Cannabis & Chronic Pain

By Lea Holz

AN INTERVIEW WITH DR. GREGORY SONN OF THE IONA CANNABIS CLINIC

I found myself sitting in a room of twenty or so recently-hired budtenders in Boulder, Colorado, listening to a lecture from our new managers on qualifying conditions for medical marijuana patients. “Who in this room has experienced chronic pain?” asked one of the trainers. To my surprise, nearly all hands in the room shot up into the air, and most of those hands belonged to women. It may have been shocking at the time, but chronic pain—medically-defined as pain that lasts longer than three months—is no stranger to the vast majority of Americans. And just like that room full of newlyhired employees, over half of Americans struggling with pain that lingers are female.

Chronic pain affects about 100 million people or one third of the population. 1 Combine those in the United States suffering from diabetes, cardiovascular

disease, and cancer, and their numbers still aren’t as great as those suffering from this common condition. Of those with chronic pain, a whopping 70% are women. 2 On top of this, an estimated and staggering 80% of our population suffers with some form of depression and anxiety, which is often associated with the coping of physical pain. And, you guessed it, from the age of puberty to the age of menopause, a woman is twice as likely to have an anxiety disorder as a man. 3

It’s no wonder, then, that a 2017 report found that of the 813, 917 registered cannabis users in the United states, 62.2% were using it to treat their enduring pain. 4 This represented the largest group of people using cannabis for evidence-based conditions in the study and appears to mirror what we see in dispensaries and doctor’s offices around us. It seems that across the board, chronic pain has become an epidemic. Thankfully, medical cannabis offers a viable option for relief, and healthcare professionals in the cannabis space are here to help guide the way for patients seeking help.

I sat down with Dr. Gregory Sonn of the Iona Cannabis Clinic to get a better idea of what chronic pain means, involves, and what new patients should keep in mind during treatment with cannabis products.

Chronic Pain is the number one diagnosis that Dr. Sonn treats in his practice. He defines chronic pain as any type of physical and or emotional pain that has extended past the normal period of time. Of course, what is considered normal often varies person to person.

“For a PTSD or emotional pain patient,” says Sonn, “the expectation for pain to linger is six months. For a physical pain patient, it is three months. So, for example, if there is a death in the family and a person is still severely grieving after 6 months, that is considered chronic. For a physical pain patient: pain that lingers after the initial onset that should have dissipated, but has not, is considered chronic.”

As is proven in study after study, women’s health is a unique entity. The female body responds differently than the male body when it comes to many forms of treatment; it also responds completely differently to pain. A substantial amount of data even suggests that women feel pain more strongly and acutely than men. Unfortunately, the way doctors treat most ailments is based on understandings of male physiology 4 , and women thusly experience a higher rate of misdiagnosis. One study even found that women were seven times more likely to be misdiagnosed and senthome from the hospital in the middle of having a heart attack than their male counterparts. 5

Interestingly, women are also less likely to turn to opioids for their chronic pain. Perhaps this is why Dr. Sonn recognizes some of the unique trends amongst his female patients that he keeps in mind when considering cannabis treatment options.

“In general, the women I see are more likely to acknowledge significant pain issues and potential treatments. They seem in general to be more open to natural alternative options,” he says. “There are definitely groups of people (women aged 30 to 50 years old, for example) that have this unbelievable amount of anxiety and depression that they are willing to acknowledge and treat. When we get to the 50 to 80-year-old-women, they definitely acknowledge the greater pain aspect and treatments more openly.”

The doctor’s experiences run parallel to findings from a review of 18 studies completed by Miaskowski and colleagues, who observed lower opioid consumption postoperatively among women. 6 Could this be due to a higher tendency amongst women to consider and seek out natural alternative therapies?

There are a myriad of options for women seeking chronic pain relief through medical cannabis. Transdermal patches, salves, and skin creams containing CBD and other cannabinoids are used by many patients with joint pain, menstrual cramps, and muscle soreness. Tinctures, tablets, and concentrates provide a familiar route of delivery for patients who are trying to reduce or discontinue their opioid medications. Full-spectrum products and whole flower cannabis for vaporizing or smoking are also options some patients use for more intense or psychological pain. Each patient’s ideal dose and delivery method is unique.

“My patients greater than 50, for example, generally prefer oral medicines specifically and find pretty good comfort, confidence, and success,” Sonn says, “While my younger groups of female patients are definitely finding their way to inhalation products.”

Talking to your doctor about your homestate’s available options is the best way to determine the best product or method for you.

Dr. Sonn finds a high level of success with most of his chronic pain patients who seek medical cannabis as an option. However, there are a few conditions that are tricky to treat and do not always respond well to cannabis therapies.

“In my practice, I’ve had poor responses in women with iatrogenic tremors,” says Sonn. “It unfortunately is not one of the things I see good results for. I also see a lot of women with Rheumatoid Arthritis (RA). The problem with advanced RA is that cannabis works best with this when prescribed at an early age, before the condition has had a chance to advance.”

For this reason, Dr. Sonn encourages any young women diagnosed with any type of RA to get into their state’s cannabis program as soon as possible to prevent the advancement of this—or any— disease.

“My recommendation, when it comes to a medical cannabis evaluation, is to do it as soon as you have a thought about it,” Sonn says. “If you are thinking about cannabis as a treatment option, try it. Because if you think it will help, it likely will. And the sooner you can break those cycles of chronic pain, the better you will feel.”

1 Ivker, Dr. Rav. Cannabis for Chronic Pain. New York: Touchtone, 2017. Print. - 2 https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562 - 3 https:// adaa.org/living-with-anxiety/women/facts - 4 http://www.nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx - 5 https://www.health.harvard.edu/blog/women-andpain-disparities-in-experience-and-treatment-2017100912562 - 6 https://www.nejm.org/doi/full/10.1056/NEJM200008243430809 - 7 https://www.jpain.org/article/S1526-5900(04)01114-9/fulltext