Pain is an unpleasant and complex sensation that can be caused by a wide range of physical, emotional, and psychological factors. It ranges from mild discomfort to severe agony and can be experienced and described in a variety of ways as aching, burning, shooting, stabbing, and throbbing. The experience of pain is different for every person, and there are various ways to feel and describe it. This variation can, in some cases, make it challenging to define and treat pain. The two categories of pain are acute or chronic.
What is Acute pain?
This type of pain is generally intense and short-lived. It’s the body’s way of telling you that you’ve been hurt or something is wrong in a specific area This type triggers the body’s fight-or-flight response, often resulting in faster heartbeats and breathing rates. A few examples are injuries, car accidents, surgery, broken bones, burns, heart attacks and more.
What is Chronic Pain?
Chronic pain lasts far longer than acute pain, and there is often no cure. This pain can be mild or severe at different times, or be continuous. Intermittent pain occurs on repeated occasions but may stop between flares. The fight-or-flight reactions eventually stop, as the sympathetic nervous system that triggers these reactions adapts to the pain stimulus.
How is pain diagnosed?
An individual’s subjective description of the pain will help the doctor make a diagnosis. There is no objective scale for identifying the type of pain. Different questions can be asked to the individual to describe and identify the pain:
-What is the character of the pain: burning, stinging or stabbing?
-What is the site, quality and radiation of the pain?
-What factors aggravate and relieve the pain?
Different indicators of pain can be used by your doctors such as numeral rating scales, verbal descriptor scales, and faces scales. Brief pain inventory and the McGill pain questionnaire (MPQ). Chronic pain is more difficult to diagnose because it is often multifaceted and flare ups can be inconsistent. Diagnosing chronic pain generally involves a combination of medical history, exams, tests, and being seen by specialists. To be diagnosed with chronic pain, it generally has to have been occurring for at least 3 months.
What conditions are leading people to search for pain management?
Arthritis: A group of conditions that cause inflammation in the joints.
Back pain: Pain in one or multiple regions of the back that can be caused by a variety of factors.
Cancer pain: Pain caused by cancer or it’s treatment, which can include bone pain, nerve pain, and pain from chemotherapy or radiation.
Chronic pain: Pain lasting longer than 3-6 months and is not directly related to any specific injury.
Endometriosis: Pain caused by the growth of extra endometrial tissue and hormones, generally affecting the pelvic tissue which can affect nearby organs.
Fibromyalgia: A condition that causes widespread pain and tenderness in the muscles, tendons, and ligaments.
Headaches & migraines: Pain in the head, face, and neck. Can be caused by a variety of factors, and can even be chronic.
Neuropathic pain: Pain caused by damage to the nerves, which can be a symptom of conditions including diabetes and multiple sclerosis.
Doctors will treat different types of pain in different ways. A treatment that is effective against one type of pain may not relieve another. Each treatment has its pro and cons and sometimes, unfortunately, may come with undesirable side effects or addiction.
Acute pain treatment
It is a type of analgesic or pain reliever available over-the-counter and prescription drugs. Often known by the brand name Tylenol, it can relieve pain and fever. It is often prescribed to treat moderate to severe pain. However, when taken in higher doses, acetaminophen can cause serious liver damage. People should never exceed the recommended dosage.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Another type of analgesic, they can reduce pain and help a person regain daily function. They are suitable for minor acute pain, such as headaches, light sprains and backaches. NSAIDs can relieve localized inflammation and pain that is due to swelling. These drugs may have side effects relating to the digestive system, including bleeding. Ibuprofen (advil) is a common one used for pain and inflammation.
Doctors can prescribe these drugs for the most extreme acute pain, such as those that result from surgery, burns, cancer and bone fractures. Opioids are highly addictive, cause withdrawal symptoms and lose effectiveness over time. Opioids may significantly affect the progression of several chronic diseases including chronic obstructive pulmonary disease (COPD), kidney disease, liver problems, previous substance disorder and dementia. They may also cause dangerous side effects in people with certain chronic diseases.
Chronic pain treatment
Individuals who are suffering from chronic pain, more than often have been using treatment(s) for acute pain with minimal or no relief. Other alternatives to medication may be more suitable for them.
These therapies include:
- Acupuncture: Inserting very fine needles at a specific pressure point may reduce pain.
- Nerve blocks: These injections can numb a group of nerves that act as a source of pain for a specific limb or body part.
- Psychotherapy: Chronic pain often reduces the enjoyment of everyday activities and makes working difficult. This can lead to depression and can intensify chronic pain. A psychotherapist can help a person implement changes to minimize the intensity of pain and build coping skills.
- Transcutaneous electrical nerve stimulation (TENS): TENS aims to stimulate the brain’s opioid and pain gate systems, thus providing relief.
- Surgery: Various surgeries on the nerves, brain, and spine are possible for treating chronic pain. These include rhizotomy, decompression, and electrical deep brain and spinal cord stimulation procedures.
- Biofeedback: Through this mind-body technique, a person can learn to control their organs and automatic processes, such as their heart rate, with their thoughts more effectively.
- Relaxation therapies: These include a wide range of controlled relaxation techniques and exercises, mostly in the realm of alternative and complementary medicine. A person can try hypnosis, yoga, meditation, massage therapy, distraction techniques, tai chi, or a combination of these practices.
- Physical manipulation: A physiotherapist or chiropractor can sometimes help relieve pain by manipulating the tension from a person’s back.
- Physical therapy: Physical therapy exercises can aid in mobility and may help relieve chronic pain.
- Heat and cold: Using hot and cold packs can help. It is possible to alternate them according to the type of injury or pain.
- Rest: If pain occurs due to an injury or overworking a part of the body, rest can help with relief and recovery.
How does medical cannabis work?
When cannabinoids from medical cannabis such as cannabidiol (CBD) and tetrahydrocannabinol (THC) are introduced to the body, they act on our naturally occurring endocannabinoid system (ECS). Once the cannabinoids enter the ECS, they act on the thousands of CB1 and CB2 receptors located throughout the body, in a “lock and key” fashion. Essentially, cannabinoids act as keys to unlock the ECS receptor locks, which creates a chemical response in the body. For instance in pain conditions, cannabinoids act on CB1 receptors in the brain and CB2 receptors in the body to block, or reduce, pain signals as well as reduce inflammation, thus reducing sensations of pain.
One of the benefits of cannabis oil when taken orally, rather than smoked or vaporized, is that the effects often last much longer (6-12 hours). Cannabis oil is a great choice for medical cannabis consumers with compromised respiratory systems or those individuals who do not like the idea of smoking or vaping their medicine.
Cannabis and Pain: The Science Behind the Plant
One of the most prominent studies on cannabis and pain was a 2017 study published in Cannabis and Cannabinoid Research which demonstrated that “cannabis is just as effective, if not more effective, than opioid-based medications for pain”. Ninety-seven percent (97%) of enrolled patients reported that their pain was reduced after using cannabis, and 81% of the sample group reported that consuming cannabis was more effective at managing their pain than using opiate therapy alone. This study suggested that the therapeutic benefits of cannabinoid therapy for pain are promising, although further research is warranted.
Another study, conducted at McMaster University evaluated the effects of a placebo against three different doses of cannabis in managing pain. Cannabis was provided to patients in 9.4% THC, 6% THC, and 2.4% THC applications and the participants were blinded to their dosage. The 9.4% THC dose provided the greatest reduction in pain, with patients reporting a .7 drop on the pain scale. This new study ”adds to the trickle of evidence that cannabis may help some of the patients who are struggling [with pain] at present,” Henry McQuay, DM, an emeritus fellow at Balliol College, Oxford University, England, writes in a commentary accompanying the study.
Another study, published in 2016 in the journal Pharmacotherapy, evaluated the role of cannabinoid therapy in reducing the severity and frequency of migraines. Although this study was performed on an animal model, the results are transferrable to a human population. In June 2017, a study was presented at the Congress of the European Academy of Neurology in Amsterdam and showed that cannabinoid therapy was just as effective at treating migraines as compared to traditional pharmaceutical migraine medications. The authors went on to state that “we were able to demonstrate that cannabinoids are an alternative to established treatments in migraine prevention. That said, they are only suited for use in the acute treatment of cluster headaches in patients with a history of migraine from childhood on”.
Apollo’s latest published research study had a total of 751 chronic pain patients who initiated medical cannabis treatment at Apollo Cannabis Clinics. After following Apollo’s treatment plan for 12 months with medical cannabis use, the study found a 43% reduction in pain interference with daily activities & a 37% reduction in pain severity.
CBD and THC
CBD and THC are the two most common chemical compounds found within the cannabis plant.
These compounds can produce various effects, which can aid with a variety of conditions and symptoms.
THC is most commonly known as it is the compound that is known to produce the euphoria associated with cannabis. It has potential medicinal benefits such as reducing depression, aiding with PTSD symptoms and treating pain.
CBD is non-intoxicating and is quickly becoming a popular compound to treat patients with pain, inflammation and anxiety, among other symptoms.
Most cannabis products will contain a combination of THC and CBD as these compounds work best, together, due to a theory called the entourage effect.
Indica and Sativa
With more than 1,000 strains of cannabis having been bred during the past several decades, it is critical that patients are aware of the different types that are available. Some varieties of cannabis are most appropriate for particular diseases and ailments, but not others. Choosing the right strain is critical to ensuring that patients receive the best treatment possible.
Indica and Sativa plants differ not only in their physiological effects but also in their appearance. Indica plants are shorter and more stocky, featuring leaves that are broad and wider, while Sativa plants tend to be taller and skinnier and may even be lanky in appearance, with leaves that are thin and pointed.
The most important difference between these two subspecies of cannabis, however, is in their potential medical effects. Indicas tend to be more relaxing, both physically and mentally. Indica strains are often recommended for use in the evening after the conclusion of the day’s work and activities. Sativas, on the other hand, are generally thought to be uplifting and cerebral, enhancing creativity and productivity.
To ensure you are getting the right cannabis varieties and strains for you, it is recommended to always consult with a medical professional.
Cannabis Consumption Methods
Smoking the dried flower from the cannabis plant is a common method of ingestion, but is not recommended by Apollo or Health Canada due to the health risks of smoking.
The smoke generated from burning papers and lighter fluid chemicals contains carcinogenic compounds. Users with compromised immune systems or lung problems should consider other methods of cannabis.
Time patients will feel the effects: Within seconds of inhalation.
Duration of effects: Effects usually peak around 30 minutes and can last between a couple of hours.
Benefits of smoking: Generally regarded as the quickest and most effective way to feel instant relief from symptoms.
Drawbacks of smoking: The smoke generated from burning papers and lighter fluid chemicals contains carcinogenic compounds. Users with compromised immune systems or lung problems should consider other methods of cannabis.
A smokeless, efficient form of inhalation. The process of heating dried cannabis to a temperature below its combustion point of 392°F. The dried cannabis flower is only heated to the point where the desired cannabinoids (typically found in the resin of the flower), are released without igniting/combusting the material.
Time patients will feel the effects: Within seconds or minutes of inhalation.
Duration of Effects: Effects usually peak around 30 minutes and can last between a couple of hours.
Benefits of Vaporizing: Known as one of the safest ways to consume dried cannabis flower, for instant relief. Minimal odour, which dissipates quickly. Portability or home units are available for convenience.
Drawbacks of Vaporizing: Vaporizing dried cannabis is a short-acting method of consumption and may only provide relief for a few short hours. Patients looking for longer-acting symptom control may wish to consider combining vaporizing with other forms of administration.
Cannabis in edible form has been a popular method of consumption since the 1960s. The cannabinoids are believed to be metabolized in the liver, which converts THC into another chemical, 11-hydroxy-THC.
Currently, patients can choose to order edible cannabis oil from their Licensed Producer. These oils are measured using a syringe, and then placed under the tongue or swallowed. Patients may choose to eat their oil on a spoonful of yogurt, or a piece of toast for example if preferred.
Cannabis oil can also be made into pre-dosed capsules, available for purchase from licensed producers. Many patients find capsules very convenient, and just as easy to administer as a traditional pharmaceutical.
Edibles, on the other hand, are food and drink items which are infused with cannabis. Edibles such as chocolates, beverages, and gummies are available.
Time patients will feel the effects: 45 minutes to two hours depending on the patient’s metabolism.
Duration of Effects: Depending on the dosage used, generally 6-8 hours.
Benefits of Edibles: Effects last longer than most other forms of cannabis use. One the most discreet and convenient forms of consumption. The diverse variety of options available.
Drawbacks of Edibles: Edibles are not ideal for users who need immediate relief as the effects take longer to commence. Finding the right dose and correct way to prepare cannabis for indigestion can be difficult. Some patients complain they do not like the taste of cannabis-infused products.
Where can I get medical cannabis for pain?
Those looking to try medical cannabis to manage their pains or symptoms associated are encouraged to contact the experts at Apollo Cannabis Clinics. We are an evidence-based clinic that has been conducting observational research on medical cannabis and conditions since 2014. Our team of healthcare professionals and patient care specialists will guide you through a thoughtful process that will answer all of your questions while helping you take charge of your health. We will also help you determine the best strains, method of consumption and a personalized treatment plan. With adequate pain management, it is possible to maintain daily activities, social engagement, and an active quality of life.
To find out if medical cannabis is right for you, book your free appointment today.