pain and flower

In an article published in Pain, researchers from Brigham and Women’s Hospital and Mass Eye and Ear reported that 50.2 million (20.5 percent) of U.S. adults experience chronic pain based on analysis of the new NHIS data. They estimated the total value of lost productivity due to chronic pain to be nearly $300 billion annually.

I have been an athlete my entire life. When I was about eight years old my grandmother enrolled me in a ballet class. Turned out I was really good and continued to dance, with the goal of becoming a prima ballerina, throughout most of my youth. But by the time I reached high school I realized that pursuing that dream meant foregoing college and living on a meager $18,000 in New York City. Even in the 1980s that wasn’t much money. Instead, I went to college and started doing aerobics (again, it was the 80s), and started running which I continued to do until a few years ago. After moving to Arizona, I also started hiking, trail running and playing tennis.

So, my body has had its fair share of wear and tear. And, as anyone in their fifties can tell you, the body starts to hurt a lot more in this decade. In addition, I have psoriasis which in recent years has also developed into the start of psoriatic arthritis. When I was younger, I reveled in the feeling of soreness the next day after a hard workout, and felt strong and fit. Now when I wake up the next day, I have a hard time getting out of bed related to the pain I experience from my chronic neck, shoulder, back, hip, and knee pain (it’s hell getting old).

Because of these issues I really became interested in the benefits of flower for pain relief. I felt like my husband (who is a Tennis Instructor and has his own set of chronic pain issues) and I were just snacking on ibuprofen like candy to relieve our pain. Our society has this horrible image of narcotics as being evil, but over the counter pain relievers have their own set of dangerous side effects too. Let’s take a look at a few of these.

Acetaminophen (Tylenol)

Personally, I don’t find Tylenol to be very effective for musculoskeletal pain relief, but many people use it for that, as well as common ailments like fever and headache relief. But Tylenol in excess is very dangerous for one main reason. It can cause liver failure and you cannot live without your liver. As a nurse I have taken care of several patients over the years who overdosed on Tylenol only to end up in liver failure and needing a liver transplant. Drinking alcohol with acetaminophen use increases this risk.

Ibuprofen (Advil or Motrin) and other NSAIDs

Ibuprofen is included in the category of drugs called NSAIDs (non-steroidal anti-inflammatory drugs). This class also includes the some of the following commonly used drugs: naproxen (Aleve), diclofenac (Voltaren), celecoxib (Celebrex), indomethacin (Tivorbex), and high-dose aspirin. NSAIDs provide good pain relief and also work as an anti-inflammatory agent. This is particularly helpful in reducing musculoskeletal pain and swelling. NSAIDs in excess, however, have the potential to cause several serious medical issues, including damage to the lining of the esophagus, stomach, and intestines, which can cause stomach ulcers and bleeding. This is particularly problematic if you are also taking an anticoagulant like warfarin, Xarelto, or Eliquis. In addition, some of the stronger NSAIDs like Celebrex, come with a strong FDA warning about the risks of  heart attack and stroke. Excessive and extended use of these medications can also cause kidney damage, increase blood pressure, and cause fluid retention.

Opioids (morphine, oxycodone, fentanyl)

Unless you’ve been living in a cave for the better part of three decades, most people today understand that although opioids are very strong and effective pain relievers, they also have several dangerous potential side effects. One of the biggest problems with opioids is that patients develop a tolerance to these drugs and become physically addicted. That means that over time it takes a greater dose of these medications to have the same pain-relieving effect, and if the patient uses opioids for a long time and stops them abruptly, they can experience dangerous or even deadly withdrawal symptoms. In addition, if the patient takes too much there is a dangerous potential risk of slowing or even stopping breathing which of course could lead to death. Opioids can also cause severe constipation, which can be painful and debilitating.

Tetrahydrocannabinol (THC) and cannabidiol (CBD)

(here’s a very basic explanation of the science)

There are literally hundreds of different compounds present in cannabis but I’m going to focus on THC and CBD. So, what’s the difference? Well let’s quickly review the Endocannabinoid System (ECS) and the CB1 and CB2 receptors. As you recall THC and CBD are phytocannabinoids (plants-based cannabinoids) that act on the CB1 And CB2 receptors in the ECS.

CB1 receptor activation helps mediate:

• Anxiety and stress,
• Pain and inflammation,
• Symptoms related to multiple sclerosis,
• Neurodegenerative disorders,
• Post traumatic stress,
• Depression,
• Intestinal Inflammation
• Blood pressure

CB2 receptor activation helps mediate:

• Inflammation,
• Neuroprotection, especially in Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and multiple sclerosis
• Addiction and drug-seeking behaviors
• Depression
• Bipolar disorder
• Schizophrenia
• Alcoholism
• Eating disorders

In the same way medications enter the body and sit on receptor sites producing a specific effect – like reducing pain or lowering blood pressure – different cultivars of cannabis, when ingested or inhaled in various forms, have the ability to sit on the CB1 and/or CB2 receptor sites. According to the National Institute of Health’s National Center for Complementary and Integrative Health, the cannabis plant contains about 540 chemical substances, two of them being tetrahydrocannabinol, or THC, and cannabidiol, or CBD. THC and CBD activate both in the CB1 and CB2 receptor sites in different ways that complement each other. THC activates both receptors equally, whereas CBD has more of an affinity for the CB2 receptor site. THC activation of the CB1 receptor causes the psychoactive euphoric effect of being “high” most associated with cannabis. THC at the CB2 receptor has a more anti-inflammatory effect. CBD, on the other hand, does not cause euphoria but instead has a more calming effect which for many people also helps reduce pain and stress (anxiety exacerbates pain). CBD can even counteract the “high” caused by THC.

The National Institutes of Health National Center for Complementary and Integrative Health recognizes the use of cannabis for pain. However, cannabis is still considered illegal at the federal level which greatly reduces the ability to conduct multiple, large scale clinical trials for efficacy on animals or people. However, according to the NCSBN National Nursing Guidelines for Medical Marijuana, noted in the Journal of Nursing Regulation, a review of literature shows moderate to high quality evidence for cannabis use for the treatment of pain in cancer, rheumatoid arthritis, fibromyalgia, neuropathy, and spasticity from Multiple Sclerosis or spinal cord injury.

In addition, although national stereotypes claim cannabis is the gateway drug and a dangerous segue to increased narcotic use and addiction, the evidence simply does not support this. Cannabis does have a synergistic effect with narcotics, meaning their combined effect is greater than the sum of the effects seen when each drug is given alone. But this is a benefit if you’re trying to decrease opiate use, not a deterrent, and here’s why. If you are addicted to narcotics for the legitimate use of pain control and want to reduce your consumption, then you must find another way to control the pain. If cannabis heightens the effects of opioids that means the patient may be able to use a lower dose of the narcotic, with cannabis, to get the same pain relieving effect. And the evidence supports this. For example, when THC and morphine are co-administered, patients require only ¼ of a typical dose of morphine to reach significant reductions in pain. Further, the literature review conducted and reported in the NCSBN National Nursing Guidelines for Medical Marijuana states that:

“Among cannabis-naive people (individuals with no or limited exposure to cannabis) who began medical cannabis, data revealed a decrease in weekly use across all medication classes, including reductions in use of opiates (−42.88%), antidepressants (−17.64%), mood stabilizers (−33.33%), and benzodiazepines (−38.89%). In addition, cannabis use is correlated with better outcomes for individuals with opioid addiction. The severity of opioid withdrawal was lower when patients used dronabinol, and this same research found a higher retention in naltrexone treatment for heroin addiction for cannabis users. In addition, a recent study showed that the legalization of medical marijuana was associated with substantial decreases in alcohol use and binge drinking among young adults and states with medical cannabis have a 24.8% lower mean annual opioid overdose mortality rate.”

Another benefit of cannabis products compared with the prescribed and over-the-counter pain medications discussed above is the reduction in dangerous potential side effects on some of the body’s most essential organs, like the lungs, stomach, kidneys and liver. According to Up to Date, one of the premier medical reference sources for healthcare clinicians, cannabis use has NOT been associated with lung, neck, throat, or oral cancer, liver disfunction, kidney damage, obesity, or stomach or intestinal bleeding. And, because the CB1 and CB2 receptors are almost nonexistent in the cardiorespiratory center of the brain, it is virtually impossible to ingest a lethal dose of cannabis.

Nothing in life, however, is risk free. There are potential health risk associated with using cannabis frequently (daily for many, many years) and in excess. For instance, smoking cannabis can cause emphysema. But let me clear, this is caused from the smoke damage to the lungs, not the cannabis, and according to Up to Date, there is no association between cannabis smoking and lung cancer. Tobacco cigarettes are full of harmful cancer-causing chemicals that cause lung cancer, which cannabis “joints” do not contain.

Cannabis can interact with some prescription medications, so it is important that you contact your healthcare provider to discuss any potential contraindications with your current medication regimen before you start cannabis use. Also, THC can effect the cardiac system. Potential side effects from ingesting or inhaling THC include increased heart rate and decreased blood pressure, and should be used cautiously in patients with arrhythmias, like atrial fibrillation, or patients on nitrates. And, in higher doses THC does have a hallucinogenic effect when inhaled or ingested so this can result in feeling dizzy, disoriented, paranoid, and/or sleepy.

So how do I use THC or CBD, and which one is better for pain relief?

First, let me say that most experts in the cannabis industry and cannabis research will tell you that THC and CBD work best together and have a synergistic effect that enhances each other’s therapeutic effects. That being said, I understand not only are some people adamant about never using THC, but cannabis is still illegal in several states. In these states, CBD derived from hemp is legal. I think it’s also important to note that when we are talking about using THC for specific therapeutic reasons, the dose needed may be low enough (something called microdosing) that the person does not necessarily feel “high.”

Secondly, whether you are using THC or CBD read the labels and look for chemical free extraction, organic if possible, high-quality products (no artificial colors, flavors or preservatives), with clear labeling of dosage/potency. Most reputable dispensaries and manufacturers use third-party labs to verify their products and will gladly provide test results.

In general, there are number of different ways to utilize THC and/or CBD products, including but not limited to inhaling (smoking or vaping), ingesting (tinctures, capsules, and edibles), drinking, and administering topically. Two books I highly recommend to learn more about how to use and dose CBD to treat pain and inflammation are The Athlete’s Guide to CBD by Scott Douglas, and Pain-Free with CBD by Alice O’Leary Randall and Eloise Theisen. A few advantages to CBD use alone are it doesn’t get you “high” like THC, avoids positive drug tests, and hemp derived CBD is accessible anywhere, not just in certain states where cannabis products are legal. Besides pain relief CBD has several other medicinal properties including anti-inflammatory, anti-anxiety, anticonvulsant, neuroprotection, and strengthening the immune system. Since anxiety often exacerbates pain, the anti-anxiety effect is another benefit to using CBD.

To figure out what product works best for you requires a bit of trial and error. Personally, I’ve tried CBD only gummies as well as 20:1 ratio CBD:THC gummies, and topical CBD and THC creams/ointments with good results. These products are not cheap, particularly the edibles which can average $1-4 per gummy. Since most of my pain is musculoskeletal the topical creams, rubbed into the affected area, work well and last longer for the price. Also, again, the topical THC ointments/creams do NOT get you “high” so you can reap the benefit of the THC without the psychoactive effect. Since I started using these products I’ve been able to reduce my usual 800mg (4 tablets) of ibuprofen once or twice a day, down to 2 or 3 tabs per day, which is a 25-50% reduction in use. And at times when the pain is not very intense, I can use the topical treatments and not take the ibuprofen at all.

Another important point regards dosing. Remember you can always take more, but you can’t subtract what you’ve already taken. In general women require 30% less THC than men to get the same effect. Geriatric patients should also start at the lowest dose possible, usually in the range of 1-5mg. If you are using edibles like gummies, don’t be afraid to cut them up and start with a lower dose. The old adage in medicine of “start low, and go slow” applies to cannabis products too. Many of the CBD gummies come in doses of 20mg or 25mg per gummy and products with THC around 10mg per edible. Cut the edible in half or even quarters and see if the smaller amount works. I personally only need about 1-3mg of THC to get a therapeutic effect. Remember, you are not taking the THC to get high you are taking it to relieve pain. If the smaller dose gives you the desired effect, then your product will not only last longer, but also save you money.

There are literally thousands of different strains of cannabis flower. If you want to use flower for pain relief I highly recommend you find a high quality dispensary and build a relationship a knowledgeable budtender. For people like me who prefer to microdose THC for specific uses, I think it is much harder to control the dose when vaping or smoking flower. However, you can use flower to make edibles, oils and butters at home with more control over dosing, and possibly save money over buying premade products. The Medical Marijuana Dispensary by Laurie Wolf and Mary Wolf is another good book if you want to learn how to cook with cannabis at home for therapeutic purposes.

Here are a few strains recommended on Leafly.com to help with pain:

Pain relieving flower

• Sour diesel
• Blueberry
• ACDC
• Northern Lights
• Harlequin

Here are a few products I’ve tried and like for pain:

Wyld Strawberry 20:1 + Hybrid Enhanced Gummies

These gummies are a good  option for enhancing pain relief and relaxation. Remember, anxiety intensifies pain. They are formulated with 20mg of CBD + 1mg of THC per gummy, making them the go-to option when you’re looking for all of the benefits of CBD with a synergistic boost of THC. All Wyld gummies are made with real fruit, high quality cannabis extract, and botanical terpenes to provide the best possible experience every time.

DRIP’s Topical Salve 1:1 THC:CBD 

This salve is great for local muscle aches and pains. I love this product. Rub it on the area that hurts and I swear in less than one minute you will not notice the pain anymore and it lasts for several hours. DRIP’s Topical Salve contains a 1:1 ratio of THC and CBD boasting a concentration of 1000mg cannabinoids, 500mg each of THC and CBD per 1oz container. This product uses all natural and organic sourced ingredients including coconut oil, shea butter, beeswax, vitamin E, menthol and a vast array of infused essential oils some which include Tea Tree Oil, Lavender and Tumeric. This blend of ingredients yields a very easy to use, smooth textured salve that absorbs easily into the skin. Remember, topical THC will not get you high or show up on a drug test.

Here are some CBD brands recommended by Alice O’Leary Randall and Eloise Theisen in their book, Pain-Free with CBD:

Basic Jane basicjane.com

Bluebird Botanicals bluebirdbotanicals.com

Circle Labs circlelabs.co

CW Botanicals charlottesweb.com

Green Roads greenroads.com

Lazarus Naturals lazarusnaturals.com

Mission Farms missionfarmscbd.com

Myriam’s Hope Hemp myriamshopehemp.com

Pure Hemp purehempbotanicals.com

As always, cannabis is subjective and effects everyone differently. Feel free to experiment and let us know if you have another option that helps you relieve pain.

WEBSITE DISCLOSURE
These statements have not been evaluated by the FDA and are not intended to treat, cure, or diagnose any disease. This website contains general information about diet, health and nutrition. The information is not advice and is not a substitute for advice from a healthcare professional. You should always get your medical advice from a healthcare professional (HCP) knowledgeable about your individual needs. A competent healthcare professional will provide a comprehensive intake meeting where you review the conditions you want to treat and assess your prescription medications to identify potential contraindications with cannabis.

Sources

American Cannabis Nurses Assocaition. cannabisnurses.org

Pain-Free with CBD by Alice O’Leary Randall and Eloise Theisen

The Athlete’s Guide to CBD by Scott Douglas

The Medical Marijuana Dispensary by Laurie Wolf and Mary Wolf

Cannabis Health Index by Uwe Blesching

Leafly.com. Best Marijuana Strains For Pain Relief. https://www.leafly.com/news/strains-products/best-cannabis-strains-for-treating-pain