Pot On The Brain
Marijuana For Pain Relief
--Damien Cave--
President Clinton may never have inhaled, but his brain has been secreting cannabis-like chemicals for years.
In fact, according to a Brown University study, anandamide has been flowing through all of our brains since birth. An analgesic in the cannabinoid family -- a generic term for anything, THC included, that hits the cannabinoid receptor -- anandamide is remarkably similar to the active ingredient in marijuana. A cousin to endorphins, our body's opiates, pain triggers its release.
Scientists have known for 20 years that our brains contained cannabinoids, but the Brown study pinpointed the location in the brain, the secretion process and the amounts released. The research confirms the massive NIH study, which proved marijuana had therapeutic uses. Like that study, it also leans toward a pharmacological replacement for the green and leafy weed. What's different is the reasoning: The NIH study opposed smoking marijuana because of its detrimental effect on the lungs; the Brown study shows that an effective marijuana pill would be not just healthier, but better.
"Whereas smoking marijuana bombards all the brain's receptors, then fades, a modulated pill could extend the natural actions of the brain's own cannabinoids or marijuana-like substances, and be more selective in its pain-killing actions," Walker said.
Sure, he said, "It would kill the pain without making you goofy." But it would also concentrate more intensely on the pain-inflamed body parts, and last longer.
"It would enhance the release of the brain's own marijuana," Walker said.
"That's what people want," he added. "People who are suffering chronic pain go to work, and they want to make decisions without the drug affecting them. That's why people love Advil, because it works without any side effects."
AIDS patients that don't respond to morphine and other opiates would be eligible for such a product, but Walker stressed the immediate value for people with neuropathic pain, those with damaged nerves that lie to the brain about pain that does not exist. Often, stroke victims suffer from this condition, as do those with multiple sclerosis. But people with gashes that never healed correctly can also be affected.
According to the Pain Clinical Research Center, thousands of people suffer such conditions, which are difficult to treat. Often traditional painkillers fail.
For those with lesser pain, Walker's research also confirms an earlier study by Ken Hargraves at the University of Texas at San Antonio, which found that a butter of cannabis often helped reduce swelling. Because the body's cannabinoid secreters reside throughout the body, Hargraves' study gained some teeth.
Still, despite the apparent rubdown from Walker's crew, medical marijuana advocates tend to oppose such research, fearing that the quest for a pot pill ignores the socioeconomic issue of access.
"In reality, the drugs will always turn on class," said Allen St. Pierre, executive director of the National Organization for the Reform of Marijuana Laws, a Washington lobby. "There will be people who can't afford access to these drugs. Regardless of this, the moralization of the issue has created an irresistible urge to remove the pleasurable aspects of marijuana."
But Walker said such attitudes ignored the neutrality of science. Understanding how our brains work is a noble effort," he said. "We shouldn't stop doing that for fear of totalitarian tactics."
- - Stephen J. Kingsbury, M.D., Ph.D. - -
Professionals have written much about reactions and adaptations to chronic illness. As a person with a chronic illness (multiple sclerosis, diagnosed more than 17 years ago) who also encounters, professionally and otherwise, many others in a similar situation, I have come to view this literature as riddled with problematic theoretical biases and stereotypes that can have damaging effects on treatment. The sources of error can be conveniently grouped into three catagories: pathologizing behavior, pitying the patient, and, paradoxically, idealizing the patient.
Mental health professionals are at risk for pathologizing because they tend to see a limited and biased sample of the chronically ill-- those who are not adapting well to the illness. Most people with chronic illness do not need psychiatric help, although patience and understanding are always appreciated. Although it is normal to generalize from one's experience and education, errors arise when pathologizing generalizations are extended to the chronically ill. For example, consider theories about the course of the response to chronic illness. Borrowing ideas from work on dying patients, writers often refer to "stages" of denial, anger, bargaining, depression, and acceptance. This widely used schema has not been validated even for reactions to dying, and it is even more dubious when applied to chronic illness.
Take denial. I have never met anyone with a chronic illness who denies having it. Certainly, when first diagnosed, many search for alternative explanations or for evidence that the diagnosis is wrong, but they do not block the diagnosis out of their minds or deny the need for therapy. Many do have objectively unrealistic hopes for a cure, but I regard this as an example of the sometimes unrealistic optimism that is an aspect of normal human psychology-- often a valuable and healthful aspect. Occasionally such beliefs interfere with adaptation and must be confronted, but in most cases, to label them "denial" is simply to crush hope without aiding in any needed therapy. The last stage of this theoretical framework, acceptance, also can leave too little room for optimism and hope.
Depression in the chronically ill is also misunderstood. The rate of depression is higher than average in some chronic illnesses, such as multiple sclerosis, but even there it occurs in a minority of cases. Depression is not a typical or normal response to chronic illness, and if it arises, should always be treated. Unfortunately, professionals often expect to find depression in the chronically ill and look too hard for it. Sometimes negative emotions, such as anger or frustration, are interpreted as depression that the patient is covering up or denying. In my opinion (and my experience), few things are as maddening as having somebody else glibly tell you what you are feeling. It is an invalidating experience.
The mistake here is not viewing the situation from the patient's perspective. Health professionals too often reason, probably incorrectly, that they themselves would be depressed or have great difficulty in coping if they contracted AIDS or cancer or suffered a spinal injury. So they overestimate the significance of minor mood fluctuations in their patients and discover non-existent problems, frustrating the patient's efforts to cope.
Professionals often talk and think about a patient as "the arthritic", "the paraplegic", or "the diabetic". Although these descriptions are accurate for limited medical purposes, they convey the impression (even when it is explicitly denied) that the person is the illness. Professionals must remember that chronic illness is only a minor part of a person's identity. It does not occupy one's mind most of the time. A person with a spinal injury, for example, is many other things as well--perhaps a computer software designer, a husband, a father, and a painter. People with rheumatoid arthritis do not spend all their time being arthritic patients or engaging in activities related to the disease. From my vantage point, it appears that even professionals who acknowledge this truth regard the illness as a greater part of the patient's identity than the patient does.
Both these tendencies--strongly believing that you know how it feels to be chronically ill and falsely equating the person with the disease-- contribute to another reaction that is unwarranted and unappreciated. I am talking about pity, an often demeaning emotion.
An equally annoying habit is idealization of the chronically ill. People who continue to function to the best of their abilities are often described as "courageous", but that is only after another well-meaning misunderstanding. Courage means choosing to undergo suffering or risk for the sake of another person or some cherished value. No chronically ill person I know chose to be ill. Yes, medical procedures and regimens may involve considerable pain and inconvenience, but the only alternative is giving up. Like most people, the chronically ill are simply trying to do the best they can. There is no real alternative, so we should not speak of courage. People who call the chronically ill courageous are taking a shortcut to understanding.
A helpful idea I often cite for the chronically ill is, "People suffer less when they have something to do." Anything is better than lying around concentrating on one's pain, disability, or disease. Many chronically ill people try to live according to this philosophy, and I believe that finding ways to apply it is one form of psychotherapeutic help.
Another useful principle is one that has been called "the dead man's rule". It states that you should never have as a goal something that a dead man can attain. Not feeling pain is such a goal. Instead, we should be concerned about what a person can do. Another statement of this rule is: work toward a goal rather than away from one.
Finally, one should always keep in mind the phenomenon of emotional inertia. We change faster than our conceptions of ourselves change. People whose health is declining may think of themselves as somewhat more capable than they are, because they are referring to an earlier period of their lives. It takes time and experience for the changes to be integrated. During that time a patient may seem to be overreaching, or even "in denial"; it is much more accurately described as a normal period of adjustment to new circumstances.
Reprinted from: The Harvard Mental Health Letter, December 2000
About the author: Steven Kingsley, M.D., Ph.D., is the Associate Professor of Clinical Psychiatry in the Department of Psychiatry, University of Southern California Medical Center in Los Angeles.
Reprinted from the Arthritis Society of Canada
Pain is one of the hallmark symptoms of arthritis. It may come and go as your arthritis goes into a flare or subsides in remission, but for most people with the disease it will never entirely disappear.
We understand a little of how pain works, but not all by any means. We have words to describe its effects, yet they can never entirely convey to someone else what you are feeling. And almost any two people will experience different levels or intensities of pain from virtually identical causes. Because your pain is entirely your own, you may never fully understand exactly what the someone else is going through.
Persistent, severe pain from arthritis requires a combination of therapeutic strategies; no one pill or management technique is enough to provide non-stop pain relief safely. Arthritis medications are only one part of an overall strategy that will help you reduce and cope with your pain, improve joint function and daily-living activities, and learn to deal with the emotional stresses that arthritis can impose. Maintaining that multi-part strategy successfully is only possible if you understand as much as you can about pain, how it can be treated, and what role you can play in its relief. Not every strategy will be equally effective for everyone; you need to discover what works for you, combining different approaches to prolong pain relief.
There's a lot to learn, but the more you understand about every aspect of your treatment plan, the more likely you are to benefit from it. Knowledge really is power. Learn to wield that power as an active participant of your own treatment team. Learn as much as you can about all the strategies available to you Ñ whether they're medications or non-medicinal techniques. That understanding is an important step toward your becoming an arthritis self-manager.
How Does Pain Work?
However unwelcome pain may be, it's clear that it has a function: survival. It's a reflex that makes us withdraw a finger from a flame, faster than thought, an irresistible impulse to massage a stubbed toe, or the urge to rest an injured limb. Pain Ñ particularly chronic pain Ñ is never a pleasant experience, but it can protect us. What's not so clear is how it does its work.
At bottom, pain (all sensation for that matter) results from the operations of the nervous system. More complex than the most advanced electronic circuitry, it's the most baffling of all the body's systems. We've known something of its workings since the time of the ancient Greeks, who described and analyzed the sets of peripheral nerves, sensory and motor, that run to and from the spinal cord and connect with the brain.
In the centuries that followed, incremental advances were made in identifying and mapping the trail of nerves, but it was the French philosopher and scientist RenŽ Descartes, in his 1664 book, 'Description of the Human Body,' who first suggested that pain travels specific pathways from extremities in the skin to the brain. With certain modifications, and within certain limits, that basic understanding has been with us down to the present day.
But as Jeremy S.H. Taylor and R.M. Gaze of the University of Edinburgh pointed out in the 1987 edition of 'The Oxford Companion to the Mind,' there's more to this than meets the eye. Our understanding of neural structure (that is, the nerves and the nervous system) is far greater than our understanding of neural function. That's because, except for the nervous system's most obvious roles, we don't really know what the function of the nervous system actually is.
We tend to think of the function of the nervous system and brain as 'information-processing,' but that doesn't really explain anything. We understand mechanical information-processing machines because we built them in a particular way and for a particular purpose. We don't have that understanding of the nervous system because we didn't construct it, and, so far at least, we haven't been able even to define some of its operations.
Part of what makes the nervous system so astonishingly complex is the fact that it's virtually everywhere in the human body, from the tips of our toes to the scalp on our heads. Its endpoints lie everywhere just beneath the surface of the skin, and connect with the muscles and other tissues of all the organs of our bodies. There's almost no place in our bodies that isn't touched Ñ and controlled Ñ by it.
The nervous system consists of three interconnected parts: afferent nerve fibres and their receptors, efferent fibres with their muscles and glands, and the central nervous system Ñ the spinal cord and brain. Like all living tissue, the entire network is made up of cell matter, primarily nerve cells, or neurons. (We're actually born with the cells of the central nervous system, which, unlike all other cells in the body, are irreplaceable.)
In most other ways, nerve cells are like other cells of the body, except that at one end they have a number of root-like projections called dendrites, and at the other end each nerve cell has a long, whiplike tail called an axon. Grouped in bundles like the fibres of a rope, nerve cells may be the merest part of a centimetre long or run a metre or more from the tip of the toe to the base of the spine. It's their fantastic interconnectedness Ñ a large neuron, for example, may be in contact with the dendrites of as many as 200,000 cells Ñ that gives us such a rich sensory apparatus.
The afferent and efferent fibres, which comprise the peripheral nervous system, are like one-way transmission lines. The afferent nerves conduct messages to the spinal cord and brain; the efferent nerves conduct signals away, to the muscles and glands. The kind of messages efferent fibres carry to their end organs are generally command signals. If the destination is a muscle, it may be a command to contract; if it's an organ Ñ the stomach, say Ñ the signal may be an order to release digestive enzymes.
The afferent fibres' messages, on the other hand, convey sensory information Ñ sensations such as heat, cold, touch and, unfortunately, pain, from bumps, bruises and other failings of the flesh. Be they via afferent or efferent fibres, messages are sent in a sort of Morse Code„series of sequential dots grouped in volleys of electrochemical nerve impulses, racing along at anywhere from two to 120 metres per second. As fast as that sounds, pain is hardly instantaneous, as everyone knows: Stub your toe, and you know you will feel pain before you actually do. In chronic pain, the signal from the nerve endings seems instantaneous, but only because it never really stops.
This kind of bare-bones description makes neural structure sound simple, and it makes the Cartesian model of pain (remember Descartes?) seem perfectly sound: You stub your toe, and the mass of bruised tissue releases chemicals (such as substance P, prostaglandins or bradykinin) to sensitize the adjacent nerve endings. Once stimulated, these send forth a volley of electrochemical nerve impulses to the spinal cord via afferent fibres. In turn, the spinal cord passes on the signals to the brain, which deciphers them as 'pain.' It then transmits secondary instructions, via the efferent pathways, to various muscle groups and glands, which initiate a series of motor activities: You lift your foot, reach down and massage the toe, while the vocal chords produce a resounding 'Ow!', in addition to the usual blood-borne 'healing cascade.' What could be more straightforward?
Important First Steps to Managing Pain
Arthritis pain can be so intense and constant it dominates your every waking moment and many a sleepless night. It has a purpose, as we've seen: All those overexcited nerve cells are racing to inform the brain that harm is being done to one (or more) of your joints. In response, the brain signals muscles in the affected area to contract as a form of protection. The resulting painful spasms prevent you from using the joint normally, while the body makes its mostly futile attempts to effect repairs.
If the source of pain isn't tended to by a doctor, there's a heavy price to pay: Studies show that muscle tissue starts wasting away after only three to six days of inactivityÊ- followed by a corresponding loss of strength and flexibility, which of course leads to more pain. Unchecked, the underlying disease process continues its dogged work, which only increases the pain further. As we've already said, persistent, severe pain from arthritis requires a combination of different strategies, a blend of different approaches that will help you prolong pain relief.
Start with your doctor. He or she can diagnose the reason for your pain and determine whether there are symptoms of inflammation. If there are, you'll be prescribed an anti-inflammatory medication, probably a non-steroidal anti-inflammatory drug, or NSAID. You'll also be prescribed medication for immediate pain relief, but you must understand that 'relief' doesn't mean a complete absence of pain. The goal is to reduce your pain levels so that you can start moving again.
Your doctor might also refer you to a physiotherapist, who can devise an exercise program for you that will help prevent muscle wastage that can reduce pain by strengthening and increasing the joint's range of motion. Your physiotherapist is a key member of your treatment team.
An occupational therapist, or OT , can also help, especially if you have an inflammatory form of arthritis. OTs can have custom splints and orthotics made to help keep affected joints properly aligned and protected from further injury. They're also an excellent resource for all kinds of practical strategies for avoiding injury and reducing pain.
How you meet 'the challenge of pain' will in large part determine not only how well you cope with your illness but how much pain you experience. It's a matter of pain management, a gradual process of learning to regain a measure of control over your body so that you can achieve some mastery of your medical condition, and thus don't feel so much that the pain is controlling you.
Different people react differently to pain and illness. Some become paralyzed. They sit at home, don't go out, becoming more and more alienated, depressed. Other people say, 'I can't let this pain get to me,' and they go out and do all kinds of things, trying to prove to themselves that they can do it, and finally they crash. The key is to find the middle ground and learn to utilize your good strategies and minimize your maladaptive strategies.
The first step is a tough one: learning to understand and accept your pain. Only then can you begin to deal with it, establishing priorities and setting goalsÊ- taking responsibility for yourself. You have to want to help yourself first. You have to be willing to take a close look at yourself and your lifestyle and learn to accept your limitations. In other words, you have to learn to accept that there are certain things you can't do any more, activities that will only increase your pain that will have to be modified or eliminated, and practices you'll have to adopt to maximize your ability to do the things you have to do to maintain your altered self-image and self-respect.
Pain-killers are a partial answer at best; they only mask the pain, and they can cause real harm by allowing you to do things that cause damage to arthritic joints, activities that pain would 'tell' you to avoid. But, while no one expects someone suffering acute or chronic pain to stop taking medication, there are complements to drug therapy that help people take repossession of their lives.
Non-Medicinal Techniques to Relieve Pain
Some non-medicinal pain strategies Ñ such as rest and energy conservation, sleep and relaxation Ñ can achieve dramatic results, despite their apparent simplicity. Don't be deceived: There are components to each that require an effort, though with practice you'll find they become easier and more effective. Don't feel guilty about taking time to make them part of your schedule; taking breaks to rest and relax and sleep better will actually save time in the long run, because if they're done properly, you'll have more energy and less pain to do the things that are important to you. They aren't meant to replace your prescribed medication and regular treatment plan, but they're often extremely effective complementary therapies.
Techniques to Relieve Pain:
Acupuncture
BioFeedback
Creams and Gels
Distraction and Flow
Heat and Cold
Imagery, Focusing, and Self-Hypnosis
Laughter
Massage
Physical Activity
Psychological Techniques
Relaxation
Rest and Energy Conservation
Sleep
TENS
For more information: Arthritis Society of Canada