Written by Lawrence May, M.D., F.A.C.P. originally for Micro-Cap Review Magazine
By Lawrence A. May, M.D., F.A.C.P.
Chief Medical Officer, Marpella, and practicing internist.
In contrast to the fictitious Dr. McCoy (“Bones”) of Star Trek fame, we don’t have a hypospray to magically erase pain, nor do patients insist on retaining pain as part of their identity. The unvarnished reality is that many people are desperately seeking better, natural alternatives for pain control. Their basic quality of life is profoundly damaged by their pain. As a physician, I understand the pain my patients suffer, the causes, and the consequences of bad treatments. I have become convinced that cannabis can be an effective option and complement to other modalities to alleviate the pain and suffering of many people.
Pain is a universal and complex symptom and medical challenge to diagnose and treat. It can be a symptom of a serious medical problem demanding the clinician’s diagnostic expertise and requiring the clinician to acquire the patient history, perform the physical exam and order the appropriate laboratory and imaging tests. What makes pain complex and insidious is that it is subjective. The perception, intensity and demands for diagnosis and/or relief are influenced by psychology and an individual’s tolerance for discomfort. Athletes and soldiers often function with intense pain suppressed by an outpouring of neurotransmitters precipitated by the stress. Others are incapacitated and seek relief from what appear to be mild injuries that are perceived as serious or disabling. Pain provokes anxiety because chest pain is feared to be a heart attack or headache is thought to be a brain tumor.
There are two basic types of pain: nociceptive pain and neuropathic pain. Nociceptive pain is produced by obvious triggers–falling, getting hit with a baseball or touching a hot stove. These painful events of daily living provoke a normal and protective pain response. Neuropathic pain is an abnormal or harmful response caused by hypersensitivity and/or nerve damage. It may be an exaggerated response to a painful stimulus or an unpleasant reaction to a normal sensation such as temperature or touch. This dysfunctional pain is often chronic, debilitating and more challenging to treat.