Medical Marijuana For Short-Term Chronic Pain Relief

November 17, 2020 / Thomas Cohn, MD

Medical marijuana is a topic we’ve written about on the blog numerous times in the past, and one point we’ve always hammered home is that we want more scientifically-backed research on the subject. As more research comes out, the more we expand our knowledge of the subject and can better treat our patients.

Recently, we read about a study that looked at the short-term benefits of medical marijuana use to control chronic pain symptoms. We share the results of that study in today’s blog.

Short Term Chronic Pain Relief With Medical Cannabis

The research was originally published in Volume 20, Issue 6 of Practical Pain Management, and it explored how medical marijuana could be used to help provide pain relief in patients with certain types of chronic pain. Patients for the study were at least 25 years of age, had experienced chronic pain for at least three months, and were willing to provide accurate reports about their chronic pain levels both before and during treatment. Treatment, in this instance, was taking medical cannabis after being informed of proper administration guidelines from a physician.

The most common chronic pain conditions that affected patients in this study were back pain, osteoarthritis, fibromyalgia and chronic headaches. Patients were asked to rank their pain at the beginning of the study and then again at 1-month, 3-month and 6-month intervals. Here’s what they found:

Patients in the study found that medical cannabis treatment was associated with significant improvements in pain symptoms and quality of life within one month of initiating treatment.
These effects were sustained at the three- and six-month intervals.
The only adverse effects patients reported were dry mouth, increased appetite and the sensation of feeling “high.”

After looking at the totality of the study, researchers stated that medical marijuana, when administered under the care and supervision of a healthcare professional, can be a safe and effective option for short-term pain relief for patients with varying types of chronic pain.

At our clinic, we always say that we want patients to find a solution to chronic pain that works for them. It won’t always be easy or passive, but we want you to find a solution that works for you. If medical marijuana or other treatments like the Daith piercing can help you find relief, we’re all for it. We’re also here to provide you with care or treatment recommendations if you want to pair your current treatments with a more professional approach. We’ll happily walk you though some of the more standard options like physical therapy or other lifestyle interventions, but we can also discuss alternative options and give you some more information so you can make the best decision for your health.

For more information about different ways to treat your chronic pain, or to set up a consultation with a specialist, reach out to Dr. Cohn’s office today.

New Laws on Chronic Pain and Medical Marijuana in Minnesota

December 14, 2015August 25, 2016 / Thomas Cohn, MD

Earlier this month Minnesota added intractable pain to the list of conditions that qualify for medical marijuana. It was a decision made by the Commissioner of Health, Dr. Ehlinger, in accordance to provisions of the legislation passed. In August of next year patients will be able to obtain prescription cannabis through the state approved pharmacies if they have been qualified. The exact rules are not yet in place, but there are some clear indicators of restrictions will be present. It is also not homegrown marijuana or any other marijuana; it is just from approved dispensaries that are strictly controlled.

Intractable pain in the State of Minnesota is chronic pain that has failed to be adequately managed by traditional medical care. This means that one has to have tried to manage the pain, gone through what is considered acceptable and approved treatment regimens, likely medication, physical therapy and possibly invasive management, and these treatments have been unsuccessful. One cannot just say they have pain, not have a diagnosis, and not go through standard treatments and expect to be able to obtain medical cannabis. Lastly, it is likely that two qualified medical providers (not just one) will both have to evaluate you and approve, and that the pharmacist at the dispensary also will have to agree.

Intractable Pain and Medical Marijuana

If you have chronic, intractable pain, it will not be easy to obtain medical marijuana. There will be good providers who will consider it an option as part of treatment. However, it is likely to be a choice only after one has failed reasonable standard treatments. The patient will have to be psychologically stable, and for most practitioners, it is likely that they will want them to be well controlled if they do have depression. Many providers will also look into any potential past substance abuse, and receiving both opioids and medical marijuana is likely not to occur. The better pain providers will likely want to closely monitor the patient receiving the alternative treatment and be in touch with the dispensary and pharmacist to know what is exactly being prescribed.

Medical marijuana is not a panacea. It is another possible treatment that may have benefit for some patients. The science and effectiveness behind its use is just in its infancy. Like all other medications there are side effects and problems. It is not an FDA or DEA approved substance and is very much considered experimental. Therefore it is not approved at this time by any insurance. Expect all management and treatments associated with its use to require cash (not credit card or check) payment up front for any services including doctor as well as pharmacy visits. Treatment is likely not to be cheap and it very well may not be readily available. Many physicians may be reluctant to be involved with this treatment, and as a patient, if you are at all mean, abusive, obnoxious, inappropriate, or otherwise difficult with a provider or their staff, this would likely close the door for further management with that office.

The State of Minnesota over the next several months will likely clarify the rules and regulations of medical marijuana for patients in the state. There will likely be a number of hurdles to climb to obtain the high quality pharmaceutical cannaboid for pain management. If it is the correct management tool when all else has failed, it may be worth the effort. It is not a simple solution, and it is not going to be a legal way to just get street quality marijuana for personal recreational use.

What Pain Professionals Are Saying About Marijuana

March 23, 2015 / Thomas Cohn, MD

Marijuana is a controversial topic in society. Some people want it legalized while others demonize the compound. The reality in the medical field is somewhat in the middle. The first thing that needs to be understood is that in most circumstances, medical experts are primarily interested in all the compounds in marijuana except for THC. That means most medical professionals are interested in what cannabinoids or cannabidiols (CBD) compounds are present and what medical purpose they serve. The major compound that is present in almost all available marijuana is THC, which also happens to be the compound responsible for the high one receives from marijuana.

For pain professionals, there is good understanding of the action and effects of THC. Most strains available in states that have legal marijuana, including strains that are “medicinal” in use have high amounts of THC, 10% or greater in amount, and virtually no other cannabidiols, or less than 2%. In the years of the hippie generation, the 1960’s and 1970’s, THC to CBD ratio was 1:1, and averaged 1-2%, while the really good stuff was just around 5%. Now available in legalized states, most available strains are minimum of 10% with up to 30% THC.

Medically, the best comparison of legal marijuana at this time, is to alcohol. The risk of dependence to THC is about 9%, including when using once a week (in reality this is a very strong way to become dependent), compared to alcohol which is 15%. Regular use, once a week, is known to increase depression, suicide, impulsivity, schizophrenia and psychosis, especially if use is started under the age of 20. It also leads to an 8-point loss of IQ in the young. Further, smoking does cause problems with the lungs. Recommending regular marijuana is no different for medical professionals to recommending drinking alcohol. The risks and associated problems are clearly out numbering benefits.

Need To Understand More

What we know about cannabidiols is just the beginning. In marijuana, we know there are over 100 different types. Our experience so far has found that they have some properties that may be helpful in about 30% of patients with neuropathic pain associated with MS and HIV. In low back pain, we’ve learned:

It has helped in anxiety but not with pain.

More people respond to acetaminophen then marijuana.

The future of cannabidiols is interesting for pain. It is unlikely that many professionals would be enthused to prescribe a substance that has the risk profile of THC. Once we can find the particular cannabidiols that have medical uses, it is likely that we will try to study them fully and make them commercially available for specific conditions. Cannabidiols may be helpful in the future, but we still don’t know enough right now to safely prescribe marijuana for a wide range of conditions.