Marijuana and Chronic Pain: Q&A with Dr. David Barton
Dr. David J. Barton (AKA Dr. B), a conservative physician by personality and training, says it required an evolutionary process to arrive at his present clinical outlook on medical marijuana.
What is your medical background?
Dr. B: I was a double-boarded general surgery trained plastic surgeon until I became disabled and retrained in Pain Medicine at the University of Utah. I hold memberships in the American Academy of Pain Medicine, the International Cannabinoid Research Society and the Hawaii Medical Society.
How did your opinion on cannabis medicine evolve?
Dr. B: I was hindered from a career in surgery, causing a neck and arm condition that lead to chronic pain. That led me to where I am today. Much of my philosophy is guided by my personal experiences with severe pain and the failed treatments.
I became frustrated by poor treatment outcomes. For many pain conditions, traditional medicine included aggressive treatments and dangerous levels of medicines. Having no personal experience with marijuana use, I learned by listening to patients who found significant relief using cannabis. With further study, I realized the truth about cannabis and its potential to relieve suffering in a safe and effective manner.
What is cannabis medicine?
Dr. B: For the Pain Doc, cannabis medicine represents a naturopathic, legitimate alternative for treating chronic neuropathic pain and muscular conditions using a variety of cannabis based medicines.
The U.S. National Institutes of Health/National Cancer Institute states the known benefits include:
- Antiemetic effects (effective against vomiting and nausea)
- Appetite stimulation
- Pain relief
- Improved sleep
- Symptom management
- Direct antitumor effect
- End of life care
Cannabis medicine focuses on treating a variety of medical conditions.
Are there risks?
Dr. B: There are risks to any treatment. Seldom headlined are the consequences of undertreated or untreated pain. According to the American Osteopathic Association, chronic pain "affects more Americans than cancer, diabetes, and heart disease combined."
Patients and physicians should discuss potential negative effects. About 90 percent of my patients use very small amounts of cannabis, and learn quickly how to avoid problems. And like with any medication, I screen for the small minority of those who may be prone to misuse and addiction.
When an individual’s health problems are addressed by a qualified healthcare provider, risks, significantly less than traditional medications, are minimized.
Many say THC and CBD transform pain signals between peripheral nerves, the spinal cord and brain. Do you agree?
Dr. B: Yes. At the 2013 American Academy of Pain Medicine meeting, Dr. Michael Moskowitz said, “preclinical studies, surveys, case studies and randomized double-blind placebo-controlled trials with cannabis have all shown its effectiveness in chronic pain conditions … Cannabis works to settle down the processing of wind-up (centralization) and is the only drug known to do so. It reduces inflammatory pain in the peripheral nerves, and has a unique mechanism for pain reduction unlike any other medicine.”
The complex interaction between innate opioid and cannabinoid systems is not well understood. But with effort and opportunity, we can unravel the mysteries of cannabis science.
How does MMJ stack up against other painkillers?
Dr. B: Studies show MMJ can be as effective as opioids. Many people are able to eliminate or significantly reduce their use of opioid pain pills. Cannabis also treats other problems associated with chronic pain, such as sleep, mood disorders, and myofascial spasms and pain, thereby reducing the need for additional medications that have potential side effects or drug interactions.
Is there a cultural transformation regarding MMJ?
Dr. B: Yes. This was most evident at a recent NIH symposium (Marijuana and Cannabinoids: A Neuroscience Research Summit) that took place in Bethesda this past spring, wherein, the medical use of cannabis was clearly discussed.
Over the past few years, we have all seen the direct medicinal effects of cannabis in the media by high profile people and entities. The most dramatic have been children with intractable seizures whose parents are directly challenging hostile politicians. The second group is our veterans with service-related conditions who find relief with medical cannabis use.
Patients, their love ones, and organizations have teamed up with activist physicians and political allies to challenge the status quo of government. The tsunami of change in every state has been accelerated by opioid related deaths.
How do you counsel patients?
Dr. B: The patient must have a qualifying condition according to the laws of Hawaii, where I practice. I expect patients to act responsibly and follow the laws that govern MMJ access and use.
I discuss various delivery systems with my patients. The majority use inhalation delivery. Oils, edibles, and topical ointments are in strong demand. I have seen great results for autoimmune conditions using high CBD low THC cannabis based juice, which provides pain relieving, strong anti-inflammatory effects without psychogenic effects.
Our goal is to combine traditional multi-disciplinary therapies with our patient’s right to use medicinal cannabis to improve their outcome. (See An Elephant Called Pain.)
David J. Barton, MD is a clinician in Pain Medicine and a Medical Political Activist with more than 31 years of experience as a physician. He is fellowship trained in Pain Medicine, and became board certified in Pain Medicine by the American Board of Pain Medicine in 2005. Past board certifications include General Surgery (1992) and Plastic Surgery (1995). He is owner and founder of Hawaiian-Pacific Pain and Palliative Care and focuses his practice on chronic pain and end of life care. Dr. Barton has personally lived in the "Pain World" for nearly 20 years.
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