Chronic pain management physicians treat a wide variety of conditions. In order to effectively treat pain, we must first identify the type of pain the patient is experiencing. We often use a variety of treatment options to optimize pain management, which can include manual therapies, such as physical therapy, chiropractic care, massage, acupuncture, and exercise. Mental therapies can include meditation, group therapy, and cognitive behavioral therapy. In addition, medications include NSAIDs (Nonsteroidal Anti-inflammatory Drugs), topical medications, seizure medications, anti-depressants, and opioids. We often will recommend supplements including turmeric, Coenzyme Q10, and Alpha-Lipoic Acid; interventional treatments include steroid injections, radiofrequency ablations, stem cell injections, and platelet-rich plasma.
One therapy option that we are often asked about is cannabidiol (CBD) or cannabis. With Colorado being one of the first states where cannabis was legalized, many patients seek this as a treatment option. The endocannabinoid system in the human body has been known about for 50 years but little research has taken place because of the laws against cannabis in the United States. There have now been studies assessing the potential efficacy of CBD for various pain conditions, including epilepsy, nerve pain, anxiety, depression, inflammation, nausea, and chronic pain to name a few.
We are still early on in CBD research and many more randomized, placebo-controlled, double blind studies are necessary. From my perspective, I see CBD as an adjunct to multimodal therapy that shows promise. I have patients that were able to reduce their daily pain medication consumption and experienced improvement in functional capacity as well as cognitive ability after taking CBD. However, this therapy does not work for every person and is not 100% effective, just like any other medication or supplement.
When I do recommend a CBD option for patients, I tell them to purchase their treatment from a respected CBD distributor with products that have been independently tested by an outside lab to assure quality and purity. I do not want my patients ingesting something that has not been thoroughly evaluated.
For now, it is trial and error on whether or not CBD is an effective treatment option for individual patients but I am seeing fewer side effects than the traditional treatment with better cognitive function. As CBD research continues, I think we will find evidence for more clinical applications.