Chronic pain, in and of itself, is considered an often intractable condition
that millions of Americans suffer from every year. Chronic pain generally
refers to persistent pain experienced by a person for 3 months or longer.
It is often debilitating, frustrating, and depression-inducing for the
person suffering it. So, when "treatments" come along that have
the potential to provide relief to sufferers, my ears always perk up hopefully
to the possibilities. Recently, a review in the
Annals of Internal Medicine evaluated the existing and available evidence involving the use of cannabis
as a choice in treating chronic pain. Disappointingly, the results are
pain management physician, I think cannabis and cannabinoid products have the potential
for reducing the use of prescription opioids, and that's a good thing
for chronic pain patients. Anecdotally, I have plenty of patients who
volunteer that they regularly use cannabinoids in some form – usually
CBD creams or gummies of some sort. Many say they are helpful. Others
say they've tried them with only minimal or moderate benefit.
The good news is that there are already several options available to lower
the use of prescription opioids, ranging from alternative pharmaceuticals to
neuromodulation procedures, to proper and effective education and learning about pain
science. I certainly believe patients are open to trying cannabinoids
– some forms more than others. But being a chronic pain patient
can mean many different things. In my experience, most "typical"
patients view cannabinoids as "possibly" or "hopefully"
effective, rather than having an unrealistic view of their role in the
management or “cure” of chronic pain.
The assumption that cannabinoids are "harmless" is held by many
lay individuals. Still, there are obvious risks associated with cannabinoids
that must be considered, studied, and reported. One major issue to consider
is the unintended side effects of any intervention, including cannabis. The
Annals of Internal Medicine review specifically describes limitations in the study relative to reports
of adverse events such as psychosis, cannabis use disorder, mood, and
cognitive deficits. These are potentially significant issues, as are long-term
efficacy and long-term effects.
There is currently a disappointing lack of robust studies to determine
whether cannabis or cannabinoids can effectively treat chronic pain. The
truth is chronic pain is a challenging condition for any intervention
to prove efficacy. Pain studies have a robust
placebo response that can be difficult to overcome in clinical trials. The reality
also exists that so many different and varying factors can cause chronic
pain, that pain is subjective to the individual experiencing it, and that
it is incredibly complex. Pain is not simply about an electrical signal.
Emotional and environmental conditions affect pain in a person, as well
as expectations and other contributing factors. In these ways, chronic
pain is challenging to measure. But the other social, legal and political
aspects of cannabis and cannabinoids further complicate the ability to
study their effects on chronic pain easily.
I believe chronic pain is best treated in a holistic and multidisciplinary
fashion with combinations of education and learning, autonomic quieting,
optimizing sleep, neuromodulation, and judicious use of medications. For most patients,
no silver bullet pill or medication is overwhelmingly responsible for
successfully managing chronic pain. As a neurologist, my approach to pain
treatment is based on a thorough knowledge of how the body works and how
the brain contributes to suffering from pain, not just how injections,
pills, medicinal options such as cannabis or cannabinoids, or other interventions
can "cover" or "block" pain. My goal is to manage
pain for patients so that they can continue to live their everyday lives,
but ultimately, I want to get to the bottom of what is causing the pain
and fix it.
Dr. Williams’ answers from Email Interview on 6/4/22