Pot and Pain, Part 1

It seems there are still some misconceptions about pain being an “excuse” for Medicinal Marijuana (MMJ), I have overheard on talk back radio old folks complaining that it didn’t work for them etc. There are several reasons why Cannabis is useful, and preferred by patients, it is to much for 1 post,  I got to 1200 words on the first attempt, so I will break it down,

  • Neuropathic Pain vs Nociceptive pain.  Part 1
  • Side effect profile vs Opiates.   Part 1
  • Synergestic effect with Opiates.  Part 2
  • Hyperalgesia.   Part 2
  • Anti Inflammatory effects.  Part 2

 

First of all, MMJ will not work for Nociceptive pain  It is well established in the scientific literature that is is effective for Neuropathic pain.  In Laymans terms, this means that it wont work if you break  a bone,  but if you happened to crush a nerve…….. then it offers good results. The Germans managed to compile a list of high quality cannabis studies in 2012, and show those with postive vs negative results.  There tallies were 26 studies for chronic/neuropathic pain, with 23 having positive results in favor of MMJ. There are also many other studies since 2012 supporting the benefits, and even getting measurable results out of tiny doses.  Some of these studies also go into secondary benefits, such as improved sleep, which anecdotally, is what a lot of older MMJ users in the USA find, it relieves some pain from sciatica or similar, and allows them to sleep through the night better.

The second nugget of knowledge is in regards to the conventional alternatives.  Many of the members of my chronic pain group have debilitating diseases, it is not a case of a bunch a people with a dodgy knee, we have 10+ people with Complex Regional Pain Syndrome (CRPS),  which is widely considered the most painful condition in existence. We also have a young woman who has been on Morphine since age 12 for Juvenile Arthritis that had so much inflammation the nerves were damaged,  several failed back surgeries, people with Lupus, MS, and Allodynia,  which is when the nerves a basically fried in a permanent state of over excitement, where even the lightest touch is severely painful.  Because this group is at the extreme end of the scale, Doctors feel the urge to “do something” and this invariably involves the Morphine family of drugs (Opiates) and the Valium class of drugs (Benzodiazepines, “Benzos”) Both classes are addictive, and while they work short term, or as a rescue medication for flares, there is actually little evidence that opiates work long term.   Many of the community have had to battle the label of addiction, when taking the medications exactly as prescribed by the GPs and specialists. I myself have seen it first hand with the 40+ Emergency Department visits my wife has made, in the cities, the doctors treat you as a junkie, as seeking relief from excruciating pain looks very similar to seeking a “fix” that the substance abusers seek.  I would go so far as to say Christchurch hospital was disgusting in that regard, yet the St Johns crew could make an estimate of a patients pain based on blood pressure and heart rate, and showed nothing but compassion, Gold Star for them!

Opiates are widely over prescribed, although it is not as bad as in the USA, where estimates are 17k people die from prescription overdoses per anum, we still have problems with it here, I have an OIA request in to get some harder numbers on deaths and near misses in NZ.  The side effects often experienced with Opiates and or Benzos are….

  • Constipation, (who doesn’t love a fleet enema )
  • Depression, (as if people in chronic pain aren’t depressed enough already)
  • Respiratory depression, (that is how it kills, you stop breathing, even if your mind is completely aware, as my wife’s was when St Johns overdosed her)
  • Aggression
  • Dizzyness, prone to falling over, causing more pain..
  • Cognitive impairment, unable to spell 5 letter words, delayed reactions, patients often feel unsafe to drive, especially at night and more so when Opiates and Benzos are combined
  • Tolerance build up, after a few weeks or months, you will need to double it
  • Nausea, though generally this side effect fades over a week or so, in some cases it is a violent reaction and the medication cannot be tolerated
  • In extreme cases heart issues, I’m aware of 1 patient on 120 mg of Methadone morning and night, and his Heart rhythm/QT Intervals went out of whack leaving him unable to walk to his letterbox.
  • Hyperalgesia – more on that later..

In comparison,  the most reported side effects, when used medcinally for Cannabis use are,

  • Dry eyes
  • Improved mood
  • Improved Sleep
  • Cognitive impairment (mild in comparison to Opiates and Benzos)

From personal experience with the wife, the cognitive deficit from Opiates and Benzos can be huge, there is an entire year of her life she barely remembers, which is just as well, as that year had the most pain and hospital visits as ACC tried to shirk their responsibilities. The aggression she displayed that year at points was enough for a social worker to become involved during one hospital visit. I also had a neighbor with a failed back surgery that would have a family intervention due to aggression after less than a week on Morphine.  I also have a contact from who had a respectable job, and on being prescribed Methadone,  “lost the plot”  and resulted in 2 Tresspass orders, of which he can barely remember the events.

More to follow,  in part 2 next week!