Are Narcotics and Marijuana Appropriate for Pain Relief?

The vast majority of people suffering with pain, even severe pain, get solid relief by following my S.H.I.N.E. protocol, because it addresses the root causes of pain. Still, for some people, pain persists and controlled medications such as narcotics are appropriate and needed. But there is reason for concern. Narcotics are sometimes addictive (though less so when used for chronic pain), and there are 15,000 overdose deaths a year from prescribed narcotics. And so the debate rages.

Sadly, despite well-meaning people on both sides, the debate is often fueled by politics and fear rather than science, and the whole discussion needs to be reframed. It should not be whether people have to choose between addiction and horrible chronic pain. Rather the issue is how do we effectively get people pain free safely by treating the root cause(s) of their pain. In that way, narcotics are not needed. And in those few who we can't get adequate relief, how do we make the use of narcotics most safe and effective. The key is that it is simply not acceptable to leave someone in severe chronic pain. For those who argue otherwise, I propose they wear a device to trigger severe chronic widespread pain for a year—after that I might be more open to their arguments.

Let's look at some simple facts:

1. Though narcotic overdoses cause 15,000 US deaths a year, arthritis medications like ibuprofen cause 30,000-50,000 deaths a year. These are easily preventable, as safer natural options that have been proven to be more effective are available. To me, this bears discussion.
2. In head-to-head studies with pain medications, herbal combinations are often more effective, lower cost, and offer side benefits instead of side effects.
3. Left untreated, pain amplifies, causing central sensitization and notable worsening. The toxicity of leaving pain untreated is likely greater than the risk of narcotics when used with proper safeguards.

Basically, this means that chronic pain left untreated is FAR more toxic than pain medications—including narcotics in the rare cases where they are needed. So let's change the debate to "How can pain can be treated most effectively and safely?"

Let's start with the narcotic issue. When they are needed, they may stop working over time. This can happen for a number of reasons:

1. Increasing drug tolerance.
2. Opioids causing testosterone deficiency, which increases pain.
3. Opioids depleting B vitamins.
4. Worsening of the causes of the pain.
5. Pain amplification resulting from chronic pain (e.g., central sensitization).

This then causes dose escalation and the accompanying side effects. Some ways to mitigate these effects include:

1. Switching back and forth between different kinds of opioids (e.g., hydrocodone and oxycododone) can decrease drug tolerance.
2. Testosterone and B vitamin supplementation.
3. Treating the root causes of the pain with S.H.I.N.E.
4. Adding non-narcotic medications and herbals to relieve pain. For example, the amino acid DLPA can increase levels of your body's own natural pain reliever, called endorphins. In addition, the herbs curcumin (must be a highly absorbed BCM 95 form), boswellia (frankincense) and willow bark have all been shown to be very helpful for pain in placebo-controlled studies. These natural aids can also be combined with pain meds. Topical Comfrey rubbed over painful areas is also helpful. Give natural remedies 6 weeks to see the full effect—which can be remarkable.
5. Research by Dr. Forest Tennant has shown HCG and Oxytocin can markedly lower the dose of narcotics needed in those with the worst chronic pain.
6. Low dose naltrexone (3-4.5 mg at bedtime, not more), affects microglial cell activity in the brain and can even decrease CRPS/RSD (Reflex Sympathetic Dystrophy) pain. This may avoid the need to add the narcotics. RSD is one of the worst pains there is!

New research shows another politically sensitive tool that may help decrease the need for those on narcotics for pain—adding marijuana. For a moment, let's suspend the political and emotional issues that swirl around the topic. Let's look simply at a study reflecting the science and medicine of the issue.

Improving Drug Performance by Adding Marijuana

A monkey study showed that adding cannabinoids (THC, the primary intoxicant in marijuana) to narcotics dramatically increased the narcotics effect, being very synergistic. The stronger the narcotic, the stronger the analgesic effect. This was pronounced even at cannabinoid doses that had no effect by themselves, shifting the fentanyl dose-effect curve leftward 20.6-fold!

Interestingly, as Dr. Paul Cheney noted in a recent article, research by Dr. Ruggiero has linked microglial cells with highly expressed endocannabinoid receptors which can be modulated by endocannabinoids from marijuana plant extracts. There are 84 endocannabinoids so far extracted from marijuana and THC is only one of the 84 endocannabinoids. So we may be able to get the pain relief benefits from THC compounds that don't cause the high as well.

Many people with fibromyalgia find that marijuana helps both sleep and pain, and in states where it's legal, I'm comfortable with people using it to help pain. This study suggests that they can be added to narcotics, in those requiring them, to enhance pain relief and lower the dose of narcotics needed.

In over 3,000 people I've treated with severe chronic pain, I can count the number we've not been able to help get good pain relief (or even elimination) on my fingers (usually without narcotics). That a forth of adults suffer with pain in the US is not from lack of effective treatment, but rather is caused by ineffective medical education and communication.

One closing thought I find amusing…Consider the saying "More fun than a barrel of monkeys." Now picture  the  scientists doing this study in a roomful of monkeys high as a kite on pot and narcotics. The monkey poo must have been flying!

The Man and the Johnstown Flood

It’s not a moral weakness to use your pain medications!

I suspect that you get no bonus points in heaven for having suffered through the pain instead of taking the medications needed to be comfortable. I often tell my patients the story about the pious man who lived in Johnstown during the Johnstown flood. The National Guard came into the city and told everyone they had to evacuate or they would drown. This man refused to leave, saying that he had faith in God and that God would protect him. The floodwaters came and soon the Coast Guard boat arrived, floating by his second story window. They beseeched him to climb in the boat and be saved but he refused, once again saying that he had faith in God to protect him. Pretty soon he was up on the top of his roof and a helicopter came by and yelled at him to get in. Once again he refused—and the man drowned. He went to heaven, and God came by. The man was very angry at God and said, "I had full faith in you and you let me drown!" God said, "What are you talking about? I sent the National Guard, the Coast Guard, and a helicopter!" The medications and natural options are like the National Guard, the Coast Guard, and the helicopter. It’s okay to use them!