Cannabis, a few things you need to know


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PainWeek 2018 has a series of conferences in different cities. This weekend 10/13-10/14, it was in San Diego teaching pain management. 

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There was a talk on cannabis by a nurse practitioner from Stanford. I would add or highlight a few things.

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There are two species:

–Indica often said to help pain, sleep.

–Sativa more activating, for daytime use.

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Most are hybrids. Some people have opposite responses. It may be contraindicated for those with bipolar disorder. Those with multiple sclerosis may use it for spasticity. It can help depression but may cause anxiety, depression, paranoia, etc.

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The plant has 400 chemicals. More than 90 are cannabinoids. Two best known cannabinoids:

–THC is psychoactive.

–CBD has no psychoactive properties and does not make you high. In recent years, it has been found to help certain forms of epilepsy in children who are resistant to all known epilepsy medication.

–THCV has been said to prevent the munchies. Only one strain I know of has this cannabinoid, Durban Poison.

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It is not necessary to have THC for pain relief. Pain in some patients may respond to CBD alone.

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Tolerance does develop. It becomes less and less effective with use.

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Side Effects: the very worst is the munchies – deadly weight gain. Dry eyes and dry mouth can affect all, but for those with Sjogren’s Syndrome, it increases the risk of corneal transplants and loss of teeth that already exists and can be a serious problem. It can increase heart rate and blood pressure especially in those who have never used cannabis.

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Leafly.com is a nationwide resource for locations where cannabis is legal, listing strains and dispensaries by zip code. For each local strain it shows a bar graph of EffectsMedical, Negatives. Negatives may include dry eyes, dry mouth, sleep, anxiety, paranoia, headache, etc. rated by buyers. For example, one strain may be rated 100% dry eyes, but only 50% dry mouth. Each strain is different. But dry eyes, dry mouth are the most common, always highly prevalent, whereas paranoia, dizziness, anxiety may be rated only 3%.

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FDA has approved 2 THC compounds available for medical use:

–Dronabinol (Marinol), schedule III drug. I have never seen a single person with cancer pain, HIV AIDS pain or chronic pain benefit. Instead they complain about it, including those who heavily used cannabis.

–Nabilone (Cesamet), a schedule II drug. I had it diluted 10 times for a healthy senior with intractable pain. He hallucinated for 12 hours after a tiny dose. I’ve never seen a plant do this.

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More research is greatly needed. It has primary effect on the immune system in brain and body including neuro-inflammation in the central nervous system and the skeletal cannabinoid system. It is anti-inflammatory. In the brain, the microglia makes and reabsorbs one of the endogenous cannabinoids made by the brain. Studies show cannabis can help pain but almost all of my patients who tried many many strains reported that it failed to help intractable pain. Others stopped due to side effects. But I have seen patients with intractable pain and treatment resistant migraine who responded to CBD alone.

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Use the search function top left above photo for previous posts on cannabis.

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Beware the munchies and weight gain. It can be deadly. That effect can be life-saving in cancer patients and end of life care.

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The material on this site is for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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Comments are welcome.

This site is not for email, not for medical questions, and not for appointments.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please IGNORE THE ADS BELOW. They are not from me.

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Spinal cord stimulators: ~ 10% are good candidates. Pulling out more than putting in


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PainWeek 2018 has a series of conferences in different cities. This weekend 10/13-10/14, it was in San Diego teaching pain management. Thank those who funded this 2 day program for doctors and healthcare providers to bring us up to date in the field.

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Anesthesiology pain specialist Michael Bottros, MD, Associate Chief of the Division of Pain Medicine, Washington University St. Louis, made a comment on spinal cord stimulators:

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They are pulling out more than they are putting in. Only 10% are good candidates.

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The material on this site is for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~

Comments are welcome.

This site is not for email, not for medical questions, and not for appointments.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

.

Please IGNORE THE ADS BELOW. They are not from me.

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Spinal Cord Stimulators, Advances? A Revolution? How about a lot more research first?


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The new issue of Practical Pain Management has a lead article on Spinal Cord Stimulators, stressing early treatment, a revolution using “new [and] different patterns of electric stimulation.” Advances?

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I don’t have the energy or time to compare these new claims with the information just posted on this site from the International Association for the Study of Pain that details existing evidence with the decades of claims by these companies and abysmal lack of research. Perhaps they could set aside some of the billions in profit they use for PR and give us good research data.

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Chronic pain would make any of us vulnerable to risk our lives for these devices. Research is desperately needed. Here are the new claims:

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Recent Advances

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Ivano Dones, MD, and Vincenzo Levi, MD, of the Functional Neurosurgery Department at the Carlo Besta Neurological Institute in Milan, Italy, highlight “an ongoing revolution” in the treatment of neuropathic pain using “new [and] different patterns of electric stimulation.”3

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Conventional SCS stimulation employs a tonic waveform in which electrical pulses are delivered at a constant frequency, pulse width, and amplitude. It has been found effective for approximately 50% of neuropathic pain patients.4 To help more sufferers, including those who develop a tolerance to conventional stimulation, the researchers say that new types and patterns of stimulation, such as burst and high frequency, should be considered.

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To date, only small studies have been performed on burst stimulation, but Drs. Dones and Levi say the results have been promising. “When compared to conventional SCS,” they state, “burst stimulation gave remarkable long-term pain higher suppression.” In addition to providing greater pain control than the traditional tonic pattern, it was also associated with a decreased incidence of paresthesia (a pins-and-needles sensation).

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Studies have also shown that burst stimulation may be more effective in reducing pain in the axial midline region, an area that conventional tonic stimulation often fails to treat effectively.5 Dr. Dones told PPM that this is because “burst stimulation can recruit more nerve fibers in the spinal cord, thus interfering with their transmission of pain to the brain.”

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The authors cite a small study using high-frequency stimulation that showed 70% of patients “experienced a significant and sustained low back pain and leg pain relief.”6 They note, however, that another study showed no significant difference between the high-frequency mode and a placebo. More studies need to be conducted, they say.

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Joshua Rosenow, MD, director of Functional Neurosurgery and Epilepsy Surgery at Northwestern Medicine in Chicago, IL, applauds these recent advances. New patterns of stimulation, including combinations, he says, “have allowed us to provide a wider population of patients with a significant amount of pain relief.” They have also enabled clinicians to “more precisely match the therapy to the patient,” both now and as pain changes over time.

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The material on this site is for informational purposes only.

.

It is not legal for me to provide medical advice without an examination.

.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~

Comments are welcome.

This site is not for email, not for medical questions, and not for appointments.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

.

Please IGNORE THE ADS BELOW. They are not from me.

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