What Is Chronic Pain?
Pain is a complex phenomenon made up of physical, mental and social segments. At a central level, the ability to perceive pain has helped people survive throughout the ages. Without feeling the irritating sensation when you touch a stove, which causes you to remove your hand, the heat from the stove would end up causing far more damage to the cells in your control, than it did before you felt the pain. In reality, pain is the body’s way of letting you know something is wrong. Though, it is when pain fails to subside, despite removing the initial cause, that it becomes pathologic, and known as chronic pain.
“The origins of chronic pain can be characterised into instinctive (internal organs), somatic (skin and deep tissue), and neurogenic (nerves).”
Chronic pain can have a wide range of causes and can be linked with a number of different disease processes, thus the ability to diagnose chronic pain syndromes has been a widely discussed topic within the medical community for many years.
Earlier this year, the American Pain Society, published a framework which ventures to account for all of the various factors that comprise chronic pain syndromes: physical, pathological, neurobiological, psychological, and social. Broadly speaking, though, the origins of chronic pain can be categorized into visceral (internal organs), somatic (skin and deep tissue), and neurogenic (nerves).
The Institute of Medicine defines that constant chronic pain affects approximately 100 million Americans adults at a cost of $560-635 billion in direct medical treatment cost and lost potency. However, while the influence of chronic pain is wide-reaching across the population, its effect on the individual person is unique; there is variation in the source(s), severity, duration, response to therapy and psychical impression from person to person.
Conventional Therapies For Chronic Pain
Given the diversity in the spectrum of chronic pain, it is no wonder why clinicians at times find difficulty in helping patients manage their chronic pain. This responsibility in management has contributed in part to the wide range of therapies which are used to treat chronic pain, such as aspirin, ibuprofen and other drugs which are classified broadly as non-steroidal anti-inflammatory drugs (NSAIDs) and can be acquired over the counter.
These prescriptions may work well for short term relief of mild to moderate pain, but they can generate side effects such as ulcers and possibly damage the liver when used continuously, such as in a chronic pain scenario. It is for certain reasons that most clinicians avoid relying on this type of medication for long term pain relief.
A more powerful option to NSAIDs are the opiates, such as morphine, oxycodone, codeine, and hydromorphone. The drugs have been well described in the scientific literature, and work by altering the body’s natural opioid receptors to prevent the nerves responsible for sending pain signals from firing.
Certain treatments have the capacity to provide tremendous pain relief and provide clinicians with the opportunity to administer life-saving therapies which would otherwise be improbable (e.g. surgery). Though in the prescription of chronic pain, opioids therapy by itself can become problematic for patients – the body begins to develop a tolerance to these medications, thus the measurement required in order to get symptomatic relief continues to increase over time.
Additionally, the side effects of taking opioids (sedation, nausea, constipation, and potential respiratory depression and death) make physicians uncertain to continue to raise dosages for patients out of fear of causing dependency. The tension is non-ill-conceived either; in 2007, the US Substance and Mental Health Services Administration declared that the dependence on and abuse of pharmaceutical medications is the fastest growing form of problematic substance use in America.
Latterly, the contention has been made that the growing rate of prescription drug abuse in the first decade of the 21st century, has been the foundation for the emerging heroin epidemic which designates this decade. Due to the impression of sensitivity and dependence on opioids, many physicians, supplement the therapy with anti-depressants, muscle relaxants, and additional interventions when treating patients with chronic pain in an attempt to provide relief.
Cannabis And Chronic Pain
The use of cannabis to manage chronic pain has had a long history, with written references of its use dating back to around 2700 B.C.E. The initial reports in the nineteenth century were recorded by the Irish doctor William B. O’Shaughnessy, who represented the use of cannabis in the treatment of cholera, rabies, tetanus, menstrual cramps and delirium tremens.
In recent times, important research has been done around cannabis therapy in the treatment of chronic pain with very promising results.
“Rick Simpsons Oil is a very effective therapy for chronic pain patients because it affects people’s understanding of pain, has the ability to moderate the inflammatory process, and has been designated to affect voltage-gated sodium channels in nerves in a way similar to lidocaine,” reports Dr. Mark Rabe, Medical Director of Centric Wellness, an integrative holistic healthcare practice in San Diego CA and Chairman of the Scientific Advisory Board.
The knowledge of cannabis therapy to help alleviate chronic pain on multiple fronts holds squarely in the cannabinoid receptors – cannabinoid receptor type-1 (CB1) and type-2 (CB2). Comparisons have shown that CB1 receptors are located all over the body, however, they have a specially high concentration in the basic nervous system in areas that control pain perspicacity. CB2 receptors, on the other hand, are essentially located in areas of the body that control immune function, such as the spleen, white blood cells, and tonsils.
The fact that these receptors are found in the two major body systems efficient for generating the sensation of pain, the immune system and the nervous system is what gives cannabis its therapeutic significance in the chronic pain space. Importantly, there is a shortage of cannabinoid receptors in the brainstem region, the area of the brain responsible for informing breathing, thus the dangerous side effect of respiratory oppression attained with high dose opioid use is not a factor in cannabis therapy.
In functional stimulant, cannabis therapy can be used in conjunction with other chronic pain therapeutics. In his clinical preparation, Dr Rabe reports, “We have many victims who come in on higher doses of opioid prescriptions. Through using cannabis, in coincidence with other therapies, they are able to lower their daily opioid requirement.”
Various observations support these conclusions, including a 2011 study proclaimed in the Journal of Clinical Pharmacology and Therapeutics which confirmed that vaporizing cannabis increased the patient-reported analgesic effect of opioids, outwardly altering plasma opioid levels. Furthermore, there is an emerging body of analysis whose conclusions recommend cannabis can be used as effective replacement therapy for patients with opiate abuse issues.
Overall, we are just at the initiation of our perception of the possible therapeutic benefits associated with cannabis in the treatment of chronic pain. In extension to the wide range of possibilities in targeting CB1 and CB2 receptors, scientists are beginning to look at targets within the body’s endocannabinoid metabolic life cycle for potential opportunities for therapeutic intervention. Given the growing need for clinicians to transition away from an opiate dependent treatment protocol for chronic pain, hopefully, these breakthroughs happen sooner rather than later. Generally, the relaxation of government prohibition would go a long way towards supporting these efforts.
Disclaimer: the principles contained here is not designed nor meant to be a substitute for professional medical advice, it is only achieved for educational confidences only. You should recognise full responsibility for how you choose to utilise this knowledge. Always request for advice from your doctor or other qualified healthcare providers before commencing any new treatment or discontinuing an existing treatment. Inquire your healthcare provider concerning any questions you may have about a medical condition. There is nothing covered here is meant to be used for medical diagnosis or treatment.