Chronic Back Pain is one of the most common illnesses seen by physicians.  Almost everyone has back pain at some time in their adult life.  Back pain occurs most commonly between the ages of 30 and 50 due to the aging process and due to a more sedentary lifestyle that begins in this age group.  The pain can be neuropathic or nociceptive.  Neuropathic pain is caused by damage to a nerve.  This kind of pain is felt as a sharp stabbing or burning.  Nociceptive pain is caused by disease to the tissues outside of the nerves.  It is felt as a dull ache or sense of pressure. Examples of these kinds of pain are a pinched nerve (neuropathic pain), and arthritis (nociceptive pain).  It is frequent for patients to have both types of pain at once, called mixed pain.

Fifty percent of patients with back pain have experienced some type of trauma, such as a sports injury or motor vehicle accident. But the other fifty percent have no known cause of their back pain.  Most patients who seek care for their back pain will undergo some type of evaluation that may include x-rays, CT scan, and/or MRI; occasionally some patients will have a myelogram (dye injected into the spinal cord area followed by x-rays) or bone scan (dye injected into the blood which will then concentrate in an abnormal area of bone).  Many times no obvious cause of the pain is found.

Patients who have acute back pain will often improve or recover in six to eight weeks.  Patients with acute pain occurring more than three times in one year or who experience longer episodes of back pain that interfere with daily activities (e.g., sleeping, sitting, standing, walking, bending, riding in or driving a car) are more likely to develop a chronic back condition.  Sometimes these chronic back pain patients will have pain, numbness or tingling in their legs.  Some patients with chronic pain do not respond to conventional therapy and have to find a way to live with their pain.  Physicians have found that living with chronic pain is extremely difficult and can lead to opioid dependency (addiction), anxiety, depression, and insomnia.

Medical marijuana is increasingly becoming the treatment of choice for many chronic back pain patients.  Conventional treatment therapies such as over the counter non-steroidal anti-inflammatory medications – NSAIDS – (such as ibuprofen, naproxen sodium, or aspirin) can be helpful but can cause side effects such as stomach upset, nausea, gastric bleeding, and ulcers.  Prescription medications like other NSAIDS (like Celebrex) or opiates (like Vicodin or Norco) can be effective at treating pain but can also cause many adverse and unacceptable side effects.  The addictive potential of opiates is very concerning to patients who struggle with chronic pain and need relief; it is this concern that leads patients to consider using medical marijuana, a very effective treatment for chronic back pain.

In 1975, scientists began studying THC in cancer patients and found that it was a very effective pain reliever without significant or toxic side effects.  Other studies followed and the conclusion was the same: marijuana safely and effectively treats chronic pain with little to no side effects.  No nausea, no stomach upset, no ulcers, no addiction – many patients jokingly only refer to an increased appetite (”munchies”) the only “bad” side effect.  Marijuana side effects of elevated mood, improved sleep, and reduced anxiety are welcomed by most patients and considered beneficial to having a good quality of life when you suffer daily with chronic pain.

How can medical marijuana help your chronic back pain?
•    You will reduce or eliminate pain, allowing you to continue being active
•    You will reduce or eliminate the use of potentially addictive medications or dangerous medication side effects
•    You will reduce or eliminate the anxiety, depression, and insomnia associated with chronic pain
•    You will feel better knowing that you are using a natural treatment for the pain
•    You will have better quality of life

Many medical marijuana patients are happy to learn about tinctures of cannabis.  A tincture is an alcohol-based liquid mixture. It is like a concentrated extract.  Currently there are tinctures of cannabis made with alcohol, oil or glycerin.  It is a very effective way to use medical cannabis.  Drops of the tincture are placed under the tongue (sublingually) and the medication passes through the blood vessels and enters the bloodstream.  You will feel the onset of effects in about 5 – 15 minutes with the peak effect at about 30 minutes after taking the medication.  For many patients, the effects are similar to inhaled cannabis.

The benefits of using a tincture of cannabis:

• no irritating smoke
• it is fast-acting
• no equipment except the bottle and the eyedropper
• no smell
• can be used discreetly.

Patients who require quick relief of pain (i.e. for migraine headaches) find that the rapid onset is very helpful.  Patients who are unhappy or uncomfortable with the smoking aspects of marijuana use also enjoy the tinctures.

It is interesting to note that tinctures of cannabis were widely available around the mid 1800’s.  Most apothecaries manufactured their own tinctures of cannabis.  Years later a number of pharmaceutical companies began to manufacture tinctures of cannabis, using marijuana from India (thought to be superior) and promising consistency in dosage.  Currently tinctures are available in dispensaries or can be made at home.

Are you one of the millions of Americans that is suffering from sleeplessness or insomnia?  It is estimated that one-third of all adults have insomnia.  Some people have difficulty falling asleep, some have difficulty staying asleep, and some have both.  Not sleeping well makes you feel exhausted all the time, and this can have an adverse effect on how you work, exercise, eat, drive and interact with others.

Currently there are a number of prescription medications on the market that are used to promote sleep.  One of the more common medications is zolpidem tartrate (brand name Ambien).  Many patients are unhappy with the side effects of Ambien which can include: severe allergic reaction, sleep-driving or sleep-eating (meaning you drive or sleep with no memory of doing so), and excessive sleepiness the next day.  Ambien is meant for only short-term use because it can be habit-forming.  Some patients try Ambien and find that it works initially but then becomes ineffective.  Another common insomnia medication is eszopiclone (brand name Lunesta).  Side effects include unpleasant taste in mouth, dizziness, morning drowsiness, headaches, and symptoms of a cold.  Many patients cannot tolerate the continued drowsiness that is present the day after taking a sleeping pill as they are unable to function at work or at home taking care of children.  Other serious side effects listed for Lunesta include sleep-driving, sleep-eating, abnormal thoughts and behaviors, memory loss, anxiety, and severe allergic reaction.  All of this is quite a heavy burden when you are just looking for a good night’s sleep.

Medical marijuana patients usually find that sleep is a wonderful benefit of cannabis. Many chronic pain patients experience insomnia due to their pain and find excellent relief and sleep when using cannabis.  Some patients find that cannabis keeps them awake but using a good Indica strain will combat this.  As many patients know, illness, pain, the ability to recover and to have a decent quality of life all improve with sleep.  If you suffer from lack of sleep and it is affecting your life negatively, you should talk with your regular physician to see if you suffer from insomnia.  If you want a natural treatment that has minimal to no side effects, you should consider using medical marijuana instead of prescription medications.  And remember, you do not have to smoke in order to get good results – you can choose to use a vaporizer, the tinctures, or edibles.

You have a choice as to how you want to take medical marijuana.  You can inhale marijuana either through smoking it or through a vaporizer.  Of course the healthier option is the vaporizer as there is no irritating smoke.   Cannabis experts now discourage smoking the plant as the only real downside to its use is the damage of the smoke to the lining of your lungs.  Both methods of inhalation put the active compounds in cannabis directly into your bloodstream, which carries them to your brain where they attach to receptors and cause the well known effects.

You can also eat cannabis in the form of what is called edibles: cookies, brownies, and other food products.  When you ingest cannabis, it goes into your intestines, then passes through your liver.  Your liver processes THC into a by product called 11-hydroxy-THC, which then travels to the bloodstream and then to your brain.  11-hydroxy THC is thought to be four to five times more potent than regular THC.  This is why edibles are known to be more potent when compared to inhaled cannabis. Edibles are also thought to be strong sedatives and many patients use them for treatment of insomnia.

Edibles take from 40 minutes to 1 hour to start working and the peak effect is at 2 hours.  The effects last from 6 to 8 hours which is very convenient for those patients who want to sleep or have longer control of pain.

The key to edibles is knowing how much to eat so as to get the best medicinal effect without going overboard.  The general rule of thumb is to cut the edible product into 4 pieces (or smaller if you are new to cannabis) and only eat one piece to start.  Wait at least one hour.  If you feel the effects of the medication, do not eat any more.  If you do not feel the effects of the medication, you can eat another piece.  There have been patients who unknowingly have ingested too much and have had the unfortunate side effects of feeling “too high”, nausea, vomiting, and very groggy.  If you follow the instructions above you should not have any problems with these side effects.

Whichever method you choose, knowing all of the advantages and disadvantages of the different methods of using cannabis helps you to make the best choice for your health.  Many opponents of medical marijuana state that smoking it is unhealthful – they are right. However you have other options like vaporizers, edibles, and tinctures so that the problems assocoated with the smoke are not an issue.

Generalized Anxiety Disorder and Panic Attacks are common illnesses affecting many people.  How do you know if you have anxiety disorder?  Symptoms include excessive and persistent worrying that interferes with everyday functioning.  You may also have insomnia, restlessness, inability to concentrate, fatigue, shortness of breath, racing or pounding heartbeat, and feelings of apprehension or dread. Panic attacks are when you have episodes of intense anxiety or fear with symptoms of chest pain, rapid breathing, racing heartbeat, shortness of breath, nausea, sweating, or chills.  Anxiety and panic attacks can start at any time and can be due to your genetics (other people in your family have anxiety disorder), due to your brain chemistry (abnormal levels of certain neurotransmitters) or environmental factors (trauma, stressful event, death in family, loss of a job, etc.)

There are a number of medications available to treat this condition including anti-anxiety medications such as Valium, Xanax, Ativan, and Klonopin.  Another group of medications called serotonin agonists have also been used.  These include Prozec, Zoloft, Effexor, and Welbutrin as well as some others.  Unfortunately these medications have very significant side effects that make them undesirable as long-term solutions.

Medical Marijuana has been espoused as an effective treatment for Anxiety and Panic Disorders.  Paradoxically there are some patients who state that marijuana causes anxiety and panic or paranoia.  It appears that one’s response to marijuana is as individual as our body chemistries. Many patients choose medical marijuana – the natural treatment – over conventional medications because of the adverse side effects from pills, lack of improvement in symptoms, and the simple fact that marijuana just works much better to control their symptoms.

Fibromyalgia is a chronic pain syndrome that is difficult to diagnose and whose cause is unknown.  Patients have symptoms of musculoskeletal pain, chronic fatigue, and tender spots in the neck, spine, shoulders and hips.  Patients may also have morning stiffness, insomnia, and irritable bowel syndrome. The pain is often debilitating and not very well controlled by conventional medications. Subsequently, many patients also develop symptoms of depression and anxiety.  Fibromyalgia may be caused by immune system problems, disturbance in brain chemistry, sleep disturbances, Epstein-Barr Virus, stress, food allergy, or nutritional deficiencies.

Conventional medications used for fibromyalgia include painkillers (like Vicodin, Percocet, other opioids), muscle relaxers (like Soma or Flexeril), antidepressants, sleeping pills, and antianxiety medications.  Many patients have difficulty tolerating the adverse side effects that result from these medications.  Side effects include nausea, constipation, excessive drowsiness, lethargy, decreased libido and headache.

Although more studies are needed,  a recent study (published in The Journal of Pain Feb 2008) assessed the benefit of nabilone, a man-made form of cannabis, on pain reduction and quality of life improvement in patients with fibromyalgia.  Nabilone was found to significantly reduce pain with minimal side effects.  Many patients with fibromyalgia have found the same is true for medical marijuana.  They find that their pain is reduced or eliminated, their insomnia is cured, and their depression and anxiety are alleviated.  Many patients choose to use medical marijuana because they cannot tolerate the side effects of the medication prescribed by their doctor and simply must get relief from the daily pain of their disease.

You may have heard about a prescription marijuana pill called Marinol. Marinol is the brand name for the generic drug called dronabinol. It is a man-made form of THC. It was made available to patients (with prescriptions from their doctors) in 1986. It has primarily been used as an anti-nausea drug for chemotherapy patients. It is also approved for the treatment of wasting syndrome associated with HIV/AIDS.

Many patients prefer natural cannabis to Marinol for a number of reasons. A main limitation of Marinol is that it is available only as a pill that is taken orally. If you have nausea and vomiting, trying to swallow a pill can be a challenge. If you do manage to keep the pill down, you have to wait up to four hours for the Marinol to reach its peak effect. And only 5 – 20% of the medication is absorbed into the bloodstream. Another limitation of Marinol is that it contains only one compound – THC.  Natural cannabis contains 60 cannabinoids (THC is the main one) and it is the interaction of these compounds with each other that gives a good therapuetic effect.  Marinol contains only THC  so it has more psychoactive effects and less of the other medicinal effects that come from the other  cannabinoids. Some Marinol patients describe hallucinations and other disturbing side effects.  Marinol also is very expensive, costing about $500 – $1000 for a month’s supply.  One advantage of Marinol is that is it pure and does not contain any bacteria, fungi, or pesticides. You can avoid this problem not smoking the medication and choosing another method to take cannabis (vaporizer or tinctures).

Many patients make the choice to use cannabis with a vaporizer or tincture to treat their symptoms instead of using Marinol.  They feel that the natural form of the medication affords the best and most effective treatment of symptoms without the unwanted side effects of Marinol.  And by using a vaporizer or tincture, the unwanted side effects of smoking are avoided.

Marijuana can be used topically (on the skin) to relieve pain from certain conditions.  The medication can be a balm, lotion, ointment or rubbing alcohol solution.  This is not a new use for marijuana.  In fact prior to the time when most medication became available and people only had plants to use for medication, many patients would soak marijuana leaves in alcohol and apply them as a poultice to an arthritic or swollen joint.  It is not known how the topical treatment works as researchers have not fully studied how the medication passes through the skin.  Although much research is needed, what we do know is that many patients find pain relief through this method and even think there is an anti-inflammatory effect.  Patients with arthritis, muscle and joint pains can testify to the ease of the aches and pains that they feel on a regular basis.  Topical marijuana preparations provide only local relief and do not have any effect on the brain (there is no high).  This is helpful for those times when marijuana use is inappropriate (like when you have to drive your car) and you still need pain relief!  Topical preparations can be purchased or home-made.

Many medical marijuana patients are using vaporizers to take their medication. A vaporizer is a device that allows patients to inhale the active ingredients in marijuana without the harmful effects of smoke. The plant material is heated to a temperature (about 350°F) where the psychoactive natural chemicals in marijuana are released and evaporate into an aerosol mist without any combustion.
Vaporization reduces a patient’s exposure to the toxins (such as tar, carbon monoxide, and the aromatic hydrocarbons) that are in marijuana smoke. It is controversial whether lung cancer or emphysema can be attributed to marijuana use but chronic marijuana smokers have been shown to have an increased risk of respiratory infections like bronchitis. A recent scientific study demonstrated that the respiratory symptoms associated with smoking marijuana (such as cough, phlegm, tightness in chest) were much less severe in patients that used vaporizers to deliver their medication.
Patients who have irritation of the throat and airways from smoking find that vaporization removes this irritation. Patients who are concerned about the respiratory hazards of smoking marijuana should use a vaporizer if inhalation is preferred. Physicians recommend vaporizers over smoking due to the clear benefits of avoiding the toxins in the smoke. Vaporizers are now considered the best and healthiest way to inhale medical marijuana.

We’re starting this blog to answer your questions about Medical Marijuana.