There are few more hotly debated discussions in the USA than the use of medical marijuana. With the common and often ugly image of drug addicts smoking joints, it’s easy to think of marijuana as just a street drug. Yet, if we could remove that image from the American psyche and replace it with that of a medication hat reduces pain with far fewer side effects than other pain medications, would it be more well received?
A Spring 2010 legislative report produced by the University of California San Diego (UCSD) Center for Medicinal Cannabis Research shared the results of five scientific clinical trials that “showed that cannabis can be helpful in easing pain in selected syndromes caused by injury or diseases of the nervous system and possibly for painful muscle spasmsdue to multiple sclerosis.” (1) I found this report compelling. These aren’t guesses made by people desperately hoping to legalize marijuana. These are valid, scientific studies that show that it has the potential of helping pain patients who may have found little relief from traditional medications.
New research has since emerged which, yet again, shows the pain fighting properties. On July 1st, 2010, the International Anesthesia Research Society (IARS) released a paper discussing a marijuana derivative (MDA19) that helps to fight neuropathic pain yet does not trigger the typical physical and emotional side effects associated marijuana use. (2) Isn’t that interesting? If research can take out the components of marijuana that help patients “get high” and keep the components that fight pain, wouldn’t that be a credible use of MJ? Could medicinal marijuana help with bladder pain? It might be worth considering.
Patients Debate the Issue
I was curious about how patients would respond to this research report and posted a link to it on my Facebook page. The first, somewhat angry, response set the tone for a vibrant debate. She said “I believe medical marijuana is just an excuse for people to do drugs.” Another offered a thoughtful counterpoint. “We should all keep an open mind about treatment options out there. Marijuana has a bad rap because people label it ‘recreational.’ What about the ‘recreational’ use of prescription meds in this country? It’s not like prescription pain killers don’t come with a huge list of side effects, including dependency…”
Most patients were receptive to the possibility that medical marijuana could offer new treatment options. “I would have no problem with this at all. I don’t see how this could possibly be worse than using stronger, more damaging drugs. It has the possibility of really helping some people and that’s what matters to me. I see no difference between using this and using any other drug for a medical purpose. I’m not going to get hung up in preconceived notions of what is a ‘good drug’ and what is a ‘bad drug’.”
Two key issues were legality and professional responsibility. One patient said “I would try it if it was legal here. I would much rather go to that than narcotics. But I live in the one state it will never be legal in.” Another offered “As I am a school librarian, I could never use marijuana (I could lose my job) but I would not begrudge anyone legal pain relief and it is legal in some states.”
And the conservative parents of an IC patient spoke out “I’ve seen my daughter suffer all her life beginning with kidney surgery at the age of 2 weeks of coming into this world. Believe me she has tried so many things and she has yet to find anything that will reduce the intensity of the pain she suffers every single day. Along with IC, she also has developed a number of additional health issues. Coming from a very old fashioned strict family background I never considered MJ until this illness intensified over the years. Now I, along with her extremely old fashioned grandparents, fully support medicinal MJ. I would prefer to find ways to improve my daughter’s quality of life than label it as an excuse.”
Survey Studies Marijuana Use in IC Patients
It dawned on me that this is such a politically sensitive topic that no researcher had, up to this point, asked IC patients if they did use marijuana to help reduce their symptoms and, if so, did it help. So, last July, I created an online survey to ask these questions. As of press time, 118 IC patients had participated. 67.5% of patients reported that they have used medical marijuana in the past six months to help improve their pain with different levels of success. For a fortunate 18.2% of survey respondents, marijuana made their symptoms go away completely. The majority of patients (63.6%) reported that medical marijuana reduced their symptoms by 50%. 14.8% reported that their symptoms reduced 25%. Two patients reported that it did not help their symptoms and one reported that marijuana made their symptoms worse.
The survey demonstrated that patients use marijuana primarily for its pain fighting properties. 31.8% of patients reported a complete resolution of their pain with another 55.7% reporting that their pain was reduced by 50%. Only 3.4% of patients reported that it did not reduce their pain. Like the research suggests, marijuana does seem to target neuropathic pain. One patient said “The nerve pain was almost gone for 2 to 3 hours.” One man reported that it “reduced his testicular pain, perineal pain and ano/rectal pain.” Others found that it helped their back pain and migraines.
Given the research that found that medical marijuana could help reduce the muscle tension in patients struggling with multiple sclerosis, we were curious to see if it could help with pelvic floor dysfunction and the data suggests that it does. 31.3% of patients reported that their muscle tension completely improved with one patient offering “It reduced the continuous spasm that comes with IC by 70%. This resulted in a reduction in pain – so less medicine has to be taken.” Another 43.4% reported that their muscle tension improved by 50%. It did not improve the muscle tension in 12% of patients participating in the survey. Several patients reported that marijuana reduced the pain that they had experienced with intimacy. One patient noted that it “changed my perception of pain. I was able to eat due to the lack of pain. Sexual relations were normal and painfree after many years of suffering.”
Patients also reported similar relief with their frequency and urgency. Roughly 56% of patients reported that their frequency improved at least 50% while 52% reported a similar improvement with urgency.
Marijuana substantially improved sleep quality in 78.2% of patients. One patient reported “The sleeping part helped a lot, I did not wake up to urinate at all. It numbed my bladder, a very awesome feeling.” 27.6% of patients reported that they could sleep through the night without getting up to use the restroom. 50.6% of patients reported that they can sleep normally and get up only once or twice a night after using medical marijuana.
Several patients reported that marijuana helped reduce their panic and anxiety levels dramatically. One patient said that it “greatly reduced panic, anxiety, IBS, GERD, depression and fibromyalgia.” Another said that it reduced “anxiety about how the flare was going to impact my life.”
Several patients noted that it improved nausea, stomach and bowel problems. One found relief for her painful bowel movements. She said “when smoking marijuana I would have total comfort, almost no flank or pelvic pain. I would be able to have comfortable bowel movements with no spasms.” Another said “I get terrible stomach cramps from my IC. Marijuana can help reduce or sometimes completely eliminate all of the cramping. It also helps with some of the bladder spasms and spasms I feel in the urethra.” Another noted that it helped reduce the nausea she experienced as a side effect from various medications.
As has been widely reported in chemotherapy patients, marijuana also helps patients eat. One IC patient offered that marijuana did not help her bladder symptoms but it did improve her appetite. She said “It stimulated my appetite and helped me eat more. I have accidentally lost 10 pounds since my diagnosis 7 months ago due to my extreme diet change and being afraid to eat. Medical marijuana encourages me to eat!”
We were curious to see if marijuana actually worsened any IC symptoms. Of the 45 people who answered that question, less than five reported that it triggered symptoms. One said “It did make the urine burn more than usual.” Another said “It can increase my urinary frequency but it reduces pain.” Others reported diet induced flares “I didn’t pay attention to what I was eating (pizza, chocolate, pop).”
The far more frequent response was “no” or “Just the opposite. It can stop a flare before it builds up steam.” One said “Medical marijuana helps me in an immediate flare-up. If I use it soon enough after I feel a flare building, it numbs the pain and the urgency much sooner than were I to take some OTC Pyridium or get an emergency instill from my urologist. It does not cut down the pain of urination but it does stop the stabbing radial pain in my pelvic and abdominal area.”
Smoked or Ingested
As I cited in the introduction to this story, some companies are developing cannabinoid analogues that may be delivered in pill form. But, for now, the most popular method of ingesting marijuana is clearly by smoking it with 97% of our survey respondents reporting that that’s how they have used it. Like cigarette smoke, marijuana smoke has chemical by-products that can irritate the bladder. Medical researchers in Europe are currently testing a new, more promising way to deliver marijuana through an inhaled vapor.
I have mixed feelings about marijuana. I think the perception of drug addicts using marijuana is valid. I worry about teens becoming addicted to recreational drugs and that marijuana is a natural starting point in drug use. Yet, I stand 100% against suffering. Some IC patients, myself included, have had extreme pain that required emergency room visits and hospitalizations. If there’s a chance that medicinal marijuana can reduce that suffering, then I think it deserves careful consideration.
I start with the research. The new UCSD report caught my attention. It’s credible, scientific and gives both patients and policy makers a chance to look at the evidence available. I strongly encourage you to read it. If we had no studies that showed that marijuana could reduce pain, then I wouldn’t be writing this article.
The ICN Survey on Medical Marijuana and IC is very preliminary but also a fascinating glimpse into this controversial topic. Clearly, some patients have found medicinal marijuana to be helpful in the reduction of their pain, their pelvic floor dysfunction, bladder spasms, night time sleep quality, etc. However, we must do more work to further understand how it might help pelvic pain patients.
In the next article, Stacey Shannon shares new research about cannabinoid receptors in the bladder and a possible new bladder instillation using marijuana under study. How’s that for shocking? And, of course, legality is the most important issue of all. I don’t want patients to read this article (and the next) and assume that they should try marijuana if it’s illegal in their state. There is a serious, real risk of criminal prosecution. You should explore the pain management options that are legally available to you.
If medicinal marijuana is approved in your state and you struggle with pain and/or using strong pain medications that limit your life due to side effects, I think it’s worth discussing it with your doctor. That’s one benefit that might be underestimated. Traditional pain medication is notorious for causing side effects, particularly severe constipation. If using marijuana can resolve that issue, that’s also worth considering.
I encourage you to be sensitive to the impact of marijuana on your family and friends as well. Second hand smoke has health risks that are
1. Center for Medicinal Cannabis Research: Report to the California Legislature (2010) http://www.cmcr.ucsd.edu/
2. Xu J, Diaz P, Astruc-Diaz F, Craig S, Munoz E, Naguib M. Pharmacological Characterization of a Novel Cannabinoid Ligand, MDA19, for Treatment of Neuropathic Pain. Anesthesia & Analgesia July 2010 Vol. 111 N. 1 99-109
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