6 ms·

In many cases, though, cannabis and CBD oil aren't nearly as effective as opioids for relief from severe pain, right? How often is this a viable alternative for

In many cases, though, cannabis and CBD oil aren't nearly as effective as opioids for relief from severe pain, right? How often is this a viable alternative for patients? This study only looked at 250 people who already have medical cannabis prescriptions for pain, so this shouldn't be extrapolated too heavily.

M_Grey 10y ago
It may not be as simple as all or nothing you know. It could be adjunct therapy for people who would normally reach for another pill. Truthfully though, I also wonder which pain cannabis is most effective for, compared to opiates. The truth seems to be that opiates are broadly ineffective at the relief of severe pain in many people too, but they're also toxic. It may be that this is better if only because of the lack of toxicity.
- Retric 10y ago
  Opioids reduce, but don't block extreme pain so much as make you not care about it. They work really well for short term, less extreme pain, but they become less effective over time and they side effects are nasty. So my guess is people with long term pain are probably better off with canibis long term even if Opiods work really well for post operation pain for example.
  - amalag 10y ago
    Would be great if opiods never left the hospital.
    - adanto6840 10y ago
      There would probably be a lot of people that legitimately would never be able to leave the hospital -- there really are people out there with legitimate chronic pain. I say this after having had a C6-C7 spine fusion surgery -- prior to that, the pain was incredible. And two or three years ago I couldn't have even imagined what that kind of pain felt like, until I was actually suffering it. Luckily surgery was incredibly effective, and I hated having to take pain pills (made it difficult to work), but the pre-op alternative (living with constant pain) wasn't very great. I certainly didn't want to sit in a hospital just to be able to move around a bit -- and I couldn't have immediate surgery, though I did have surgery as soon as I was allowed to (primarily due to insurance). I'm sure there are people out there with far worse pain, and in many cases likely untreatable causes. Putting all of those people in the hospital certainly isn't going to help with insurance prices, nor is it a particularly humane way to treat people in the general sense.
    - emcq 10y ago
      I was on opiods for a month. At the time it was prohibitive to get out of bed, let alone go to the hospital. I dont remember it much but sleeping on my own bed beats the heck out of the hospital.
    - DanBC 10y ago
      People in long term pain need better access to specialist pain management clinics with the full range of interventions - exercise, alternative prescribing, etc. But even with Opioids Aware prescribing, and even if cannabis is legalised, some people will still need opioids. http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
antisthenes 10y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/ A few queries resulted in this, which is pretty informative as far as cannabioid treatments go. You're right, the benefits and potency aren't very clear cut, but, unlike opioids, THC-based treatments can produce desirable side benefits, which result in overall better outcomes (if we treat patient satisfaction as a major factor)
taneq 10y ago
If even 250 people are taking cannabis (not physically addictive, limited health impact, no tolerance buildup) over opiates (highly addictive, rapid tolerance buildup, very risky) then that's a good thing, right?
- ehnto 10y ago
  The lack of side effects should be a key part of the decision. Effectiveness of pain relief is in my perhaps inempathetic opinion less important. People can handle some pain, and that is fine. 100% pain relief through opiates vs 50% pain relief through less detrimental means is probably worth it.
  - ryanlol 10y ago
    But surely most opioid pain treatments will have less side effects than pot? Although, I suppose the side effects of pot are considered desirable by many.
    - PeterisP 10y ago
      No, most opioid pain treatments have far more severe side effects than pot, and they tend to have a high risk of serious addiction that limits their dosage.
      - ryanlol 10y ago
        >most opioid pain treatments have far more severe side effects than pot What are those? Beyond the physical addiction, which shouldn't be much of an issue with proper dosage.
        PeterisP 10y ago
        First, physical addiction is an issue, since the "proper dosage" to mitigate a particular patient's pain can easily be higher (or more frequent) than the "proper dosage" to avoid addiction; so on one hand some patients have to suffer without being able to increase the dose, and on the other hand the statistics show that even if in theory it "shouldn't be much of an issue", in practice addiction does happen. But for the pure side effects, the most common issues are constipation and nausea. Then there's sedation (which may be comparable to effects of pot), and of course the suppressed breathing which makes accidental overdoses potentially deadly, unlike pot. Especially for chronic pain management, the long term effects add up, then you also risk liver damage, etc. https://www.ncbi.nlm.nih.gov/pubmed/18443635 https://www.ncbi.nlm.nih.gov/pubmed/18443635 is a good place to start if you're interested in details.
deelowe 10y ago
Treating chronic pain has less to do with pain relief and more to do with mental health. Sometimes people just want to forget or feel different for a while. Also, opiates suck!
- sergers 10y ago
  I see it as more of a therapeutic effect that relieves the pain/symptoms till there not noticeable and doesn't limit you Combine this with other therapy methods and you have rid yourself of pain, or at least rid yourself of the holds it has it over you.
- millstone 10y ago
  Where'd you get this idea? Any citations? Your comment reads condescending to me: "my pain is all in my head." But it's not, and treating my mental heath is treating the symptoms and not the cause. The best thing for my mental health would be an end to my physical pain.
  - lukewink 10y ago
    That's the thing though... with chronic pain there is no end to the physical pain, and this fact alone can be mentally taxing. Sometimes taking your mind off your situation is more effective than painkillers. Chronic pain is a life long mental _and_ physical battle.
  - DanBC 10y ago
    You've said that your mental health is suffering because of the pain you're in. People offering mental health treatment are not saying the pain is "all in your head"[1]. They're saying you deserve treatment for all your problems, not just a focus on one specific pain problem. We've known for sometime that treatment for mental illness is more effective if it looks at more than the patient's mental illness - if it looks at all the biological, psychological, and social factors. This concept is moving into physical health treatment, especially for long term pain. And it seems that mental health treatment can reduce the amount of pain that people feel. [1] I'm not sure if you realise just how dismissive this sounds. Mental illness is debilitating and one of the top ten causes of years lost to disability. Those people aren't "making it up", which is the implication many will draw from your "all in my head" comment.
conistonwater 10y ago
I think the authors say that the pain relief itself is only part of it: > Lucas suggests the main reasons for the switch to cannabis from prescribed meds is due to reduced side effects, better symptom management and a feeling that cannabis is safer than prescription drugs. Also, looking at http://www.webmd.com/pain-management/guide/understanding-pain-management-chronic-pain http://www.webmd.com/pain-management/guide/understanding-pai..., it seems like chronic pain doesn't necessarily (?) mean severe pain, but maybe I'm wrong about that.
- brokenmasonjars 10y ago
  I don't really have any authority to really add anything but I will say my understanding of chronic is long lasting. Doesn't necessarily have to be severe pain, just long lasting. I have some chronic pains from a bad fall a few years ago. Unfortunately PA is moving like a turtle in it's medical marijuana roll out. When I think of cannabis, I view it as safer. You don't hear about overdoes like you do with opioids. Add in a few famous celebrity deaths like Prince you quickly get a public image that views opioids with suspicion. In my opinion rightly so. Hopefully medical marijuana can be more accessible to more people sooner.
WalterSear 10y ago
I was diagnosed with chronic pain syndrome, and when given the opportunity, had my doctor switch my prescription from opioids to cannabis. I don't think that one can appreciate how effective it is for chronic pain, until you've had to use it for that.
- poohbs 10y ago
  similarly, those who have only had opioids for acute pain (injuries, post-op, and such) have a hard time appreciating just how much baggage comes with these drugs when they are taken indefinitely.
  - WalterSear 10y ago
    Yes, the side effects of the opioids were as much of a reason for me to want to switch, if not more so.
  - PastaMonster 10y ago
    Well, they lose effectiveness. The body adjusts to the constant input. Which is what addiction is. What many people don't understand is that addiction isn't drug abuse. We should fight to remove the negativity the word addiction have. Very annoying that the body do this. If you could figure out a drug that prevents this you could make billions! For example and something everyone can try: My body is addicted to coffee. If I don't take it for a few days I'll become very tired, headaches, etc. It's lasts for about two weeks. While addicted I don't abuse it. I've even switched to tea a few times.
- seattle_spring 10y ago
  Could you recommend what products specifically help you the most? I've had chronic neck and back pain for years. Smoking marijuana actually tends to make it worse, but I haven't experimented with specific strains, ingestion methods, etc.
  - WalterSear 10y ago
    It's important to note that, unlike opioids, cannabis doesn't make the sensation of pain less strong, it makes it less urgent. This means that if you won't necessarily feel a direct effect on the pain, but that its subsequent effects aren't as strong - the pain is not as exhausting, distracting, or debilitating. In fact, the initial 'come-on' of cannabis tends to make me more aware of my pain for a few seconds. Moreover, my pain is neuropathic, rather than physiological in nature, and so what works for me, may not work for other forms of pain. That said, I had the best effect managing pain with high CBD low THC strains - meaning strains with over 7% CBD and one percent or less THC. For me, the pain relief is so profound and quick acting that I can pinpoint the second it starts to have an effect, and it has the added benefit of leaving me sober enough that I can go about my business. Unfortunately, while I found CBD strains most effective for pain, I personally have not been able to tolerate them - they cause me memory problems that I have not found any mention of in the literature, not anyone else who experiences them. So, what do I use, when I need to keep the pain at bay? Usually I reach for a concentrate of a indica-dominant hybrid, or an pure indica. I stay way from Sour Diesels, and the like, as they don't agree with me, but these things tend to be individual in nature. Sorry not to be much more help: all I can really recommend is low THC/high CBD strains, and smoking/vaping concentrates or hashish rather than eating, at least until you find something that works for you.
FullMtlAlcoholc 10y ago
> , cannabis and CBD oil aren't nearly as effective as opioids for relief from severe pain, right? Taking opioids for pain relief is a dangerous route as doctors are now more likely to cut your Rx off if they suspect abuse. IF you are addicted and/or still have significant pain, you may have to resort to street drugs with unknown potency and purity. I'd rather go with the medication that won't lead down a life-threatening path. If the treatment is worse then the symptoms, it's not really worth it.
thescriptkiddie 10y ago
Opioids are dramatically more effective than cannabis at relieving acute pain. Arguably, so are ibuprofen and acetaminophen. What cannabis is useful for is chronic pain, especially pain of inflammation. The use of opiods to treat chronic pain is problematic for many reasons, addiction being a big one, but there are also significant side effects. Cannabis is much safer to use long term.
jessep 10y ago
I wrote my story as a root comment, but I get kidney stones, which are among the most intensely painful things humans experience. I have found getting really high more effective than opioids. I haven't yet used cannabis during the peak pain, because I haven't had kidney stones again since I first tried cannabis instead of opioids, but next time I'm going to.
sehugg 10y ago
MS sufferers take it for muscle spasms and neuropathy. Opioids have problems like tolerance and stomach irritation that cannabis does not, and since MS is usually a lifelong affliction this can be bad over the long term.
- Broken_Hippo 10y ago
  I was going to comment something similar. I'll add this, however. Some MS patients also suffer with muscle spasticity - basically a muscle that stays contracted. This can be painful and limit mobility: At best it is uncomfortable. Normal treatment includes things like Valium. In tests with cannabis, patients reported improvements with both mobility and the amount of pain/discomfort. However, when researchers measured the spasticity there was no clinical improvement. Both were true - it seems sometimes all folks need to do is not be so bothered by their daily pains.

M_Grey 10y ago

It may not be as simple as all or nothing you know. It could be adjunct therapy for people who would normally reach for another pill. Truthfully though, I also wonder which pain cannabis is most effective for, compared to opiates. The truth seems to be that opiates are broadly ineffective at the relief of severe pain in many people too, but they're also toxic. It may be that this is better if only because of the lack of toxicity.

Retric 10y ago
Opioids reduce, but don't block extreme pain so much as make you not care about it. They work really well for short term, less extreme pain, but they become less effective over time and they side effects are nasty. So my guess is people with long term pain are probably better off with canibis long term even if Opiods work really well for post operation pain for example.
- amalag 10y ago
  Would be great if opiods never left the hospital.
  - adanto6840 10y ago
    There would probably be a lot of people that legitimately would never be able to leave the hospital -- there really are people out there with legitimate chronic pain. I say this after having had a C6-C7 spine fusion surgery -- prior to that, the pain was incredible. And two or three years ago I couldn't have even imagined what that kind of pain felt like, until I was actually suffering it. Luckily surgery was incredibly effective, and I hated having to take pain pills (made it difficult to work), but the pre-op alternative (living with constant pain) wasn't very great. I certainly didn't want to sit in a hospital just to be able to move around a bit -- and I couldn't have immediate surgery, though I did have surgery as soon as I was allowed to (primarily due to insurance). I'm sure there are people out there with far worse pain, and in many cases likely untreatable causes. Putting all of those people in the hospital certainly isn't going to help with insurance prices, nor is it a particularly humane way to treat people in the general sense.
  - emcq 10y ago
    I was on opiods for a month. At the time it was prohibitive to get out of bed, let alone go to the hospital. I dont remember it much but sleeping on my own bed beats the heck out of the hospital.
  - DanBC 10y ago
    People in long term pain need better access to specialist pain management clinics with the full range of interventions - exercise, alternative prescribing, etc. But even with Opioids Aware prescribing, and even if cannabis is legalised, some people will still need opioids. http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

antisthenes 10y ago

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/ A few queries resulted in this, which is pretty informative as far as cannabioid treatments go. You're right, the benefits and potency aren't very clear cut, but, unlike opioids, THC-based treatments can produce desirable side benefits, which result in overall better outcomes (if we treat patient satisfaction as a major factor)

taneq 10y ago

If even 250 people are taking cannabis (not physically addictive, limited health impact, no tolerance buildup) over opiates (highly addictive, rapid tolerance buildup, very risky) then that's a good thing, right?

ehnto 10y ago
The lack of side effects should be a key part of the decision. Effectiveness of pain relief is in my perhaps inempathetic opinion less important. People can handle some pain, and that is fine. 100% pain relief through opiates vs 50% pain relief through less detrimental means is probably worth it.
- ryanlol 10y ago
  But surely most opioid pain treatments will have less side effects than pot? Although, I suppose the side effects of pot are considered desirable by many.
  - PeterisP 10y ago
    No, most opioid pain treatments have far more severe side effects than pot, and they tend to have a high risk of serious addiction that limits their dosage.
    - ryanlol 10y ago
      >most opioid pain treatments have far more severe side effects than pot What are those? Beyond the physical addiction, which shouldn't be much of an issue with proper dosage.
      - PeterisP 10y ago
        First, physical addiction is an issue, since the "proper dosage" to mitigate a particular patient's pain can easily be higher (or more frequent) than the "proper dosage" to avoid addiction; so on one hand some patients have to suffer without being able to increase the dose, and on the other hand the statistics show that even if in theory it "shouldn't be much of an issue", in practice addiction does happen. But for the pure side effects, the most common issues are constipation and nausea. Then there's sedation (which may be comparable to effects of pot), and of course the suppressed breathing which makes accidental overdoses potentially deadly, unlike pot. Especially for chronic pain management, the long term effects add up, then you also risk liver damage, etc. https://www.ncbi.nlm.nih.gov/pubmed/18443635 https://www.ncbi.nlm.nih.gov/pubmed/18443635 is a good place to start if you're interested in details.

deelowe 10y ago

Treating chronic pain has less to do with pain relief and more to do with mental health. Sometimes people just want to forget or feel different for a while. Also, opiates suck!

sergers 10y ago
I see it as more of a therapeutic effect that relieves the pain/symptoms till there not noticeable and doesn't limit you Combine this with other therapy methods and you have rid yourself of pain, or at least rid yourself of the holds it has it over you.
millstone 10y ago
Where'd you get this idea? Any citations? Your comment reads condescending to me: "my pain is all in my head." But it's not, and treating my mental heath is treating the symptoms and not the cause. The best thing for my mental health would be an end to my physical pain.
- lukewink 10y ago
  That's the thing though... with chronic pain there is no end to the physical pain, and this fact alone can be mentally taxing. Sometimes taking your mind off your situation is more effective than painkillers. Chronic pain is a life long mental _and_ physical battle.
- DanBC 10y ago
  You've said that your mental health is suffering because of the pain you're in. People offering mental health treatment are not saying the pain is "all in your head"[1]. They're saying you deserve treatment for all your problems, not just a focus on one specific pain problem. We've known for sometime that treatment for mental illness is more effective if it looks at more than the patient's mental illness - if it looks at all the biological, psychological, and social factors. This concept is moving into physical health treatment, especially for long term pain. And it seems that mental health treatment can reduce the amount of pain that people feel. [1] I'm not sure if you realise just how dismissive this sounds. Mental illness is debilitating and one of the top ten causes of years lost to disability. Those people aren't "making it up", which is the implication many will draw from your "all in my head" comment.

conistonwater 10y ago

I think the authors say that the pain relief itself is only part of it: > Lucas suggests the main reasons for the switch to cannabis from prescribed meds is due to reduced side effects, better symptom management and a feeling that cannabis is safer than prescription drugs. Also, looking at http://www.webmd.com/pain-management/guide/understanding-pain-management-chronic-pain http://www.webmd.com/pain-management/guide/understanding-pai..., it seems like chronic pain doesn't necessarily (?) mean severe pain, but maybe I'm wrong about that.

brokenmasonjars 10y ago
I don't really have any authority to really add anything but I will say my understanding of chronic is long lasting. Doesn't necessarily have to be severe pain, just long lasting. I have some chronic pains from a bad fall a few years ago. Unfortunately PA is moving like a turtle in it's medical marijuana roll out. When I think of cannabis, I view it as safer. You don't hear about overdoes like you do with opioids. Add in a few famous celebrity deaths like Prince you quickly get a public image that views opioids with suspicion. In my opinion rightly so. Hopefully medical marijuana can be more accessible to more people sooner.

WalterSear 10y ago

I was diagnosed with chronic pain syndrome, and when given the opportunity, had my doctor switch my prescription from opioids to cannabis. I don't think that one can appreciate how effective it is for chronic pain, until you've had to use it for that.

poohbs 10y ago
similarly, those who have only had opioids for acute pain (injuries, post-op, and such) have a hard time appreciating just how much baggage comes with these drugs when they are taken indefinitely.
- WalterSear 10y ago
  Yes, the side effects of the opioids were as much of a reason for me to want to switch, if not more so.
- PastaMonster 10y ago
  Well, they lose effectiveness. The body adjusts to the constant input. Which is what addiction is. What many people don't understand is that addiction isn't drug abuse. We should fight to remove the negativity the word addiction have. Very annoying that the body do this. If you could figure out a drug that prevents this you could make billions! For example and something everyone can try: My body is addicted to coffee. If I don't take it for a few days I'll become very tired, headaches, etc. It's lasts for about two weeks. While addicted I don't abuse it. I've even switched to tea a few times.
seattle_spring 10y ago
Could you recommend what products specifically help you the most? I've had chronic neck and back pain for years. Smoking marijuana actually tends to make it worse, but I haven't experimented with specific strains, ingestion methods, etc.
- WalterSear 10y ago
  It's important to note that, unlike opioids, cannabis doesn't make the sensation of pain less strong, it makes it less urgent. This means that if you won't necessarily feel a direct effect on the pain, but that its subsequent effects aren't as strong - the pain is not as exhausting, distracting, or debilitating. In fact, the initial 'come-on' of cannabis tends to make me more aware of my pain for a few seconds. Moreover, my pain is neuropathic, rather than physiological in nature, and so what works for me, may not work for other forms of pain. That said, I had the best effect managing pain with high CBD low THC strains - meaning strains with over 7% CBD and one percent or less THC. For me, the pain relief is so profound and quick acting that I can pinpoint the second it starts to have an effect, and it has the added benefit of leaving me sober enough that I can go about my business. Unfortunately, while I found CBD strains most effective for pain, I personally have not been able to tolerate them - they cause me memory problems that I have not found any mention of in the literature, not anyone else who experiences them. So, what do I use, when I need to keep the pain at bay? Usually I reach for a concentrate of a indica-dominant hybrid, or an pure indica. I stay way from Sour Diesels, and the like, as they don't agree with me, but these things tend to be individual in nature. Sorry not to be much more help: all I can really recommend is low THC/high CBD strains, and smoking/vaping concentrates or hashish rather than eating, at least until you find something that works for you.

FullMtlAlcoholc 10y ago

> , cannabis and CBD oil aren't nearly as effective as opioids for relief from severe pain, right? Taking opioids for pain relief is a dangerous route as doctors are now more likely to cut your Rx off if they suspect abuse. IF you are addicted and/or still have significant pain, you may have to resort to street drugs with unknown potency and purity. I'd rather go with the medication that won't lead down a life-threatening path. If the treatment is worse then the symptoms, it's not really worth it.

thescriptkiddie 10y ago

Opioids are dramatically more effective than cannabis at relieving acute pain. Arguably, so are ibuprofen and acetaminophen. What cannabis is useful for is chronic pain, especially pain of inflammation. The use of opiods to treat chronic pain is problematic for many reasons, addiction being a big one, but there are also significant side effects. Cannabis is much safer to use long term.

jessep 10y ago

I wrote my story as a root comment, but I get kidney stones, which are among the most intensely painful things humans experience. I have found getting really high more effective than opioids. I haven't yet used cannabis during the peak pain, because I haven't had kidney stones again since I first tried cannabis instead of opioids, but next time I'm going to.

sehugg 10y ago

MS sufferers take it for muscle spasms and neuropathy. Opioids have problems like tolerance and stomach irritation that cannabis does not, and since MS is usually a lifelong affliction this can be bad over the long term.

Broken_Hippo 10y ago
I was going to comment something similar. I'll add this, however. Some MS patients also suffer with muscle spasticity - basically a muscle that stays contracted. This can be painful and limit mobility: At best it is uncomfortable. Normal treatment includes things like Valium. In tests with cannabis, patients reported improvements with both mobility and the amount of pain/discomfort. However, when researchers measured the spasticity there was no clinical improvement. Both were true - it seems sometimes all folks need to do is not be so bothered by their daily pains.