While research is limited, what we have learned is impressive in regard to CBD and pain management doctors work with patients
CBD SOUNDS ALMOST TOO GOOD TO BE TRUE — it reduces pain, relieves anxiety, grants relief from inflammation … and it could boost the income and patient results for pain management doctors. But is it all it’s cracked up to be?
Cannabidiol or CBD is one of the dozens of active ingredients found in the cannabis plant. It specifically triggers receptors in the human body in the endocannabinoid system that help reduce pain, anxiety and stress — and is expressly not hallucinogenic. Some indications show that regulating the endocannabinoid system can also reduce inflammation, relax an overactive immune system, and reduce depression.
What CBD is not
CBD is not tetrahydrocannabinol (THC), the hallucinogenic component of the cannabis plant. Although the endocannabinoid system is better adapted to utilize THC, legality issues and a lack of research restrict its use. In commercial preparations of CBD products, the THC must be below 0.3% (more on this below).
Speaking with many patients who use CBD, you can get endless reasons. Unfortunately, research is still limited, but scientists know CBD works for certain things:
Pain — Several studies have proved CBD can reduce pain for a variety of conditions. Currently, most of the research revolves around how CBD relieves pain. Clinical trials for efficacy and safety are scarce (mainly in animal studies, currently). By triggering the endocannabinoid system, CBD can reduce nociceptive transmission of pain throughout the nervous system to reduce pain, particularly in the spine and brain. Specifically, the exogenous cannabinoids bind to the CB1 or CB2 receptor, triggering a reduction in pain.
Inflammation and Diabetes — CBD can also trigger various pathways to reduce inflammation. As a result, it works exceptionally well for people with rheumatoid arthritis and other conditions related to inflammation. According to the study, “Antioxidative and Anti-Inflammatory Properties of Cannabidiol,” “The therapeutic potential of CBD has been evaluated in cardiovascular, neurodegenerative, cancer, and metabolic diseases, which are usually accompanied by oxidative stress and inflammation. One of the best-studied uses of CBD is for therapeutic effect in diabetes and its complications in animal and human studies. CBD, by activating the cannabinoid receptor, CB2, has been shown to induce vasodilation in Type 2 diabetic rats, and by activating 5-HT1A receptors, CBD showed a therapeutic effect in diabetic neuropathy.”
Anxiety — People who experience anxiety, and to a limited degree depression, often feel more relaxed and in control of their thoughts when using CBD. The mechanism isn’t well-defined, but it is suspected that CBD alters the production and use of serotonin. It’s been effective in various case studies and reports for general anxiety, PTSD, depression, seasonal mood disorders, PMS, psychiatric disorders and social anxiety issues. Anxiety can increase muscle tension, affecting body alignment, and CBD can help reduce this anxiety. CBD should not be used with or used in place of any medication for mental issues or anxiety without doctor supervision.
Gastric Problems — Many gastric complaints link to inflammation. Since CBD reduces inflammation, many gut complaints can be reduced or eliminated. Although it’s debated whether oral ingestion is necessary for this release, several studies show CBD can help with IBS, reflux and autoimmune conditions like Crohn’s and Still’s.
Comparisons to other options for pain management doctors
Before we look at how CBD compares to other options for pain management doctors, we have to look at the role of CBD in the collective consciousness.
Without proper education, some people are going to see this as illicit activity, something they would never do. So before recommending CBD to your patients, you should get their opinion. Other people see CBD as an alternative to modern medicine. They feel it is a replacement for prescription medications.
Your goal should be to educate patients on the role of CBD and how it fits into the overall medical landscape of their health. In this case, you may be competing against social media and exaggerated accounts of how CBD works. Education regarding CBD is paramount to proper use and the best outcome for patients of pain management doctors. CBD is part of the healing program, not a replacement.
Let’s look at some of the common pain management tools and how CBD fits in:
Analgesics — Analgesic gels are one of the most used pain-relieving tools of a chiropractor. However, it is not recommended CBD and analgesic gels be used simultaneously. Creams that deliver a specific dose of CBD can be used in place of analgesic gels to help relieve pain. However, it is not the same type of relief, nor is it as instantaneous. CBD products for pain relief can be used in place of over-the-counter medication, some prescriptions and herbal pain relievers. You should recommend your patients speak to their primary physician before using CBD. It is never recommended to use CBD and pain relievers at the same time.
Anti-Inflammation Supplements and Medication — The ability of CBD to reduce inflammation helps reduce the need for medication for many people. Some more advanced doctors recommend CBD as a first step to reduce inflammation, similar to recommending turmeric, boswellia, astragalus, ashwagandha and even ginger. Again, anti-inflammatory medication and concentrated supplements should not be used at the same time as CBD without the supervision of pain management doctors.
TENS Units — Transcutaneous electrical nerve stimulation, or TENS therapy, uses low-voltage electrical stimulation to block nerves from transmitting pain signals. Theoretically, TENS therapy can combine with CBD as the pathways for pain relief are entirely separate. However, no study shows patients get additional or longer-lasting relief combining the two therapies. Currently it is unknown what the results would be combining these two therapies. There is the potential that CBD could reduce a patient’s ability to respond to TENS therapy, resulting in excessive use.
Chiropractic Adjustment/Physical Manipulation — The primary tool of a chiropractor is a chiropractic adjustment. For many people, using a combination of therapies that include chiropractic adjustment, pain-relief medications and medical devices can bring the fastest and most complete recovery. For patients who are open to it, helping relax the muscle with CBD both during a chiropractic adjustment and in the time between adjustments can bring faster recovery. Discussing this option with your patients is the best way to avoid any side effects and get the highest patient compliance.
Current state of the CBD industry
Possession of CBD from cannabis that contains 0.3% or more THC is still a Class I felony. However, CBD from hemp with less than this amount of THC is legal.
Additional laws vary state to state, and several medical associations have censored and even revoked the license of medical doctors, chiropractors, osteopaths and other licensed medical professionals for using CBD in their practice or actively engaging in selling the products.
If you choose to sell CBD products or use CBD in your practice, it is recommended to speak to your local and state chiropractic boards for their official position on CBD use. The problem that faces the industry is a complete lack of regulation and oversight. It relies on the manufacturer’s honesty to accurately report the CBD origin, content and any potential contamination. And new manufacturers and sellers are opening daily, most without quality control.
The risk you take using CBD products is the level of contamination with THC. The THC content must be below 0.3% legally; however, some products touting this level test much higher. You also have full-spectrum and broad-spectrum CBD products that contain terpenes and other vital chemicals found within cannabis.
The decision to incorporate CBD into practice
Many chiropractors find CBD useful and a good revenue stream within their practice. It may prove a valuable tool as part of your therapy.
Using CBD topically helps relax the muscles before a chiropractic adjustment. Through massage and CBD, you may achieve a faster and more thorough adjustment. CBD is also helpful between adjustments for people who wish to remain calmer and avoid the use of prescription painkillers. CBD can help relax the muscles and keep the alignment longer between sessions for people prone to anxiety or muscle tension because of stress.
In addition, recovery times can improve with the use of CBD. For chiropractors allowed to sell CBD in their practices, it can be an excellent revenue stream through affiliate marketing. Although currently not covered by any insurance, many people will pay out-of-pocket for CBD products. Additionally, products sold by chiropractors are often seen as being higher quality, attracting a buyer willing to purchase better products more consistently.
If you choose to use CBD products in your practice, check your ability to use it, your liability, and check in with your patients on their view of CBD. Once you begin using CBD in your practice, you’ll find many different ways to incorporate it as part of standard treatments. It can be a potent revenue stream and a way to increase positive patient results.
ANTHONY CRIFASE, DC, CNS, DACBN, is double board-certified in clinical nutrition and maintains an active chiropractic practice in Denver, Co. With experience in multiple different industries and as a seasoned chiropractor who understands the ins and outs of functional medicine, chiropractic and practice management, he is on a mission to help other practitioners maximize their time, revenue and systems. Learn more at drcrifase.com.