The dilemma of chronic pain. Shoot, as though the agony isn’t enough, there’s the remedy. And my heart goes out to those who’ve had to turn to opioids, especially for the long-haul. But maybe there’s another option, one that produces true and lasting relief. Let’s talk about cannabinoids...
The cannabinoids, particularly cannabidiol (CBD), are being praised as non-addictive alternatives to using escalating doses of opioids to treat chronic pain.
Zipping around the web in search of something worthy for this week’s article, Psychiatric Times came through with “Cannabinoids for Chronic Pain: An Opioid Alternative?”
It’s actually a research update for psychiatrists, psychologists, and other healthcare professionals written by Thomas R. Kosten, MD and Coreen B. Domingo, DrPH. Both are professors at the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.
Hey, much to review, so let’s get right into it. As usual, I’m skipping all of the “Drs. Kosten/Domingo said…” formality. What you’re about to read is my summary of their work. Okay?
Psychiatrists and other addiction specialists are well aware of the challenges of chronic pain management. Fact is, according to a recent JAMA Network Open survey, almost half of primary care providers are refusing to treat chronic pain.
This reality has presented a new challenge: assessing the use of cannabinoids for the relief of “chronic benign pain.” What’s that? It’s pain generated by inflammation, stress or damage to organs, or other physiological processes not associated with the spread of disease (such as cancer).
The cannabinoids, particularly cannabidiol (CBD), are being praised as non-addictive alternatives to using escalating doses of opioids to treat chronic pain. But there’s one little kink: 10% of the population who use tetrahydrocannabinol (THC), which is not in CBD, become addicted to it.
Cannabidiol (CBD): Facts
Just about two years ago I posted “CANNABIDIOL: What Is It? Why Should a MOOD or ANXIETY DISORDER Sufferer Care?.” I’m referring you to that article for lots of foundational information (link at the end). Still, we need to go over a few things here.
CBD is derived directly from the hemp and marijuana plants. And though CBD is one of approximately 100 cannabinoids found in the marijuana plant, it doesn’t cause a “high.” Indeed, CBD exhibits no effects that would indicate any abuse or dependence potential. All 50 states have laws that legalize CBD with varying degrees of restriction.
Cannabidiol (CBD): Dosing
It’s important to note that FDA (US) action pertaining to CBD began earlier this summer. The work includes legislative hearings concerning regulation.
With the exception of two rare seizure disorders, the most effective CBD therapeutic dose for medical conditions, including pain, is unknown. However, some preliminary estimates are available, such as the 5 mg/kg twice-daily dose of Epidiolex (prescription CBD, more in a bit) to treat those two seizure disorders.
But there’s more. In comparing pain-relieving effects in a variety of medications a metric known as number needed to treat (NNT) is used. Tricyclic antidepressants and opioids have the lowest NNT (2.6 and 2.1, respectively) for treating neuropathic pain. That means that for every one patient showing a therapeutic response to the treatment agent, the NNT is the number of patients who need to be treated. In other words, for every two patients treated with opioids, one will have satisfactory relief from chronic neuropathic pain.
Bringing all of this to CBD, the oral CBD spray used in studies has an NNT of 5.0. Here’s what we find when comparing this to other meds for neuropathic pain: opioids 2.1, SSRI antidepressants 5.0, gabapentin 6.4. You can see that this particular CBD formulation, though not as powerful as the opioids, brings results.
Cannabidiol (CBD): The Foreseeable Future
Oh, you can be sure the pharmaceutical industry is ready to make CBD widely available, under state regulation, with and without prescriptions.
Epidiolex, an oral solution developed by Greenwich Biosciences, is available in the US for the management of refractory epilepsy. It may offer relief for chronic pain conditions, as well. Also, recent data shows that heroin cue-induced craving was significantly reduced in subjects given an oral CBD solution once daily for three consecutive days.
GW Pharmaceuticals markets nabiximols (Sativex), a marijuana extract approved in the UK for the treatment of neuropathic pain. overactive bladder, and other symptoms associated with multiple sclerosis. A plan to conduct Phase 3 trials in the US is in the works.
Finally, Cara Therapeutics and Zynerba Pharmaceuticals are developing investigative synthetic cannabinoids that are showing promise for the treatment of specific psychiatric disorders and chronic pain symptoms.
All Set
Obviously, the cannabinoids, including cannabidiol, are getting a ton of well-deserved attention. Within the context of this article it’s about pushing away from opioids for pain relief. And there’s a lot going-on in the mood and anxiety disorder neck of the woods.
Much more research and development to be done, but I really believe we’re onto to something.
We may have been led to believe that meds were the quick fix for mood and anxiety disorders, but how we’ve grown wiser. Sustained relief is based upon how many arrows we keep in our quivers, their variety and how well we use them. See what you think about intermittent fasting…
Inflammation: Some studies show reductions in inflammation markers, a key driver of many chronic diseases. One may be depression.
In last week’s piece, BDNF: What It Is and Why It’s Crucial to Know, I pointed-out that it behooves those who struggle with mood and anxiety disorders to increase their BDNF levels. I mentioned that one of the ways we can do it is through intermittent fasting (IF). When I found that in my article research, I had no idea what is was or how it could be relevant.
I do now, and so will you.
Before we get crankin’, this important point. Obviously, in any discussion of IF, weight-loss is going to be featured. Certainly, a healthy loss of weight would have a positive impact on anyone’s mood or anxiety status, but that isn’t the reason I’m bringing you this information. Fact is, IF has become a very popular health and fitness trend, and that’s because it really can have powerful effects on our brains and bodies.
Let’s see what’s up…
What Is Intermittent Fasting?
Makes sense that IF refers to a food intake pattern of alternating periods of fasting and eating. IF doesn’t specify what foods you should eat, rather when you should eat them.
Does it surprise you that humans have evolved to be able to do without food for extended periods of time? In fact, one could say occasional fasting is more natural than chowing-down three-plus meals per day.
There are a variety of IF methods, these being the most popular…
The 16/8 method: Aka the Leangains protocol. It involves skipping breakfast and restricting your daily eating period to eight hours, say 1-9 pm. Then you fast for 16 hours in between.
Eat-Stop-Eat: This is fasting for 24 hours, once or twice a week. Maybe that means not eating dinner one day until dinner the next.
The 5:2 diet: Involves consuming only 500-600 calories on two non-consecutive days of the week, but eating normally the other five.
Seems most IF’ers go with the 16/8 method.
How Does Intermittent Fasting Affect Your Body?
Fasting causes a variety of positive things to happen in our bodies at the cellular and molecular levels. Understandably, most of us never pause to think about the potential impact of such tiny things, but it’s real as it can be.
A handful of examples are an increase in human growth hormone (HGH), improvement in insulin sensitivity and a drop in insulin levels, ramped-up cellular repair processes, increased release of the fat-burning hormone norepinephrine (noradrenaline), and changes in gene expression relating to longevity and disease prevention.
Pretty powerful.
What Are the Health Benefits of Intermittent Fasting?
All of those IF-induced cellular and molecular changes we just talked about translate into significant health benefits. Check these out…
Brain health: Increased levels of BDNF, which induces neuronal growth and repair dynamics such as neurogenesis and neuroplasticity. As a result, mood and anxiety management are enhanced.
Insulin resistance: Reduced insulin resistance can significantly lower blood sugar levels, providing a leg-up on type-2 diabetes
Inflammation: Some studies show reductions in inflammation markers, a key driver of many chronic diseases. One may be depression.
Heart health: Reductions in LDL (bad) cholesterol, triglycerides, inflammatory markers, blood sugar and insulin resistance
Cancer: Animal studies suggest IF may prevent cancer
Anti-aging: Extends lifespan in rats by 36-83%
Weight loss: Lose weight and belly fat without having to consciously restrict calories
Intermittent Fasting Isn’t for Everyone
Though IF brings many health benefits to the table, it isn’t for everyone. Those who are underweight or have a history of eating disorders need to chat with their doc before using IF. Actually, to be safe, anyone contemplating IF should check-in with their doc.
There’s some evidence suggesting that IF isn’t as beneficial for women as it is for men. The areas of concern include compromised blood sugar control and amenorrhea (which returns to normal when the previous eating pattern is resumed). It’s likely a good idea to hold-off on IF if you have fertility issues or if you’re trying to conceive, pregnant, or breastfeeding.
Finally, IF may produce side effects, some of which may be temporary as one adapts to a new eating pattern. Numero uno is hunger.
Again, chat with your doc!
All Done
Absolutely, success in living with a mood or anxiety disorder is all about how many arrows we have in our quivers and how well we use them. I mean, we’re not talking a “quick-fix” scenario here (is that hard to accept?).
Seems to me intermittent fasting is worthy of consideration. Yes, no?
Hey, they were good enough to use as resource material, so they’re good enough for you to invest your time in reading…
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