Medical Cannabis For Chronic Pain Could Increase Heart Arrhythmia Risk

January 11, 2024 / Thomas Cohn, MD

New research out of Denmark suggests that medical marijuana use for chronic pain issues may significantly increase a person’s risk for de novo arrhythmia compared to patients who pursue other treatments for their pain.

While the absolute risk of developing heart arrhythmia while taking medical cannabis for a chronic pain condition is still relatively low (0.4%), the fact that is raises your risk at all could be a cause for concern for many patients, especially those with a history of heart issues.

“Short-term risk of arrhythmia was significantly elevated in patients prescribed medical cannabis compared with matched control patients, but the absolute risk increase was modest at 0.4% in the first 180 days,” said Anders Holt, MD, cardiologist at Copenhagen University Hospital – Herlev and Gentofte in Denmark, in an interview with Healio.

Medical Cannabis And Heart Issues

For their research, Holt and colleagues used nationwide registers to identify 5,391 patients with chronic pain who began using medical cannabis between 2018 and 2021 as part of their treatment plan. This group was then age- and sex-matched 1:5 to 26,941 control patients with a chronic pain diagnosis that were pursuing another pain medication treatment other than medical cannabis.

For the patients that used medical cannabis:

24% used CBD
29% used combination CBD/THC
47% used THC alone

For patients pursuing other treatments, the most common medications were NSAIDs, anti-epileptic drugs and opioids.

Researchers reported that medical cannabis use was associated with a 180-day absolute risk for new-onset arrhythmia of 0.8%, whereas non-use was linked to a 180-day absolute risk for new-onset arrhythmia of 0.4%, meaning patients who pursued medical cannabis were twice as likely as their counterparts to develop a new heart arrhythmia. Researchers said the increased arrhythmia risk was similar regardless of the type of medical cannabis they pursued.

“Both CBD and THC have an effect on the CB1R receptor, which theoretically could lead to CV [cardiovascular] side effects,” said Holt. “Previously, side effects have been mostly suspected to be related to THC since the psychoactive properties of cannabis arise from this cannabinoid. Findings from this study suggest that both THC and CBD may play a role in the risk of CV side effects.”

The team did note that they observed no significant association between medical cannabis use for chronic pain and risk for acute coronary syndrome

“This study adds important and much-needed data on CV side effects related to medical cannabis; however, clinicians should consider the observational nature of these findings which limits their impact and applicability for clinical recommendations before changing any practice,” Holt concluded. “Considering all available data on medical cannabis treatment for chronic pain, I believe that it should probably be reserved for chronic pain conditions where the effect is supported by sufficient evidence, eg, neuropathic chronic pain. Considering data from this study, some improved monitoring of CV symptoms immediately following initiation could be beneficial, especially in patients with known cardiometabolic disease or history of cancer.”

Dr. Holt’s takeaway point here is key. Given the nature of the study results, physicians should thoroughly review a patient’s heart history before recommending medical cannabis as a treatment option, and heart monitoring could be beneficial for chronic pain patients who are beginning a medical cannabis regimen. Medical cannabis has been shown to be an effective tool in managing symptoms for many types of chronic pain patients, but it’s not without its own risks. Patients would benefit from an open and honest dialogue with their doctor about their heart health prior to beginning a medical cannabis regimen as part of treatment for their chronic pain condition.

For more information about medical cannabis or chronic pain treatment, reach out to Dr. Cohn and his team today at (952) 738-4580.

Chronic Pain The Main Reason For Medical Marijuana In Minnesota

October 12, 2023 / Thomas Cohn, MD

Recreational 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

January 12, 2023 / Thomas Cohn, MD

New 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.

New Study Suggests Medical Marijuana Ineffective For Most Chronic Pain Patients

September 10, 2021 / Thomas Cohn, MD

A new study published in the British Medical Journal concluded that while some chronic pain patients find helpful relief through medical marijuana, the treatment is unlikely to benefit most patients.

To get a better understanding of the effectiveness of medical marijuana for chronic pain sufferers, an international group of researchers analyzed three dozen medical cannabis studies. Overall, they found that only a small percentage of participants reported “an important improvement” in chronic pain, physical function or sleep quality when taking oral or topical cannabis treatment.

“When we look at the overall evidence for therapeutic cannabis products, the benefits are quite modest,” said lead author Jason Busse, associate director of McMaster University’s Michael G. DeGroote Centre for Medicinal Cannabis Research in Ontario. “So medical cannabis is not likely to be a panacea. It is not likely to work for the majority of individuals who live with chronic pain. We do have evidence that it does appear to provide important benefits for a minority of individuals.”

Chronic Pain and Medical Marijuana

We have talked up the potential benefits of medical marijuana for chronic pain on this blog in the past, but at the same time, we’re not entirely surprised by the findings for a number of reasons. Here’s why:

Chronic Pain Is Complex And Individualized – Chronic pain is not like a broken arm. A chronic pain condition is highly individualized to the patient, and what works for one patient may not work for others. When it comes to chronic pain, there is no one-size-fits-all answer to chronic pain. Expecting medical marijuana to treat all different forms of chronic pain would be foolish.

Medical Marijuana Is Complex – Even though medical marijuana is highly regulated, there are so many different cannabis strains, and they can each affect a user differently. It’s not like taking 400 milligrams of Ibuprofen. Chronic pain treatment effectiveness may simply be lacking because of the differences between cannabis forms and strains.

Early Stages Of Understanding – We’re still in the early stages of learning about the effectiveness of medical marijuana for chronic pain. Moreover, federal regulations oftentimes make it difficult to research medical cannabis. We’re trying to learn more and increase its effectiveness, but we’re in the early stages, and access to data isn’t always easy to come by.

Certain Side Effects – Even if medical marijuana did help with a patient’s pain, the treatment can also come with some side effects that can leave people questioning whether it is the right treatment for them. Minor or mild pain improvements may not be worth it if they find that they are dizzy, anxious or have the sensation of being “high,” which have been reported in some users. Again, more research could help limit these unwanted side effects in some patients, but the research is lacking for a number of reasons.

There are also plenty of benefits associated with medical cannabis. Aside from it’s potential to unlock chronic pain, it’s also much less likely to become addictive or physically harmful like opioids – another common chronic pain condition treatment. Simply put, we’re not ready to give up on this potential solution to chronic pain, and we hope that this study only makes it clearer that more funding and research on the potential benefits and best practices for administering medical cannabis for chronic pain is needed.

Withdrawal Symptoms Common In Chronic Pain Patients Using Medical Marijuana

January 13, 2021 / Thomas Cohn, MD

As we’ve said on the blog in the past, we’re a proponent of helping patients find a treatment plan that works to help prevent or control their unique chronic pain condition. For many individuals, medical marijuana plays a key role in their treatment, but it’s far from a perfect solution. As we’ve also said on the blog in the past, we want more studies to be conducted on medical cannabis so that we can begin to unwrap this complex component. A recent study did just that, and they found a potentially concerning side effect associated with its use for chronic pain patients.

According to a new study, more than half of all patients who used medical marijuana to help treat a chronic pain condition experienced withdrawal symptoms during even short consumption breaks. There have been documented studies that suggest among recreational users, with about 40 percent experiencing some sort of withdrawal symptoms when not using, but this study took a closer look at these effects on medical marijuana users. Withdrawal symptoms aren’t expressly projected as a user’s yearning for their next dosage, rather, these symptoms can manifest in a number of different ways that affect a person’s health. For example, withdrawal symptoms can affect a person’s sleep, mood, mental state, energy and appetite, and these issues are manifesting in roughly half of medical marijuana users.

Withdrawal Symptoms And Chronic Pain

For this study, researchers polled more than 520 individuals using medical marijuana to treat non-cancer-related chronic pain issues. They were asked if they experienced any of the symptoms after not using for a significant time: Craving for cannabis, anxiety, sleep difficulties, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger and shakiness.

At baseline, 41 percent of people were classified in the mild withdrawal symptom group, 34 percent were in the moderate group, and 25 percent were in the severe group. Additionally, 13 percent of participants saw their withdrawal symptoms rise to the next level by the end of the first year of treatment, and eight percent transitioned upwards by the end of two years.

Interestingly, regardless of the group they were in, sleep problems were the most common symptom. And as we’ve said on the blog, inadequate sleep can have significant effects on your chronic pain condition. Poor sleep quality can worsen pain symptoms, so while some of these withdrawal symptoms may not seem all that bad, they can actually be making your pain condition worse.

At the end of the day, while they are two different treatment paths, a medical marijuana program needs to be implemented much like an opioid regimen for pain. A comprehensive patient profile needs to be developed, the patient needs access to educational material to ensure they understand the potential risks associated with the treatment, and regular checks need to be conducted along the way to ensure everything stays on track. If withdrawal symptoms or other issues are present, specific interventions need to be developed, because it’s unlikely that the problems will go away on their own. In fact, they oftentimes get worse.

So while medical marijuana can be a great addition to a chronic pain treatment plan, we doctors and patients need to be aware of the potential pitfalls to successful treatment so that they can be avoided and managed. If you’re dealing with a chronic pain condition and want help with treatment, reach out to Dr. Cohn and his experienced medical team for more information.