I tend to be fairly flexible and open-minded about pain management interventions but I’ve always been concerned about the medical marijuana controversy.  There is not doubt that many of our modern medications come from plants but I cannot think of any that use the smoking delivery system that most people use with medical marijuana.

Today I ran across information from the National Pain Foundation at http://www.nationalpainfoundation.org/ and a report titled What Does the Future Hold for Marijuana for Pain? By Bill H. McCarberg, M.D.  I’m including some excerpts from that report below.

What progress is being made toward developing cannabinoids as prescription pain relievers? Some cannabinoids are unstable and many are insoluble in water, which makes them difficult to research and turn into modern medicines. Patients react very differently to cannabinoids. Data from recent clinical trials are encouraging, but somewhat mixed. Looking closely at the results suggests that composition and delivery route (i.e., how a medicine is administered) are extremely important to the viability of cannabinoid medicines.

The Delivery Route: When taken orally, cannabinoids are not very well absorbed and often have unpredictable effects. Patients often become sedated or have intoxication-like symptoms when tetrahydrocannabinol (THC—the primary psychoactive cannabinoid in cannabis) is metabolized by the liver. A small number of studies with Marinol (synthetic THC in sesame oil in a gelatin capsule) and Cesamet (synthetic THC analogue) have shown some effectiveness in pain relief, but optimal doses that relieve pain often cannot be achieved because of unpleasant psychologic side effects.

Inhaling cannabinoids, especially THC, also may cause problems for many patients. Blood levels rise suddenly and then drop off sharply. This rapid on-off effect may produce significant intoxication, particularly in patients who are new to cannabinoids. This may pose the risk of abuse potential. Smoking cannabis produces this effect, which is the very reason that recreational users prefer the inhaled route. Patients, however, generally wish to avoid psychologic effects, and it is unclear how difficult it might be to find a dosing pattern that enables them to have pain control without side effects.

The use of herbal cannabis — usually smoked — has received considerable media attention since California and Arizona passed “medical marijuana” initiatives in 1996. Despite numerous anecdotal reports of effectiveness, very few controlled studies have been published in the pain area. Little is known about the number of patients who actually experience some degree of benefit or side effects.

Furthermore, herbal cannabis is neither standardized nor monitored for quality. The cannabinoid content can vary a great deal, and cannabis sold at dispensaries may be contaminated with pesticides or mold. Dosing is uncertain, depending on the preparation or method of use. So-called “vaporizers” do not eliminate all the contaminants. Without clinical trial data and an assurance of product quality, physicians lack the information necessary to assist patients in making informed therapeutic decisions. Both the FDA and Institute of Medicine have stated that there is no future for herbal cannabis as a prescription medicine.

To learn more about chronic pain management please check out our website at www.addiction-free.com and go to our Publications page and check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. You can also check out our Articles page to download my free article Medical Marijuana Controversy to learn more of my ideas about this topic.

I have always thought that prevention was much more cost-effective than crisis management for any healthcare related issue but especially in pain management.  I have seen many of my patients experience unnecessary pain and suffering because they did not receive adequate pain management right away.  I ran across an online report discussing the need for better pain interventions after traumatic injuries and wanted to put some of the highlights from that report posted on Medscape Medical News below.

March 25, 2008 — Patients who have sustained a traumatic injury continued to have moderately severe pain 1 year after the injury, suggesting that better pain interventions are needed, according to the results of a study reported in the March issue of the Archives of Surgery.

“Recent studies with long-term follow-up of trauma revealed that 5 to 7 years after injury, chronic pain was present in most patients who sustained pelvic fractures and serious lower extremity injuries,” write Frederick P. Rivara, MD, MPH, from the University of Washington in Seattle, and colleagues. “Pain was an important contributor to disability in these patients and often interacted with other sequelae of trauma, such as posttraumatic stress disorder and depression, to affect functional recovery.”

This study aimed to determine the prevalence of pain in a large cohort of trauma patients 1 year after injury as well as to identify personal, injury-related, and treatment factors predicting the presence of chronic pain in these patients.

“The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed,” the study authors conclude. “The high prevalence of pain, its severity, and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to aggressively treat early pain and better manage neuropathic pain.”

To learn more about chronic pain management please check out our website at www.addiction-free.com and go to our Publications page and check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. You can also check out our Articles page to download my free article Managing Pain without Pills to learn more about nonpharmacological pain management.

I spent last week in Salt Lake City teaching the Relapse Prevention Counseling Track at the University of Utah’s School on Alcoholism and Other Drug Dependencies annual week long school. This was my first year teaching there but I certainly hope it will not be the last. As a matter of fact they have already approached me about the possibility of bringing my Addiction-Free Pain Management® System information to next year’s school.

The University of Utah’s School, which is recognized internationally, has continually expanded its scope to keep pace with increased awareness of the health and social problems of alcoholism and other drug dependencies.  All areas of these problems are presented in training sessions for professional and lay personnel.  The School provides students with the latest methods and techniques for working effectively in their respective disciplines.

COURSES OFFERED for substance abuse counselors, clinicians, physicians, dentists, pharmacists, nurses, medical personnel, rehabilitation counselors, public health administrators, educators, judges, lawyers, peace officers, county commissioners, industrial and community leaders, advisory council and board members, college and graduate students, families, treatment center personnel, and others desiring special instruction on alcoholism and other drug dependencies.

GENERAL SESSIONS for the entire student body will focus on current issues and trends in the field of substance abuse education, prevention and treatment.

GROUP SECTIONS provide specialized information and techniques for working effectively with substance abuse problems in various disciplines.  Specific groups are: American Indian; Criminal and Juvenile Justice; Dental; Drugs: Treatment and Rehabilitation; Education, Prevention and Youth Counseling; Employee Assistance and Human Resources; Mining Industry; Nursing; Pharmacy; Physicians; Professional Treatment; Recovery Support; Relapse Prevention Counseling; Substance Abuse Overview and Current Issues; Vocational Rehabilitation and Women’s Treatment.

If you want to learn more about the Addiction-Free Pain Management® System go to our website at www.addiction-free.com and also go to our Publications page and check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. You can also check out our Articles page to download my free article From Denial to Effective Pain Management to learn more about denial and chronic pain; including a look at the 12 Common Pain Mangement Denial Patterns.