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Ways to cope with Chronic Pain

Topic: Living With Chronic Pain

Chronic pain is best treated through multi-modal therapies including physical therapies, psychotherapy, spiritual care, lifestyle management, and interventional therapies.

Start by setting goals that are SMART (specific, measurable, action oriented, realistic, and time-based). For example, “I want to reduce my pain from an 8/10 to a 6/10 so I can walk the dog around the block within 4 weeks after starting treatment”.

The drug classes that correlate to the three pillars of the pain triangle – Chronic Pain, Insomnia and Stress are listed below. Medical cannabis is a promising alternative for all, and it is likely to avoid the negative side effects associated with these drugs, particularly opioids.

Retrieved from:
http://nationalpaincentre.mcmaster.ca/documents/Opioid%20GL%20for%20CMAJ_01may2017.pdf

 

Medical Cannabis as an Alternative Therapy for Chronic Pain

Alternative pain treatment options are necessary to address the opioid crisis and the high prevalence of chronic pain. There is an increasing number of chronic pain patients not achieving their pain management goals, and there is a lack safe options to address chronic pain1.

Cannabis has better safety profile than opioids, with no reported deaths directly due to overdose. In the U.S, in the states with legalized cannabis, there was a reduction in opioid-related mortality and opioid prescriptions2.

Furthermore, our body’s own endocannabinoid system and opioid system interact synergistically with major pain pathways. Cannabinoids have several mechanisms of action to produce pain relief, whereby cannabinoid receptors are present in the peripheral and central nervous system, and in immune cells.

References:
[1] Stucke, A. G. et al. Opioid Receptors on Bulbospinal Respiratory Neurons Are Not Activated During Neuronal Depression by Clinically Relevant Opioid Concentrations. J Neurophysiol 100, 2878–2888 (2008).
[2] Bradford, A. C., Bradford, W. D., Abraham, A. & Adams, G. B. Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population. JAMA Intern Med (2018)
[3] Wen, H. & Hockenberry, J. M. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees. JAMA Intern Med (2018).
Previous Article
An Alternative Solution to the Opioid Crisis
Chronic pain is rarely isolated; it is frequently linked with sleep disturbances and emotional distress, forming the well-known “Pain Triad”. These three interconnected ailments can affect a person's quality of life. For example, a high level of pain can lower your mood and reduce your quality of sleep. Medications typically used to treat the Pain Triad The drug classes that correlate to the three pillars of the pain triangle are listed below1. Medical cannabis is a promising alternative for all, and it is likely to avoid the negative side effects associated with these drugs, particularly opioids. Medical cannabis as an alternative solution to the opioid crisis Medical cannabis is a promising alternative to opioids for the treatment of chronic non-cancer pain2, which is the most common indication for its use. Other areas where cannabis has showed promise to date are in fact covered by drug classes overwhelmingly used to the three pillars of the pain triad. Moreover, cannabis may well spare patients many of the side effects associated with opioid use3. For those interested in using medical cannabis as an adjunct therapy option to opioid, Starseed offers several product options that maybe helpful for patients. Starseed’s clinic partner ‘North Star Wellness’ is also available for medical cannabis consultations free of charge. With 9 clinics across Ontario and a team of expert health care professionals, North Star Wellness offers in-person and telemedicine consultations for patients in need of education and medical authorization for cannabis. Register and book your appointment today. References: [1] National Pain Centre (2017). The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain. Hamilton, ON: McMaster University. Retrieved from http://nationalpaincentre.mcmaster.ca/documents/Opioid%20GL%20for%20CMAJ_01may2017.pdf [2] Benedict, G., Sabbagh, A., & Conermann. (2022). Medical cannabis used as an alternative treatment for chronic pain demonstrates reduction in chronic opioid use – a prospective study. Pain Physician Journal, 25, E113-E119. Retrieved from https://www.painphysicianjournal.com/current/pdf?article=NzQwOA%3D%3D. [3] Ergisi, M., Erridge, S., Harris, M., Kawka, M., Nimalan, D., et al. (2022). An updated analysis of clinical outcome measures across patients from the UK medical cannabis registry. Cannabis and Cannabinoid Research, X(X), 1-10. Retrieved from https://www.liebertpub.com/doi/epdf/10.1089/can.2021.0145.
Next Article
A Clinical Framework on Evaluating Cannabis Product Quality and Safety
With the rise in medical cannabis demand and product availability, establishing if a product fulfils acceptable quality standards has become more important. Patients can use the proposed framework when evaluating a cannabis product. 1.     Type of product Common product types used for medical purposes are ingestibles (i.e., Oil capsules, oral spray, edibles), topicals (i.e., Compounds & transdermal patches), and inhalation (i.e., dried cannabis flower and vapes). Dabs, waxes, and shatters, among other typical cannabis concentrates, are considered higher-risk products and are generally not recommended for medical usage. 2.     Product labelling Adequate health warning labels should be given for any health product, including cannabis. Indications of appropriate storage requirements can help in product quality preservation. 3.     Listed Cannabinoid content The content of cannabinoids is crucial in determining the appropriateness of cannabis and the risk associated with it. It's important to think about the amount of THC and/or CBD listed, whether it's in percentages, concentrations, or weight. According to Health Canada, the maximum amount of cannabis allowed in a medicinal cannabis format is as follows: -       Dried flower: <30g per package. -       Topicals/Extracts: THC level is <1000mg per container. -       Edibles: THC quantity <10mg per package. 4.     Listed product/manufacturing details Product specifications that are detailed are useful in ensuring product quality. Components of labelling include: -       packaging date -       expiry date -       lot number -       net weight/volume -       listed ingredients -       decontamination methods -       evidence of third-party testing The aforementioned information can be found on product packaging or in the Licensed Provider's own website's product description. 5.     Product packaging Health Canada requires particular packaging considerations or security elements. The following factors should be considered when determining whether or not the package is safe to use -       Child-resistant -       Made of Opaque material -       Designed with Non-desirable image or logo -       Sealed and secure before use References: Health Canada. (209). Final Regulations: edible cannabis, cannabis extracts, cannabis topicals. Retrieved from https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/resources/final-regulations-edible-cannabis-extracts-topical-eng.pdf MacCallum CA, Lo LA, Pistawka CA, Boivin M (2022) A clinical framework for evaluating cannabis product quality and safety, Cannabis and Cannabinoid Research X:X, 1–8, DOI: 10.1089/can.2021.0137.

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