INTRODUCTION TO PAIN MANAGEMENT
Perhaps the pain is from a muscle injury or a tumor, or perhaps from a spinal injury or recovery from surgery. Regardless of the source of pain, unfortunately pain has become a noticeable and disruptive force in the daily lives of so many people.
They have turned to medications and other remedies to no avail.
CBD may offer an incredible alternative to dangerous opioids and bring pain relief to so many who suffer from pain.
Let’s explore the topic further.
TYPES OF PAIN
Pain can be acute or chronic, but either way, pain affects millions of people each year.
Pain affects people on many levels – financially, physically and emotionally — and pain treatment constitutes a significant amount of America’s health care costs.
Employees suffer lost income, lost benefits and perhaps even loss of work.
Employers are affected by employee absence and lost productivity of their workers. Pain places a financial and emotional burden on patients and families. Unresolved pain can mean longer hospital stays, increased doctor visits, increased medication costs and increased rehabilitation costs.
The Institute of Medicine’s recent report entitled, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research”, presents pain as one of America’s main public health issues.
Shockingly, pain costs over $600 billion annually – or about $2,000 per American. Furthermore, companies estimate that pain costs them over $300 billion in lost productivity of days lost due to pain each year.
ACUTE vs. CHRONIC PAIN
Acute pain is a normal nervous system sensation that alerts the body about the injury.
Chronic pain is very different.
Chronic pain is persistent pain.
The pain signals just keep on firing–for weeks, months, or even years.
Chronic pain sufferers had an initial injury, such as a back injury or an infection, yet keep suffering chronic pain long after, and certain individuals have chronic pain even though they’ve never had an initial injury.
Common complaints are:
- Arthritis
- Headache
- Lower Back Pain
- Cancer Pain
- Neuropathic Pain from Peripheral Nerve Damage due to Diabetes and other Conditions
Chronic pain affects more Americans than three of the main disease combined–diabetes, heart disease and cancer. Compared to other major health conditions, chronic pain is by far the most prevalent.
Five times more people suffer chronic pain than strokes and other heart conditions, and ten times more people have chronic pain than cancer.
PAIN'S IMPACT ON DAILY LIFE
At the end of life, over half of all patients hospitalized experience significant pain.
Three-quarters of cancer patients experience pain even though there are a multitude of therapies specifically designed to alleviate cancer pain.
REPORTED PAIN
A recent National Institutes of Health (NIH) report showed that four types of pain are commonly reported:
- Low back pain (27%)
- Severe headache, such as migraine (15%)
- Neck pain (15%)
- Facial pain (4%)
Regardless of age, Americans suffer more disability due to back pain than any other injury.
As constant pain takes a toll, a person’s mental and physical health both suffer as a result.
Here are some statistics:
- 30% – back pain limits their physical activity
- Three times more likely to be in poor health because of all the limitations
- Four times more likely to have mental and emotional distress
In the report “Special Feature on Pain” by the National Center for Health Statistics Report, 25 percent of adults (age 20 or over) say they’ve had pain that lasted more than 24 hours.
That number goes up the older you get; adults age 45-64 years experienced more pain episodes, and the number is even higher for the 65 and over group.
QUALITY OF LIFE IMPACTS
It affects physical, emotional and mental stability, and disrupts even the most basic of daily functions.
Here are some statistics from the Voices of Chronic Pain Survey:
- Sleep disruption or inability to sleep or sleep well (86%)
- Depression (77%)
- Loss of focus or concentration (70%)
- Loss of energy (74%)
Chronic pain causes loss of productivity, lost work time and lost wages.
In the American Productivity Audit, nearly 30,000 working adults were surveyed to estimate the impacts of chronic pain on their work. Participants were asked how conditions like back pain, arthritis, headache, and other painful conditions affected their work ability. Amazingly, over half of those surveyed had experienced this type of pain over the last two weeks, and about 12 percent had lost time at work.
Headaches were the most common condition reported, followed by back pain, arthritis and other pain.
In general, workers lost about a half day in a 40 hour work week—all due to pain.
Age was not a factor; in this survey, workers of all ages suffered these painful conditions.
A half day may not sound like much, but it definitely adds up—to the tune of $61 billion per year of lost time due just to the above-listed conditions. Absenteeism is not the main issue, either. Over 75 percent of people are at work but they’re losing productive time because of the pain.
In another survey called America Speaks: Pain in America, American viewpoints about chronic pain were the focus, and researchers wanted to determine perceptions about how people and their doctors deal with chronic pain.
Over 10 percent of people with pain needed outside help from others just to get by with daily living activities. Many moved to a home that was easier for managing pain (such as a one story instead of a two story home).
TRADITIONAL PAIN TREATMENTS
Some see rheumatologists for arthritis or an orthopedic doctor for lower back pain. Almost half have seen multiple doctors in an attempt to reduce or alleviate their pain.
One in four has tried specialized pain management at clinics or chiropractors.
Regarding pain treatments, the results are not stellar.
Nearly 60 percent said prescription medications were somewhat effective, and only 40 percent found relief with over-the-counter pain medications.
Although there is not much compelling evidence that opioids actually help lower back pain, these medications are still widely prescribed.
In fact, little to no research had been done proving the efficacy of opioid drugs.
Opioids usually only provide a modest short-term pain relief, and that is only in cases where patients can actually tolerate the medicine without the devastating and unwanted side effects.
In the American Pain Foundation’s Voices of Chronic Pain Survey, researchers evaluated the impact of chronic pain on 303 participants who were being treated by a physician and taking opioids to treat pain. Despite these treatments, more than half still responded that they felt powerless over their pain, having little or no control of it.
Despite the constant use of opioid medication, 60 percent experienced breakthrough pain, at least once per day, but often multiple times; respondents said the breakthrough pain was severely limiting to their quality of life and that it had a “tremendous impact on their overall state of well-being.”
As the world learns about the addictive nature of opioids, consumers are looking for drug-free pain relief without harmful side effects.
CBD FOR PAIN RELIEF
CBD is short for cannabidiol, and it is a very effective pain reliever already used by millions of people worldwide for this very reason.
Use for pain is indeed the number one reason people turn to CBD products in all their forms.
CBD is an inflammation fighter, so it can relieve pain stemming from many different sources.
CBD, a non-psychoactive compound found in the cannabis and hemp plants. Both plants are known to contain over 80 such cannabinoid compounds. Perhaps the most well-known cannabinoid is THC or tetrahydrocannabinol, which is primarily responsible for the psychotropic effects of cannabis. Unlike THC, CBD is non-hallucinogenic. It has no known abuse potential.
CBD works with the body’s natural endocannabinoid system, a network of neurotransmitters and receptors. A neurotransmitter is a chemical molecule produced at the synapse (connection) of a neuron (brain cell).
These chemicals bind with receptors and trigger a signal in a connecting neuron. This system of signaling molecules and receptors found on the surface of cells is the brain’s way of transmitting brain signals to relay instructions to other cells in the body to basically tell them how to behave.
HOW CBD WORKS
CBD is a cannabinoid, sometimes called a phytocannabinoid, that plants use as their natural defense or attractive chemicals.
Normal receptor function keeps the body in balance (homeostasis).
Each individual person has a unique endocannabinoid system of receptors.
Some people have more receptors than others, so each person reacts differently to CBD. Lots of other things factor into how your body will react to CBD:
- Body Weight
- Genetics
- The form of CBD you are using (topical, edibles, etc.)
- CBD dose matters too
- CBD’s bioavailability, an indication of how quickly the cannabinoid enters the bloodstream
- Gender matters too, as it seems that women require less CBD than men. CBD works in conjunction with estrogen, so women usually get much more pain relief with smaller amounts.
A person’s receptors do morph and change over his or her lifetime, so two different people who take the exact same CBD can definitely experience different effects.
CBD is widely used to help a variety of health issues.
The strongest scientific evidence in favor of CBD is the Epidiolex data, but CBD is also used for everything from anxiety to insomnia.
Additionally, CBD may be beneficial for chronic pain and inflammation.
Several studies, including one from the European Journal of Pain shows that CBD inhibits the inflammatory response and also inhibits neuropathic pain. More human studies are needed; research is in part hampered due to the illegal status in the U.S. federal government.
STARTING WITH CBD
Many people have begun using CBD for general health and wellness.
For example, runners rub it on before a run to help with inevitable sore muscles.
Talk to your physician or health care provider before you begin using CBD. Ask questions and share concerns.
Try CBD for your pain.
Why not?
It is already showing great promise as a natural pain relief alternative, and it is definitely better than taking dangerous opioid drugs.
While more research is definitely needed for in-depth study of how CBD relieves pain, promising studies have already demonstrated CBD’s effectiveness in relieving arthritis pain caused by inflammation – without any adverse side effects.
FORMS OF CBD
There are many factors to consider when trying to determine the form of CBD that will work best for you.
First and foremost, you want to consider what you’re using CBD for, and always make sure you get a quality product.
Topical CBD treatments have been shown to be very effective for migraines.
These creams, oils and gels are easy to apply and fast-acting.
If you are taking migraine medications, CBD theoretically should not interact at all since it works via an entirely different mechanism than common migraine prescriptions and over-the-counter medications.
The reality regarding what form of CBD is best is that there have been no human studies to date studying the best intake method for migraine.
In general, there are five forms of CBD:
- Topicals, Topical administration of CBD is very popular. CBD comes in creams, oils, salves and balms, to name a few, which are used to relieve joint pain and sore muscles. There are many cannabinoid receptors in the skin, so this form of CBD is generally fast-acting.
- Tinctures are extracted using the CO2 method, which preserves many of the cannabinoids. Tinctures are generally taken orally, but can also be mixed into food or drink.
- Edibles are also very popular because they taste great, are easy to use and are also discrete. CBD is usually infused into a baked good or smoothie to make it an edible. Many patients find it is easier to dose CBD with an edible. Since edibles in general have a higher concentrated form of CBD, this is a great way to take higher CBD doses. If the edible has a sufficient amount of other oil or fat, such as coconut oil, that formulation generally increases CBD’s bioavailability.
- Oral CBD in the form of drops, sprays and capsules are another ingestion method. They’re easy to use. Capsules are quickly digested, and drops or sprays of CBD under the tongue are very fast acting. Many oils and oral sprays are flavored to mask the earthiness of natural CBD.
- Vaping: While vaping is certainly another way to ingest CBD, and while inhalation has been deemed a very effective method, there have been many recent serious lung health hazards attributed to vaping and vaping additives, so caution is warranted.
IS CBD LEGAL, AND IS IT SAFE?
There is only one CBD formulation that is FDA-approved to date, and that is Epidiolex, an epilepsy drug made by British-based GW Pharmaceuticals. Epidiolex is the first FDA-approved natural cannabis-based drug created to treat two rare forms of epilepsy, Dravet Syndrome and Lennox-Gastaut Syndrome.
Like many migraine sufferers who don’t find relief with conventional medications, up to 35% of patients with refractory epilepsy cannot control their seizures with currently available conventional treatments.
In both cases, there has been growing interest in the potential of cannabis-derived products for treatment.
GW Pharmaceutical collected a tremendous body of research evidence in the course of conducting their clinical trials on over 500 adult and pediatric epilepsy patients. In fact, the company’s scientific rigor played a significant role in helping the FDA reach its decision. Results of this clinical trial are available in the New England Journal of Medicine publication and show that Epidiolex used in conjunction with conventional anti-seizure medications reduced seizures by over 40 percent.
While Epidiolex does bring relief to so many epilepsy patients, the drug is not without its adverse side effects. Some studies have demonstrated several important adverse effects associated with Epidiolex, which must also be considered as it becomes more widely used.
Adverse events were determined to be dose-dependent in some studies; the higher the dose, the more likelihood there was of an adverse event, mostly seen in the first two weeks after the dose was increased.
The negative side effects included diarrhea, vomiting, fatigue, lethargy, decreased appetite and others.
Regarding legality in the United States, even though the majority of states have approved some form of medical cannabis or CBD use, and despite the fact that a handful of states like California and Colorado have even approved recreational (adult use) marijuana, cannabis remains illegal at the federal level.
Even though CBD is widely sold in the U.S., everywhere from the smallest pet shop to national chains like CVS, purchasing CBD is only legal at the federal level if the product contains less than 0.3 percent THC.
Federal provisions allow CBD to be sold as long as the stores do not make any health claims about the CBD and what it can cure or treat.
The FDA can pursue any seller that does so, but the truth is they have limited staff to make such enforcement. The agency has issued warning letters to some violators. The picture gets even more complicated because individual states have imposed further restrictions. Some states like Iowa and Texas have even conducted raids on CBD stores.
The FDA mandate is to ensure the safest dose of any medication, and the rapid proliferation of hemp-based and CBD products has put the agency in a tough spot.
In 2018, federal lawmakers legalized hemp, and that opened the CBD floodgates even more.
The FDA does caution against using off-the-shelf CBD products because they are not regulated.
Indeed, independent lab tests are showing that other potentially harmful chemicals like solvents, synthetic cannabinoids, toxins and pesticides, might be in some CBD formulations.
TIPS FOR CHOOSING CBD
While many are excellent formulations from very reputable vendors, many products are of questionable quality.
Here are some tips for how consumers can look for truth in packaging to ensure you choose a quality product:
- Make sure the amount of CBD in the bottle (in mg) is clearly displayed on the package or bottle
- Make sure the total volume of CBD oil is clearly labeled on the bottle
- Determine whether the CBD is cannabis- or hemp-derived
- Make sure to determine whether the hemp is organic or non-organic
- The extraction method used to separate the CBD from the hemp plant should be plainly labeled; common extraction methods are ethanol, butane and CO2
- Third-party independent lab test results should always be available on the company’s website
HOW THE PUBLIC FEELS ABOUT PAIN
The National Institutes of Health, as well as many other organizations, are conducting pain research nationwide, at universities, hospitals, and other institutions.
The future is bright for this research to lead to promising new methods of facilitating pain management.
CBD needs to be part of that research effort.
While more human research is definitely needed, CBD is receiving lots of clinical attention for many ailments. With many of the current medications being ineffective or unsafe, natural relief is sorely needed.
CBD is fully natural, plant-derived and non-hallucinogenic. If more migraine research is done, CBD may prove to be just as effective as these other medications, but without the harmful side effects.
