marijuana

Chronic Pain The Main Reason For Medical Marijuana In Minnesota

/ Thomas Cohn, MD

medical marijuana benefitsRecreational marijuana became legal in Minnesota on August 1, but many patients with chronic pain were legally seeking out marijuana well before this year. That’s because Minnesota is one of many states that allows for the production, purchase and use of medicinal marijuana.

Medicinal marijuana has been recommended as a way to relieve symptoms in patients with a variety of conditions. From easing the symptoms of terminal cancer to providing relief for much less serious issues, medicinal marijuana is currently being pursued by tens of thousands of Minnesotans for their health condition. Recently, we learned that the most common reason why a person sought out medicinal marijuana in Minnesota was due to chronic pain.

“By far, chronic pain is what drives our program,” said David Rak, research manager for the Minnesota Department of Health’s Office of Medical Cannabis.

Medicinal Marijuana For Chronic Pain

According to Rak, nearly 60 percent of patients in Minnesota’s medicinal marijuana program cite chronic pain as their reason for enrollment. Currently, 24,270 of the program’s 41,183 participants are seeking treatment for chronic pain.

Researchers are still working to understand exactly why medical marijuana can help relieve symptoms in patients with chronic pain. However, because chronic pain is so unique to the individual, and because there are so many different types of marijuana, it’s not easy to pinpoint why some patients experience relief why others do not. Some researchers believe medicinal marijuana works by triggering the release of certain natural chemicals in the brain that can provide pain relief, while others suggest that medicinal marijuana can help to reduce inflammation and associated discomfort.

Others swear by the benefits of medicinal marijuana for another reason. As we’ve talked about on the blog in the past, healthy sleep is critical for working to overcome a pain condition, and many patients find that medicinal marijuana helps them fall asleep faster and achieve a more restful sleep.

“Sleep is really an important factor, actually,” said Rak. “If you’re sleeping better and you wake up rested, you’re more ready to start the day. You feel stronger.”

Others love that it has helped them transition away from potentially dangerous opioids. A study by the Department of Health found that 38 percent of patients with intractable pain who had been using marijuana for five months were able to reduce the amount of opioids they were taking as a result of their marijuana use. That same study also found that 42 percent reported a significant reduction in pain intensity after using medicinal marijuana.

So if you have chronic pain, should you consider enrolling in the state’s medical marijuana program, or should you just buy recreational weed and see if it offers the same benefits? For starters, you’ll want to talk with your pain management specialist before beginning either regimen. Odds are they will have some recommendations and additional treatments they’ll propose in conjunction with the medical marijuana program, like exercise or physical therapy.

If you do decide to move forward with marijuana, it’s probably best to go through the state’s medicinal marijuana program. Being enrolled allows your doctor to work with a dispensary pharmacist and decide on a type that will work well for your symptoms and not interfere with any other medications you’re taking. Medicinal marijuana products are also highly regulated and tested to ensure they have a specific amount of THC and CBD, something you may not get if you buy elsewhere. The program used to carry a $200 enrollment fee, but now it is free, although you’ll have to have your chronic pain condition certified by a professional like Dr. Cohn.

For more information about whether or not chronic pain could be a viable complimentary treatment for your chronic pain condition, reach out to Dr. Cohn and his team today at (952) 738-4580.

More Patients Swapping Out Opioids For Medical Marijuana To Manage Pain

/ Thomas Cohn, MD

medical marijuana programNew research has found that nearly one-third of patients with chronic pain report using medical cannabis to manage their pain, with more than half of them decreasing their reliance on other pain medications, like opioids, in the process.

“That patients report substituting cannabis for pain medicines so much really underscores the need for research on the benefits and risks of using cannabis for chronic pain,” said lead author Mark C. Bicket, MD, PhD, assistant professor, Department of Anesthesiology, and director, Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, in an interview with Medscape Medical News.

Medical Cannabis Use

For the study, researchers surveyed 1,724 Americans over the age of 18 with chronic noncancer pain living in areas where medical cannabis was available. Participants were asked about their use of three different types of pain management:

  • Medical marijuana
  • Pharmacologic treatments like opioids, non-opioid analgesics and over-the-counter medications
  • Non-pharmacologic treatments like physical therapy, cognitive behavioral therapy or mindfulness

After looking at the survey results, researchers found that 25.9 percent of respondents reported using medical cannabis within the last year, and 23.2 percent reported using it within the past 30 days. More than half of patients who said they used medical cannabis said this also led to a decrease in prescription opioid use, prescription non-opioids and over-the-counter medications. “Almost no one” said that medical cannabis led to a higher use of these medications, said Dr. Bicket.

Medical cannabis use also impacted other treatments as well, for the good and the bad. 38.7 percent of people said that cannabis use led to decreased physical therapy sessions, 19.1 percent said it led to lower use of meditation, and 26 percent said it led to less CBT. Conversely, 5.9 percent of patients said cannabis use led to more physical therapy, 23.7 percent said it led to more meditation therapy, and 17.1 percent said it led to more CBT, so cannabis use clearly had a more widespread variance on other therapies than it did on pharmacological treatments, which saw a very obvious decreased correlation.

While Bicket was pleased with the findings, he noted that the current environment – where cannabis use is medically approved on some state levels but illegal on the federal level – makes it harder to accurately study the best ways to implement cannabis use for a patient population.

“We really don’t have a good sense of the relative risks and benefits that could come from cannabis as a treatment for chronic pain,” said Bicket. “As a physician, it’s difficult to have discussions with patients because I’m not able to understand the products they’re using based on this regulatory environment we have.”

Bicket seems to have the same gripes about the current medical marijuana climate that we have about chronic pain care in general. For one reason or another, we’re not able to easily study the best ways to treat chronic pain or harness the power of certain treatments like medical marijuana. Hopefully the landscape changes in the near future so that patients can have better access to the right treatments for their individual needs.

Opioids, Medical Marijuana and Chronic Pain

/ Thomas Cohn, MD

marijuana pillsWhen it comes to managing chronic pain, we’re always looking for new and better ways to help patients control their discomfort. If you’re a regular follower of our blog, you probably know that we’ve written a number of blogs on opioids and medical marijuana, but a recent study decided to take a look at what happened when these two treatment plans were used simultaneously. You might be surprised at the findings.

According to research presented at the 2019 American Pain Society Scientific Meeting, individuals with chronic pain who used both prescription opioids and recreational marijuana showed higher levels of mental health and substance abuse problems than those who use opioids alone. Now, the study makes a big distinction noting that patients were using marijuana recreationally and not medicinally, but it still shines a light on how problems can occur when people try to supplement their opioids with other substances.

Study Results

Those weren’t the only findings that were of concern according to researchers. The team said that anxiety and depression scores were also significantly higher for patients who used both opioids and recreational marijuana, as were measurements of opioid dependence severity and alcohol and cocaine involvement. Researchers also noted that there was no difference in pain severity or pain disability between the group of individuals just using opioids and those using opioids and recreational marijuana.

“The things psychologists would be most worried about were worse, but the thing patients were using the cannabis to hopefully help with — namely pain — was no different,” said Andrew Rogers, University of Houston, who worked on the study. “Co-use of substances generally leads to worse outcomes. As you pour on more substances to regulate anxiety and depression, symptoms can go up.”

Abhiram Bhashyam, MD, MPP, of Massachusetts General Hospital in Boston, who was not involved with the study, said the findings provide even more evidence that patients shouldn’t assume that recreational marijuana will help with the effects of their chronic pain if they are already on opioids.

“This study provides further evidence that cannabis may not be an effective substitute or alternative to opioids for pain management,” said Dr. Bhashyam. “Studies like these are important for clinicians as patients increasingly ask about opioid-cannabis co-use for managing their pain. We lack robust evidence to provide appropriate guidance due to a paucity of research on this topic at present.”

Both opioids and medical marijuana can be helpful if you’re dealing with chronic pain, but it’s important to realize that there’s a significant difference between regulated medical marijuana and recreational marijuana, so don’t assume that what you pick up on the street will be beneficial in combination with opioids for your pain. As this study suggests, it doesn’t appear to help and it can certainly make some problems worse. If you’re considering medical marijuana or another treatment plan for your pain, consult with a physical medicine specialist first to ensure you’re making the right choice for your individualized condition.

Chronic Pain The Most Common Reason Patients Seek Medical Marijuana

/ Thomas Cohn, MD

medical marijuana painA new study found that chronic pain was the most common reason why individuals in state-approved medical marijuana programs turned to cannabis to help with their health condition.

The study looked at data from 15 states who have legalized marijuana for medicinal purposes. Here’s a look at the top three reasons why people turned to medical marijuana:

  1. Chronic Pain
  2. Stitfness related to Multiple Sclerosis
  3. Chemotherapy-related nausea

“The majority of patients for whom we have data are using cannabis for reasons where the science is the strongest,” said lead author Kevin Boehnke of the University of Michigan.

Marijuana For Chronic Pain

More than 30 states allow the use of medical marijuana, but the conditions that are eligible for the product vary from state to state. For example, Minnesota allows medical marijuana to be used to alleviate symptoms from conditions like glaucoma, chronic pain, PTSD, seizures and much more. They are always evaluating which conditions meet the requirements, and Minnesota will add Alzheimer’s Disease to the list of approved conditions in July of this year.

When taking a closer look at the study results, researchers found that about two-thirds of the roughly 730,000 reasons listed for taking medical marijuana were related to chronic pain. Since patients could report more than one pain condition, researchers say the figure may be a little over-inflated, but it still speaks to how many people are looking for a better way to deal with their chronic pain condition.

“Cannabis is the first thing I’ve found that actually makes the pain go away and not leave me so high that I can’t enjoy my day,” said Brandian Smith, 37, of Illinois, who takes medical marijuana for her fibromyalgia.

Researchers also noted that in Arizona, Colorado, Nevada and Oregon, there was a noticeable decline in medical marijuana patients after those states legalized recreational marijuana. Currently there are about two million people in the United States who use medical marijuana for their pain condition.

Is you need help managing your pain condition, set up an appointment with a pain specialist like Dr. Cohn.

Can Marijuana Relieve Pain?

/ Thomas Cohn, MD

MarijuanaThere is currently a raging controversy about legalizing marijuana, especially for medicinal purposes.  A few states have recently legalized it, and several other states (including Minnesota) are considering it. This article will examine the potential benefits of marijuana for managing pain.

Marijuana Compounds & Ingredients

The active ingredients in marijuana are cannaboids, and there are at least 84 different ones present in the plant.  There are also 483 known compounds in marijuana.  The main compound is THC, which has psychoactive components.  For medical purposes, it has been used and approved for glaucoma and poor appetite related to chemotherapy and cancer.  Unfortunately, there are claims about the success of the plant for many other conditions, but very little scientific support to determine the reality of these claims.

Studies have shown that marijuana has psychoactive effects, some positive, and some negative. A few of the more common effects include:

  • Heightened mood
  • Relaxation, and euphoria
  • Decreased short-term memory
  • Impaired motor skills and judgment
  • Anxiety and paranoia

Marijuana & Pain

Marijuana has been known to have some impact on pain. Some studies show its effectiveness in managing nerve pain such as:

Why it works it not understood, but there are multiple areas in pain pathways that it may modulate.

The Need for Better Research

The problem with marijuana is that there are many compounds in the plant when taken as a whole.  Some of the chemicals may be beneficial, while others may cause problems.  On a scientific basis, most medical doctors want to know the specific compounds that are effective for any condition and use just that compound.  Marijuana has 483 different compounds and at least 84 cannaboids, and the whole plant is on the “Black List” – thought to be dangerous to society.  In the United States, research on marijuana is strictly controlled.  The variety of plants grown is extremely limited by the U.S. government and the restrictions on handling the plant make good research extremely difficult.

In reality, it is likely that there are beneficial cannaboids for a variety of painful conditions.  Good research is needed to determine which compounds are effective for what conditions.  The U.S. government needs to at least legalize marijuana for medical research, and get serious about determining the real safety issues with the various compounds.  Control of marijuana for safety versus making it illegal on all fronts is wise.