Orthopaedic Surgeon Supports Cannabis as Medicine

Dr. Frank D’Ambrosio is an author and orthopaedic surgeon with over 30 years of experience treating and operating patients. He works at the California Orthopedic and Spine Medical Group and is a staunch medical marijuana advocate. Here, he explains why cannabis could work as a therapeutic option for spinal injuries. I have been an orthopaedic surgeon for around 30 years now, meaning that I tend to injuries to the musculoskeletal system. This includes bones, joints, ligaments, tendons, muscles and nerves. Anyone who knows anything about orthopaedics will also realise that I work with spinal injuries, too - one of the most complicated parts of the human body to operate on, and one of the parts where so much pain stems from. As part of my job, I have seen patients for whom a life of pain is a very real prospect. Unfortunately, for many, this may also mean a life of being addicted to very addictive and dangerous opiate- or opioid- based painkillers. I started paying more and more attention to cannabis, and the increasing amounts of evidence proving its efficacy in dealing with a broad spectrum of health issues. Sure, the medical world knew marijuana had uses for cancer, AIDS/HIV and glaucoma sufferers, but it didn’t just stop there. Evidence started to come out about marijuana’s uses for combating epilepsy, nervous system conditions like multiple sclerosis (MS) and Alzheimer’s disease, mental health problems like depression and anxiety, Crohn’s disease and lots more besides. There was also the discovery of the endocannabinoid system (ECS) in the early 90s - a system that turns out to be immensely important for keeping the body’s physiological processes in equilibrium (homeostasis). The laws considering cannabis to be a Schedule 1 drug with no medical benefit had started to look more and more like a farce. Then, about 5 years ago, I started to dedicate more of my time to medical marijuana and becoming an advocate for patients - sick people who were essentially denied medicine because of draconian government policies. As for my specialty area of orthopaedics, marijuana has plenty of uses. In my area of work, addictive & dangerous painkillers are prescribed on a daily basis, sometimes without even a second thought. This has lead to a prescription drug crisis that sees thousands of people die needlessly from overdoses every week. Moreover, those who start using painkillers like percocet, vicodin and oxycodone today are likely to become the morphine and heroin addicts of tomorrow. For many painful conditions concerning the musculoskeletal system, being prescribed painkillers is the norm. Marijuana is perhaps the perfect replacement. There are several good reasons for this, including:

• Opioids and opiates block out opiate receptors (delta, kappa, mu zeta and nociceptin) entirely - to such an extent that the body stops producing its own natural painkiller, endorphin. Marijuana not only works on the ECS, but on the opiate receptors in the body, too - without the addiction.

• Opiates are effectively useless for nerve pain, whereas cannabis is not. This is because marijuana works on the ECS, and opiates/opioids do not.

• There are a huge number of cannabinoids and terpenoids- not all of which are psychoactive - that have beneficial medical properties. Lavender, for example, is a great stress-buster, whilst the non-psychoactive cannabidiol (CBD) is a proven anti-inflammatory and neuroprotective.

This makes marijuana a better medication for a broad-spectrum of illnesses and diseases, unlike opiates/opioids.

• Opiates/opioids are not ideal for chronic pain, and its side-effects are far more extreme than those arising from marijuana use.

• Back pain in particular is difficult to manage, and carrying out surgery on spines can be not only risky but ineffective due to the number of complications that can arise (i.e. it can sometimes make things worse rather than better).

What’s more is that it is sometime extremely difficult to find out where back pain is coming from. This can make such pain difficult to manage, and figuring out the right medications can be a risky business. Marijuana can help overcome such obstacles. We must also look at the different types of pain, and how marijuana can help …

• Somatic Pain - This is where pain signals travel through to the brain via the peripheral nerves from the injured area. Typically experienced as a constant, dull ache localized in a particular area.

Somatic pain is caused by the nociceptor (pain-detecting) nerve cells responding to damaging stimuli by sending signals to the spinal cord and brain. Cannabinoid receptors modulate nociceptive thresholds, inhibit production of inflammatory molecules and display synergistic effects with other systems that influence analgesia, most notably the endogenous opioid system.

• Visceral Pain - When tissues or organs are stretched or disturbed due to disease or injury. Pain signals are sent from specific areas of the gut, and produces a feeling of deep pressure in the abdomen. Visceral pain can sometimes be experienced as referred pain, meaning pain that seems to be coming from a different area of the body.

Visceral pain triggers the same nociceptor cells that somatic pain does, except the receptors triggered are in the gut. Such pain usually indicates damage or problems with the internal organs. This is also why marijuana can treat stomach conditions like irritable bowel disease (IBS), Crohn’s disease and other conditions that cause bowel inflammation.

• Neuropathic Pain - Pain that arises from nervous system injury, disease or damaged, often experienced as a “burning” sensation.

Neuropathic pain results from damage to the peripheral nerves or central nervous system (CNS) itself. Nociceptors aren’t involved in detecting this type of pain, hence the ineffectiveness of opiate-based painkillers for this kind of pain. Instead, pain is caused by overactive, underactive and damaged nerve cells. Examples include the “shingles”, nerve trauma, phantom limb pain, carpal tunnel syndrome, widespread nerve damage, neuropathic diabetes and many more. Nervous system pain is, however, connected to the ECS, and marijuana can help regulate pain signals sent by the nervous system. Both THC and CBD help regulate the ECS.

• Psychogenic Pain - Stress, depression and anxiety can both exacerbate existing pain and cause pain. Stress can also contribute to inflammation, which is why it is one of the main triggers to look for in conditions like IBS. Marijuana has plenty of stress-busting (e.g. myrcene, lavender) terpenes that can help with the psychological side of pain management.

Basically, there are few (if any) plants in the world with the pharmacological complexity of cannabis. The huge number of different phytocannabinoids - all with both distinct and similar medical uses - make cannabis very unique indeed. I have not seen any other medication in the world with such broad therapeutic potential as marijuana. Unfortunately, the precise science of how cannabis works is still unknown. However, the testimonies from thousands (and millions) of patients the world over suggest that cannabis is a very good analgesic, anti-anxiety, anti-stress and anti-inflammatory medication. More research needs to be carried out on cannabis, which remains difficult whilst it is a Schedule 1 drug.