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Suggest Treatment For Lower Back Pain, Stenosis And Scoliosis In My Spine
Question: I am 66 years old, male, with lower back pain. I have stenosis and scoliosis in my spine. Two well regarded neurosurgeons are in agreement that my back anomalies rule out the use surgery to address the back pain.
Among the interventions I use as support are:
- medical massage
- chiropractic
- SI injections about each 6 months
- daily hatha yoga postures
- professional workout trainer
- use of hydrocodone 5-325 MG half a tablet in morning and evening.
My question is regaridng the appropriate use of medaicl Marijuana. Throught he supervision of my medical pain doctor at the Dent Clinic I now have a Dept of Health Rx card for this medication. I have not acquired this product as yet.
I am seeking sound medical advice of the short-term use of medical marijuana for back pain when my condition becomes acute. I am not interested in the long term use of marijuana due to concerns on costs and side effects.
Among the interventions I use as support are:
- medical massage
- chiropractic
- SI injections about each 6 months
- daily hatha yoga postures
- professional workout trainer
- use of hydrocodone 5-325 MG half a tablet in morning and evening.
My question is regaridng the appropriate use of medaicl Marijuana. Throught he supervision of my medical pain doctor at the Dent Clinic I now have a Dept of Health Rx card for this medication. I have not acquired this product as yet.
I am seeking sound medical advice of the short-term use of medical marijuana for back pain when my condition becomes acute. I am not interested in the long term use of marijuana due to concerns on costs and side effects.
Brief Answer:
Am I ever the right doctor for this question.
Detailed Answer:
Hello,
My whole family lacks narcotic receptors. When we take them we feel bad/nauseated and they can be used in anesthesia, but they do less than nothing for pain relief.
Everyone else in my family has used Marijuana for pain. Marijuana is known to be effective on back and other pain. One in six find the inhalation of Marijuana too irritating to use. This will be much higher in those who do not smoke cigarettes. The dosage of plant based substances is not easily quantified so guidelines on dosing are not going to be possible. Also, things like expiration date, potency, duration of action are not known with a firm scientific basis.
Oral Marijuana has a long lag until it works (up to an hour). Therefore, it might have advantages in a non-smoker, the amount is going to have to be found. There are different strains which are more likely to work on back pain, but again, it is not scientifically determined, so trying at least 3 or 4 with both subspecies of Marijuana would be recommended prior to saying it didn't work.
Safety is quite good. It is a very mild stimulant of the cardiovascular system. There can be lung effects that are almost never enough to need treatment. There can be a wide variety of psychological effects which are actually LESS in older adults rather than the teenager population.
It could be tried.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Matt Wachsman
Addiction Medicine Specialist
Am I ever the right doctor for this question.
Detailed Answer:
Hello,
My whole family lacks narcotic receptors. When we take them we feel bad/nauseated and they can be used in anesthesia, but they do less than nothing for pain relief.
Everyone else in my family has used Marijuana for pain. Marijuana is known to be effective on back and other pain. One in six find the inhalation of Marijuana too irritating to use. This will be much higher in those who do not smoke cigarettes. The dosage of plant based substances is not easily quantified so guidelines on dosing are not going to be possible. Also, things like expiration date, potency, duration of action are not known with a firm scientific basis.
Oral Marijuana has a long lag until it works (up to an hour). Therefore, it might have advantages in a non-smoker, the amount is going to have to be found. There are different strains which are more likely to work on back pain, but again, it is not scientifically determined, so trying at least 3 or 4 with both subspecies of Marijuana would be recommended prior to saying it didn't work.
Safety is quite good. It is a very mild stimulant of the cardiovascular system. There can be lung effects that are almost never enough to need treatment. There can be a wide variety of psychological effects which are actually LESS in older adults rather than the teenager population.
It could be tried.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Matt Wachsman
Addiction Medicine Specialist
Above answer was peer-reviewed by :
Dr. Raju A.T
Dr. Wachsman,
What does the research show on the efficacy of different means of intake of the marijuana?
After you comment, can you provide several links to sound research studies?
Thank you.
What does the research show on the efficacy of different means of intake of the marijuana?
After you comment, can you provide several links to sound research studies?
Thank you.
Brief Answer:
Thank you, nobody ever asks for the science.
Detailed Answer:
Hello,
I'm trained in pharmacology, but nobody ever cares about the science; it is a rare opportunity to give the right information.
The amount of active stuff versus plant fiber varies tremendously and is not standardized and seems to go from < 1% of the weight of the plant being active ingredients to over 30%.
Then, only a small amount gets in. About 25% gets in with smoking and about half as much with oral Marijuana. It gets immediately broken down by the liver. Practically, ALL of it if taken orally, BUT the breakdown product still has effects. They are likely subtly different than the original chemicals. Therefore, smoking will have somewhat different chemicals in the system than with oral and result in probably a different experience.
In any case besides Tetrahydrocannibol (THC) -- the most known compound in Marijuana -- several other chemicals contribute to its effects and not all of these are known what they even are. However, the composition of these will vary with plant, with route of taking it and in different individuals whose metabolism of the drugs will be quite different.
https://www.XXXX.gov/YYYY/0000
Therefore, ffficacy is not exactly known to any real extent since what and how much you get is NOT STANDARDIZED.
Efficacy depends on what it is used for. For chronically hurting nerves, you have to realize that in diabetic neuropathy, getting a good response in even a third of those treated would be quite a good result. The mediocre efficacy of marijuana puts it into the same range as all the conventional therapies.
https://www.XXXX.gov/YYYY/0000
There just isn't much data on how well Marijuana works on pain.
https://www.XXXX.gov/YYYY/0000
https://www.XXXX.gov/YYYY/0000
But then, reviews on this are not as good as reviews on benefits of say, gun ownership or abortion and are more politicized and have pre-set ideas of what they want to conclude for example
https://www.XXXX.gov/YYYY/0000
wants to say whatever you are using for your pain is wrong and that you are deluded and likely addicted. Personally, I question the reviews.
Bottom line, there is about a 1 in 6 risk of lung irritation and about that risk of bad psychological effects from Marijuana and a non-zero effect on pain that is HIGHLY unpredictable in a given individual.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Matt Wachsman
Addiction Medicine Specialist
Thank you, nobody ever asks for the science.
Detailed Answer:
Hello,
I'm trained in pharmacology, but nobody ever cares about the science; it is a rare opportunity to give the right information.
The amount of active stuff versus plant fiber varies tremendously and is not standardized and seems to go from < 1% of the weight of the plant being active ingredients to over 30%.
Then, only a small amount gets in. About 25% gets in with smoking and about half as much with oral Marijuana. It gets immediately broken down by the liver. Practically, ALL of it if taken orally, BUT the breakdown product still has effects. They are likely subtly different than the original chemicals. Therefore, smoking will have somewhat different chemicals in the system than with oral and result in probably a different experience.
In any case besides Tetrahydrocannibol (THC) -- the most known compound in Marijuana -- several other chemicals contribute to its effects and not all of these are known what they even are. However, the composition of these will vary with plant, with route of taking it and in different individuals whose metabolism of the drugs will be quite different.
https://www.XXXX.gov/YYYY/0000
Therefore, ffficacy is not exactly known to any real extent since what and how much you get is NOT STANDARDIZED.
Efficacy depends on what it is used for. For chronically hurting nerves, you have to realize that in diabetic neuropathy, getting a good response in even a third of those treated would be quite a good result. The mediocre efficacy of marijuana puts it into the same range as all the conventional therapies.
https://www.XXXX.gov/YYYY/0000
There just isn't much data on how well Marijuana works on pain.
https://www.XXXX.gov/YYYY/0000
https://www.XXXX.gov/YYYY/0000
But then, reviews on this are not as good as reviews on benefits of say, gun ownership or abortion and are more politicized and have pre-set ideas of what they want to conclude for example
https://www.XXXX.gov/YYYY/0000
wants to say whatever you are using for your pain is wrong and that you are deluded and likely addicted. Personally, I question the reviews.
Bottom line, there is about a 1 in 6 risk of lung irritation and about that risk of bad psychological effects from Marijuana and a non-zero effect on pain that is HIGHLY unpredictable in a given individual.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Matt Wachsman
Addiction Medicine Specialist
Above answer was peer-reviewed by :
Dr. Prasad
Dr. Wachsman, If I have a choice on methods of intake, it seems you are saying smoking delivers higher amounts of THC.
If I am limited to purchasing an oral tincture, can you recommend a compounding formula (1:1 .. 2:1 ... 20:1) that I could request?
Lastly, is marijuana helpful for osteoarthritis?
After you offer your reply, I will likely close out our conversation. Thank you for your support!
XXXX
If I am limited to purchasing an oral tincture, can you recommend a compounding formula (1:1 .. 2:1 ... 20:1) that I could request?
Lastly, is marijuana helpful for osteoarthritis?
After you offer your reply, I will likely close out our conversation. Thank you for your support!
XXXX
Brief Answer:
Personally, I would go with oral
Detailed Answer:
Hello,
If smoked I would go vaping. There is so much variability I would first look at the possibility of reproducibility and talk to customers not the staff about whether it is possible to reliably get the same result. The answer will likely be no, but in the same ballpark. It is a biological. Buying "herb" is likely like buying herb. So, there are different cinnamons because they are different plants. Within a plant there is wide variation not least of which is due to how long it's been on the shelf. BUT, McCormick sweet cinnamon is pretty reliably similar. A major manufacturer that does some quality control and keeps a recognizable brand is your best bet.
I frankly have no idea what the ratio's mean. BUT sublingual absorption will be faster and more reliable in getting a result.
http://www.XXXX.com/cannabis/XXXX/
The tincture should be a small amount and potent and absorbed fully under the tongue.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Matt Wachsman
Addiction Medicine Specialist
Personally, I would go with oral
Detailed Answer:
Hello,
If smoked I would go vaping. There is so much variability I would first look at the possibility of reproducibility and talk to customers not the staff about whether it is possible to reliably get the same result. The answer will likely be no, but in the same ballpark. It is a biological. Buying "herb" is likely like buying herb. So, there are different cinnamons because they are different plants. Within a plant there is wide variation not least of which is due to how long it's been on the shelf. BUT, McCormick sweet cinnamon is pretty reliably similar. A major manufacturer that does some quality control and keeps a recognizable brand is your best bet.
I frankly have no idea what the ratio's mean. BUT sublingual absorption will be faster and more reliable in getting a result.
http://www.XXXX.com/cannabis/XXXX/
The tincture should be a small amount and potent and absorbed fully under the tongue.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Matt Wachsman
Addiction Medicine Specialist
Above answer was peer-reviewed by :
Dr. Prasad
Thank you.
You may have missed my final question ...
Is marijuana helpful for osteoarthritis?
You may have missed my final question ...
Is marijuana helpful for osteoarthritis?
Brief Answer:
Sorry, here is more information.
Detailed Answer:
Hello,
Actually, the facts are controversial. I would say the consensus is that it has some effect on pain.
https://www.XXXX.gov/YYYY/0000
This is the one best article that I found. It is quite UNDER whelming on it's views on cannabis on osteoarthritis pain. I am not entirely pleased with the article because the consensus of opinion is more positive than the article states. On the other hand clearly there is some lung irritation in a significant minority of those smoking cannabis and there is certainly some risk of psychological side effects.
The psychological side effects of cannabis is uniquely unpredictable. One could be fine for years of use and then have it severely. I do not have this issue with any other medicine for pain. NSAIDS have a 10% chance of serious ulcer, but if you don't have any sign of it in the first 2 months of use, that is quite rare to happen afterwards. If someone is going to develop problems with narcotics, that occurs most in the first year and is quite uncommon to start later than that. Frankly, it puts me off recommending cannabis.
Hope I have answered your query.
Thank you.
Regards,
Dr. Matt Wachsman
Addiction Medicine Specialist
Sorry, here is more information.
Detailed Answer:
Hello,
Actually, the facts are controversial. I would say the consensus is that it has some effect on pain.
https://www.XXXX.gov/YYYY/0000
This is the one best article that I found. It is quite UNDER whelming on it's views on cannabis on osteoarthritis pain. I am not entirely pleased with the article because the consensus of opinion is more positive than the article states. On the other hand clearly there is some lung irritation in a significant minority of those smoking cannabis and there is certainly some risk of psychological side effects.
The psychological side effects of cannabis is uniquely unpredictable. One could be fine for years of use and then have it severely. I do not have this issue with any other medicine for pain. NSAIDS have a 10% chance of serious ulcer, but if you don't have any sign of it in the first 2 months of use, that is quite rare to happen afterwards. If someone is going to develop problems with narcotics, that occurs most in the first year and is quite uncommon to start later than that. Frankly, it puts me off recommending cannabis.
Hope I have answered your query.
Thank you.
Regards,
Dr. Matt Wachsman
Addiction Medicine Specialist
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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