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Medical Marijuana for Chronic Pain - A Smoking Success?

February 18 2016 5:29 AM ET via RheumReports RheumReports

Think about the most severe cases of chronic rheumatic pain and what treatments are available. Chronic pain is prevalent - in Canada about 1 in 5 people suffers from chronic pain which translates into about 6 million people in total. The most severe cases of chronic pain encompass about 2.5% of patients which means about 2 or 3 out of every 100. This means about 150,000 people in Canada have the most severe cases of chronic pain. 

Chronic pain is not just pain but a constellation of symptoms that can include pain, insomnia, nausea, cognitive difficulties, depression, and anxiety. Opioids are frequently used in the management of chronic pain but the Cochrane Collaboration concluded that opioids have only a small effect on pain and physical function. Other therapies for chronic pain including amitriptyline have no supportive unbiased evidence for a beneficial effect and only a minority of patients achieve a satisfactory effect. Pregabalin (an FDA and Health Canada approved therapy for chronic pain) only slightly reduces pain and fatigue.

In an online survey of 1300 patients with fibromyalgia, duloxetine, pregabalin and milnacipran were rated as very effective by only 8%, 10% and 10% of patients, respectively. Sixty two (62%) percent of patients who use medical marijuana report the effect as very beneficial. 

What about the risks of marijuana? Marijuana is one of those terms that almost elicits a visceral response. The fact is, medical marijuana is much safer than opioids. Opioids are responsible for 1000 Canadian deaths each year and numerous hospitalizations. Statistics were not provided for medical marijuana risks.

Medical marijuana can help alleviate more than just pain - it has beneficial effects on nausea, insomnia, and anxiety. The number one condition for 40,000 people in Canada who received a license for medical marijuana in 2013 was arthritis.

Medical marijuana is not just one thing (smoking). It used to be but times have changed. Today, there are over 100 different types of medical marijuana available in Canada. The most common type of oral medical marijuana is CanniMed 12-0 which is 12% THC, 0% CBD, has definite psychoactivity, and is sleep inducing. Another common type of medical marijuana is CanniMed 1-13 which is 1% THC, 13% CBD, has virtually no psychoactivity, and promotes wakefulness. 

Chronic pain centres are moving to multi-disciplinary, multi-modal management strategies that include physiotherapy, psychology, Yoga & Tai Chi, sleep approaches, and dietary modification. Dr. Pereira urged the audience to keep their minds open and to consider medical marijuana including strains that do not have psychoactivity. All physicians should acknowledge that we don't have great treatments for chronic pain and we should consider alternatives.


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About the Author

Dr. Andy Thompson
Dr. Andy Thompson

Dr. Andy Thompson is an Associate Professor at Western University and founder of Rheuminfo.com, Rheumtalks.com, and RheumReports.com.

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