"I suffer from chronic back pain and have been using vicodin. However, my doctor has stated that I need to end my reliance on this drug, and I am looking for a replacement. Advill and others don’t provide the relief I am looking for. What cannabis products might be a good choice for me?"
Cannabis has had more and more positive feedback in people trying to cut down or eliminate their opioid use. Every day in the United States about 44 people die as result of opioid overdoses. There has never been a reported death from cannabis use. Donald Abrams, MD, a professor of medicine at University of California, San Francisco, has studied the effects of medical marijuana on pain since the mid-1990s. In 2011, he published a small study of 21 patients that found that the addition of marijuana to a twice-daily opioid regimen led to a 25 percent reduction in pain. It suggests cannabis could allow pain patients to lower their opioid dosage and still get pain relief.
It seems that patients can get short term pain relief from cannabis that contains only 1.3 percent tetrahydrocannabinol (or THC), the ingredient that gives marijuana its psychotropic effects. Pot used for recreational purposes has 6 to 12 percent THC, but can go as high as 20 percent. A higher concentration of cannabidiol (CBD) mixed with a little THC seems to be the best bet for decreasing opioid use. There is one called “20:1,” named for its ratio of CBD to THC.
The fastest way to obtain relief is by smoking or vaping the cannabis product. Tinctures or capsules are effective as well as using an edible that can last the longest.
Perry Solomon, MD
The short answer is, yes!
I have had many patients decrease their reliance on opioids such as Vicodin, Percocet and oxycodone for pain relief by substituting often large quantities of opioids with medicinal cannabis. I strongly urge this be done under close medical supervision, guided by a physician familiar with both opioid pain medication and cannabis use.
For a longtime I struggled with my chronic pain patients for whom Tylenol and Nonsteroidal anti-inflammatories such as ibuprofen and Naprosyn didn’t offer enough pain relief. It seemed like the next step was opioids and there was very little in between to offer patients. These days I spend less time transitioning patients off their opioids and more time convincing them to try cannabis first. Using cannabis, many of my patients have avoided the whole opioid epidemic.
The choice of cannabis product for your back pain should be tailored to your individual pain relief needs. It will depend on whether your pain is constant or intermittent. Whether your pain is predominant throughout the day or whether it affects your sleep as well. It will depend on your personal situation such as your need to drive or work.
Vicodin is a short-term opioid that relieves pain for hours at a time. As such, it often needs to be dosed several times a day. The equivalent short term method for pain relief with cannabis could be inhalation such as vaporizing or using a vape pen. Pain relief starts within 5-10 minutes usually but only lasts 2-4 hours.
Other methods of cannabis provide longer coverage of pain relief and you may find topicals, tinctures and edibles more useful. I rarely find one cannabis product fits all and often different products at different times works best. Also, it is important to understand that everyone reacts differently to cannabis products.
If you are new to cannabis use, I would recommend trying a topical CBD cream or lotion directly on the skin over you back initially, as there is no high associated with CBD topicals with perhaps time release patches being the theoretical exception. I would then likely recommend a 20:1 CBD:THC tincture in addition. If your pain was preventing sleep, I might introduce a different product such as a 1:1 THC:CBD tincture for night time pain relief and sleep enhancement.
drbluto
It’s so frustrating when you can’t get a good nights sleep! Many factors come into play but if it is your back that’s keeping you awake at night that’s fairly easy to resolve.
If you have been doing Sativa in the evening, to go to sleep you need to add CBD (Oral spray tincture works well to stop the brain chatter) but if you are doing Indica and you suffer with brain chatters the same technique works because you tend to sleep much better when your CBD and THC are in a one-to-one or equal balance. I also suggest that you may want to do a CBD dominant topical salve rubbed into your back just before bedtime to keep you out of pain and muscle spasm through the night. If you wake up in the night you can vaporize off a 1:1 vapor pen to go back to sleep. If your sleep problems are actually from an accumulation of stress and anxiety throughout the day please, consider using the low-dose CBD (an 8:1, CVD: THC should work well and does not make you high) a couple of times during the day to keep yourself calm and even with your emotions and you will actually sleep better. Some people just don’t sleep well with high THC so please be aware of that and you may need to balance with CBD. Good luck, a good night sleep is worth making some changes.
drolson
Limiting your exposure to opiate medications is a great way to improve your overall health and limit the risks that come with this class of medications. Many patients experience side effects such as nausea, constipation, drowsiness, and poor appetite not to mention the long-term risks of abuse and addiction.
There are several options for pain control depending on the specific underlying cause of your pain. You may consider non-steroidal pain medications like ibuprofen, naproxen, and meloxicam. Local pain treatment with a lidocaine patch or voltaren gel is also an option with lower risk of side effects. Of course, there are non-pharmaceutical options, which is likely the reason for your question on this site.
The same principles that apply to traditional medications apply to cannabis. A topical cannabis-infused product is recommended as the first approach to pain control. This could include a cannabis-infused patch, lotion, balm, or ointment applied directly to the skin or massaged into the skin. Higher CBD content products tend to work well for this since there is an anti-inflammatory property associated with CBD.
Pain can also be treated with as needed vaporized cannabis products. Vaporizers work well for immediate relief since they take 5 minutes or less to feel the effect. Again, a higher CBD product is preferred due to its anti-inflammatory properties. THC can be effective but tends to be more of a way to distract from pain as opposed to treating the inflammation associated with pain. You own trial and error is important when treating pain. Just remember to use as little as needed for relief without overdoing it.
Finally, don’t forget about conservative pain management using physical therapy, massage therapy, heat and cold packs, and acupuncture which can be very effective for certain individuals depending on the underlying cause of the pain.
sankmd
Fibromyalgia affects a large number of Americans, and medical marijuana can be an effective alternative to traditional pharmaceutical products. Generally, a balanced product with both THC and CBD is a good choice for chronic pain, while avoiding excess side effects. Products that are ingested/swallowed have a longer duration of action, so you can experience a gradual, steady pain relief effect. There are a few articles on fibro in our Health & Wellness section that you can check out for more details, including some recommended strains. Best of luck to you in finding improved pain relief!
drbultman
This question is a real challenge because I have different answers for different parts of the body and do you want to be awake or asleep?
I love the topical CBD dominant salve for most all pain in my body and so far I have enjoyed many brands but my favorite is Canna Care because it is very effective at relieving pain especially the ~2:1 ratio.
For vaporizing, I think it is hard to beat AC/DC because it is fast and effective and it does not leave me with any psychoactive effect and no anxiety as it quickly relieves the pain.
I personally tend to avoid edibles due to the carbs and the edibles are so regional, any recommendation would be of little benefit but I am certain another doctor might be able to give advise on edibles.
I like a variety of tinctures but I tend to like to spray the tincture in my mouth or hold it under my tongue so that makes the strong alcoholic tinctures too hot for me but the alcohol extracted tinctures are still excellent products.
We have many fine products on our website so please, explore the products.
drolson
Consider CBD for pain since it works well and usually very little if any side effects as long as the THC is low. Once the ratio of CBD to THC is more than 8 parts CBD to 1 part THC, it is unlikely you would notice any psychoactive effect. If you are in pain and you want to go to sleep try a 4:1 CBD dominant or even a 2:1 or 1:1 but you will notice the psychoactive effect before you go to sleep. It will take some experimenting, go low and slow and you will find your perfect dose but do not be afraid, cannabis tends to be much more gentle than pharmaceutical narcotics or benzodiazepines.
drolson
Pain is one of the most common uses for medical marijuana. Whether it’s inflammation, headaches, neuropathic pain, muscle soreness, spinal injury, fibromyalgia or cramps, people have seen varying degrees of success with cannabis.
wendynp
I believe the best relief for severe back pain are the CBD topical salves in a 2:1 ratio, applied every hours during your waking hours to keep the pain in remission, take a high CBD oral spray or tincture in addition so you are treating yourself inside and outside And within one week you should have a profound reduction in your pain level. If you are still experiencing pain within one week please, be sure to have your vitamin D blood level checked and take vitamin D3 in order to get your blood level above 55 MG/ML for optimum pain relief.
Stay well hydrated and pay attention to your posture. If your posture is poor, the nerves can’t call you on the phone to scream, "Get off me!" and you will experience pain.
You must do everything to get better or except the fact that you’re not going to get better until you do everything. The body likes to be healthy and well and wants to be healthy and well and now you have the tools to get healthy and well. You cannot get enough sunshine to make enough vitamin D to correct your problem.
drolson
Many good answers here, and I’d just like to mention that there is clear published medical science demonstrating that cannabis improves the pain relieving effects of opioids. This has allowed many people to use cannabis to reduce their Vicodin dosage while maintaining adequate pain relief.
drelkind
Whether it’s Vicodin, Percocet or another opioid, cannabis typically works well as an alternative to these pain killers. Marijuana can either reduce opioid use or eliminate it altogether.
Here’s an excerpt from the above video:
Pamela: Dr. Solomon I love this next question because it’s so timely with what’s going on in the news today. Can cannabis be replaced by Vicodin?
Dr. Solomon: We certainly hope so and more and more studies are showing that it absolutely can. Dr. Donald Abrams, a professor of medicine at UCSF has shown in a study that people who had been using Vicodin showed a 25% decrease in their Vicodin use when they started using cannabis to replace it. It’s just remarkable how many people are seeing that the side effects of cannabis are so little compared to the side effects of Vicodin and as you know the new demands by the government are saying that people can’t even get Vicodin for their chronic pain.
Pamela: Yeah so it’s so hard to get and people are also recognizing [they] don’t want to be on opioids anymore [they] want an alternative.
Dr. Solomon: And the dangers of opioids are huge, with suicides, overdoses, etc. As a matter of fact the 24 in the country now that have legalized medical cannabis have shown a 25-30% decrease in the opioid overdoses that occur, causing death.
Pamela: And my own personal story, I know that I was able to replace Vicodin with cannabis in my own pain management, so personally I do believe that it works.
Danielle Lim
