CANNABIS AND PAIN

My life as an Osteopath is probably quite unique in comparison to some of my colleagues , certainly within the Birmingham area . My clinical experience is developed within the field of CHRONIC DISEASE, SOCIAL EXCLUSION AND PALLIATIVE CARE . This has developed due to my involvement with FRESHWINDS CHARITABLE TRUST for the last 19 years. A lot of this work is done within the charitable sector at our established clinic in SELLY OAK and in addition some of my work is done in the homes of people in very restricted situations . I do believe that Osteopathy has its place here as well as in the field of sports injury and general back pain . One of the areas of expertise that results from this, is the use of prescribed ‘analgesia’ . For the patient being pain free means feeling comfortable , emotional , practical and spiritual issues become sidelined in the experience of pain. So quality of life may become ‘impaired’ for a patient suffering with a disease which means limited life expectancy or social exclusion ,then this may become all encompassing. Many of my clients are on opiate based analgesia and antispasmodic however where this is limited or ineffective the question has arisen in discussion about cannabis as an analgesia.

Cannabis has a kind of ‘underground ‘popularity and this is probably based on reported anecdotal effectiveness, notoriety and the politics surrounding a drug , which had the promise of development in the pharmacological industry .
Hemp which is made from the plant and Cannabis which is made from the flowers was used extensively before the thirties and there are apparently records that indicate use as far back as the 3rd millennium BC (1) .It was ‘criminalised ‘ in America as part of the Marijuana Tax ACT which prohibited the production of Hemp and Cannabis it was suspected that this law had both a racial and economic agenda based on the  production of cotton However it has continued to be consumed all over the world.

The United Nations 2012 ‘ GLOBAL DRUG REPORT ‘ stated that cannabis was the worlds most widely produced , trafficked and consumed drug in the world in 2010 , identifying that between 119 million and 224 million users existed in the worlds adult population . ( 2)

Indeed it may be that other forces drive the ‘legendary analgesic’ reputation of CANNABIS , other than the direct pharmacology . These may be social popularity based on the above consumption and a kind of notoriety that somehow means you end up taking “ your pain” into your own hands .
PAIN is a complex area as explained in one of previous posts and very well by the work of PROFESSOR LORIME R MOSLEY in his PUBLICATION  ‘Explain Pain’. PROFESSOR MOSLEY an Australian researcher of world renown ,postulates that pain when associated with threat is always worse ,and one way of diminishing that pain is to view the pain from a different perspective IE NO THREAT.  In addition discomfort increases pain,  as does emotional trauma , also pain may be learned by the primitive brain to become more of a reflex and overreact to situations that do not create the same pain stimulus.  Of course the almost ‘lucid dream world’ of a ‘high’ the associated muscle relaxation may contribute to its effectiveness . Quiet ‘tea and cake sessions’ and ‘smoking alone or in small groups’ characterises cannabis use , this in it self may form part of its whole effect. I must reinforce my stance here which as a HEALTH PROFESSIONAL is to say it is still illegal in this country and that there are definitely correlations between cannabis use and changes in mental health, indicated in those already susceptible, and the developing brains of teenagers.

CANNABIS can remain in the system up to 6 – 12 hours , I have seen even 20 hours cited. This is probably dependant on dose , this may have an impact on driving and operation of machinery . Much more research has to be completed and indeed more pharmacological preparations may emerge in the near future .

‘Self medication’ may have its dangers based on the quality and potency of the supply and because of the possible interactions of other prescription drugs being taken . Its not all plain sailing cannabis usage does carry an element of risk .

Prescriptions based on CANNABIS ARE AVAILABLE IN THE UK , SATIVEX is the name of the drug , the site recommends its use in pain relief for Multiple Sclerosis, further developments hope to see it being used for neuropathic pain and pain associated with CANCER. . It is available on prescription from a GP or pain specialist and studies show effectiveness without change in mood or cognition.
It is an oral spray and is prescription only .

The effective part of the CANNABIS PLANT is the female flower , from this we have a chemical called THC OR

DELTA – 9TETRAHYDRCANNBINOL .

My reading indicates that the ‘drug’ effects of the plant may be as a protective mechanism against HERBIVORES.
THE DRIED FLOWERS or resins created from this are used and can be taken in numerous ways . The most common ar inhalation with tobacco as a JOINT OR A SPLIFF , VAPOURISATION where it is heated and the ensuing vapour taken into the airways, and INGESTING it in the form of special sweets or cakes . THE FIRST TWO METHODS allow for a speedy and slightly regulated response , again depending on amount and potency . The third method is a slower method of absorption and although it protects the lungs the effects can be much more pronounced once the amount is ingested you are not able to take a ‘rest’ from taking the drug .

It is FAT SOLUBLE which accounts for the rapid absorption in the lungs and slow absorption through the digestive system . ONCE IN THE SYSTEM it acts upon what are called RECEPTORS , these are sites where a chemical in the drug attaches itself to and then creates an effect. The two main chemical parts of THC ARE known to be

  • CB1
  •  CB2 .

CB1 creates the affects on the nervous system mainly the ;

  • Hippocampus
  • Cerebellum
  • Basal Ganglia

The HIPPOCAMPUS is located within the temporal lobe, its primary function concerns short term memory. When the THC binds with the cannabinoid receptors inside the HIPPOCAMPUS, it AFFECTS the recollection of recent events. THC also affects COORDINATION, which is controlled by the CEREBELLUM. The BASAL GANGLIA controls UNCONCIOUS muscle movements, which is another reason why motor coordination is impaired when under the influence of marijuana. general effect is relaxation of the muscles and mental processes. There may be some unwanted effects based around regular use, initial findings relate the following symptoms to continual marijuana use: irritability, nervousness, depression, anxiety and even anger, restlessness, severe changes in appetite, violent outbursts, and insomnia. HOWEVER THIS MAY BE DOSAGE RELATED , which may be difficult to regulate in terms of self medication.

There is currently a legalisation experiment taking place in AMERICA , two states WASHINGTON and COLORADO , there are no ‘stats’ as yet however supporters predict an economic boom in business activity , tourism and reduced public expense. CRITICS worry that drug traffickers will exploit the new markets, and that there might be a danger to teenagers in overconsumption. I read this report in the NEW YORK TIMES in December and Im keen to read any reports on at the end of 2014.

So I HOPE I have indicated the dangers and benefits as well as given details possible legal routes through prescription in the UK . There will always be CAMPS in this debate whilst we don’t have any definite figures on social and medical impact.  A plant unfortunately is not a ‘constant’ there can be variables based around variety , methods of farming and the intention of the seller to progress the user onto a level of dependency etc  . Additionally the ‘human being’ comes in different shapes and sizes and different physiological and psychological types which means that even within the controlled world of ‘prescribed drugs ‘ there can be unknown and unexpected effects . Its a free world and CANNABIS USE has always been part of ‘ free choice’ ; there’s a freedom in choosing your drug AND WE ALREADY HAVE CAFFIENE AND ALCHOHOL and TOBACCO The effects of two of these comes with a HEALTH WARNING .  Maybe in the future we will say the same about CAFFIENE . Also a BRAVE NEW WORLD may involve legal use of CANNABIS but of course WITH A HEALTH WARNING  – of course.