Why a Marijuana Card is Great for Chronic Pain
Most patients who need a medical marijuana card suffer from some form of chronic pain. The word chronic means that it is lasting for a long period of time, usually 6 months or more. There are different types of chronic pain. One form of chronic pain is inflammatory pain, which is caused by immune cells becoming inflamed and irritating to the local tissues. This kind of pain is usually accompanied by warmth and redness in the area. It can feel like throbbing and it can be deep in the tissues.
Another form of chronic pain is neuropathic pain: pain that is caused by nerve fibers being compressed or pinched. Sometimes this can be caused by nerves being damaged by diseases like diabetes. This type of chronic pain feels like electric shocks running down the nerves (like in sciatica) or it can be felt like a tingling in the toes or other nerves (such as in diabetic neuropathy).
Sometimes chronic pain is a combination of these reasons. Back pain, for example can be a combination of a pinched nerve in the spine and inflammation from the discs being worn out in the spine, which causes bone-on-bone rubbing.
Seeing a doctor for a marijuana card can be super helpful because cannabis is a safe medication to use and has no long-term side effects. Even using over-the-counter drugs like ibuprofen can have significant side effects like kidney damage or high blood pressure and getting a marijuana card is a much safer option if you need treatment for a pain condition that won’t go away. Other drugs, like oxycodone (Percocet) are super addicting and can lead to dependency and even worse pain when they are not taken after your body gets used to them.
How a Marijuana Card Will Relieve Your Pain
When a pain signal is transmitted across the body, it travels from the area of the pain (usually) towards the brain. The nerves that carry the signal are made of neurons. Multiple neurons transmit the signal from one to the next in a sequence, like a line of dominos falling. The location where a neuron meets another neuron is called a synapse. The neuron before the synapse is called a presynaptic neuron and it releases chemicals into the synapse, which stimulates the other neuron (postsynaptic neuron) to continue sending the pain signal towards the brain.
Cannabis works because it contains tetrahydrocannabinol (THC), which acts on presynaptic neurons to lower the intensity of their pain signal. It also lowers the amount of chemicals (neurotransmitters) that release into the synapse, so the postsynaptic neuron doesn’t react as much to the signal. The reason this happens is that THC binds to a receptor called CB1 (cannabis 1) on the presynaptic neurons and activates it. When this happens, the presynaptic neuron’s pain signal lowers in intensity and stimulates the postsynaptic neuron less. The result is that the pain signal doesn’t carry on between nerves, like someone holding up a domino and preventing it from tumbling when the one next to it bumps into it.
The pain doesn’t go away all the way, however. It will still be there but it will be much more tolerable than before being certified for a marijuana card.
Why Cannabis Works Better than Pain Meds (Opioids)
Opiates come from poppy plants, which produce morphine and opium. They include oxycodone (Percocet), hydrocodone (Vicodin), and hydromorphone (Dilaudid). Opioids include synthetic forms of these drugs (fentanyl). The way that these drugs work is that they are blockers of pain receptors. The problem with using them is that when you block pain receptors in the body, the body realizes that it does not have enough functional pain receptors and creates more of them, a process called upregulation. Then, when you no longer take a pain medication, the receptors are no longer blocked and there are many more of them. This means your body is much more sensitive to pain and feels it more.
Once you have a medical marijuana card, you can go to a dispensary and use cannabis instead. While you can develop a tolerance to cannabis, it doesn’t have the same effect as pain medications, which make you feel pain more when you stop taking them. Cannabis doesn’t have the same withdrawal effects either. It is far less addicting and can be taken in large amounts for extended periods of time without having much side effects if you choose to stop using it. For more information about how cannabis is better than opioids, read our article Marijuana vs Opioids – Which is Better for Treating My Chronic Pain.
How a Marijuana Card Helps Inflammation
Inflammation is caused by immune cells, called white blood cells. When a white blood cell detects damaged tissue, or an infected cell, or a bacteria, it begins sending out chemicals into the blood stream that tell other white blood cells to come closer. This communication is similar to ants: When an ant finds food, it releases pheromones that other ants can smell and before you know it you have a whole colony of ants walking in a line and onto the food. White blood cells do the same thing, and when you have damage in a joint, like when you have arthritis, the area gets inflamed and full of immune cells.
The chemicals that immune cells release when there is inflammation do more than call other white blood cells to the area. These chemicals also cause the blood vessels to dilate and become more open. This is so that the immune cells have an easier access to the area. This also allows more blood to flow and the area can become red and warm to the touch. Veins that drain blood away from the area will actually constrict so there is more pressure that builds up and the area will become swollen. If there are nerves being compressed, they can become even more squeezed by the swollen tissues pinching them. This leads to more pain and a vicious cycle.
After entering a dispensary with your marijuana card, you can buy THC products and eat or inhale them. The THC will enter the blood stream and activate receptors that are located on the immune cells in the inflammed area. This second set of receptors is called the Cannabis 2 (CB2) receptors and, like in the nerves, they lower the activity of the cells and their signals. Immune cells stop releasing chemicals where the inflammation is occuring and move to other parts of the body, where they can continue their usual tasks. Its as if the ants on the food were to stop calling one another and go look for food elsewhere. The inflammation will cool down, go down in swelling, and the pain is relieved.
Pain management for shallow, superficial pain can be started with topical treatment. There are creams and ointments you can buy in dispensaries using your marijuana card that contain THC. These creams and ointments can work well by applying them to areas that the cream can penetrate and be absorbed in. For example, nerve pain on the outside of the skin, or joint pain in the fingers, can be treated by applying the topical products and allowing the THC to pass into the skin and the area around the joints. This will allow the THC to lower inflammation or soften the intensity of nerve pain.
Since the cream only lasts as long as the THC is there, it is best to use it two to three times per day for continuous relief. However, if the pain is deep in the body, like in the lower back or the inside of the knee joints, it will not be able to absorb deep enough there. These creams can be very expensive since health insurance does not cover them so make sure to only use them in areas of pain that are close enough to the skin to allow the THC to reach them.
One of the benefits to topical THC is that it does not have many side effects. It will not go into your blood stream enough to cause you to get high. This is one of the main reasons that patients love to get marijuana cards even if they do not want to be high. They can use creams instead and keep a clear mind.
Pain Management Steps
Most patients who have a marijuna card use more than topicals. They accept the side effects of cannabis because the relief they feel is greater than the downsides. If topicals do not work enough, the next step is to use THC by inhaling it or eating it because then the THC can be absorbed into the blood stream and travel to the areas of pain from the inside of the body, instead of being absorbed from the outside.
After topical products, the next step in managing your pain is to use THC in the vaporized form. This is safer than smoking and can be used on an as needed basis. Since inhaling THC only will last two hours, it is best as a short-acting pain treatment. Patients can take one to two puffs of vapor every two to three hours to treat their pain. It is recommended to read up on inhaling marijuana and using it for the first time if you are new to using cannabis.
If inhaling THC is required every two hours to provide relief, a long-acting pain management strategy should be added. This will require edible forms of THC, like edibles (gummies and baked goods), tinctures, pills, or Rick Simpson Oil. The THC lasts five to six hours when taken this way but it can take two hours just to become active. For this reason, oral products of THC should be taken twice daily (once in the morning and once in the late afternoon) for daytime coverage. Another dose before bed can help during the night. It is recommended to start with 12.5mg THC by mouth for each dose. Read our article about THC dosing to better understand how much THC should be used for adequate pain relief.
Taking THC by mouth will provide baseline pain relief while inhaling it will add as needed pain control for breakthrough pain. This combination of THC treatment is the best pain management for severe, debilitating chronic pain and is a much better alternative to opioid pain medications. It can also treat other conditions besides pain so other medications can be stopped too.
The pain management ladder is meant for marijuana card patients and is used with permission here from The Clinician’s Guide to Medical Cannabis by Dr. Matthew Roman, MD. It shows in the image that the first step to pain management is topical THC. If the pain is not controlled after using topicals, inhaled THC should be added to this (PRN means as needed). If this fails to control the pain enough, oral THC products should be taken by mouth and added to that. If that fails, the oral marijuana product can be titrated up in dose until the pain is controlled. Remember, however, that the pain will never be gone completely. The goal is to make it tolerable and increase your quality of life.
Abortive Pain Management
Some conditions have pain that is not chronic and instead it comes on suddenly and with extreme intensity. Examples of this can be severe migraine headaches or trigeminal neuralgia, a condition where excrutiating nerve pains shoot into the face. When conditions like these occur, the best pain management is abortive therapy. This means that high doses of THC are used to literally abort the pain as fast as possible and stop it in its tracks.
The best form of cannabis to use when aborting a sudden (acute) pain condition like this is THC concentrates. These products have very high percentage concentrations of THC and allow for a rapid influx of THC to enter the system and combat the pain condition. Even if complete relief is not achieved, the THC will help tolerate the pain until it goes away again.
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