Cannabis for Chronic pelvic pain
By: Anusha Gandhi
Tags: Medical Marijuana, Pelvic Pain, Cannabis, Opioids, Endometriosis

I wanted to do a post about medical marijuana as I think this is such an important topic. The legalization of these products has opened the eyes of individuals who would not normally smoke a joint — let’s say — to explore the effects of cannabis on pain, as these products are becoming more accepted and easier to obtain. Likewise, those skilled users are sharing their experiences more and more on social media. I am not one of those people. In fact the thought of smoking a joint doesn’t jive with me and never has. The handful of times I’ve smoked a joint in my life I’ve laughed my head off, been paranoid about leaving my house, and have consumed more chocolate than I thought possible. Each time I have woken up in the morning feeling rough. But I got to a point recently where it was either opioids or nothing.

Our cannabis journey began nearly two years ago when Greg was talking to his cousin about having trouble staying asleep. She told us her husband found tinctures at an Indian reserve down the street that he now relies on for good sleep. We went there on the way home and picked up two bottles; one labeled ‘sleep’ (mostly comprised of THC) and one labeled ‘pain’ (mostly CBD). Gotta say, we stopped taking them after a while because we ended up titrating 5 drops worth and still felt nothing. No high, no sleep inducement, nothing. And that’s when it ended.

And then — two years later — I got to a point in my health journey where NOTHING was helping my pain. Morphine makes my pain worse, hydromorphone mostly only works in injection form, I am limited to NSAIDS due to ulcerative colitis, and nothing else even touches it. Tramadol became my go to, and then I decided I really didn’t want my go-to to be an addictive opioid (a drug chemically formulated in a lab and resembles that of codeine). That’s when I decided it was time to pick this ol’ cannabis thing back up again.

I have a few really good friends in the industry who were able to give me the push I needed to get started. And the scientist in me made sure I was doing this in a fairly comparative and repeatable way. With that I made some notes of what the goal was:

I needed something that would take away my pain in those moments where I would normally reach for tramadol

I needed something that would not make me too high as anxiety and insomnia are not in the cards

I needed something that wouldn’t hinder me during the work hours. That meant if I needed to take something for pain during the day (like I do with Naproxen) it cannot make me high, cloudy or stupid. Likewise if I take something at night, it cannot carry through to the morning when I need to work.

Phase 1: Research

My research told me that there were two things I needed to be aware of: 1) the CBD and THC content, as well as 2) the strain (Indica vs Sativa). Studies were showing that those with pain experienced psychoactive and pain alleviating effects from THC, but high pain alleviating affects with CBD (and only a slight high). Anecdotal evidence was also stating that indica was a more calming strain that helped with sleep, whereas sativa tended to bring about more active highs. So with that in mind I decided to start with Indica and low doses of THC and CBD.

Phase 2: Medium THC, Indica

Edibles (2.5mg THC, 0mg CBD: I started with something tasty and low dose: a peppermint chocolate with a total of 10mg THC from the Indica strain. Each square contained 2.5mg of THC. I ate the chocolate before bed, and within 45min I could start to feel … loosy goosy, a bit tingly but mostly zen, and tired. If I managed to get myself into a sleep position within those 45min I learned it would put me into a deep slumber — one that made me feel very rested in the morning! I will say, this was the best sleep of my life. I was asked “does it put you in such a deep sleep you wont wake up to someone screaming” and my answer is it is no different than regular sleep but it provides you with more instances of deep sleep. Your sleep style however, doesn’t all of a sudden go from light sleeper to ‘nothing wakes you up’ sleeper. It’s still you in there 🙂 Evidence of deep sleep and more REM sleep was noted on a fit bit which correlated perfectly to the quality of sleep felt in the morning. And then just my luck, the store I was buying from discontinued the THC Indica chocolates. This scared me a bit but it provided the perfect opportunity to move on.

Keeping with the same theme, I decided to do a gummy with the same dose and strain of THC. 2.5mg per gummy, 45min before bed. However, it provided a buzz within 15min, very similar in nature but a bit stronger than the peppermint chocolate. It was promising BUT one big component to developing a good product is reliability and repeatability. This product unfortunately flopped on me the second and third and fourth time around. The tingly buzz varied each time, always affecting me around 15min in, but did nothing for my sleep. I don’t have a reason for this, but I wasn’t really needing or wanting to try it again.

Phase 3: Medium CBD, Indica

Topicals and Edibles (12.5mg CBD, 0.2mg THC): So let’s parallel this with the CBD. On the first round of purchases I bought a topical CBD cream. Social media goes wild for CBD topicals and creams for the purpose of pelvic pain. As healing pains started to emerge post-operatively, I decided to buy a legal CBD cream. I didn’t know what I was supposed to feel, but I didn’t think I was feeling anything. I’ve tried it several times since I have purchased it and I find my mind wanting it to work but physically there are no real signs that it is doing anything for me. I was frustrated to say the least, as this journey began for the purposed of pain relief. I decided, along with the THC gummies, I would buy some high dose CBD gummies to up the anti a bit. We are talking 50mg (or rather 12.5mg CBD per gummy), which did a whole lot of nothing. I have never felt it, and I don’t know that I ever will.

At this point, I was able to feel zero with the topical and edible CBD products, I got a good reliable buzz and tremendous sleep on the 2.5mg THC Indica chocolate which they discontinued, and I got a higher but unreliable — mediocre sleep — result from the 2.5mg THC Indica gummy. Where do you go from here?

Phase 4: Blend

Edible (2.5mg THC): I was a bit stuck by this point, so I took a gamble and bought a 2.5mg THC blend dark chocolate. The blends freaked me out a bit because all I could picture was my naked self running around the house in a stupor. But at this point, I was in safe hands, in the comfort of my own home AND I kept reminding myself this is safer than morphine. The dark chocolate was very yummy (and on sale I might add) with a good buzz and a good sleep but not quite as good as the Indica. You could just tell in the morning you didn’t get all the good deep sleep and REM sleep as with the Indica pure. So where do you go from here? You call a friend.

Phase 5: CBD drops and disposable vapes

Phase 5 is something a bit more courageous and I didn’t think I would get here, but here we are. I called a friend to ask what I do next. She proposed that I try CBD drops that melt under the tongue. Sure, safe enough and easy to do. They reminded me of the tincture I used two years ago with little to no effect but I was willing to try something a bit more vetted this time. As for THC I was stuck without the product I liked so I asked her how I obtain THC Indica — not by edibles but not by smoking — so that I have something I can trust. She recommended trying a vape. Oh god a vape. I didn’t want to be one of those cool kids. But the one she showed me was this discrete little pen-like tool that comes ready to use, has ~50 pulls you can take from it, and you can control how much you want or need. I did some comparisons and went with a strain called Pink Kush. Mostly because of the name, and because it had a good concentration of THC; a good bang for my buck. This little hand held device is very sleek, very discrete and even easy enough for the likes of this green lady to use.

Disposable vape (THC, Indica): One night, as I could feel pain encroaching, I took out the pen and asked Greg if he could ‘see’ anything while I was pulling. All of a sudden I felt it give, and a light lit up at the opposite end. The little battery on the end was being charged (or warmed up) by my pulling. I didn’t feel anything or see smoke when I exhaled but I did the second time around. I did two pulls that night and almost within 10min I felt buzzed. This truly was like smoking it. There was no denying I had just smoked some weed LOL. But I did love the control it provided. I deemed to only use this for those nights I would have reached for a tramadol or a hydromorphone. Ultimately though, with it being the strain I like, and being more comfortable with it, I had ended up using it more often than I expected and I really like it. But there are some things you really need to be aware of here. Cannabis and Tramadol CANNOT MIX! They are lethal. So you have to make a decision which one you are going to take. I accidentally (yes I am admitting it), took both and felt like my heart was going to explore. I was sweating and anxious and this did not subside for hours!!! Secondly, the more consistently I was using it, the more I was feeling residual effects in the morning AND it was starting to affect my moods. It took me a few days to realize that the vape was actually making me depressed in a subtle but substantial way. While I didn’t expect this, it was reasonable to accept that it too would have unwanted side effects. I reserve this product for the really tough times, and for weekend nights when I know I am going to get those extra hours of sleep.

CBD drops (25–50ml, Indica): Next — not the same night — I tried the CBD drops. I took 25ml (I think) from the dropper and put it under my tongue to let it dissolve. It’s hard to explain this one. So I asked around to several different people to find out what CBD should feel like. And mostly people described it as loosening or releasing. Just a bit of tension release. Yup, that’s exactly what it feels like. There is no high, and there are no real ‘things’ that happen other than roughly 30min in you feel just a bit better. The tension around where the pain was is just a little less noticeable. I asked people why they take THC with it, and I can attest to the fact that the THC buzz is just de-stressing. So combining the less tension with the buzz makes for a pleasant and long sleep. Again, this is if you are using the right strain. I have NOT tried CBD with THC from the Sativa strain so I cannot comment on that. Mostly because I want to use this product in the evenings and weekend, and absolutely NOT when Im working. I don’t need something to keep me awake if it’s mixed with an active high.

Phase 6: THC Sativa

Edibles (2.5mg THC, 0mg CBD): To round out my little experiment we ‘accidentally’ purchased the peppermint 2.5mg Sativa chocolates as I misread and thought they were Indica. Nevertheless I wanted to keep them for a rainy day. One day, on a Saturday, feeling bloated and in pain, I decided to take one of the chocolates. BAHAHAH ok this was fun, to say the least. It gave me a great high, a fun high, and I could have cleaned the whole house at that point. I have tried taking it before bed and since it is calming still (though your mind is racing your body feels calm) it isn’t the greatest for sleep. If you happen to wake up in the middle of the night you won’t really be able to fall back asleep because of your mind. Maybe that’s just me. As for the pain, I think I was just distracted which was fine.

Literature:

OK nerd alert, here comes the scientific discoveries.

One article looked at the use of medical marijuana for the use of diminishing pain in patients with fibromyalgia. People with fibromyalgia have several types of pain so this was interesting to learn about.

As for cannabis, its major cannabinoid is Tetrahydrocannabinol (THC)…that produces a variety of effects including altered cognition and motor function, analgesia, and psychotropic effects (eg. drug high). Another key component of cannabis is cannabidiol (CBD) that, while nonintoxicating, does affect mood and cognition.”

This study concluded that overall, the pain threshold for these patients was heightened by the strains with high THC content. Conversely, the CBD content had no such effect on these patients which is counter to what I’ve heard and read. Of course, logically I wanted to find a study using cannabis for chronic pain in pelvic pain disorders such as endometriosis. Sadly, the one study I found was utter shit, starting with their definition of endometriosis (*eye roll*).

The best study I found was very informative. In an assessment of cannabis use, selection methods and results in those suffering from chronic pain, they compared men vs women, experienced vs novice users, and recreational users vs medical marijuana users. The findings showed that for the use of chronic pain, across the board users were selecting products with High THC;High CBD OR Low THC;High CBD. This tells you that for chronic pain the CBD component was most sought after (unlike what we read in the fibromyalgia study). And while both groups sought after CBD, it was only the recreational users who tended to also choose High THC whereas the novice users were comfortable with the low THC content. Those who had only used ‘medical marijuana’ chose to use vapes and edibles versus those who were used to using recreational marijuana and often chose smoking versus any other method.

The only conclusion I could draw from all of these finds is that we are inching our way towards products with evidence of medical benefits — ones that can scientifically be reliable and reproducible — so that even non-users have more tools in their toolbox for chronic pain. This is a cautionary tale as just like my experience with opioids is different from yours, so too will our experiences be with cannabis. Listen to your body, make sure you feel comfortable and safe, and try to get out of your comfort zone just enough to try some things you may benefit from. And most of all, please let me know if you have any questions.

❤ Crampmystyleblog

Resources:

Cannabis Use Preferences and Decision-making Among a Cross-sectional Cohort of Medical Cannabis Patients with Chronic Pain

An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia

Disease-modifying effects of natural Δ9-tetrahydrocannabinol in endometriosis-associated pain