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What Cannabis Can (and Can’t) do for Chronic Pain. Pot for Pain Relief?

What Cannabis Can (and Can’t) do for Chronic Pain. Pot for Pain Relief?

(Story by Karen Weintraub, USA TODAY) reprinted 1/26/2023. 
A growing, but still incomplete body of research suggests the cannabis plant, the source of marijuana, can help fight some kinds of pain.

Rob Sims grew up hearing stories about what opioid addiction could do. The former Detroit Lions guard, whose father, Mickey, also played in the NFL, watched a number of his dad’s friends get hooked. Some died. He vowed his own story would be different.

Then, playing for the Seattle Seahawks in 2008, early in his pro football career, Sims tore a pectoralis muscle in his chest. Primed for his best year ever, Sims was sidelined.

After surgery, he received an open-ended prescription for opioids. “Take when you have pain,” the bottle read. “That’s seared in my memory,” he said. As a football player, “I have pain all the time.”

Scared by the lesson he had learned as a child and with little to do besides focus on his recovery, he remembers thinking: “This could go in a bad way.”

That’s when he turned to marijuana.

It remains unclear whether cannabis can be an effective treatment for pain. Plenty of circumstantial evidence supports the idea, but exactly how, what kinds of products and what can be expected from them has yet to be determined.

“There’s some caveats before it’s ready for broad, prime-time usage for chronic pain,” said Dr. Devan Kansagara, a professor of medicine at Oregon Health & Science University and a staff physician at the VA Portland.

It’s possible that cannabis helps with the psychological aspects of pain, said Dr. Nora Volkow, head of the National Institute on Drug Abuse. “Cannabis may improve pain indirectly, for instance, through decreasing anxiety so that someone may be able to deal with pain better,” she said.

Rob Sims was a guard with the Detroit Lions and now runs a cannabis business with fellow former Lion Calvin Johnson Jr., right. © Carlos Osorio, AP

Detroit Lions guard Rob Sims during the game against the Green Bay Packers at Lambeau Field, Dec 9, 2012.© Benny Sieu, USA TODAY Sports

One recent examination of previous studies found the benefits of cannabis were equal to the benefits of a placebo, which means that if people thought it would help, it did.

“There’s very limited evidence out there to support that cannabis is effective against pain,” said Karin Jensen, the Swedish neuroscientist who led the study. So far, most of the information showing its usefulness is anecdotal.

“People who use cannabis to relieve pain may have the experience that it helps – there is no doubt about that,” she said. “What’s needed is solid scientific evidence to determine how much of the relief is due to the cannabis and how much is due to other things, such as the placebo effect.”

The general public is already largely convinced.

Marijuana remains illegal in 12 states, but as of 2019, 18% of U.S. adults reported using cannabis at least once in the previous year, and 4% to 5% use it daily or nearly daily, Kansagara said.

In a 2017 study, the majority of people who used medical marijuana or self-medicated with the drug said they did so to relieve pain, and 65% of those who requested medical marijuana licenses said they wanted it to treat pain.

The marijuana plant provides a wide range of chemicals, including THC, which has psychotropic effects/

But cannabis comes with cautions.

At least 5% of Americans ages 12 and up abuse or are dependent on marijuana, and the risk for dependence increases the younger someone starts. Marijuana use directly affects parts of the brain responsible for memory, learning, attention, decision-making, coordination, emotion and reaction time. And long-term or frequent marijuana use, particularly at higher doses, has been linked to increased risk of psychosis or schizophrenia.

It’s not possible to predict ahead of time who will react badly to marijuana, said Dr. Charles Berde, co-founder of a pediatric pain clinic at Boston Children’s Hospital.

THC, the part of the plant that has psychotropic effects, “has narrow uses for nausea and appetite stimulation in patients with severe weight loss due to AIDS or cancer,” but the data for CBD for treatment of chronic pain is “murky,” Berde said. “All the more reason to be hesitant to prescribe it.”

Cannabis and pain relief

When a body is in pain, the brain releases its own pain relievers. There are special receptors in the brain designed to take in these natural cannabinoids and offer relief.

Ingesting or inhaling weed fills up those receptors, too.

Providing more cannabinoids than these receptors can accept overloads them making the person’s own internal cannabinoids ineffective, said Dr. Jordan Tishler, a cannabis specialist physician in Cambridge, Massachusetts, and founder and president of the Association of Cannabinoid Specialists.

That’s why higher doses don’t provide any additional pain relief compared with lower ones and can have “all sorts of risks,” he said. Side effects from cannabis can include increased heart rate, dizziness, impaired concentration and memory, slower reaction times and, more rarely, increased risk of heart attack and stroke and dependence.

Tishler said many patients come to him taking far too much cannabis, which increases the risk for side effects. He works to convince them that 5 mg to 20 mg a day will treat their pain better than the 200 mg they’re using.

Cannabis is now sold in many different forms.

“Just because (cannabis) doesn’t lead to breaking the law and incarceration and those sorts of troubles doesn’t mean people can’t have their lives significantly altered by getting overly involved with this particular substance,” he said.

There are also open questions about cannabis, including whether the pain-killing benefits seen in short-term studies will last. Some painkillers, like opioids, can actually make people more sensitive to pain. It’s not yet clear whether cannabis can have this effect.

“You’d like to see what happens with these products over a longer period of time, ideally,” Kansagara said. “I would like to see that before recommending wholesale to patients.”

Although legalization and decriminalization are making a difference, cannabis remains hard to study. Until recent years, it was extremely difficult to gain access to cannabis for research, and there was little federal funding for such work. In early December, President Joe Biden signed a law that will make it easier to research cannabis.

Dr. Donald Abrams, speaking in support of the Adult Use of Marijuana Act ballot measure in San Francisco on May 4, 2016. © Jeff Chiu, AP

Gold-standard studies compare a treatment versus a placebo, but it’s impossible to keep people in the dark about whether they’re getting high, said Dr. Donald Abrams, an oncologist and professor emeritus at University of California, San Francisco, who studies cannabis.

When Abrams studied cannabis use in his HIV patients, some critics thought patients must be too stoned to notice their pain. But Abrams said the patients reported that it did alleviate their pain.

Dosages of cannabis aren’t standardized, which adds to the difficulty of comparing one study against another, he said.

That’s why trials of cannabis for pain relief have shown mixed results, said Wil Ngwa, an associate professor of radiation oncology at Johns Hopkins Medicine, who’s working to create such standards for drug trials.

This lack of standardization also means people have to use trial and error to find an effective dose for them, according to Staci Gruber, who directs the Marijuana Investigations for Neuroscientific Discovery (MIND) program at McLean Hospital, a Harvard-affiliated psychiatric hospital outside Boston.

In one study, Gruber followed 37 volunteers using cannabis for chronic pain. After six months of treatment, participants reported lower levels of pain, better sleep, more coherence and less use of conventional painkillers.

‘Positives, not negatives’

Sims experienced the same benefits.

Daily marijuana use after his pec injury helped cut the pain, allowing him to lift more weight and recover faster. “I was able to come back stronger than I was before.”

Playing NFL ball, Sims said, is like living through a train wreck every Sunday. The best players – the ones whose careers last the longest, he said – “have learned how to recover quicker and get ready for that next train wreck.”

During his career, marijuana helped Sims rebound and improved his sleep, which allowed him to push his workouts.

Asked about side effects from his marijuana use, Sims pointed to his athletic and financial successes. “I wouldn’t call those side effects,” he said, laughing. “I see positives, not negatives.”

In 2021, Sims co-founded the cannabis company Primitiv Group with fellow former Lion Calvin Johnson Jr. Sims and Johnson acknowledge they used cannabis during their professional careers, though there was a zero tolerance policy then, which has loosened only slightly since. Both men believe the restrictions should be lifted.

About a decade ago, Sims persuaded his wife, Natalie, to try cannabis, when a bout with the bowel syndrome Crohn’s disease left her on a morphine drip in an emergency room.

“This can’t be how we live for the rest of our lives,” he told her. She uses cannabis now and finds relief, Sims said.

“It made me very passionate about pain and help for pain.”

Challenges of cannabis care

Cannabis doesn’t make pain go away, like Advil might get rid of a headache, Tishler said.

Instead, “it makes it so it doesn’t bother you so much,” he said. “It divorces the pain from the suffering.”

Whether it’s the THC or the CBD in cannabis or both that might be helpful against pain remains an open question, Kansagara said. THC is what makes people feel “high.” CBD appears to have anti-inflammatory properties, which may be useful to some.

Smoking joints isn’t a good approach for relieving chronic pain, said Tishler, who recommends his patients use edibles instead. The effect of inhaled cannabis wears off in three to four hours, while a gummy might last eight to 12 hours.

The yo-yo effect, when pain comes and goes over a few hours, can exacerbate suffering, Tishler said. “Short-acting actually turns out to be a bad approach in general in pain management.”

In Massachusetts, where medical cannabis has been legal since 2013 and recreational since 2016, doctors are more comfortable giving their patients permission to use cannabis, Tishler said. But they rarely bring it up themselves.

So, Tishler is trying to educate his peers. “If you were thinking the patient needs opioids, think cannabis first. Don’t wait for the patient to bring it up – it’s your job to bring it up,” he tells them.

Similarly, he’d like to get cancer patients on cannabis early in their care, rather than waiting until agony sets in. “Once people are at the end of their rope, things are worse and harder to treat than if we had started when things were still kind of OK.”

Most of the advice on what product to use now comes from the patient care advocates or “budtenders” who work behind the counter at dispensaries, Gruber noted with some concern. They typically don’t know the person’s medical history or history of cannabis use or whether they use other substances such as alcohol, other drugs or prescription medication. Product labels can often be misleading about their THC and CBD content.

The trial-and-error approach can be difficult and challenging for patients with major medical problems.

“Knowing what’s in your weed is critical, but also how you’re going to respond to it is an important consideration. And that’s something we don’t spend a lot of time on,” Gruber said. “You have to educate patients. They’re desperate for it, but it’s not easy, because we’re all different and cannabis is not a ‘one size fits all’ solution.”

Research may change future use.

For cannabis to reach its full potential as a painkiller, more research is needed, experts say.

“It’s really untapped right now, because of that lack of research,” Johnson said.

That’s why NFL players and owners have been supporting cannabis research. Owners have donated more than $1 million this year to two cannabis research programs.

“We need to become better educated about all these issues,” said Dr. Allen Sills, the NFL’s chief medical officer.

Dr. Allen Sills, the NFL’s chief medical officer© Rebecca Blackwell, AP

Ngwa, at Hopkins, collaborates with Sims and Johnson to lead some of that research.

He’s also looking at better ways to treat cancer pain with cannabis.

His studies suggest that not enough of the painkiller gets to a tumor when the cannabis is inhaled or ingested, so he has been exploring smart-drug delivery systems than can target the drug directly to the tumor. So far, he has tested only pancreatic tumors but hopes to rapidly expand to other cancer types.

Ngwa is concerned that preliminary research like his will encourage people to self-medicate, taking doses that may not be helpful. “You really have to wait for the clinical trials, but when people are desperate, they just do (anything). I definitely worry about that,” he said.

Until more is known, Sims will keep up his cannabis routine.

Now 39, he has dropped 50 pounds from his 320-pound playing weight, which has helped reduce the lingering bone-on-bone pain in his right knee. He rubs a Primitiv topical on it knee every day.

“My passion behind the plant and what it’s done for my family reigns supreme.”

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

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Inspirational Technologies Celebrates Record CBD Sales & Mother’s Day CBD Beauty Sale

Inspirational Technologies, CEO, Steven Smith, announced May 1st, 2020, record setting sales for April, despite or possibly encouraged by our current Covid-19 pandemic. Steven cites that our own immune system benefits from CBD and the more protection we can throw at this and other infectious diseases the better. He mentioned that he and his loved ones all use and give him so much positive feedback, that he finds it especially encouraging in these uncertain times.

✅ Thank you all for helping us have a record-breaking April in terms of sales! We are so happy that we could help so many of you with our Immune support supplements. Our goal has always been to inform our readers and current customers as to the benefits of our Premium CBD Products, and encourage you to try them. They are all Full Spectrum CDB (THC Free) and available in all 50 US States.

✅ All flavors of our 500mg Drops are back in stock in the US! They are also being shipped over to the UK and will be available to our International markets very soon!

✅ US: Happy Mother’s Day to all of you moms out there! We have a Mother’s Day special on a brand new pack, our Bath & Beauty Pack that includes one bottle of Face, one bottle of Body, and two bath bombs (available in 4 different scents) for only $69! Check this out on our store now!

These packs are both over a 50% discount and are available now through May 15th! Great for Mother’s Day or just as a gift to love on the ladies in your life, the guys in your life, teachers, health care workers, essential workers, etc!

Remember, we still our Immune Support pair of our “Patented CBD Brain Capsules” plus 250mg Flavored Drops for only $99.

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We at Inspirational Technologies and HempSmart wish you Good Health and practice Smart Social Distancing. Be Well.

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Inspirational Technologies to Report Optimistic 2020 Sales Gain on 1st Year Anniversary. April 1, 2020

“The Great News is, Our Vision for 2020 is in line with our 20% per Quarter Increase in Sales over our previous same year’s quarterly reports.”

Steven Smith, CEO and Owner of Inspirational Technologies, on soon to be released company 4th period quarterly results And finally passing it’s 1 year anniversary. 

BackgroundNoiseNewswire:All Rights Reserved (2020):04/01/2020

Steven Smith, CEO and Founder of Inspirational Technologies, a Health and Wellness Company, released a statement to Background Noise Newswire on Wednesday, April 1st, 2020. The following is an excerpt of the full statement which can be found on a later link.

Background Noise News, a Proprietary Inspirational Technologies Messenger Service to Announce End if Year Gross Sales Report April 10th, 2020.

“I again, would first like to say and express my gratitude to all of our over 3700 loyal subscribers on our site.  Your Support means finding positive experience and relationships that foster the very foundation of support. Now, this New Year, we have found ourselves faced with a Human Condition unlike no other. Inspirational Technologies is changing health and wellness to include protection. Protection in the form of the Human Immune System and forming Habits of Health.

Our 2020 Vision for our Company is to pledge to support and be a positive influence. We are positioned to inspire those in an inspirational and informative manner. We will begin with education and move into action. One ☝️ step at time with the knowledge that living is, but a way of life which embraces us, not one which divides us. We were taught by love what is meant to love each other as we wish and should be loved and respected by all. “ Steve remarked.  Gross Sales as reported to the State of Florida, for our forth period, quarter. An end of year company statement will be provided in the near future. In the statement the overall report also showed a projected 2020 increase in quarterly gross sales projections in the 20% range. Of course, all projections are based on market fluctuations, that can cover a large umbrella of interest or no interest.” Steve concluded in the statement, “For 2020, Inspirational Technologies Commits. That will be our mantra this year to go the distance to achieve, and to believe, in not only ourselves, but others, also. Continued Happy Ness and Prosperity for you and yours in 2020! Thank you for your consideration.

Steven M Smith, CEO and Founder of Health and Wellness Company, Inspirational Technologies and Background Noise Studios with Background  Noise News (2020) All Rights Reserved!

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“Inspirational Technologies” Announces Global Expansion, Exponential Growth!

September 7, 2019 FloridaInspirationalNewswire For Public Release

Inspirational Technologies, a Health and Wellness Company, announced Friday, September 6th, 2019, in a Closed Company Announcement of it’s future…

“Following that announcement, there was a positive review of the company’s direction and opportunities, by interested parties.” said Steven Smith, The Company’s Founder and Owner. “We have already Partnered with some major players in the CBD Global arena, such as HempSMART, a Subsidiary of Marijuana Company Of America, a US publicly traded company (MCOA), along with VivaBuds, a New Cannabis Delivery Company, currently serving the Greater San Fernando Valley area”. Said Steven. “We say partners, and by that, we say that all of our interactions are in our arena of partnering with Global Companies with common goals and interest. HempSMART is now in the UK, Scotland, the Netherlands with future countries in Europe on the horizon. We are appreciative to those partners who have since made significant impact to our Company’s Mission, beyond my expectations. Although, I can’t comment yet on 3rd Quarter statistics, I can report that our Website has had over 2,400 New Members, over the past 2 quarters. We are growing exponentially and over 100 new members a day are not uncommon.” he said. “We are now poised to deploy our New Technologies, now being Beta Tested and are bracing for the new opportunities and an outreach to those we can call partners.” Steven Smith also made mention of DirectView Holdings, saying, “Knowing that we needed a Security Company, we looked to Direct View and Apex CCTV (Closed Circuit Security System) and found them to have an awesome product, in their HIKVISION 4 Camera -1 TB NVR.” Steve continued, “I actually installed the system, myself! After all, we are an Innovative Technological Company, and as it’s founder, we have to know what we are doing.” Steve added, “We knew that these days would soon be upon us and we welcome everyone and our ‘Partners’ to ‘Put on your Thinking Caps, Reserve a Seat on This Rocket we call “Inspired One”, put on your seatbelt. Get engaged with Our resources. The COUNTDOWN BEGINS NOW.”

Steven Smith concluded with a short Q&A.

FloridaInspirationalNewswire

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