Archive for the ‘Pain Management’ Category

Marijuana & Chronic Pain: Q & A With Dr. David Barton
Marijuana and Chronic Pain: Q&A with Dr. David Barton
Celeste Cooper, RN / @FibroCFSWarrior, Health Professional

marijuana         Credit:  Thinkstock

Dr. David J. Barton (AKA Dr. B), a conservative physician by personality and training, says it required an evolutionary process to arrive at his present clinical outlook on medical marijuana.

What is your medical background?**

Dr. B**: I was a double-boarded general surgery trained plastic surgeon until I became disabled and retrained in Pain Medicine at the University of Utah. I hold memberships in the American Academy of Pain Medicine, the International Cannabinoid Research Society and the Hawaii Medical Society.

How did your opinion on cannabis medicine evolve?**

Dr. B**: I was hindered from a career in surgery, causing a neck and arm condition that lead to chronic pain. That led me to where I am today. Much of my philosophy is guided by my personal experiences with severe pain and the failed treatments.

I became frustrated by poor treatment outcomes. For many pain conditions, traditional medicine included aggressive treatments and dangerous levels of medicines. Having no personal experience with marijuana use, I learned by listening to patients who found significant relief using cannabis. With further study, I realized the truth about cannabis and its potential to relieve suffering in a safe and effective manner.

What is cannabis medicine?**

Dr. B**: For the Pain Doc, cannabis medicine represents a naturopathic, legitimate alternative for treating chronic neuropathic pain and muscular conditions using a variety of cannabis based medicines.

The U.S. National Institutes of Health/National Cancer Institute states the known benefits include:

Antiemetic effects (effective against vomiting and nausea)
Appetite stimulation
Pain relief
Improved sleep
Symptom management
Direct antitumor effect
End of life care
Cannabis medicine focuses on treating a variety of medical conditions.

Are there risks?**

Dr. B**: There are risks to any treatment. Seldom headlined are the consequences of undertreated or untreated pain. According to the American Osteopathic Association, chronic pain “affects more Americans than cancer, diabetes, and heart disease combined.”

Patients and physicians should discuss potential negative effects. About 90 percent of my patients use very small amounts of cannabis, and learn quickly how to avoid problems. And like with any medication, I screen for the small minority of those who may be prone to misuse and addiction.

When an individual’s health problems are addressed by a qualified healthcare provider, risks, significantly less than traditional medications, are minimized.

Many say THC and CBD** transform pain signals between peripheral nerves, the spinal cord and brain. Do you agree?**

Dr. B**: Yes. At the 2013 American Academy of Pain Medicine meeting, Dr. Michael Moskowitz said, “preclinical studies, surveys, case studies and randomized double-blind placebo-controlled trials with cannabis have all shown its effectiveness in chronic pain conditions … Cannabis works to settle down the processing of wind-up (centralization) and is the only drug known to do so. It reduces inflammatory pain in the peripheral nerves, and has a unique mechanism for pain reduction unlike any other medicine.”

The complex interaction between innate opioid and cannabinoid systems is not well understood. But with effort and opportunity, we can unravel the mysteries of cannabis science.

How does MMJ stack up against other painkillers?**

Dr. B**: Studies show MMJ can be as effective as opioids. Many people are able to eliminate or significantly reduce their use of opioid pain pills. Cannabis also treats other problems associated with chronic pain, such as sleep, mood disorders, and myofascial spasms and pain, thereby reducing the need for additional medications that have potential side effects or drug interactions.

Is there a cultural transformation regarding MMJ?**

Dr. B**: Yes. This was most evident at a recent NIH symposium (Marijuana and Cannabinoids: A Neuroscience Research Summit) that took place in Bethesda this past spring, wherein, the medical use of cannabis was clearly discussed.

Over the past few years, we have all seen the direct medicinal effects of cannabis in the media by high profile people and entities. The most dramatic have been children with intractable seizures whose parents are directly challenging hostile politicians. The second group is our veterans with service-related conditions who find relief with medical cannabis use.

Patients, their love ones, and organizations have teamed up with activist physicians and political allies to challenge the status quo of government. The tsunami of change in every state has been accelerated by opioid related deaths.

How do you counsel patients?**

Dr. B**: The patient must have a qualifying condition according to the laws of Hawaii, where I practice. I expect patients to act responsibly and follow the laws that govern MMJ access and use. I discuss various delivery systems with my patients. The majority use inhalation delivery. Oils, edibles, and topical ointments are in strong demand. I have seen great results for autoimmune conditions using high CBD low THC cannabis based juice, which provides pain relieving, strong anti-inflammatory effects without psychogenic effects.

Our goal is to combine traditional multi-disciplinary therapies with our patient’s right to use medicinal cannabis to improve their outcome. (See An Elephant Called Pain.)

David J. Barton, MD is a clinician in Pain Medicine and a Medical Political Activist with more than 31 years of experience as a physician. He is fellowship trained in Pain Medicine, and became board certified in Pain Medicine by the American Board of Pain Medicine in 2005. Past board certifications include General Surgery (1992) and Plastic Surgery (1995). He is owner and founder of Hawaiian-Pacific Pain and Palliative Care and focuses his practice on chronic pain and end of life care. Dr. Barton has personally lived in the “Pain World” for nearly 20 years.

Celeste Cooper, RN, is a chronic pain patient, freelance writer, and contributor to the Health Central Community. She is also lead author of five published self-help books and enjoys writing and advocating for people living with chronic pain as a participant in a local patient leadership group and the PAINS Project. She is lead author of Integrative therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and the Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain book series.  Connect with Celeste through her website, Twitter @FibroCFSWarrior, or follow her FB page:
Published On: Aug 1st 2016


For more on medical cannabis:

CBD for Pain

Does CBD oil work for chronic pain management?

While many people use cannabidiol oil to relieve pain, more scientific research is needed to be certain it can be safely used. Understanding cannabidiol can help overcome the stigma associated with it.

Some people experience side effects when taking cannabidiol (CBD) oil and there are other things to consider before using CBD oil for pain.

In this article, we look at how CBD oil works and how it can be used to relieve chronic pain.

CBD in the body

CBD oil is usually extracted from industrial hemp.


Cannabidiol, or CBD, is one of over 60 compounds called cannabinoids. Cannabinoids are found in many plants but are most commonly linked to cannabis.

Unlike other cannabinoids such as tetrahydrocannabinol (THC), CBD does not produce a euphoric “high” or psychoactive effect. This is because CBD does not affect the same receptors as THC.

The human body has an endocannabinoid system (ECS) that receives and translates signals it receives from cannabinoids in the body. The body produces some cannabinoids on its own, which are called endocannabinoids. The ECS helps regulate functions such as sleep, immune-system responses, and pain.

THC produces a “high” feeling by affecting the brain’s endocannabinoid receptors. This activates the brain’s reward system, producing pleasure chemicals such as dopamine.

CBD is an entirely different compound, and its effects are very complex. It is not psychoactive, meaning it does not produce a “high” or change a person’s state of mind. Instead, it influences the body to use its own endocannabinoids more effectively.

According to one study posted to Neurotherapeutics, this is because CBD itself does very little to the ECS. Instead, it activates or inhibits other compounds in the endocannabinoid system.

For instance, CBD stops the body from absorbing anandamide, one compound associated with regulating pain. Increased levels of anandamide in the bloodstream may reduce the amount of pain a person feels.

Cannabidiol may also limit inflammation in the brain and nervous system, which may help people experiencing pain, insomnia, and certain immune-system responses.

What is CBD oil?

There are different levels of compounds found in the natural hemp or cannabis plant. CBD levels vary depending on how the plant is bred. Most CBD oil comes from industrial hemp, which usually has a higher CBD content than marijuana.

Makers of CBD oil use different methods to extract the compound. The extract is then added to a carrier oil and called CBD oil. CBD oil comes in many different strengths and is used in various ways. It is best to discuss CBD oil with a qualified health care practitioner before using it.

Benefits of CBD oil for pain

CBD oil has been traditionally used for thousands of years to treat various types of pain, but it has only recently begun to be studied again by the medical community. Here are some of the potential benefits of CBD oil:

Arthritis pain

CBD oil is popular for easing pain associated with arthritis.


A study in the European Journal of Pain used an animal model to see if CBD could help people with arthritis manage their pain. Researchers applied a topical gel containing CBD to rats with arthritis for 4 days.

Their research noted a significant drop in inflammation and signs of pain, without additional side effects.

People using CBD oil for arthritis may find relief from their pain, but more human studies need to be done to confirm these findings.

Multiple sclerosis

Multiple sclerosis (MS) is an autoimmune disease that affects the entire body through the nerves and brain.

Muscle spasms are one of the most common symptoms of MS. These spasms can be so great they cause constant pain in some people.

One report found that short-term use of CBD oil could reduce the levels of spasticity a person feels. The results are modest, but many people reported a reduction in symptoms. More human studies are needed to verify these results.

Chronic pain

The same report studied CBD use for general chronic pain. Researchers compiled the results of multiple systematic reviews covering dozens of trials and studies. Their research concluded that there is substantial evidence that cannabis is an effective treatment for chronic pain in adults.

separate study in the Journal of Experimental Medicine supports these results. The research suggests pain and inflammation can be reduced through CBD use.

They also found that subjects were not likely to build up a tolerance to the effects of CBD, so they would not need to continually increase their dose. Researchers noted cannabinoids such as CBD could be a helpful new treatment for people with chronic pain.

Side effects of CBD oil

Possible short-term side effects of using CBD oil include fatigue and changes in appetite.


CBD oil is well tolerated in most people, but there are some potential side effects. According to a review in Cannabis and Cannabinoid Research, the most common side effects include:

Using CBD oil with other medications may make those medications more or less effective. People who are considering using CBD oil should discuss this with their doctors. Doctors will want to monitor the person for any changes and make adjustments accordingly.

The review also noted there are some aspects of CBD that have yet to be studied, such as the long-term effects of CBD use on hormones. Other long-term studies will be helpful in determining any side effects CBD has on the body over time.

CBD and other cannabinoids may also put the user at risk for lung problems. One study in Frontiers in Pharmacology, suggested cannabinoids’ anti-inflammatory effect may reduce inflammation too much.

A large reduction in inflammation could diminish the lungs’ defence system, increasing the risk of infection.

 Other considerations for CBD oil

Almost all research on CBD oil and pain comes from adult use. CBD oil is not recommended for use in children, as there is little research on the effects of CBD oil on a child’s developing brain. It is also not recommended for pregnant or breast-feeding women.

 Takeaway message

While many studies have suggested CBD oil is helpful for pain, more research is needed, especially long-term studies with human subjects.

However, CBD oil does show a lot of potential for pain relief. If anecdotal evidence is to be believed, it can be used to help manage chronic pain in many cases.

CBD oil is especially promising due to its lack of intoxicating effects and a possible lower potential for side effects than many other pain medications. A person should discuss CBD oil with their doctor before starting to use it.