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Medical Cannabis and Chronic Pain

The last few years has seen some movement in thinking and research on whether medical cannabis and chronic pain management can work together.   However the  Australian Federal governments last update on the subject was in 2017

Medical Cannabis has been widely accepted by the medical professions in America however the subject is highly politicised and permitted usage is State based – see an article from the Facial Pain Association below

Read article here

The FPA produced two extensive articles in their Fall/Winter 2018 and Spring/Summer 2019 which contain a huge amount of information, although based around American laws, the content and issues are very relevant.

FPA Medical Cannabis Part 1 FPA Medical Cannabis Part 2

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The Australian Government advise was issued in 2017  – see below for a portion of the advise.  The full article can be downloaded below

Medical Cannabis: Patient Information

Medicinal cannabis: patient information

Over the past few years, a number of Australians have expressed interest in the use of cannabis for medicinal purposes. The Commonwealth and State and Territory governments have either used their current laws or passed specific laws to allow the prescribing and dispensing of medicinal cannabis products. The Commonwealth, and in some cases, State and Territory governments, have also passed laws allowing cannabis cultivation and manufacture for medicinal purposes.

Currently there is limited evidence about the effectiveness of medicinal cannabis for use in different medical conditions. There is also little known about the most suitable doses of individual cannabis products.

For a particular product to be registered on the ARTG, a sponsor (usually a company) would need to submit a dossier of evidence on the clinical efficacy, safety and manufacturing quality of a particular medicinal cannabis product to the Therapeutic Goods Administration. At this time, the Australian Government does not subsidise the cost of medicinal cannabis products through the Pharmaceutical Benefits Scheme (PBS).

The Australian Government Department of Health and the NSW, Victorian and Queensland state governments commissioned a team from the Universities of New South Wales, Sydney and Queensland under the co-ordination of the National Drug and Alcohol Research Centre (NDARC) to review the available clinical evidence for using medicinal cannabis. The team focused on the five areas for which the largest numbers of studies have been carried out – palliative care, chemotherapy-induced nausea and vomiting, chronic pain, multiple sclerosis and epilepsy in paediatric and adult patients.

The researchers conducted a review of previously published reviews from multiple databases such as Medline, Embase, PsychINFO and EBM Reviews. Searches were guided by a specialist Librarian using specific search terms and were limited to studies published between 1980 and early 2017. Two reviewers independently examined titles and abstracts for relevance and the GRADE (grading of recommendations, assessment, development and evaluation) approach to evaluating the quality of evidence was also applied. The GRADE[1] method is the international standard that applies to weighting of evidence in scientific and medical literature and gives weight to certain evidence based on the level of evidence and strength of recommendation. For example, evidence as a result of randomised control trials (RCTs) are given priority because this study method typically yields more reliable results. RCTs are at the top of the hierarchy of evidence.

This brochure provides a broad overview of the current evidence to support using medicinal cannabis for the above conditions. It also highlights the cautions surrounding treatment, how medicinal cannabis can be prescribed and future research.

The Department of Health will update this brochure as new evidence emerges.

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There are companies who have invested in the business of providing Medical Cannabis in Australia.  These companies work within the guidelines of the laws governing the product.

An example is https://www.alternaleaf.com.au

Our mission is simple. We want to help people feel better.

We believe everyone should have the option to access natural alternatives over conventional medicines, and yet only 5% of Australian doctors are currently prescribing cannabis. We are here to help you get the right care so you can manage pain, anxiety, insomnia, mental health and other conditions, and live a better life. We are setting new standards in cannabis care by connecting thousands of Australians to qualified doctors and support you through our dedicated patient care team.

It is important to educate yourself on the subject and evaluate if Medical Cannabis could be of benefit to you, and always discuss your options with your primary medical practitioners.

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President’s Monthly Musing – Dec 2022 Thriving through Christmas Festivities

It is Christmas – when the world takes on a loving glow and everyone is excitedly looking forward to parties, carol singing, roaming around lit up streets, gathering with family and friends, eating too many chocolates, and generally eating too much all together……

Except that isn’t the case for many of our members who are dealing with the pain of trigeminal neuralgia.  Enduring stabbing pain, having the lightest of breezes or a cold evening trigger pain, dreading talking and eating, and all you want to do is stay quiet, calm and on your own……

So how do we make the most of spending time with family and friends at Christmas and thrive rather than survive. 

The following tips may help you create a plan around your festivities

    1. Shop online. This will allow you to avoid stressful traffic and crowded stores. You are also less likely to catch a cold, flu or covid when you shop from the comfort of your own home.

    2. Limit gatherings to smaller groups to reduce stress and pain.

    3. Start shopping early and wrap your presents early. If you wrap a few gifts per day vs. all of them at once, you’ll be less tired and less sore from being hunched over.

    4. If you are feeling anxious – pop on your favourite Christmas songs and enjoy the memories, they conjure.  Research has shown that music can relax blood vessels and increase blood flow.

    5. Set boundaries around your activities and let your family know what they are, so you can drop in and spend the time that suits you, rather than coping with a long afternoon of festivities.

    6. Learn what works best for you to reduce stress, sometimes fragrances like lavender can calm your mind, applying firm pressure on the fleshy place between your index finger and thumb, called the Hoku spot for just 30 seconds is believed to reduce stress and tension in your upper body which is used in traditional Chinese medicine.

Take care of your body

The holidays look different for everyone, but they often have a few things in common: too much food and alcohol, and not enough sleep and exercise. These unhealthy behaviours are the perfect formula for triggering illness and pain. To avoid these common pitfalls, take steps to protect yourself and your immune system by:

  • Getting enough sleep
  • Staying hydrated
  • Avoiding large, heavy meals
  • Limiting or avoiding alcohol
  • Exercising regularly
  • Washing your hands frequently

These steps can also help keep other health conditions in check, such as diabetes and heart disease.

Stick to your routine

When you live with chronic pain, routine is key — especially if you take medications or have interventional treatments. Unfortunately, it can be easy for schedules to get disrupted during the holiday season.

To avoid these complications, set an alarm on your phone and checking your medication supply to ensure you won’t run out over the holidays. You should also talk to your provider about scheduling any pain management treatments you may need to keep your symptoms controlled during the season.

As you celebrate the Christmas Festivities, take time to just enjoy those special moments, watching a smile radiate on a child’s face, smelling the food cooking, listening to your family’s laughter, holding the hand of your partner, being present for as long as you are able.  The memory of special days can often stay with us long after the tinsel has been cleared away.

No matter how you spend Christmas – please remember

“you are not alone”

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Julian Whittaker – Frozen in Fear – Waiting

One of our members has written an article which describes how he feels about the impact that trigeminal neuralgia has on him.

Frozen in fear. Waiting…by Julian Whittaker

All is fine in your world, as if Trigeminal Neuralgia was a myth.

The day is going well, but in the back of your mind you know anytime the evil thing can hit like a freight-train. Pain like you’ve never dreamed possible. Suddenly attacking out of nowhere, like a dozen white-hot electrically charged needles plunging into your face.

Then, almost as quickly as it arrives, it departs, after perhaps 10 seconds, maybe 20 or 30 seconds of agony. Screaming rolling on the floor pain. After minutes you’ve recovered, but you’re absolutely shaken.

The slightest breeze or lightest touch somewhere on your face can set it off, but where, when? That’s where the fear comes in. Expecting it.

Sometimes you wake in the morning frozen, knowing that any movement could set it off. You’re lying on your left arm which has gone numb, but you’re unable to turnover or move a muscle for fear of setting the pain off, (you’ll feel that dead arm all day, and the next too!).

You can just lay there, but you know you have to make a move eventually, aware that the electric-shock needles will then hit you, eventually you have to take a plunge into the pain.

I had a big ‘hit’ today, completely out of the blue, ironically just an hour before an appointment with my neurosurgeon who, 7 months ago operated using the ‘R F Ablation’ technique. This gave me 7 months free of the pain, which was a blessing, but I knew the procedure probably wouldn’t be a permanent cure. In the meantime, I thank ‘Trileptal’ for intercepting the pain. But…

…It’s back.

This is the reality for many of our members who are struggling to understand their pain, have not yet seen a neurologist, or who don’t have an operable option, or who don’t have good pain management plans, and who sometimes, just aren’t believed.

We have to raise our voices, describe, educate, provide information, support and find a permanent cure.

 

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MLS Treatment Therapy

So what is MLS Treatment Therapy, and how can it help sufferers of trigeminal neuralgia?

What is a Multi Wave Locked System?

The Multiwave Locked System (MLS®) is a new patented LLLT system that combines 905nm pulsed emissions with 808nm continuous emissions.I

It was developed by ASA Laser to help overcome some of the limitations on previous LLLT systems. The aim is to produce simultaneous actions on pain, inflammation and oedema. With the MLS® system it is possible to achieve strong anti-inflammatory, anti-oedema and analgesic effects simultaneously and in a short period of time.

The unique synchronised laser beam delivers a balance of the two wavelengths and powers providing safe and effective delivery. The optical design of the delivery system transfers energy up to 3 – 4 cm deep to effect tissue at a cellular level. The synchronised wave results in a synergistic effect where both the analgesic and anti-oedema effects are greater than if two single lasers had been used.

Research suggests for lasting effects from MLS Laser you will likely require 5-6 treatments depending on how your condition responds. Often you will experience a noticeable improvement after just 2 treatments.

For further information about the technology please See Here

This technology has been utilised for a number of years and research has been undertaken  Successful treatment for neuropathic pain with MLS®: a case study.

Some clinics use different terminology, however the MLS is used to deliver the treatment.

How does it work?

MLS Laser Therapy is a medical breakthrough therapeutic device with unparalleled applications and treatment outcomes. The laser works by converting light into biochemical energy, resulting in normal cell function, which causes symptoms (PAIN) to reduce significantly.

The primary biological action of PBM (MLS) Therapy results from stimulation of cellular transport mechanisms in the mitochondria, cell membranes and epithelial tissues. This action causes the release of vasodilating chemicals, the stimulation of DNA and RNA (building blocks) synthesis, an increase in enzyme production, normalisation of tissue Ph and increased ATP production (healing of the cells from the inside).

 

10 BENEFITS OF MLS LASER THERAPY

  1. Anti-inflammatory: MLS Laser Therapy has anti-oedema effect as it causes vasodilation, but also because it activates the lymphatic drainage system which drains swollen areas. As a result, there is reduction in swelling caused by bruising or inflammation.
  2. Analgesic: MLS Laser Therapy has a beneficial effect on nerve cells, it blocks pain transmitted by these cells to the brain which decreases nerve sensitivity.  Also, due to the decreased inflammation, there is less oedema and less pain.  Another pain blocking mechanism involves the production of high levels of pain killing chemicals such as endorphins and enkephalin from the brain and adrenal gland.
  3. Accelerated Tissue Repair and Cell Growth: Photons of light from the laser penetrate deeply into tissue and accelerate cellular reproduction and growth.  The laser light increases the energy available to the cell so the cell can take on nutrients faster and get rid of waste products.  As a result of exposure to laser light, cells are repaired faster.
  4. Improved Vascular Activity: Laser light will significantly increase the formation on new capillaries in damages tissue which speeds up the healing process, closes wounds quickly and reduces scar tissue.  Additional benefits include acceleration of angiogenesis, which causes temporary vasodilation and increase in the diameter of blood vessels.
  5. Increases Metabolic Activity: MSL Laser Therapy creates higher outputs of specific enzymes, greater oxygen and food particles loads for blood cells.
  6. Trigger Points and Acupuncture Points: MLS Laser Therapy stimulates muscle trigger points and acupuncture points on a non-invasive basis providing musculoskeletal pain relief.
  7. Reduced Fibrous Tissue Formation: MLS Laser Therapy reduces the formation of scar tissue following tissue damage from cuts, scratches, burns or surgery.
  8. Improved Nerve Function: Slow recovery of nerve functions in damaged tissue can result in numbness and impaired limbs.  Laser light speeds the process of nerve cell reconnection and increase the amplitude of action potentials to optimise muscle healing.
  9. Immuno-regulation:Laser Light has a direct effect on immunity status by stimulating immunoglobulins and lymphocytes.  Laser emissions are absorbed by chromophores (molecule enzymes) that react to laser light.  Upon exposure to the laser, the enzyme flavomononucleotide is activated and starts the production of ATP (adenosine-triphosphate), which is the major carrier of cell energy and the energy source for all chemicals reactions in the cells.
  10. Faster Wound Healing: Laser light stimulates fibroblast development in damaged tissue. Fibroblasts are the building blocks of collagen, which is the essential protein required to replace old tissue or to repair tissue injuries.  As a result, Laser Therapy is effective post surgically and in the treatment of open wounds and burns.

An interesting  in depth article covering every thing you need to know about MLS laser treatment in America, the history, the believers, the skeptics, the medical profession, the politicians and the people who use it

 Does it really work – blog

Pain clinics around Australia are now using this technology see below for examples – please note we do not recommend providers and suggest you discuss any new treatment options with your medical practitioners.

Introducing MLS Laser Therapy The first of its kind on the Central Coast

 

MLS Laser Therapy

Latest Technology

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4 What to Do When Your Surgeon Says There is Nothing Left to Do

FACIAL PAIN: A 21st CENTURY GUIDE 4 What to Do When Your Surgeon Says There is Nothing Left to Do For People with Trigeminal Neuralgia Neuropathic Pain By Jeffrey A. Brown, MD (USA) You think you will have a microvascular decompression (MVD), but there is no compression. Your pain returned after your MVD, and your doctor […]
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Facial Pain Diagnosis Tool Q&A – Dr. Kim Burchiel

Walking the path of facial pain  diagnosis for Trigeminal Neuralgia is not easy.  We know that many sufferers of Trigeminal Neuralgia struggle getting across to their medical practitioners where there pain is and how it feels for them.

  • The following information was published by the FPA in 2021 but is so relevant

Facial Pain Association

Neuropathic facial pain is diagnosed almost exclusively by the individual’s description of the symptoms. Dr. Kim Burchiel developed a list of questions to help doctors determine exactly which classification may describe a patient’s pain. You may want to complete the Burchiel Questionnaire for your physician as a way of helping to determine the correct pain classification. This questionnaire in the hands of experienced neurologists and neurosurgeons can be very powerful

 

Dr. Kim Burchiel, an OHSU neurosurgeon and one of the world’s leading experts on facial pain, talks with Shirley McCartney, Ph.D., about the facial pain diagnostic tool he developed.

McCartney is the director of clinical research at the OHSU School of Medicine’s Department of Neurological Surgery. She and Dr. Burchiel have worked together on many facial pain studies

Read the interview here

The questions that have been developed can be found below for your reference

QUESTIONS

1) When you have pain, is it predominately in your face (i.e. forehead, eye, cheek, nose, upper/lower jaw, lips, etc.)?

2) Do you have pain just on one side of your face?

3) Is your pain either entirely or mostly brief (seconds to minutes) and unpredictable sensations (electrical, shocking, stabbing, shooting)?

4) Do you have constant background facial pain (aching, burning, throbbing, stinging)?

5) Do you have any constant facial numbness?

6) Can your pain start by something touching your face (e.g. by eating, washing your face, shaving, brushing teeth, etc.)?

7) Since your pain began, have you ever experienced periods of weeks, months or years when you were pain-free? (This does not include periods after any pain-relieving surgery or while you were on medications for your pain.)

8) Have you ever taken Tegretol, Neurontin, Baclofen, Trileptal or other anti-seizure drugs (AED’s) for your facial pain?

9) Did you ever experience any major reduction in facial pain (partial or complete) from taking any of these AEDs?

10) Have you ever had surgery for your pain? (e.g. neurectomy, radiofrequency, lesioning, glycerol injection, balloon compression, rhizotomy, microvascular decompression or radiosurgery)

11) Did your current pain start only after trigeminal nerve surgery? If this is a recurrence of your original pain after successful trigeminal nerve surgery, the answer is, “no”.

12) Did your pain start after facial herpes zoster or “shingles” rash (not merely “fever blisters” around the mouth)?

13)Do you have multiple sclerosis?

14)Did your pain start after a facial injury?

15) Did your pain start only after facial surgery (i.e. oral surgery, ear/ nose/throat surgery or plastic surgery)?

16) When you place your index finger right in front of your ears on both sides at once and feel your jaw open and close, does the area under your fingers on either side hurt?

 

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Emergency Department – Break-through Trigeminal Neuralgia Pain

This week the Association launched our Emergency Department plastic wallet cards – to assist sufferers with communicating when attending a hospital emergency department with break-through trigeminal neuralgia pain

The following study highlights why this is such an important issue – and very relevant to all of our sufferers

Treatment of acute exacerbations of trigeminal neuralgia in the emergency department: A retrospective case series

Affiliations

  • 1Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.
  • 2Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.

Abstract

Objective: To evaluate the response to treatment of acute trigeminal neuralgia (TN) exacerbations in the emergency department (ED).

Background: TN is characterized by recurrent and intense pain paroxysms. Some patients experience severe acute exacerbations requiring ED presentation. The optimal management of these episodes is not well established.

Methods: We present a case series of TN exacerbations in adults who presented to the ED of a tertiary centre from January 2008 to December 2020. We analysed demographic and clinical data, including pharmacological management in the ED. The primary outcome was pain relief, classified into “no relief,” “partial relief,” and “satisfactory relief” based on the qualitative description in the ED’s records.

Results: Ultimately 197 crisis episodes corresponding to 140 patients were included. Most were women (61%, 121/197) with a median age of 63 years (interquartile range: 52-73). Acute TN exacerbations were treated with opioids in 78% (108/139) of crisis episodes, nonsteroidal anti-inflammatory drugs in 42% (58/139), corticosteroids in 21% (29/139), intravenous phenytoin in 18% (25/139), and intravenous lidocaine in 6% (8/139). Of the 108 cases treated with opioids, 78 (72%) required additional drugs for pain management. Intravenous phenytoin allowed satisfactory pain relief in 64% of cases.

Conclusion: In our sample, opioids were the most used therapeutic approach in acute TN exacerbations despite their low efficacy and subsequent need for further drug treatment in most cases. Most crisis episodes managed with intravenous phenytoin reached total pain relief. Prospective studies are needed to guide the treatment of acute exacerbations of TN.

Keywords: emergency department; exacerbation; lidocaine; opioids; phenytoin; trigeminal neuralgia.

Similar articles

References

REFERENCES

    1. Melek LN, Devine M, Renton T. The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review. Int J Oral Maxillofac Surg. 2018;47(7):869-878.
    1. van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654-662.
    1. Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain. 2017;158(6):1166-1174.
    1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. 2018;38(1):1-211.
    1. Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Pract Neurol. 2021;21(5):392-402.
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Emergency Department Plastic Wallet Cards

Following the webinar presented by A/Prof Arun Aggarwal in July, we brainstormed the possibility of providing a plastic wallet card for our sufferers to present to the Emergency Department of their hospital, when Trigeminal Neuralgia break through pain becomes too much to cope with. We worked with PR Design and produced a fantastic card which […]
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3.7 Motor Cortex Stimulation

FACIAL PAIN: A 21st CENTURY GUIDE For People with Trigeminal Neuralgia Neuropathic Pain 3.7  Motor Cortex Stimulation Olga Khazen, BS and Julie G. Pilitsis, MD, PhD Not all facial pain is TN. This is a common mantra of experienced physicians to their trainees. How to differentiate between TN, especially TN type 2 and trigeminal neuropathic […]
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Webinar – Prof Arun Aggarwal- presenting to the emergency department for pain management

When Trigeminal Neuralgia pain is too much: presenting to the emergency department for pain management

In July 2022 we were delighted to host a webinar chaired by A/Prof  Liam Caffery and presented by Prof Arun Aggarwal

Professor Arun Aggarwal is a highly experienced neurologist with expertise in chronic pain management.

Professor Aggarwal graduated from the University of Adelaide in 1987 and went on to specialise in neurology, rehabilitation medicine and pain medicine and is a Fellow of the Royal Australasian College of Physicians, the Australasian Faculty of Rehabilitation Medicine, and the Australasian Faculty of Pain Medicine.

Professor Aggarwal completed his PhD at the University of Sydney on motor neuron disease. He currently oversees a number of research trials at the University of Sydney’s Medical School including trials on trigeminal neuralgia and chronic neuropathic pain.

Professor Aggarwal sits on the on the Medical Advisory Board of Trigeminal Neuralgia Association.

In this webinar he will speak on “When trigeminal neuralgia pain is too much: presenting to the emergency department for pain management”

You may download the presentation with this link Acute Pain Management for Trigeminal Neuralgia - A/Prof Arun Aggarwal

Our Association is working hard to provide clearly understood information, not only to our sufferers but to the medical and dental profession.  We thank all who logged in to watch the webinar live and they had the opportunity to ask questions and receive replies.

We would like to thank our Medical Advisory Board Members for the work they do and the advocacy they provide to all sufferers.  Contact details for our MAB members can be found here

 

012 – YouTube TNAA – Prof Arun Aggarwal – When Trigeminal Neuralgia pain
is too much Presenting to the Emergency Department