back Pain Guidelines From The ACP

 

Low back pain treatmentIn the last week, the American College of Physicians (ACP) published new guidelines for the care of low back pain. The guidelines are their recommendations based on the available research on the subject. The most important thing to remember is this information is designed for physicians to assist with the management of particular problems.

However, the recommendations are only as good as the knowledge and ability of those who put together the data. These guidelines provide some reasonable information, but they do not contain significant information from board certified pain practitioners who are treating the problem every day. The reason why we need to highlight this issue is because the guidelines attack back pain as if it has one single cause, which we know is not always the case.

Where The Guidelines Fall Short

For the pain practitioner and as it should be for every doctor, pain is one symptom, and the low back region covers a large number of structures that can cause problems. A diagnosis is based on a history of symptoms, a physical exam, and then the application of medical knowledge to determine the causes related to the problem.

The new guidelines move away from coming up with a specific diagnosis of the pain problem. They also recommend any number of treatments that have a limited scientific basis, like acupuncture and spine manipulation, and they did not address medications very well. Muscle relaxants are recommended as well as duloxetine (Cymbalta), while many more common medications like Celebrex were not studied. The guidelines also recommend many psychological therapies and exercises that are not readily available or not covered by insurance.

Treating Back Pain

Guidelines are meant to serve as a road map to help practitioners establish appropriate treatment for patients. The new ACP guidelines lack instruction on establishing appropriate diagnoses and true evidence-based treatment alternatives. The guidelines appear to be the answer to what is the cheapest way to get a complex problem patient out of an office. They recommend everything but appropriate diagnostic testing, referrals to experts in pain, or advice on all the non-opioid options available and when to use them. These guidelines made headlines in the national news, but they surely are not truly newsworthy.

Acute, subacute, and chronic low back pain all have different meanings and can be quite well treated with a variety of interventions. It is true that most acute back pain is short lived, but primary care physicians should learn much more about all the causes and treatments available.  For the patient, telling them “No matter what you do, it usually gets better in a month,” as these guidelines suggest, is poor quality care. No patient wants to be sidelined for a month, and they want to have a definitive diagnosis and treatment plan. These guidelines fall short of offering the best care for each patient with back pain.

Are Stretch Studios The Next Big Fitness Wave?

stretching benefitsOne of the three key aspects of exercise is stretching. The other two are strengthening and conditioning. When one has pain, a component may be tight muscles. A recent article in the New York Times took a look at the new fad of stretching studios. There have been all kinds of health and fitness crazes, but this was something new.

There are many different types of exercise gyms, from the bare bones centers to the multimillion-dollar health clubs to the specialty studios for yoga. Now the new kid is the studio that works individually with a client to increase a person’s flexibility through muscle stretching. Athletes and those with a wide variety of injuries or conditions like neck and low back pain have muscle tightness. Muscle pain with lack of full range of motion often contributes significantly to pain.

Stretching Benefits

The advent of the “stretch” centers, the studios that concentrate on working with people on muscle stretching, is an outcome of our world of pain. Muscle pain is common in athletes due to strengthening without also concentrating on maintaining full muscle length and joint mobility. In the person with neck or low back pain, muscle tightness occurs due to the muscles contration in an effort to prevent someone from moving a painful area. In either cause, tight muscles and lack of joint range of motion are causes themselves for pain.

Stretching is an essential component of exercise. Being an ancient doctor, the reference book of my time was “Stretching” by Bob Anderson, and it was an easy to understand guide to stretching any region of the body. Now, the Internet or your phone’s apps can be an easy source of exercises to stretch any part of the body. Routines do not need to be complicated or take large amounts of time. Stretching for 5 to 10 minutes every day is extremely helpful to loosen up muscles. Sometimes, it takes multiple times a day that one has to stretch, especially if the problems are neck and low back pain. A stretch can be as simple as bending over to touch your toes or sitting on the floor and reaching for your toes.  A lot of people are stiff at the end of the day or first thing in the morning. Doing a stretching routine before going to bed and first thing in the morning can often help reduce tightness and pain especially at night and early in the day.

Advanced Stretching

The stretching studios are a bit higher level of stretching. A staff member works with a client to help them stretch a wide variety of muscles. They spend 45-60 minutes work on whole body flexibility. Getting all the muscles loosened up by stretching can be very relaxing. Supposedly the relaxation is similar to what is felt with a massage, but it would require more participation for the client.  

Physical therapy can also teach a person how to effectively stretch, especially a person who has had an injury. Working with a therapist is helpful to learn the correct techniques and to prevent further injury. Oftentimes a therapist will give a patient numerous exercises to perform, and doing the whole set could take 45 minutes. Once one understands the exercises, you can choose a few that cover the areas that need work so the whole routine can be done in hopefully 10 to 15 minutes at the most. The main message is tight muscles are often a source of pain, and learning and performing effective stretching routines daily can significantly improve function and diminish overall symptoms.

An Update On Daith Piercings

daith migraineI wrote my first article on Daith piercings about a year and a half ago. As many know, this has been advocated for the treatment of headaches. The questions I have been asked since that time have been numerous but the most common question is, “Will it work for me?” I obviously cannot tell if it work for anyone in particular. I have heard from many that it has helped them manage their migraine headaches. Most interesting to me was some of my regular patients have tried it successfully.

Daith Piercing Information

Daith piercings are a specific type of ear piercing. The ear cartilage midline toward the front of the ear is pierced. This type of ear piercing has been around for 3,000 years, but the name “Daith piercing” was probably started in the 1990’s. The placement of the piercing is at the entrance to the ear canal and has symbolic meaning as the “Guardian to the Gate.” This piercing can be quite painful, and since it is through bony cartilage, care must be given to keep the site clean and to prevent infection.

There are many types of headaches, and only certain types of headaches will respond to Daith piercings. Those most likely to improve are migraines that are sensitive to ear stimulation, and likely to be one sided in nature. Daily headaches may be caused be a variety of factors – most common are muscle tension and stress headaches. Muscle tension headaches are caused by neck muscles tightening up, often associated with the position one has while working on a computer. Stress type headaches are caused by psychological factors that make a person anxious.  The most common headache in my practice are those associated with neck problems; either from nerve and disc problems or from the joints in the neck causing pain. These types of headaches are best treated successfully by managing the underlying causes.

Managing Headaches

The headaches that have been managed by Daith piercings are those that are migraine headaches. If you have been diagnosed by a neurologist with definite migraine headache (not self diagnosed), Daith piercings may be a treatment option. Over the last 18 months of studying this subject, an interesting correlation occurred to me that this treatment was similar to acupuncture and vagal nerve stimulation. All these treatments seem to affect the vagal nerve via a branch near the ear, which sends signals back to the brain that may affect various neurotransmitters and hormones that lead to vascular headaches.

Unfortunately, the true scientific proof and medical evidence with regards to Daith piercings is not present. All the results when one researches the topic seem to be stories that it worked for them. There is some basis as noted above why it may work. For those who are interested, a few cautions should be remembered. First, this is specifically going to work best for migraine headaches. If you have frequent and sometimes severe headaches, and they are not easily managed, first see a medical doctor and possibly a neurologist and get a good diagnosis made, and try conventional treatment. The cause should be treated first and may be straight forward to manage. If the headaches are migraines, and they are not responding to management, Daith piercing may be reasonable. Physicians normally do not perform this procedure, so do not ask them to do it. Only get this done by someone who does body piercings and is familiar with this particular one. It is extremely important that meticulous care is performed before and afterwards to keep the area clean and free from infection. Since this is through ear cartilage, near the brain, an infection in the area can be very dangerous and should be treated aggressively by a doctor.

If you want to run a test before piercing, first try massaging the area of the ear when you have a headache and see if that makes a difference. Another possibility is to try acupuncture to see if that works. Most acupuncturists will report what they do is different than the piercing and this is not going to be equal to the piercing, but it may be safer and easier for a test. If you go ahead with a piercing, make sure you try to prevent an infection in the area of the piercing.