Pain that affects the bones, joints, cartilage, muscles, and tendons is considered musculoskeletal pain. Osteoarthritis and low back pain (Chapters 6 and 7) are the most frequent types of M-S pain for which patients seek medical treatment. The bulk of the common musculoskeletal pain conditions affect the knees, neck, shoulders (especially rotator cuff injury), hips, spine, wrists (especially carpal tunnel syndrome), and ankles, and are diagnosed as sprains, strains, tears, fractures, and tendinitis.
Sports- and work-related injuries, motor vehicle accidents, orthopedic surgery, or overuse of the affected joint or body part are the most common causes of M-S pain cited among the patients seeking treatment with medical marijuana. Athough the human body is a self-healing organism, for a variety of reasons this painful condition is not healing in these particular patients. Of all chronic pain conditions, musculoskeletal pain is among the most challenging to treat, for both conventional and holistic medicine.
Opioids and NSAIDs, both prescription (Naproxen, Celebrex) and over-the-counter (ibuprofen), are the drugs of choice for physicians treating patients suffering with chronic M-S pain.
The MMJ recommendations are essentially the same as those for osteoarthritis, with the exception of a greater emphasis on treating inflammation in those suffering with arthritis. Nearly all forms of M-S pain have an inflammatory component, but it is not typically as severe as it is with arthritis.
• Topicals—localized (apply to painful joints), especially Apothecanna Extra Strength or Mary’s Medicinals CBC.
• Topicals—generalized (apply to wrist or ankle for rapid absorption) transdermal patches, especially 1:1/CBD:THC, 3:2/CBDa:THCa, and THCa; also Mary’s Medicinals transdermal gel pens, CBD, THC, or CBN.
• Vaporizing high-CBD strains of flower—especially Harlequin (a 50:50/S:I hybrid), Lucy (a 70:30/I:S indica), Cannatonic (a 50:50 hybrid), or other hybrids (either 50:50, 60:40/S:I, or 60:40/I:S).
• High-CBD tinctures—1:1, 2:1, or 3:1/CBD:THC.
• High-CBD hash oil—3:1 or 6:1/CBD:THC.
• Juicing raw cannabis leaves—for those without access to fresh plants, THCa tincture, CBDa tincture, and CBD tincture are excellent alternatives.
• Indica strains of flower—I:S of 70:30 or above (also good for sleep).
• Indica and hybrid edibles—gluten-free, without sugar or dairy (indica edibles are also good for sleep).
• Any strain or MMJ product containing CBG.
NOTE: Avoid sativa strains above 60:40/S:I and high-THC products. Although THC has both analgesic and anti-inflammatory properties, it can also increase anxiety, which has the potential to increase pain. If spasticity is a prominent symptom, then THC may be beneficial.
Diet can play a significant role in reducing M-S pain due to the fact that inflammation is an important contributor. The anti-inflammatory and alkalinizing diet presented in Chapter 5 is recommended. I suggest you pay particular attention to the “Acid/Alkaline Food Chart” and reduce highly acidic foods from your diet.
If your M-S pain involves a joint or cartilage, then I would suggest you adhere to the recommendations and dosages in Chapter 6 for osteoarthritis, including:
• Wellness Essentials Active Packets (Metagenics): These contain glucosamine sulfate and chondroitin sulfate, both of which help to build new cartilage.
• Essential fatty acids, flaxseed oil, and MSM: All of which will reduce inflammation.
• Vitamin D3: See the recommendations for vitamin D in Chapter 5.
Yoga can be especially beneficial as part of the treatment program for M-S pain. The exercise you choose should avoid repeated impact of an affected joint—e.g., no running or jumping if you’re healing a painful knee, hip, or ankle. If it’s your shoulder, neck, back, or wrists, I would recommend you avoid weight training. Brisk walking, as long as it does not exacerbate the pain, is a good option, along with swimming.
Conventional medicine relies heavily on physical therapy to treat patients suffering with chronic musculoskeletal pain, and for many patients this can be quite helpful. However, as I explained in Chapter 7 with respect to chronic low back pain and yoga, it is usually most effective if the patient continues doing the physical therapy exercises and stretches at home on a daily basis.
In addition there are many complementary therapies that are helpful for relieving chronic M-S pain, including: traditional Chinese medicine, especially acupuncture and Chinese herbs; Ayurvedic medicine, especially Boswellin Cream, camphor, and eucalyptus oil; bodywork (Rolfing, Hellerwork, and the Loren Berry Method); body movement therapies (Feldenkrais and Pilates); chiropractic and osteopathic manipulation (can increase circulation to a painful joint); homeopathy; and craniosacral therapy.
Energy medicine therapies such as Healing Touch or Reiki are among the most beneficial for treating M-S pain. Energy medicine is a comprehensive approach to healing that features all interactions between body, mind, and environment, including magnetic, electric, electromagnetic, acoustic, chemical, physical, and gravitational factors.
Healing Touch is a holistic energy medicine therapy utilizing a variety of hands-on techniques to balance and realign the energy within and surrounding the body. As a Healing Touch practitioner, some of my most successful and dramatic treatment outcomes have occurred with patients suffering from long-term musculoskeletal pain—knees, shoulders, back, and wrists.
I understand quite well that in most cases of M-S pain, you can easily identify the physical cause—an injury or accident—that triggered your pain; however, I believe everything in life happens for a reason and there are no accidents. Pain is a messenger, and it’s in your life to teach you a valuable lesson about yourself.
I would strongly suggest using MMJ to heighten self-awareness and help you in this healing process to get high with an intention. For example, you can ask the question “What is this pain about? What do I have to learn from the pain?” You will invariably receive valuable input in the form of thoughts, visions, or messages that either directly or indirectly respond to the questions you’ve asked. It’s helpful to have a journal in which to record this information. The process works similarly with meditation.
In addition to receiving input from your soul, higher self, and spirit guides through MMJ or meditation, I have found Louise Hay and her book You Can Heal Your Life to be a consistently reliable resource for helping to clarify the issues and the message of the chronic pain. Ms. Hay published this remarkable book in 1984, after healing herself from stage 4 ovarian cancer. I have continued using the book as a mind-body reference for more than thirty years, to help me and my patients better understand the mental, emotional, and spiritual causes of their pain and dis-ease. Once you have more clarity about the underlying source of your pain, it can facilitate your healing.
Each of the following physical problems is followed by the possible mental and emotional issues contributing to it, and then an affirmation that might help relieve the problem. This material is derived predominantly from Louise Hay.
Knees: This pair is representative of stubborn ego and pride; inability to bend; fear; inflexibility; won’t give in. Knee pain can also result from conflict between your authentic self and tribal teachings. “Tribal” refers to community—i.e., family, coworkers, religion. I bend and flow with ease, and all is well.
Neck: This embodies a refusal to see other sides of a question; stubbornness; inflexibility. It is with flexibility and ease that I see all sides of an issue. There are endless ways of doing and seeing things. I am safe.
Shoulders: These are meant to carry joy, not burdens. Shouldering too much responsibility; too many shoulds—universal or too much shoulding on yourself. I am free to be joyous.
Hips: They are about fear of going forward in major decisions; nothing to move forward to; self-pity. I am in perfect balance. I move forward in life with ease and with joy at every age.
Ankles: This pair represents mobility and direction. I move forward easily in life.
Wrists: These represent movement and ease. I handle all my experiences with wisdom, with love, and with ease.
Brian R. is a twenty-six-year-old graduate student who badly fractured his right ankle (both tibia and fibula) in a skiing accident in February 2015. The surgical repair involved a metal plate and several screws, and resulted in chronic ankle pain with which he continues to suffer. Postoperatively he was prescribed Vicodin, but he was unable to maintain the mental clarity he needed for his PhD program in engineering, and he disliked the other side effects he experienced, such as constipation and nausea.
Within two to three weeks following his surgery, on the recommendation of his roommate, Brian began using marijuana for pain relief. It worked well enough for him to obtain an MMJ license.
Brian’s orthopedist has told him he may have to live with some degree of pain for the rest of his life, and can only offer him opioids for pain relief. The pain is worse later in the day, when Brian rates it as a 5. MMJ has offered him relief though. He typically uses it when he gets home after class. Late afternoon he’ll vaporize a hybrid, often Harlequin or a 60:40 or 70:30/indica strain, which almost immediately reduces his pain to a 1–2. He also uses tinctures, both 2:1 and 3:1/CBD:THC, with good results. Before bed he ingests indica edibles, which relieve the pain and help him get a good night’s sleep, and be nearly pain-free to start the new day.