Another tool in our Tool Box to Face Neuropathic Pain
Neuropathic pain is not a rare condition. Approximately two to three percent of people living in the developed world suffer from this condition. This means that around one million Canadians are dealing with this problem right now. When it comes to problems, the only good thing about the word MILLION is that it grabs our attention.
I have the privilege of being a pain physician and a neuropathic pain patient at the same time. This gives me a better perspective of the view from both sides of physician’s desk. Above all, I have felt and understood the frustrations of a neuropathic pain patient.
For many other medical conditions there are tests that can exactly show a structural problem that is causing the condition. Once the test results come back, there is usually a surgeon who can fix it with a knife or a doctor that can help it with a pill. When it comes to neuropathic pain, it becomes a completely different story. To begin with, Neuropathic pain is an umbrella term for a wide selection of different diseases that it can cause. Each of these hormonal, traumatic, viral, ischemic or other causes have a different natural history, course of behavior and as such respond differently to treatments. Their level of progression or severity can affect the presentation of neuropathic pain in different shapes and forms.
Neuropathic pain once established is a very uncomfortable condition.
When we have a condition like that, we like to have a test to get to the bottom of the problem and a quick solution for it so that we can get on with our lives. Unly this is not possible with neuropathic pain most of the time. That is when frustration builds up for both patients and pain practitioners. As patients we are looking for answers and can’t care less for the evidence and guidelines that doctors are looking for. As doctors, we have the goal of making patients better without ever harming them.
In order to help them and not harm them, we have to look for evidences and follow the guidelines. Dr. Angela Mailis, Dr. DE Moulin and other colleague have published a descriptive consensus statement and guidelines from Canadian Pain Society on Pharmacological management of chronic neuropathic pain in 2007. This guideline put Cannabinoids as the Fourth line of treatment. It means that there other classic and accepted groups of medications should be tried first before resorting to cannabis or products from this family.
Currently the courts have allowed patients to have access to dried marijuana if a doctor would recommend it through a medical document. It is something like a prescription but because Health Canada does not recognize Cannabis as medication yet, we don’t call it prescription. However, the College of Physicians and Surgeons of Ontario has decided to consider it as prescription to make it simple for everyone involved. This document should have the patient name and address, the amount of marijuana allowed per day and the duration of validity for medical document in order to be accepted by one of Health Canada approved licensed producers. The patient will send it to the producer and they would sell it to patient by sending it patient’s home address.
So what is the problem?
The problem is that patients can get all the lung hazard of smoking with smoking marijuana. Young patients of less than 25 years of age may have long lasting cognitive impairments with regular use of marijuana. Patients may have a higher risk of car accidents if drive after smoking. Mixing marijuana and alcohol can majorly increase the cognitive impairment. Mixing it with tobacco would increase the risk to patient’s long and there are some reports of increased risk of lung cancer with smoking marijuana.
Marijuana is not a cure for all as some may believe. Patients with history of mental disorders may do poorly on marijuana and it may aggravate schizophrenia presentations. Despite the common belief of many users, there are some people who do get addicted to marijuana; increasing urge to use more in daily use, spending a lot of time and money on acquiring marijuana, decline in social and professional performance and continuation of us how to use it.
This article was published in the Action Ontario Fall Newsletter OUCH