Musculoskelatal Disorders

(Osteoarthritis, Disc Disease, etc.)

Arthritic complaints, bad backs, sore necks, and injuries have been with us as long as we’ve been human. As many as 100 million Americans suffer from chronic complaints of this sort. They vary from annoying to disabling. Depending upon the origin of the complaint these disorders tend to be chronic. What might work for a short-term illness or complaint may very well not work when the disorder is long term and/or progressive.

As in any other disease or disorder, patients should first consult a primary care or family physician about their problem. Examination by a specialist and advanced diagnostic procedures are essential to understanding the nature and degree of any disorder. X-ray, MRI, CAT scan or even endoscopic procedures may be employed. This said, most of us with a bad back or arthritis have to muddle through, prey to bad weather and gravity. Activity hurts and prolonged in-activity seems to make things worse.

Physical therapy and Non-steroidal Anti-inflammatory Agents (NSAIDS) are the major responses to musculoskelatal problems. Properly conducted, physical therapy is of tremendous benefit for most. NSAIDS, though, provide only limited relief and can have serious side effects, particularly gastric upset. New classes of medicines called “COX-2” inhibitors have fewer GI problems associated with long-term use but are also limited in their degree of relief.

As these disorders progress, medicine looks to occasion relief with narcotics. Many patients can become opiate dependent over the course of time and significantly increase both the dose and frequency of dose in order to maintain the fleeting effects of the drugs. Therapy with long acting narcotics such as methadone and Oxycontin may be employed producing better pain relief but a more profound addiction. For more on pain management and addiction please refer to those pages.

Often, local injections of cortisone are used to quiet inflamed areas. These injections can be painful and are of limited utility. In good cases up to six months of relief may be established. A series, as opposed to a single “shot” may be necessary. Should you consider “epidurals” or joint injection it is advised you find a licensed practitioner who specializes in these procedures and does a lot of them.

As time goes by and discomfort increases, surgery may be suggested. Surgery is never a minor consideration. Obtaining second and even third opinions is strongly advised. Surgical “outcomes” vary. All surgery has major risks. Lower back surgery, in particular, has mixed results. Should you consider this option it is strongly advised you find a specialist in your particular disorder and who operates frequently, preferably at a University associated medical facility.

Numerous alternative therapies are available including biofeedback, acupuncture, self-hypnosis, and herbal supplements. Patients have mixed results with alternative therapies but they should be tried before resorting to the more extreme procedures. Oral and topical supplements of chondroiten and glucosamine may be particularly helpful.

So where can adjunctive therapy with cannabis be helpful? You’d be surprised.

Topically applied tinctures, oral tinctures, cannabis food products, inhalers, and smoking have all been used alone and combination to supplement (not replace) traditional treatment.

Cannabis is both an anti-inflammatory and pain relieving medicine. As such its broad action addresses a number of different aspects of musculoskelatal problems. Most pain is caused by inflammation, particularly where nerves may be impinged. The mechanisms of inflammation and pain are extremely complex. Different medicines try to intervene in one of a number of inter-related pathways. Cannabis impacts on many different pathways serving to inhibit prostaglandins, to scavenge free radicals, inhibit COX-2, reduce autoimmune cells like macrophage, and inhibit pro-inflammatory cytokines like TNF. At the same time cannabis reduces the muscle spasm associated with pain of this type. In the central nervous system, cannabis helps block ascending pain signals and binds to natural pain relieving sites in the brain. In some patients, cannabis provides relief from the depression that can often accompany long-term illness.

The comprehensive actions of cannabis have attracted new scientific research. Dozens of new anti-arthritic and pain medications based on different cannabis actions are now in development by major pharmaceutical companies.

Tincture: High-grade pure extract of cannabis in ethanol is obtainable. Usually just 1\2 of an eyedropper of tincture in cranberry juice or tea is sufficient to provide long lasting relief. Tincture can also be applied topically in conjunction with ice packs. A detailed description of tincture and methods of preparation can be found under “Routes of Delivery and Doses”.

Smoked or Inhaled: Every patient is different in terms of the dose needed. Dose is variable depending upon level of discomfort, tolerance to the effects of cannabis, the strength of the cannabis used and the strain. Most strains today are hybrids having the properties of both Indicas and Sativas.

Food products: Food prepared with cannabis including “bud” butter, oil, leaves, and flowers is perishable. Cannabis treats should be refrigerated in airtight containers. Many such products can be frozen. Eating food products with cannabis produces less intense effects that last significantly longer. Usually the dose required from a food product is 4x-10x the amount smoked.

Medical References: National Library of Medicine - PubMed

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