I made a choice over 20 years ago that the field of medicine I practiced would be dedicated to helping patients in pain. Over the years, the trend of patients who were referred to me came to me already prescribed with medications to manage pain and related disorders, and these medications made it hard for me to start at level zero.
I then noticed in recent years a rather alarming trend: I would encounter patients referred to me who were already taking a high dose of short-acting pain medications. In many cases the patients had their doses repeatedly increased by well-intentioned care providers who simply did not have access to the resources, skills and specialized training required to treat the complex patient who suffers from chronic pain. In these scenarios it is then difficult to reverse the effects on the receptors in their nervous system which have become adapted to, or used to, the opioid pain medications. Once started on opioid pain medications, the body very quickly becomes tolerant to these medications, such that a patient can very quickly begin to tolerate a large amount of opioid medication or can experience unpleasant withdrawal effects when the medications are abruptly stopped.
Today, an alarming rate of patients who come to my office already are taking more than the limit of opiates, as recommended by the Centers for Disease Control and Prevention. They take so much because of long-term use and abuse. Is their pain real? Yes, it is. But, because of the detrimental effects of pain killers, the overuse occurs when the normal level no longer works. Patients need more milligrams to no longer feel the pain, and over time they become physically dependent and possibly addicted. When medical marijuana was passed in New Jersey, it was a lifesaver for many of my patients. While it is still relatively expensive, many patients are benefiting from prescribed marijuana and no longer suffer the side effects of opioids.
Opioids are chemicals that contribute to pain relief by attaching themselves to corresponding receptors in the central nervous system. Once bonded, the cells transmit signals that stifle feelings of pain and increase feelings of well-being. However, opioids alter one’s perception of pain. This effect can lead to increased sensitivity to pain, also known as opioid-induced hyperalgesia.
Other possible side effects of opioid medications include itching, nausea, vomiting, constipation, sedation and life-threatening respiratory depression — whereby the medications, when taken in large quantities, can cause the patient to stop breathing, leading to cardiac arrest and, all too often, death.
So, what are the choices for patients experiencing pain? There are now a multitude of options; through our practice, we have researched and identified that medical marijuana is an excellent substitute for patients experiencing pain and on high doses of opioids.
What’s more, patients often need an ecosystem of care for all their related health needs and that is why my practice offers a variety of services for patients in need. My office uses acupuncture, cognitive and behavioral therapy, interventional injection therapy, adjuvant pain medication (non-opioid medication) management, minimally invasive spine procedures including lumbar decompression, endoscopic discectomy, nerve ablations, spinal-cord stimulation and other safely performed, same-day procedures without the need for major spine surgery or in-patient hospitalization.
Here’s the story of a recent patient — Linda (not her real name) was referred by another care provider. I immediately looked at her pain management history and other medical conditions that contributed towards her medication history. Her medical records indicated that Linda has had a hard time over the years. Pinging between three, four and five doctors every month made Linda even more frustrated.
When I approached Linda about a new and guided way to address her pain and give her some amount of her life back, she was in disbelief. “You mean I can be who I used to be?” For many, the stigma of marijuana can be a prejudice but for patients in need, it can be lifesaving. After one month of taking the medical marijuana, Linda was a new woman. While this may not be for every patient, it can help many. And that is why New Jersey needs to continue to educate providers about the nontraditional options that can be lifesaving.