Chronic Pain Chronicles with Dr Karmy
Join Dr. Grigory Karmy M.D., a distinguished chronic pain management physician with over 20 years of experience, on a captivating journey through the world of pain relief in his podcast series. Delving into the latest regenerative medical treatments like PRP, stem cell injections, and prolozone therapy, alongside educational discussions on pain transmission and the latest medical innovations, Dr. Karmy shares invaluable insights and real-life stories, empowering listeners to find relief and regain control over their chronic pain.
Chronic Pain Chronicles with Dr Karmy
Episode 24: Update on Medical Marijuana
Medical marijuana is often used for chronic pain, but how effective is it? Also, what about the risks: does natural mean safe?
Find out.
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Welcome to another episode of Chronic Pain Chronicles with Dr. Carmi, where we explore treatments that continue to spark conversation and curiosity in the world of pain management medical marijuana. I'm Raveena your host and advocate for making sense of what these evolving treatments mean for people living with chronic. Today, Dr. Karmy, a pain management doctor, with over 20 years of experience, will discuss the facts, the myths, and what you should know if you're thinking about trying medical marijuana for chronic pain.
Dr Karmy:Hello, this is Dr. Karmy, and today I wanted to talk briefly about medical marijuana. Medical marijuana has been used throughout history for thousands of years. More recently, it has been illegal in Canada until 1990s when there was a movement to legalize it for certain medical purposes such as epilepsy. Fast forward to 20 15, 20 17, and marijuana became legalized for recreational use. So suffice it to say marijuana has been used for chronic pain as well as other disorders for a long, long time. Marijuana is a plant, and like any other plant, it has hundreds if not thousands of ingredients. However the most important ones people feel are CBD and THC. There's actually a lot of discussion about value of some of the other ingredients, however these two seem to be the most important ones, which between the two CBD is felt to be safer because although both of them can help reduce pain and improve sleep, it is the THC, which causes one to feel high. Let me make it clear that marijuana does not have any long-term benefit. Unlike physiotherapy or exercise or even injections, which you can do for a period of time and then stop. And if you're somebody who responds to these treatments, the benefit will continue without you having to continue to do these treatments. With marijuana like with taking Tylenol when it works, it'll only help for a few hours that the marijuana is in your body, and as soon as it leaves your body, your pain returns. Also, I want to make it clear that marijuana did not go through standard drug approval process, but rather was legalized in the same way that alcohol is legal. In other words there was less research done on it in terms of safety and effectiveness compared to a typical drug. Having said all of that, I have not seen severe complications in patients using marijuana, and there's no question in my mind that it is far safer than Oxycontin and other opioid medications. My concern with marijuana and to be honest, I think that could be an issue with prescription medications as well, is not so much about short-term side effects, but more about long-term side effects. And the answer is that we don't really know yet what the long term side effects are. The short term side effects include dizziness, memory problems, dry mouth anxiety, drowsiness, vomiting. Marijuana can cause decline in sperm count, and concentration and maternal exposure to marijuana can adversely affect conception and or maintenance of pregnancy. So who should not be trying marijuana? First of all, people under the age of 25 should avoid using marijuana for chronic pain because there is some evidence to suggest that they are at increased risk for psychosis and schizophrenia later in life. The risk is also there for people over 25, and that is why it is not recommended for people with strong family history of schizophrenia, psychosis, or bipolar disorder. Obviously if they themselves had these issues to use medical marijuana for chronic pain. Also, the use of marijuana is not recommended for people who had issues. With addiction in the past or patients who are pregnant or planning to become pregnant or breastfeeding. For patients who are interested in trying marijuana for their chronic pain. Typically they ask their chronic pain physician or family physician to refer them to marijuana clinic where medical doctors will try to find the best product and those for the pain. One could of course just go to marijuana store. And bypass medical system completely. However, there are some advantages to attending a marijuana clinic. First of all, you are supervised by a physician with a lot of experience of starting and adjusting the doses of this drug. Second of all, I believe there is some financial advantage to being prescribed medical marijuana by a medical provider. Because one could write off the costs of marijuana from taxes. Which brings me to my next big point, and that is that, however, a very rare drug plan will cover medical marijuana. Vast majority of plans do not, and given that patients with chronic pain expect to have this pain for many, many years. The cost of medical marijuana does adapt over time. Another issue that I came across when talking to my patients is batch to batch variability, unlike drugs where you get exactly the same amount of drug each time you buy it with medical marijuana, which is a plant and one batch maybe more effective than another batch, even if it is produced by the same provider. So consistency of product still seems to be an issue, which will hopefully resolve as the producers become more and more experienced. When one attends marijuana clinic, typically the patient started on pure CBD product because as I mentioned earlier, it is considered safer. Typical starting dose is five milligrams twice a day. The dose is gradually increased by 10 milligrams per day, every two to three days. Once the total dose goes above 40 milligrams per day. Typically, some THC is added if they're still suboptimal. Response to marijuana product, typically starting dose for THC is 2.5 milligrams a day. THC is also raised every two to seven days until patient obtains pain relief or the maximum dose of 40 milligrams per day has been reached. With any other approach to chronic pain management. Not everybody responds to marijuana. In my experience, average only about one in five patients respond to this treatment. And if you are somebody who does not respond or has side effects that uh, significant. Then one typically stops using this product. There is also concern about driving while high. Just like it is illegal to drive while intoxicated, it is also illegal to drive while high, and that issue should be discussed with your medical provider at Marijuana Clinic. In terms of research, as mentioned earlier of what, there is some research supporting the use of medical marijuana for various types of pain. The research is far from conclusive as there. My views on most other approaches to chronic pain. This issue is not unique to marijuana, but rather a general problem for most approaches that we use. That is one of the reasons why most drug plans do not cover medical marijuana. So what are my overall thoughts? Well, as. Mentioned earlier, if you are under 25, if you had history of schizophrenia or bipolar disorder or had a strong family history of those things, you should avoid medical marijuana. If on the other hand, you have no contraindications to trying this approach. It could certainly be considered if you do choose to go that route. My advice is to get a referral to marijuana clinic in Ontario. Thank you.
Raveena:Thanks for joining us on this episode of Chronic Pain Chronicles with Dr. Karmy. Our episodes focus on common treatments for chronic pain management, like nerve blocks and regenerative therapies to explore what's working, what's emerging, and what to watch out for. We're also excited to bring you episodes featuring guest experts who are actively shaping the future of chronic pain care. From groundbreaking regenerative therapies and stem cell research to ortho biologic therapies that are changing the game. If you haven't already, be sure to follow our Instagram at@karmychronicpain or subscribe to our podcast so you don't miss what's next. Until next time on Chronic Pain Chronicles with Dr. Karmy. Disclaimer, when it comes to your health, always consult with your own physician or healthcare provider for personalized advice and guidance. The information provided in this podcast is for educational and informational purposes only and should not be considered medical advice or a substitute for professional medical care.
