Alternative Pain Management

Chronic pain is a common problem in this country. In fact, according to the National Institute of Health Fact Sheet (2019), pain is the most common reason people access the health care system, and the leading cause of disability. Further, one in four americans, which is approximately 76.2 million people currently or have suffered from pain lasting longer than twenty four hours (NIH Fact Sheet, 2019). For these reasons, many studies are being conducted to determine effective pain management for different populations. The National Institute of Health is looking into behavioral therapies, genomics, and systems for tracking pain management to help come up with sustainable and healthy solutions.

A new option for pain management is medical marijuana. Even though marijuana has been around for many centuries, its presence in the medical field is gaining new legal recognition. Despite its state approval, it is still a controversial topic which is not recognized federally. Due to this, it is difficult to perform the appropriate studies necessary to determine the effects, whether beneficial or otherwise, of the drug.

As a consumer or health care provider, it is important to determine if there is scientific data that supports the use of a drug. More importantly, does this data coincide with an individual’s specific need. Opioids are the most common choice for pain management; however, that does not mean they are the best choice for each person as they can cause nausea, constipation, over-sedation, and even respiratory depression. This is creating an epidemic in our nation with the over prescription and overconsumption of opioid medications. That could be a topic for another time, but it also begs the question of why there are not more options for pain management? It could be the pharmaceutical industries trying to make money; it could also be the controlled nature in which the drugs are created (i.e. they are chemically derived to determine potency and efficacy). Regardless, not every person is the same, meaning not every person will respond well to the same pain management options.

Medical marijuana is an option for chronic pain. While this is not an option in hospitals for pain control, it can be used in a person’s home. What is it about marijuana that makes it helpful for managing pain? Well, according to Elikkottil, Gupta and Gupta (2009), cannabinoids can act on two different receptor types, CB-1 and CB-2; CB-1 receptors are primarily found in neurons while CB-2 receptors can be found on immune cells. Activation of CB-1 receptors from CBD within marijuana decreases pain stimulus by increasing the release of neurotransmitters (including dopamine, serotonin, GABA, and acetylcholine to name a few). Additionally, cannabinoids are shown to influence the cycle of cells and may cause cell death in some forms of cancer (Elikkottil, Gupta, & Gupta, 2009). Due to its positive effects on pain and cell life, the use of cannabinoids has been studied for helping manage inflammatory pain, neuropathic pain, and cancer pain. Further, it has been shown to be helpful as anti-nausea medication and an appetite stimulant, especially in patients with HIV and multiple sclerosis (Elikkottil, Gupta, & Gupta, 2009).

Despite its benefits, cannabinoids do have some negative side effects as well. These include some increased risk for cancers, despite some cancer reducing effects. Additionally, it has been shown to increase the risk of schizophreniform disorders in people with a predisposition, as well as a decrease in cognition when utilized too early for the developing brain (i.e. used by adolescents) (Ellikkottil, Gupta, & Gupta, 2009).

Just as opioids need a medical reason to be prescribed and contain side effects, so do cannabinoid products. However, each person responds to medication differently; therefore, increased options should be made available to the general population. This way, with the proper education and prescription, people can manage chronic pain and maintain a better quality of life.

In addition to pharmacological intervention, non-pharmacological treatments have proven to be effective adjuncts in managing chronic pain. The Joint Commision reports the use of meditation and mindfulness based stress reduction can help decrease the perception of chronic pain. This can mean focusing on the mind body connection, relaxation techniques and imagery. Additionally, they sited other relaxation therapies such as music and lighting as alternatives for helping manage pain. In fact, in many hospital settings, essential oils are being offered as part of relaxation techniques.

No one pain management technique is perfect; therefore, it is important for individuals to determine which treatment modalities are right for their pain needs.

References:

Elikkottil, J., Gupta, P., & Gupta, K. (2009). The analgesic potential of cannabinoids. Journal of opioid management, 5(6), 341-57.

NIH Fact Sheets - Pain Management. (n.d.). Retrieved January 18, 2019, from https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=57

Non-Pharmacologic and non-opioid solutions for pain management. (n.d.). Retrieved January 19, 2019, from https://www.jointcommission.org/assets/1/23/QS_Nonopioid_pain_mgmt_8_15_18_FINAL.pdf

Imagery and meditation to as an adjunct for pain management.