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Arkansas Medical Cannabis Program Qualifying Condition: Pain

Leslie kahn


I will be writing a series of posts on some of the conditions that qualify patients for the Arkansas Medical Cannabis Program. Since so many conditions involve pain, that seems like an excellent first post. In Arkansas, it is defined as Intractable Pain.  In this article, I will discuss the different types of pain, Pain Scales, tracking your pain using a Pain Diary and different treatment options, including medical cannabis products.

Pain is one of the most intense sensations we encounter as human beings. If you deal with chronic pain on a daily basis, you are not alone. 50 million adult Americans or 20.4% of the population reported that they are in chronic pain.

Pain is a very subjective feeling. No two individuals perceive pain in the same way. In an attempt to create a useful diagnostic tool in order to assess pain, medical professionals have developed Pain Scales. There are 10 different types of pain scales. The ultimate goal is to assess pain with the end result of implementing an effective treatment plan.

Types of Pain Scales

They fall into 3 different categories:

1. Numerical rating scales which use numbers to rate pain
2. Visual analog scales ask patients to mark a spot on a scale that reflects their level of pain
3. Categorical scales primarily use words to describe the pain but may also include numbers, colors or location on a diagram.

Some common questions to ask include:

How bad is the pain at its worst? It is not unusual for individuals to exaggerate their level of pain, so it is incumbent upon the medical professional to remind patients to be truthful.

Has the pain gotten better or worse from one appointment to the next? If using the 0-10 Pain Scale, avoid reminding the patient of the number they gave at the previous appointment.

Descriptive Words for Pain

  • Pulsing
  • Cutting
  • Crushing
  • Wrenching
  • Tiring
  • Tingling
  • Miserable
  • Numbing
  • Hot
  • Agonizing
  • Sore

3 Types of Musculoskeletal Pain

1. Nociceptive Pain is caused by injury to tissue or potential/actual damage to tissue
Examples would be closing a door on your finger, a mild ankle sprain or burning yourself by touching a hot surface

2. Nociceptive Inflammatory Pain is your body’s inflammatory response to the damage of tissue. These include swelling, redness, discoloration of the skin from black and blue to purple to yellow, a sensitivity to touch and movement.

3. Neuropathic Pain is nerve tissue pain or injury
Examples include shingles, sciatica, radiculopathy, trigeminal neuralgia and neuropathy associated with diabetes

Different Types of Pain

  • Acute pain
  • Chronic pain
  • Breakthrough pain occurs between recommended doses of painkillers
  • Bone pain
  • Soft tissue pain
  • Nerve pain
  • Referred pain occurs when pain experienced in one area of the body is felt in other areas
  • Phantom pain is the pain felt in any area of the body which has been removed

Pain Diary

Keeping a record of the details of your pain is an effective assessment tool that helps your medical professional create a successful treatment
Questions include:

1. Where was the pain?
2. Describe and rate it from 0-10
3. Activity you were engaged in when the pain started or increased?
4. Which medicine/supplements did you take and the dosage?
5. Which other therapies/treatments did you try?
6. Overall, how would you rate your pain today?

Treatment Options: Oral, Topical and Therapies

Oral Medications

Over-The-Counter (OTC) medications include:

  • NSAIDs
  • Acetaminophen
  • Anti-inflammatory drugs
  • Anti-depressants
  • Anti-seizure medications
  • Muscle relaxants
  • Opioids

Topical Treatments

  • OTC topicals which are typically made with camphor, menthol, capsicum and eucalyptus can be found in ointments, lotions, creams, salves, balms, sprays and transdermal patches

Therapies

  • Massage Therapy/Chiropractic
  • Physical Therapy/Occupational Therapy, Exercise
  • Acupuncture, Yoga and TaiChi
  • Cognitive Behavior Therapy and Psychotherapy
  • Meditation Guided Imagery, Hypnosis, Visualization Therapy, Relaxation Techniques
  • Biofeedback
  • Hot and Cold Therapy
  • Music Therapy
  • TENS Unit
  • Supplements/Vitamins
  • Trigger Point Injections, Steroids, Epidural, Nerve Blocks
  • Diet

Medical Cannabis Products

Medical cannabis is gaining traction as a new treatment option for patients. The variety of products available in an assortment of delivery methods provides many different choices. The array of THC: CBD ratios in conjunction with different terpene profiles increases the selection of products.

For those who do not like the psychotropic effects, there are: 

  • CBD only products
  • High-CBD/Low THC products

For those who enjoy the psychotropic effects and/or don’t mind them, there are:

  • 1:1 THC:CBD products
  • High THC/Low CBD products

Different Delivery Methods

There are 3 basic delivery methods; oral, inhalation and topical. Various new techniques are constantly being developed as the popularity of medical cannabis products accelerates.

  • Vaping or Smoking using hand pipes, water pipes, joints, one-hitters, desktop and portable vaporizers and dab rigs.
  • Tinctures are typically ingested sublingually using alcohol in the extraction process. They can also be added to foods and beverages.
  • Ingestible Oils fall somewhere between edibles and concentrates. They can be swallowed in capsules or eaten in foods/drinks.
  • Edibles are most effectively infused with high fat ingredients like butter or oil and added to foods/drinks.
  • Topicals use cannabis extracts that are applied to the skin. They do not provide psychotropic effects. They include transdermal patches.
  • Suppositories are inserted internally.

Sources:
macmillan.org.uk, Types of Pain and How To Talk About Them
verywellhealth.com, 10 Common Types of Pain Scales, Erica Jacques, Updated June 27, 2019.
cvscaremark.com, Daily Pain Diary
leafly.com, The Different Ways to Smoke and Consume Cannabis, Kayla Williams
painhealth.csse.uwa.edu.au, Pain Types
asra.com, Treatment Options for Chronic Pain