In Cannabis for Chronic Pain, Rav Ivker, DO, ABIHM, establishes a new standard of care for the treatment of chronic pain with medical marijuana.
Ivker's book directly addresses pain sufferers, but the detailed treatment protocols he shares are equally valuable to physicians. As a self-proclaimed "cannabis clinician" and former chronic pain patient himself, Ivker culls both from his own experience recovering from shingles, and his treatment of more than 7,000 patients. The result is a definitive guidebook on marijuana--and cannabis derived compounds--for relief of persistent pain.
Chronic pain, affecting upwards of 100 million Americans today, is among the top reasons patients seek medical care. It is more common than heart disease, diabetes, and cancer combined. With over a third of the US population suffering persistently, the need for novel strategies not only to manage, but to truly heal pain has never been greater. A small but growing body of scientific literature highlights the immense potential of cannabis as a safe, effective alternative to prescription painkillers.
Ivker, a holistic family physician and co-founder of the American Board of Integrative Holistic Medicine, objectively presents marijuana's myriad therapeutic benefits. He makes a convincing argument that no prescription drug rivals the natural herb's powerful healing properties. He recommends it for a wide range of challenging conditions, including arthritis, back pain, migraines, fibromyalgia, menstrual cramps, pain from cancer or its treatment, insomnia, anxiety, depression, neuropathy, and Crohn's disease. In the book, he lays out specific treatment protocols for each one.
A Safe Opioid Alternative
Fast-acting, effective, and safe, cannabis is a promising solution to the current public health crisis of opioid overprescribing, misuse, and abuse, says Ivker. Opioid drugs are the conventional medical system's go-to pain treatment. But their highly addictive nature can have deadly consequences. According to recent CDC data, 115 Americans die from opioid overdose every day.
Even when used judiciously, opioid side effects can be alarming. They range from nausea and constipation to brain and liver damage, and sometimes necessitate the use of additional drugs for symptom management. They can also, paradoxically, increase a patient's experience of pain. A 2016 study found that morphine, one of the most commonly prescribed opioids, prolongs neuropathic pain by amplifying inflammasome activation in animal models (Grace, PM et al. PNAS. 2016;113 (24): E3441-50).
Cannabis, on the other hand, triggers few adverse effects. Many patients who use medical marijuana to treat pain eventually reduce or eliminate their use of opioids and related drugs. Indeed, in states where cannabis is legal for medicinal purposes, opioid prescriptions are dropping as are overdose rates.
Cannabis for Chronic Pain outlines comprehensive instructions on using medical marijuana to heal from the "plague of chronic pain." It opens with a selection of frequently asked cannabis questions, from safety concerns and addiction issues, to evaluating the quality of marijuana dispensaries and products, and identifying physicians well equipped to support cannabis patients.
Contemporary medical journals contain relatively few studies of cannabis as a pain cessation treatment, and clinical use of cannabis is not yet widely taught. Ivker reviews the available literature, augmenting the data with observations of thousands of patients at his Boulder, CO practice. The result is an authoritative set of best practice recommendations for patients and practitioners alike.
He provides detailed step-by-step instructions on using various forms of cannabis to treat specific physical and emotional pain conditions. With chapters devoted to inflammation, musculoskeletal pain, and neuropathic pain, the book serves as a manual for tailoring cannabis use to meet patients' unique needs. It teaches readers how to create personalized cannabis treatment plans that address different manifestations of chronic pain, including marijuana strain, formulation, and delivery method suggestions.
Ivker also discusses the various marijuana products pain sufferers might add to their "cannabis medicine chest." With over 80 identified cannabinoid compounds available in varying forms and combinations across nine different consumption categories, choosing the best cannabis product to effectively quell pain can be challenging. Some treatment methods provide greater pain relief than others, so finding the right combination of cannabinoid concentrations and products is key to maximizing marijuana's benefits, he says.
But Ivker stresses that cannabis alone is only part of the therapeutic equation. It should not be used in isolation, but rather as part of a broader integrative regimen that addresses the multiple physical, emotional, and social drivers of chronic pain.
From a mind-body-spirit perspective, he recommends dietary changes, herbal and nutritional supplement use, and physical health practices that patients can combine with marijuana to enhance overall wellbeing.
Apart from teaching readers how to use cannabis for pain relief, it is clear that Ivker too aims to dispel some of the many misconceptions surrounding marijuana. This herb had a long history of fully legal medicinal use throughout most of American history. It is only relatively recently that it was deemed a "dangerous" substance.
But a new age of acceptance is dawning -- medical marijuana is now legalized in more than half the states in the country, and the number of patients using cannabis as medicine increases annually. Legal cannabis is now a multi-billion dollar industry in the US. Physician attitudes are also changing: Holistic Primary Care's 2018 practitioner survey indicates that more than half (56%) of the 469 respondents believe CBD and cannabis have therapeutic value and should be used more widely.
Ivker believes that no other medicinal herb or prescription drug possesses the breadth of therapeutic applications that cannabis does. Well aware of the upsurge in acceptance and popularity, not to mention its high financial value, even the pharmaceutical industry now wants a piece of the pot pie. Last summer, the FDA approved the first cannabis-derived medication, GW Pharmaceuticals' Epidiolex, for the treatment of two rare forms of epilepsy.
While the future of federal cannabis regulation is still uncertain, the plant's health benefits offer great hope to countless pain sufferers. As Ivker points out, for physicians whose best advice to chronic pain patients is "you'll have to learn to live with it," cannabis provides a very viable alternative approach. Cannabis for Chronic Pain is a useful reference for seasoned cannabis clinicians and the canna-curious alike.