How Does Medical Marijuana Fit Into Pain Management?

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Bob Twillman, PhD, executive director of AAPM.
Bob Twillman, PhD, executive director of AAPM.

Clinical Pain Advisor sat down with Bob Twillman, PhD, executive director of the American Academy of Pain Management (AAPM) following his association's yearly meeting to understand where medical marijuana comes into play when managing pain; how clinicians can combat opioid misuse, abuse, and overdose; and what the medical community can expect from AAPM in 2016.

Clinical Pain Advisor: When it comes to pain management in today's medical landscape, where are clinicians struggling?

Dr. Twillman: I think they are struggling in different places, depending on the type of clinician involved. Primary Care Providers (PCPs) feel increased pressure to treat pain with methods other than opioids, but many don't know how to do that. Even if they did, the ability of their patients to access non-opioid care and pay for it, is very limited. This makes PCPs frustrated and anxious about managing the care of people with chronic pain. As a result, many of them would just as soon avoid the problem entirely, either by establishing a “no opioids” policy or by referring many of their patients to pain management specialists.

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Specialists, on the other hand, are increasingly frustrated because they see a flood of new patients coming their way, many of whom could be treated successfully by PCPs (either independently or with occasional specialist consultation). Many of these patients do not have the kinds of very complex conditions that really warrant ongoing regular care from a specialist. Yet PCPs won't treat them because of all the pressure around opioids, and the specialists simply don't have room to see all of these patients.

Clinical Pain Advisor: What is the role of medical marijuana in pain management?

Dr. Twillman: We don't really know the answer to this yet. We certainly have indications that some components of marijuana can be effective in relieving pain, especially neuropathic pain, but we need a good deal more research into which components are most effective and a means of obtaining those positive effects without the unnecessary psychoactive effects from other components. In the best of all possible worlds we would have products that provide standardized doses of a known mix of compounds, supported by research demonstrating effectiveness and safety, but I fear we are a long way from that world. For now that leaves us trying to manage medical marijuana use without really understanding it and feeling pretty unsure every step of the way.

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