OT: CBD oil for pain management

[jimcav]

Originally Posted by IJWS

I am using a tincture. .25ml every 2-3 hours.

The comment about the fda and pharma industry is becoming relevant. 30 Percocet can be had for an $8 copay. The oil is 5 times that.

i found i needed 40-60mg per dose for it to work. as you say, it gets expensive, especially if you have to try 3-4 brands and titrate to a dose that works. It worked for me and now even if i miss a few days i can pick up with a nightly dose and do okay. It is now harder for me to find good pure CBD as most of it has some ratio of CBD:THC I found a 20:1 that worked, but forget the brand. I try to stick with pure CBD

[IJWS]

Dekonick,

I have dr’s appointments tomorrow. Was planning on discussing this. My nurse recommended trying alternative pain relief and my sister who is a doctor gave me the go ahead-not that either of those are official.

They gave me ketamine when they were setting my leg in the ER. I don’t ever want anything like that ever again. That said, it does seem like an interesting candidate for pain management since the effect is kind of like removing your consciousness from your body...sounds terrifying to me.

Jimcav,

I hope that my tolerance doesn’t build that quickly. I think the .25ml dose works out to 9mg. I am feeling lucky that I found something relatively effective on the first go. Had it not worked, I think I would just have abandoned this pathway immediately.

It was a complex surgery, 8 hours, lots of procedures. That was 2 weeks ago and I am starting to show some signs of recovery that even I think are promising. I am hoping that sometime over the next x weeks, the pain will go down significantly. For the most part, I have a swollen foot and hip that account for 60% of my perceived pain. The rest of the leg is just a consistent sharp throb that I honestly think I could stand for a while. Time will tell. Waiting, and the accompanying anxiety don’t help but I’m told that being patient is the most I can do right now.

[Hawker]

IJWS,
Really sorry to hear about all you're going though. I wish you all the best and at least a good nights sleep ASAP. I know this may sound trite...but I've had several major surgeries that have taken me up to six weeks to recover from. I found that at least for short periods of time distraction by something humorous really helped. Not sure what that would be for you, but Youtube is full of funny and hilarious stuff that may help. Or it may be something on one of the movie channels?

There has been quite a bit of research indicating laughter is indeed "good medicine".

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125057/

I wish you well.

[theboucher]

Hang in there!

I have some discount codes for Floyd's of Leadville, which I've found to be helpful for me when I'm particularly beat up. If anyone needs a code, pm me!

[gasman]

IJWS-

Sorry to hear you've been through so much. You're only two weeks out from major trauma and surgery, don't worry about addiction unless you have a history of addiction. Night is always the worst time for pain so taking 1 or 2 percocet in the evening isn't a problem if it helps you sleep at night. Miralax or metamucil helps prevent the constipation.

What about NSAID's like ibuprofen or naproxen ? They are effective for many patients post surgery. There are also many different prescription NSAID's that may work better for you. Plain old Tylenol in the morning can help.

They aren't going to give you ketamine. It only works intravenously or intramuscularly so it's not for home use. There is a nasal spray form of ketamine but it's only approved for severe depression. If you had a bad reaction to it in the ER it's because they didn't give you another med like midazolam (a valium relative) that would have kept you from having nightmares.

Your anesthesiologist (my profession) likely gave you Propofol and then a general anesthetic which is why you don't remember anything for 9 hours-that and your surgery was really long I gather. So it's good you don't remember any of your surgery.

CBD is so poorly studied that I'm not sure I would recommend it unless you have some THC with it. CBD is largely snake oil as far as I'm concerned-lots of people are making money off something that is unregulated and unmonitored. The brain does have THC receptors which is how many drugs work-they bind to receptors in the body. If you find a combination that works-great !

Let us know how it goes. Good luck.

[IJWS]

I talked to my physician about supplementing/substituting my pain meds with cbd oil and he was ok with it.

I ordered some more oils to try from the same company that made the oil I find effective. They have daytime (20:1 cbd/thc) and a night time (1:4 cbd:thc). The daytime seems about as effective as something with no thc in it. The night time, thc-heavy oil put me to sleep and kept me there all night. First full night of sleep since the 25th!

The CBD is isn’t my new silver bullet. Yesterday my gf and I were out on a wheelchair-bound hospital visit adventure. That was intense. Halfway into the adventure I was in so much pain that I had to resort to taking the Percocet. About an hour later my leg was kind of strangely comfortable and tingly but numb. It was an actual extended relief from that pain. CBD can’t compete with that but I think it’s great that it can get that close.

[redir]

My brother and sister swear by CBD oil but I have my doubts. If you 'think' it works then it does so that's powerful enough right there.

I never like opiates either. When I get injured now I ask for Ultracet (Tramadol). Technically it's considered a narcotic and can be addictive but it's nothing like Percocet and for me actually worked better and with less side effects.

[PacNW2Ford]

I was told post-surgery that pain management is preventative, not reactionary. IE, you should be on a schedule for taking your pain meds to control the pain. Waiting to take it until you can’t stand the pain is likely why it’s ineffective. Not a doctor, but have had several orthopedic surgeries.

[Octave]

One thing that hasn't really been mentioned in this thread is that CBD is also a major enzyme modulator, meaning that it will interfere with other meds you are taking.

For those interested in the nitty-gritty of that:

- CBD is metabolized by cytrochrome P450 (CYP3A4), which is also the enzyme responsible for the metabolism of 60% of clinically prescribed drugs. For example, that's the same substrate as most antidepressant drugs (citalopram/Celexa, sertraline/Zoloft, venlafaxine/Effexor), basically every prescribed benzodiazepine (aplrazolam/Xanax, midazolam/Versed, diazepam/Valium, clonazepam/Klonipin), sleeping medications (zopiclone, zolpidem/Ambien, zaleplon/Sonata), statins (atorvastatin/Lipitor, lovastatin/Mevacor, simvastatin/Zocor), plus most opioids (codeine, hydrocoddone, methadone, tramadol, fentanyl, buprenorphine), antipsychotics, TCAs, chemotherapeutics.... basically, if you are prescribed a drug right now, there's a good chance that it shares an enzymatic substrate with CBD. For any women reading this thread, that's also the same enzyme that processes ethinylestradiol, the ingredient in the most common forms of pill-based birth control. Just because there is no data yet on significant interactions in humans between CBD and the drugs I just listed doesn't mean they don't exist, it means that the CBD market has only blown up in the past couple of years and these datasets are just being built...

- Because widespread use of CBD is so new, there isn't a TON of data on interactions yet, but it has a known and documented major interaction with the antibiotic rifampicin, as well as the antifungal med Ketoconazole. It also alters plasma levels of clobazam, warfarin, and pretty much any modern barbiturate (so this matters a lot if you're undergoing surgery). I have no doubt we will hear about more of this soon (because I know physicians who have seen these interactions and are in the process of publishing them).

Originally Posted by redir

I never like opiates either. When I get injured now I ask for Ultracet (Tramadol). Technically it's considered a narcotic and can be addictive but it's nothing like Percocet and for me actually worked better and with less side effects.

FYI Tramadol is an opioid. It's also an SNRI. It can be extremely addictive and the withdrawals can cause serious problems. Proceed with caution.

[jzinckgra]

I've tried cbd oil under the tongue before bed and found it does make me sleep a bit better, but does not seem to work for continued lower back pain, however I probably need to experiment more with dose. But, the taste is nasty even if chasing with water or flavored drink. Do cbd caps work as well?

[FlashUNC]

Been using a CBD infused cream after hard rides that seems to be helpful with soreness and stiffness. Though maybe that's just the truckload of frankencense they have in it as well.

[redir]

Originally Posted by Octave

One thing that hasn't really been mentioned in this thread is that CBD is also a major enzyme modulator, meaning that it will interfere with other meds you are taking.

For those interested in the nitty-gritty of that:

- CBD is metabolized by cytrochrome P450 (CYP3A4), which is also the enzyme responsible for the metabolism of 60% of clinically prescribed drugs. For example, that's the same substrate as most antidepressant drugs (citalopram/Celexa, sertraline/Zoloft, venlafaxine/Effexor), basically every prescribed benzodiazepine (aplrazolam/Xanax, midazolam/Versed, diazepam/Valium, clonazepam/Klonipin), sleeping medications (zopiclone, zolpidem/Ambien, zaleplon/Sonata), statins (atorvastatin/Lipitor, lovastatin/Mevacor, simvastatin/Zocor), plus most opioids (codeine, hydrocoddone, methadone, tramadol, fentanyl, buprenorphine), antipsychotics, TCAs, chemotherapeutics.... basically, if you are prescribed a drug right now, there's a good chance that it shares an enzymatic substrate with CBD. For any women reading this thread, that's also the same enzyme that processes ethinylestradiol, the ingredient in the most common forms of pill-based birth control. Just because there is no data yet on significant interactions in humans between CBD and the drugs I just listed doesn't mean they don't exist, it means that the CBD market has only blown up in the past couple of years and these datasets are just being built...

- Because widespread use of CBD is so new, there isn't a TON of data on interactions yet, but it has a known and documented major interaction with the antibiotic rifampicin, as well as the antifungal med Ketoconazole. It also alters plasma levels of clobazam, warfarin, and pretty much any modern barbiturate (so this matters a lot if you're undergoing surgery). I have no doubt we will hear about more of this soon (because I know physicians who have seen these interactions and are in the process of publishing them).


FYI Tramadol is an opioid. It's also an SNRI. It can be extremely addictive and the withdrawals can cause serious problems. Proceed with caution.

Thanks I have been appreciating your input on these discussions.

[Octave]

Originally Posted by jzinckgra

I've tried cbd oil under the tongue before bed and found it does make me sleep a bit better, but does not seem to work for continued lower back pain, however I probably need to experiment more with dose. But, the taste is nasty even if chasing with water or flavored drink. Do cbd caps work as well?

CBD oromucosal (like the drops you're using, or the Sativex prescription THC:CBD spray) bioavailability is about 35%. Oral bioavailability is ~10%. So in theory you'd need to be taking a >3-fold larger doses if you switch over to caps. What is the current dose you're using for sleep?

Lower back pain can come from a lot of sources, and CBD only really helps with inflammatory and neuropathic pain. So depending on why you're having lower back pain, it may or may not be effective.

Originally Posted by FlashUNC

Been using a CBD infused cream after hard rides that seems to be helpful with soreness and stiffness. Though maybe that's just the truckload of frankencense they have in it as well.

Question: were you using a non-CBD cream before that? I think the reason so many people think that CBD creams are very effective is because they started using a cream, not because of the CBD. If you go from no-cream to cream, you're adding a nice little massage to get the cream on, stimulating blood flow and moving LA byproducts out of muscle tissue, so it's going to be better than when you weren't using a cream at all. Transdermal bioavailability, especially without carrying agents like DMSO, is basically 0%.

Originally Posted by redir

Thanks I have been appreciating your input on these discussions.

My pleasure. I think education is the key to all of this. I'm not anti-CBD, but I do think there is a whole boatload of nonsense being spread about it.

If you're interested in more, I do discuss this a bit in a recent podcast interview over at The Mary Jane Experience. The podcast mostly focuses on prenatal/perinatal cannabis use, which is my primary laboratory research subject, but we talk about CBD a fair bit (especially in Pt. 2 of the podcast, which came out last week). I'm not a big fan of Canna-Evangelists, but I do think that outreach from scientists to the public is really important, especially in the age of paywalls and academic jargon, and the hosts of the show were really receptive (despite some of my data and reasoning not aligning with their ideals..)

[IJWS]

1-week update:

$200 later and I am still saying the same thing. The cbd oil that I am trying works relatively well. It is not an opioid and can’t match that level of pain relief. It is close enough that I am taking 1 Percocet / day usually at night and I can get close to a night’s sleep now. I bought oils with larger percentages of thc in them. These have been the most effective but they make me a little groggy/not quite there/probably just high. I was also adding thc edibles to especially hard parts of the day (late evening and early afternoons for me). The edibles obviously exaggerated the aforementioned side effects.

I’m relieved to be taking less Percocet. I’m not out of oil yet. The pain relief is pretty good.

More updates to come. Looks like I am going to be on this ride for a while.

[buddybikes]

...could you just be healing a bit?