By Ginevra Liptan, MD.
CBD (cannabidiol) is everywhere
You can get CBD at the health food store or in your coffee drink now, and everyone is curious about it. Recent New York Times had this to say about CBD “It’s hot, everywhere and yet almost nobody understands it.”
What is behind the CBD explosion? Access has greatly increased to changing legal status over the past few years and CBD has found huge visibility thanks to social media. And finally, there is a real need for alternative pain management options as diminished access to opioid medications forcing patients to seek solutions “outside the box”.
The bad news:
- The CBD industry is unregulated and can be hard for consumers to know the quality and purity of CBD products, meaning it really is not very “medical” yet.
- Vastly inadequate current state of research means we only have limited information on effectiveness, dosages, side effects and potential medication interactions.
The good news:
- CBD has great potential as a treatment for many different conditions including anxiety, PTSD and chronic pain
- Patients can easily access this relatively low risk treatment for pain.
Opioids are OUT
As our society reckons with opioid abuse, across the country opioids are being pulled away from patients—in many cases without other effective options to replace them— resulting in increased suicide rates and worsened agony for those in chronic pain.
There is now a great deal of fear and panic among chronic pain patients that opioid pain medications are going to be yanked away without any replacement. Chronic pain patients and advocates in Oregon are fighting against a proposal by Oregon Medicaid to mandate a taper of opiates for all chronic pain patients. When I testified against this before the Oregon Health Authority my primary argument was that fibromyalgia and chronic pain patients need MORE tools in their pain management toolbox, not less. Of course, it makes sense to ensure that opioids are a last choice option to be utilized only if other treatments are not effective, and to ensure that opioids are prescribed safely and with focus on preventing misuse and abuse.
The bad news:
- The hysteria around the opioid abuse crisis has lead to a chronic pain crisis as opioids are being pulled away from patients without effective replacements.
The good news:
- As opioids fall out of favor, significantly more research dollars are being directed towards studying new approaches to treating pain.
For example just this year resiniferatoxin, a plant-derived chemical that can destroy nerve endings that signal pain, while leaving other sensory nerves intact, has emerged as a promising painkiller.
A new drug that lowers brain glutamate activity is showing promise for fibromyalgia pain. This medication lowered glutamate levels in certain areas of the brain important in pain, and also lowered pain levels, with no major reported side effects
A novel non-drug therapy using electrical stimulation of the occipital nerves lowered fibromyalgia pain. Small electrodes were implanted under the skin in the back of the neck under local anesthesia. One study showed that this type of electrical stimulation increased the brain’s ability to filter out pain signals resulting in decreased pain.
Here is my “prescription” for a better 2019:
We need more funding for research on non-opioid pain management, including CBD. My hope is that Lady Gaga, who has spoken publicly about her personal struggles with fibromyalgia herself, will donate to fund this type of research. We need to move to a rational approach to prescribing opioids, focusing on prescribing them safely but not pulling them out of the pain-management toolbox until other better options are widely available. Ultimately, to solve the opioid abuse epidemic we need to focus on the root causes of poverty and lack of adequate medical care for mental health and addiction, NOT reflexively take opioids away from patients using them responsibly to manage chronic pain. As I pointed out in a blog post, the historical parallels to prohibition are obvious. Making alcohol illegal did not stop alcohol use or abuse, just as refusing to prescribe pain medications for those in chronic pain will not stop the abuse of opioids.
Ginevra Liptan, MD is a graduate of Tufts University School of Medicine, board-certified in internal medicine who developed fibromyalgia during medical school. She is the author of The FibroManual: A Complete Fibromyalgia Treatment Guide for You and Your Doctor and The Fibro Food Formula: A Real-Life Approach to Fibromyalgia Relief. Learn more at http://www.drliptan.com and http://www.youtube.com/drliptan