Medical Marijuana: An Alternative Treatment for Chronic Pain
Ninth in a series
Although conventional medicine offers many treatments for chronic pain, doctors can also assist with an alternative option, medical marijuana.
Leonard Kamen, DO, a physical medicine and rehabilitation physician and pain specialist at MossRehab in Northeast Philadelphia, is a medical marijuana “practitioner.” This means he has taken a state training course that allows him to “certify” patients for treatment with medical marijuana.
Treatment with medical marijuana, or cannabis, is legal in 38 states. A 2017 report from the National Academies of Sciences, Engineering, and Medicine concluded that it is somewhat effective against chronic pain and a few other conditions.
However, U.S. law still classifies marijuana as a prohibited drug in the same class as heroin, LSD, and several others. For this reason, doctors like Dr. Kamen cannot “prescribe” it. They can only “certify” that a patient has a condition – such as chronic pain – that qualifies for treatment with medical marijuana under state law.
Research on the effectiveness of medical marijuana is still evolving, and insurance plans typically don’t cover it.
Einstein pharmacies do not dispense medical marijuana. Patients purchase it at independent marijuana dispensaries.
“The primary reason I use medical marijuana in treatment is for patients who are diagnosed with a chronic pain syndrome,” Dr. Kamen says. “Pain is a subjective sensation. There are many complex pathways that generate what we perceive in the brain as pain. ” (See “Why We Feel Pain and Why It Can Last So Long.”)
Many of Dr. Kamen’s chronic pain patients are using medical marijuana to reduce their use of opioids. Both drugs can help relieve pain, but by different pathways in the nervous system.
“I have seen a reduction in the use of especially what’s called short-acting opioids with the use of medical marijuana,” he says.
Some patients also have anxiety, which Dr. Kamen believes amplifies suffering.
Medical marijuana “interferes with and diverts people from the emotional strain that pain puts on them,” he says. “That includes anxiety and the anticipation of pain from simple things that they would like to do, and then they wind up not doing. I think marijuana releases them and, furthermore, gives them a sense of self-control.”
The self-control comes from the fact that patients, not doctors, determine what they buy at a dispensary and how often they consume it, Dr. Kamen says.
Saman Zafar, MD, a neurologist at Einstein Medical Center Philadelphia, also is able to certify patients for medical marijuana treatment. She has provided certification to patients dealing with neuropathic (nerve-related) pain, among other conditions.
“I know that some of my patients use it and know from experience that it works, so I prefer to have them get it from a proper source,” she says. “They appreciate my acceptance of this use and my effort to help them access a better source.”
Products come in a variety of forms and have varying amounts of THC, the chemical that causes the marijuana “high,” and CBD, another component that has been less studied.
Dr. Kamen always specifies that new patients speak to a specialist (usually a pharmacist) at the dispensary, so they can have some guidance. Because products are not closely regulated, their effects also may vary from one purchase to the next, he says.
He also warns patients about potential side effects, such as severe vomiting and brain fogginess. He always advises them not to drive after using medical marijuana.
In the future, Dr. Kamen says, “I look for better research on the specific components of marijuana, how these elements work in the body and how they can consistently be effective in treating challenging human problems like chronic pain.”