In order to properly introduce the patient to medical cannabis, frequent follow-up visits must be scheduled until a strain has been chosen that meets the treatment goals of both patient and physician. Initially, an active follow-up schedule may be required to address any changes in the patients’ regimen, such as a need to alter the route of administration. A follow-up schedule will help the patient receive adequate education to be able to continue safely and confidently. After the patient has been stabilized, the focus of the follow-ups should be on monitoring for adverse reactions, including dependence.
On November 10, 2015, she was started on a trial of medical cannabis Indica strain (vaporizer) at a dosage of 1 gram per day (THC 3%-5% + CBD 4%-6%) but felt too “stoned.” The strain of medical cannabis was changed to a Sativa strain with higher CBD (13%-16%) and low THC (0.4%-1%). She reported much improved (80%) pain relief without any psychoactive side effects.
Cannabis sativa (cannabis) has been used as a medicinal agent for almost 5,000 years in traditional Eastern medicine. Its introduction into Western medicine took place in 1841 as a result of the work of William O’Shaughnessy, an Irish physician who encountered “Indian hemp” in Calcutta. By the late 19th century, pharmaceutical companies in the Americas were producing medical cannabis in the form of cannabis-based extracts, tinctures, cigarettes, and plasters. 1,2 These agents were mainly indicated for a wide range of conditions, many related to pain. 3,4
Prescription and recommendation of medical cannabis has typically been nonspecific in Canada. Patients are recommended to a medical cannabis access program, or it is suggested to them that they attempt to sign up as per the advisement of their physician. Increasingly, an understanding of how specific strains of medical cannabis can offer benefit for specific ailments, or not, is appreciated by those recommending the use of medical cannabis. Unfortunately, there is limited knowledge regarding such practices due to a lack of investigation, which prevents physicians from making informed decisions about the use of medical cannabis.
A 55-year-old woman reporting neuropathy and back pain due to the diagnoses of fibromyalgia, Lyme disease, and migraines, occurring for the past 15 years, was referred to our clinic. Her initial baseline recorded pain score in the clinic was 10/10 on a numerical rating scale. The patient also had a history of allodynia and hyperesthesia over the arms, shoulders, and abdomen.
Fibromyalgia—Widespread Neuropathic Pain
Typically, recommendations at our clinics are made based on medical history, cannabis use history, and financial barriers. Once all of these factors have been considered, a strain is selected from a range of varieties recommended for medical use. Using the principles of “start low, go slow” titration, individuals with little or no experience, histories of bipolar disorder, strong familial schizophrenia, and/or a history of substance abuse (the latter three conditions may be considered contraindications for use of cannabis) begin their process with medical cannabis on a CBD-dominant strain. Patients with a history of cannabis use and no significant risk factors are initially prescribed a strain with higher THC content and maximal CBD content. If the initial strain does not address the patients’ therapeutic needs, THC content will be increased in a stepwise manner provided that no serious risk factors are present. In the presence of risk factors, the risk-benefit analysis for the patient must be readdressed.
Reduced usage of other medications, as described as “a little or much less frequency,” was found in 94% of patients with fibromyalgia, 81% of arthritic patients, and 61% of patients with neuropathy who used medical cannabis. Moreover, 75% of medical cannabis users who experienced opioid dependency reported a lot or almost complete overall relief . 8 These findings highlight the wide range of clinical uses for medical cannabis, as well as the value of such studies at a time where evidence from controlled clinical trials is still emerging.
Brain Vitale also provides precursors to the brain neurotransmitter acetylcholine (ACh), and improves production and receptor function for various other neurotransmitters. It is formulated to help boost brain cell energy production, reduce age-related mitochondrial decline, and provide antioxidant protection.
68 percent of Americans are deficient in magnesium according to a government sponsored study. Magnesium is one of the most critical minerals in the human body, where it is involved in over 300 enzyme reactions. It plays a pivotal role in healthy bone growth, energy production, muscle relaxation, heart health, and in supporting a healthy nervous system. Our nervous system relies on magnesium to help regulate calcium and potassium molecules in nerve tissues, as well as the brain. A recently published study suggested that elevation of brain magnesium supports protective effects in a mouse model of Alzheimer’s disease. Specifically, magnesium-L-threonate conferred protection against the plaque formation and synaptic loss that is characteristic of Alzheimer’s disease.