Managing Chronic Pain With Medical Marijuana
Last updated: May 2023
Accepting that something so stigmatized could be helpful for Keegan took a while for me to get over. When we got married, I knew I'd do anything and everything I could to help with his disease and chronic pain. It took a while for us to accept that medical marijuana was a route to try, and boy am I glad we pushed through the stigma. Medical marijuana has changed Keegan's life radically.
Yes, that sounds dramatic, but it's proven to be a key tool in the AS treatment toolbox. Right now, Keegan's on Humira to help slow down disease progression, but he has pain every day. And most likely, that pain will never go away. Before medical marijuana, we tried NSAIDs like Aleve and Motrin, Celebrex, and some opioids. However, none of it helped Keegan. Even the opioids did little for his pain and we were both worried about addiction.
Getting a medical marijuana license
The same year, Pennsylvania passed the law for medical marijuana. Shortly after, we moved to Philadelphia and Keegan got a license. To get a license, we started with his rheumatologist. She wrote a letter so the doctor who'd "certify" (not prescribe, as it's not covered by insurance) Keegan knew that she recommended it as a pain relief treatment. Finding doctors who were certified was a bit confusing. There's a list of doctors online but we didn't know who to call. The most important was to know which condition in Pennsylvania Keegan would fall into. It is "Severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain." (Note that each state's laws are different, so Google your state's medical marijuana laws.)
Tip #1: Get a doctor's recommendation
Get a recommendation for medical marijuana from a rheumatologist, if they're willing. It helped prove to Keegan's pain management specialist the severity of his AS and chronic pain.
Once his rheumatologist recommended medical marijuana for this condition, we sought out a pain management specialist. The cost of the initial appointment surprised us. Medical marijuana isn't covered under insurance, so everything is out of pocket. The new patient appointment was $250. Keegan got the appointment and was out within 20 minutes and in a week had a card to go to a dispensary.
Tip #2: Ask questions at the dispensary
Don't be afraid to ask questions at the dispensary. Think of the employees there like pharmacists; they're there to answer questions.
I've never been inside the dispensary--only Keegan is allowed. But from what he says, it can be a bit overwhelming. In Pennsylvania, there are a bunch of medical marijuana treatment options, including:
- Tincture: Oil that a patient puts under their tongue.
- Vape cartridges: Oil that can be used in a vape pen. Right now, this is controversial as many don't know what additives are in vape cartridges and whether they cause lung injuries.
- "Flower" or dry herb: Dried marijuana plant that is ground and vaped in a herb vaporizer. (Different from an oil or cartridge vaporizer.)
- Injection: Syringe with medical marijuana that's injected.
Tip #3: Experiment to find what works
Try and try and try until you find what works for you. (Or you've exhausted all options.)
Medical marijuana's effects are unique to each person. There are 2 strains: Indica and Sativa. Within those 2 strains, there are many variations, just like garden flowers. What may work for Keegan may not work for you, and that's totally fine. At his first visit, Keegan asked for types that will help with chronic pain and sleep. The employee picked out a few Indica variations to try out. Keegan saved on his phone which variations worked well for him and which didn't. Keegan's biggest takeaway: It can take time, effort, money, and patience to find medical marijuana that worked well for him.
Keegan's advice for a first-timer
- Be okay with being nervous and find a safe space when medicating: Taking medical marijuana for the first time, Keegan was feeling a bit uncertain and anxious given what we grew up learning about marijuana. It's okay to be uncertain. The best thing to do is to find a safe environment to try it for the first time. For Keegan, that was with me at night in our living room watching YouTube.
- Find your tolerance: Each person tolerates different levels of CBD and THC, the chemicals in marijuana. THC is the most important to keep an eye out for. Start at low levels and work your way up. For Keegan, he has a very high tolerance and needs high THC. However, that could make another patient have a bad experience.
- Medicate before bed: It helps Keegan immensely with his sleep. Before medical marijuana, I felt Keegan toss and turn. Not anymore! He finds using a tincture before bed helps him.
- Different ways of consuming medical marijuana may change the effect: Keegan finds a milder, yet deeper pain relief with the tincture. Dry vaping helps him with acute pain, especially throughout a flare-up.
- Take more than usual if a flare-up or inflammation comes on: CBD, the other chemical in medical marijuana, can help with inflammation. Keegan's found that taking a bunch if he feels a flare-up coming on helps reduce the overall sensation but also the inflammation in his body.
Can medical marijuana help ankylosing spondylitis pain?
Before medical marijuana, we saw improvements in Keegan's pain with Humira, a biologic. However, every day still brought on the pain. And that was without a flare-up going on. Now, he uses medical marijuana throughout the day. Mornings are particularly rough. He wakes up stiff and nauseous, which medical marijuana helps with immensely. He can start the day without waiting 2 to 3 hours until his body is ready to move.
When I asked Keegan how medical marijuana affects his pain, he told me "it doesn't get rid of the pain." Rather, he describes it as a pain management tool. Medical marijuana does 2 things for him: 1. It dulls the pain and changes the sensation so it's easier to manage and 2. Distracts him from the pain. This makes managing sharp and acute pain much easier. It also means he sleeps better and is able to actually rest at night. For me, it's a huge relief to see him happier and more relaxed. As a caregiver of someone with AS, seeing him with less pain and enjoying some moments of the day is all I hope for.
Have any of you tried medical marijuana to treat pain or AS symptoms? How has it gone for you?
Do you notice worsening flares in colder weather?