Medicinal Cannabis and Chronic Pain

Chronic Pain by Dr Gerard Sinovich

Do I have chronic pain?

Chronic pain is a distressing condition which is not widely understood. Because it is an ‘invisible’ illness, it can be difficult for other people to understand how the sufferer is feeling – after all, a broken leg is easy to see and therefore easier to understand. 

Pain is called chronic when it does not go away and you have experienced pain on most days of the week for at least 3 months. Tests and investigations may not find an explanation for the pain. This does not mean that chronic pain is not real. The nervous system, which sends pain signals, may have become oversensitised. The pain itself, however it began, has become an ongoing problem.

Injury is the leading trigger of chronic pain, with the most common injuries resulting from playing sport, car accidents, and accidents at home or work.

The most frequent areas of pain cited by people with chronic pain are the back, leg, shoulder, arm and neck. Chronic pain is slightly more common among women than men, and is more common with increasing age.

It is easy for those suffering with chronic pain to steadily decrease their daily activities, due to the fear of aggravating their condition. However, maintaining your physical fitness is very important.

This article aims to teach you coping strategies to manage your pain. At Cannabis Access Clinic we can offer you medicinal cannabis to help treat your pain where other treatments have failed. To find which product suits you, and if you would like more information, contact info@caclinics.co.uk or book an eligibility consult with one of our health professionals.

What can I do about my pain?

Living with pain is difficult. Chronic pain can cause physical problems, but it can also cause emotional distress such as depression, frustration or feelings of helplessness. It can leave you feeling tired, worried, angry, or just generally in a bad mood. This can make the pain seem worse.

You don’t have to put up with pain. Ask for, and accept, help and advice from others. People who take active responsibility for the management of their pain can lead a very productive life.

There are a number of things you can do to help yourself, that can make an enormous difference

• learn techniques of relaxation and distraction – a psychologist or an occupational therapist can teach you these simple skills
• Think in a positive way so that negative thoughts don’t take over. Speak to your doctor about seeing a health professional (such as a psychologist or a counselor) who can teach you these skills
• pace your activity so you don’t get over-tired
• set priorities so that the most important things get done before the less important things
• Involve yourself in appropriate exercise. Inactivity contributes to weakness, fatigue and sleeplessness. Speak to your doctor or a physiotherapist about suitable exercise options
• Maintain good sleep habits. If you have a sleeping problem, try these things: 
  • have a regular time for getting up in the morning
  • avoid tea, coffee and alcohol later in the day
  • limit or avoid daytime napping that may upset your sleep pattern
  • try a hot bath before bed
  • don’t regularly use medication to help you sleep
  • speak with your doctor about the timing of your pain medication
  • Reward yourself for each positive step you take towards dealing with your pain.

How does chronic pain affect families? 

Chronic pain not only affects the individual who is suffering, but also family members. Family members are naturally distressed by their loved ones being in pain, but over time this can develop into feelings of frustration, anger and resentment, and emotional exhaustion.

The roles played by family members can change as a result of chronic pain. The person who has chronic pain may not be able to carry out everyday activities leading to other family members, usually the spouse, taking on more domestic duties. Child-rearing tasks may fall more heavily to one parent. Grandparents, aunts and uncles may be called upon more often to provide practical help. The family may suffer a loss in income, and leisure activities may become less frequent or even abandoned.

There are many things that family members can do to help their loved one who has chronic pain:

• learn about the pain problem – there are many reliable books and internet sites on pain
• attend visits to the doctor to hear about the pain problem and the treatment first hand
• at home, be patient and supportive but shift the focus of attention away from the pain and suffering
• encourage the person to be involved in everyday activities (e.g. domestic chores, child care), family activities, social and leisure pursuits
• Encourage a healthy lifestyle that includes good sleep and rest patterns, a balanced diet, moderate alcohol use, regular exercise and other physical activity.

As well as medication, and psychological intervention, it can be useful to self-manage your condition and it is therefore very useful to keep a pain log/diary. This is a sort of diary which lets you record when you feel pain and will hopefully help you to determine patterns so that you can learn to better manage daily activities to minimize the pain you feel. A pain log will help you to understand what sorts of activities most influence your pain. This will teach you how far to push yourself before your pain become unbearable.

I’ve been advised to keep a pain diary – what is this?

There are various resources that you can download with a bit of research on Google, or your GP may be able to give you a log to complete directly. However, we suggest that as a bare minimum you include:

• Date
• Time
• Pain levels 0 – 10 (from 0 for no pain to 10 for the worst pain)
• Where is the pain and what sort of pain is it? (i.e. lower leg pain, pins and needles in feet and aching joints)
• What activity was I doing when the pain started? (i.e. walking to the local shops)
• How I feel 0 – 10 (from 0 for ok to 10 for very upset and agitated)
• What am I thinking now? (E.g. I wish I hadn’t tried to walk to the shops etc.)
• What could I alter to affect my pain? (E.g. only walk short distances, or walk to the shop but have someone pick me up etc.)

Inserting the above into a simple table, and filling in the details every day will help you to spot patterns in your daily life that effect your pain.

The diary is particularly helpful for discussing how to manage your pain with your doctor or other health professionals. Sharing the information in your diary with family members may help them to understand what you are experiencing

What we offer at Cannabis Access Pain Clinic?

If your pain does not respond to standard medical treatments offered by you, then medicinal cannabis may be an option. Medicinal Cannabis is by no means a cure for chronic pain and we would only consider trying you on medicinal cannabis if all other treatment modalities have failed. Medicinal cannabis will not be used as a first line treatment but will be used as an adjuvant therapy to treat your pain.

Medicinal Cannabis contains active ingredients called cannabinoids. Two of these, tetrahydrocannabinol (THC) and cannabidiol (CBD) are the active ingredients that are best understood. The concentration of THC  and other cannabinoids varies depending on growing conditions, plant genetics and processing after harvest. Medicinal cannabis comes in various forms including capsules, oils and sprays.

Whilst laws are changing to enable some people to be able to get CBD oil as a medicine, we are now seeing more and more CBD products available on the high street, being sold as food supplements  or nutritional additives. Medicinal cannabis oil is not the same as you buy from the high street. CBD oil bought over the counter is a food supplement that can have varying levels of CBD, and should never promote health claims. Concentrations of THC in over the counter CBD food supplements is normally less than 0.2%, whereas medical cannabis based products typically have a higher concentration of THC. 

With the new legislation medicinal cannabis has moved to the Schedule 2 category, it will join substances such as morphine, which can be medically prescribed by a specialist pain consultant for your pain. As a patient at Cannabis Access Clinics, you will have access to a pharmaceutical grade product which has undergone testing from contaminants and we ensure the highest grade product available benefiting from the THC/CBD concentration ratio specially formulated to treat your pain. We monitor your treatment and adjust your dose so getting the maximal benefit from medicinal cannabis with the fewest possible side effects.

How do cannabinoids affect the body?

The surprising answer is that our body produces a group of ‘cannabis-like’ chemicals called endogenous cannabinoids, or endocannabinoids. Together, the endocannabinoids regulate many bodily functions, as widely diverse as pain, sleep, mood, immune responses, and bone growth, among others. When the different endocannabinoids work together effectively, they help to keep us balanced and therefore, healthy. Conversely, it is becoming increasingly clear that an unbalance in endocannabinoid activity is involved in many medical conditions. Cannabinoid receptors are mainly found in the nervous system and immune system. Medicinal cannabis can be used to treat pain from various sources including: nerve pain; chronic pain; cancer pain; arthritic pain and pain from central nervous system dysfunction as in multiple sclerosis or stroke. Cannabinoids may also improve your sleep and mood, which can have a positive effect on your pain. 

For those chronic patients on high dose opioids which carry significant health issues, cannabis can act as an opioid sparing drug, and could enable you to reduce your opioids based pain-killers. High dose opioids in themselves can indirectly worsen your pain. This medical term for this is ‘opioid induced hyperalgesia’ and come with recognized side effects including: addition, impairs your cognitive ability, nausea and vomiting, constipation, immune suppression and endocrine dysfunction. 

More research is needed to understand the role in safely reducing the reliance on opioid treatment for treatment of severe chronic pain. In conjunction with Applied Cannabis Research, Cannabis Access Clinics will be running a number of studies to investigate the role that cannabis based products can have in treating UK patients with Chronic Pain, as well as how this treatment may impact the UK health system and its reliance on opioid based painkillers.