3 Ways To Treat Pain And Inflammation
Pain is the number one reason people seek medical treatment. It affects our short term (acute pain) and sometimes long term (chronic pain). It negatively affects workplace productivity, our social interactions, and the ability to exercise and be active in life.
From a medical perspective, pain can be divided into various subcategories, neuropathic pain (for example diabetic neuropathy or sciatica), visceral pain (gallbladder pain, bowel distension) and nociceptive pain, which includes inflammatory pain (arthritis of joints/spine, trauma pain, or ankle sprain)
Inflammation is a needed and necessary part of the acute healing process. After an initial insult to the body, inflammation can persist longer than needed, causing more harm than good. From a chronic perspective, inflammation in an unfortunate by-product of continued degenerative joints/tissue and is one of the sources for persistent pain.
From a therapeutic perspective, there are generally 3 types of groups that treat inflammation via anti-inflammatory activity.
Corticosteroids are a subclass of steroids that are recognized as having the most potent anti-inflammatory activity. These types of steroids include Prednisone as an oral medication that some people who have severe rheumatologic or arthritic diseases may need. These are also the same type of medication that we inject for spinal inflammation such as facet or epidural steroid injections. Occasional use typically is without significant side effects, however, long-term use is associated with reduced adrenal function, diabetes, insomnia, swelling, mood changes, and blood pressure changes to mention a few.
2. Non-Steroidal Anti-inflammatory medications (NSAID’s)
These medications have a long history of anti-inflammatory activity. They are available both over the counter (Ibuprofen and Naprosyn) and prescribed (diclofenac, meloxicam, celecoxib). They all work generally by inhibition of cyclooxygenase (COX-1 and COX-2) enzymes. Side effects for the NSAID’s include gastrointestinal (ranging from gastritis to bleeding ulcers), renal (decreased kidney function to acute renal failure), cardiovascular (increased blood pressure, increased thrombotic events, congestive heart failure), and neurologic (increased risk of stroke) to name a few. It is estimated that there are 16,500 NSAID related deaths per year.1 In addition to the side effects listed, there are many patients that cannot take NSAIDS because it can be a potent anticoagulant (blood thinner). For people with a history of recent or recurring stroke, heart attack, prosthetic heart valve or other medical condition requiring an anticoagulant medication such as Lovenox, Warfarin, Xarelto, Eliquis, Pradaxa, adding NSAIDS can thin the blood out too much.
3. Cannabidiol (CBD)
CBD has been looked at only recently as the presence of the endocannabinoid system (ECS) has only recently been discovered (1980’s) and research is ongoing and continuing to discover wide-ranging effects of the ECS system, its receptors CB-1 and CB-2, and how CBD affects the receptors to provide beneficial therapeutic action. The most prominent data regarding CBD and its ability to provide pain relief is through its anti-inflammatory activity ²,³ Mechanism of action relates to the arachacitidonic acid pathway ⁴ and direct targeting of a3 glycine receptors.⁵ One of the equally impressive features of CBD is its lack of severe side effects. We have seen side effects in our clinic with The Physicians Choice CBD to include mild gastritis, headache and agitation, all less then 1% giving it the most favorable side effect profile of the subgroups. As Board Certified Pain Specialists, Dr. Kubitz and I treat inflammatory pain every day. There is no easy or one answer to every pain-related condition. Many of our decisions regarding therapeutic options center upon the particular risk and benefit ratio for each and every medication. There are instances that we feel each and every subgroup listed above is the best option for a particular patient. Our feeling, however, is that CBD has an ever-increasing niche in the treatment of pain from inflammation given its clinical benefit and low side effect profile. We would urge healthcare providers and the general public to consider CBD as a realistic option in their decision making regarding safe and effective treatment for inflammatory pain.
1 Am J Manag Care. 2013;19(16 suppl):S267-S272
₂ Future Med Chem. 2009 Oct; 1(7): 1333–1349.
³ Journal of Pharmacology and Experimental Therapeutics June 2018, 365 (3) 652-663;
⁴ Prostaglandins and Medicine Volume 4, Issue 6, June 1980, Pages 409-417
⁵ J Exp Med. 2012 Jun 4;209(6):1121-34. doi: 10.1084/jem.20120242. Epub 2012 May 14.