When to Consider Cannabis or CBD for Pain Relief Before Surgery
The practice of dentistry is currently evolving at a fast pace. As a physician, I see major technological advancements that include pain free implants, app-based post-surgical follow-up, and the use of artificial intelligence to predict problems, all of which elevate the way dentists provide care.
It is tempting for dentists to jump on the current CBD (cannabidiol) bandwagon. CBD is very popular right now and claimed to be effective for a range of issues from pain to anxiety. Ironically, CBD is, in fact, not proven useful for any of these things in adult humans. Cannabis, meaning THC containing products derived from the cannabis plant, has been shown to address these problems. However, the complexity of administering, adjusting to, and monitoring cannabis use makes it less than ideal in the acute dental situation.
For patients undergoing simple, one-time procedures, cannabis is not a good substitute for the tried-and-true approaches to pain or anxiety relief. For patients who are contemplating major work, perhaps spanning many procedures – for example, root canals or maxillofacial reconstruction – planning ahead to initiate cannabis medication is viable and should involve consultation with and ongoing guidance from a Cannabinoid Specialist.
Below are key points about what is known about cannabis and CBD and how to effectively use them.
- What is CBD and what is cannabis? How are they related?
CBD or cannabidiol is a cannabinoid or a chemical compound derived from cannabis. It has become incredibly popular recently but largely because it is a good product to sell, not because it is a safe or effective medication.
In general, questions about CBD pre-suppose that CBD is a useful medication. It is not. There is no data in adult humans to show that CBD is useful. All studies to date, except for kids with rare genetic seizure disorders, are done in mice or cell culture and are NOT reasonably applied to humans.
THC (tetrahydrocannabinol) is another cannabinoid from cannabis. While it does cause some intoxication for which it has become famous, it is really the best researched and clearly proven compound in cannabis. There is some evidence that pure THC is not as effective as using whole cannabis that contains THC and other compounds, including CBD. This is a case where the whole appears to be more effective than the individual components. This is called the Entourage Effect and while the evidence to support it is sparse, it is intriguing.
- What is the average dose of CBD or cannabis?
Extrapolating from kids and mice, CBD has been shown to require vast doses: 10-20 mg per kilogram of body weight, equating to 700 to 1400 mg per day for the average 70 kg human. This is not available, sustainable, or affordable.
While low dose CBD may not be harmful it is not helpful either. When you get to higher doses it has been shown to interact dangerously with many conventional medications like blood thinners, heart medications, and a range of others including over-the-counter meds like Loratadine (Claritin). There are even data that show that at higher doses CBD can cause direct liver toxicity.
THC-dominant cannabis, on the other hand, has been shown to be effective for pain and for anxiety. Doses are quite low, typically 5-15mg, delivered by inhalation (vaporized flower is safest) or orally. In the acute setting vaporized flower would be most helpful as the onset is 10-15 minutes compared to 1-2 hours for oral.
- Are there regulated guidelines for dosing CBD and cannabis?
There are no dosing guidelines for CBD beyond the 10-20 mg per Kg range mentioned above. Again, there are no studies in adult humans to show that CBD is safe or effective for any condition.
Dosing guidelines for cannabis use are more readily available and scientifically justified. A great source of information on use of cannabis to treat patients is the Association of Cannabinoid Specialists. They have a dosing and treatment handbook for members. You can find them at cannaspecialists.org.
As an MD, I would argue that it is the responsibility of your cannabinoid specialist physician to know the available products and to be able to recommend the best ones as well as the actual use regimen.
- What factors influence how much CBD or cannabis you should take?
You should not take CBD at this time. There are not sufficient data to assure that it is safe or effective. In the future, we may well have data to support the use of CBD but for now it is not a medically justified product.
Cannabis dosing is not clearly affected by weight or other common factors. Low doses are safer and more effective than higher ones and less likely to lead over the long-term to misuse and addiction. Guidance on dosing for individuals and specific situations should come from consultation with a cannabinoid specialist.
- Are there any side effects to CBD or cannabis? Can you take too much?
While low dose CBD may not be harmful it is not helpful either. Nausea, poor appetite, fatigue and diarrhea are minor issues that have been reported. When you get to higher doses CBD has been shown to interact dangerously with many conventional medications like blood thinners, heart medications, and a range of others. There are even data that show that at higher doses CBD can cause direct liver toxicity.
Cannabis will always come with some degree of side effects. Primarily this includes intoxication and dry mouth. Our job is always to maximize the benefit while minimizing these side effects. This is primarily accomplished with attention to dose and timing. The dental literature does show that chronic dry mouth in cannabis recreational users can lead to recession and complications. For this reason, attention needs to be paid to both medical and recreational users of cannabis.
It is commonly said that you cannot overdose on cannabis. This is incorrect. It would be correct to say that you cannot lethally overdose on cannabis. However, death is not the only negative outcome possible. Getting too much cannabis can be a very unpleasant experience, and while non-lethal, should be avoided. Further there are no safe and proven pharmacological interventions for over-intoxication.
- Should anyone avoid CBD or cannabis?
Everyone should avoid using CBD. It has not been proven to do anything, but the risks of drug interactions and liver toxicity are real.
I would strongly urge against using either cannabis or CBD while pregnant. Whatever the unclear data we have on cannabis and pregnancy, we have none on CBD specifically and every reason to expect that it may have effects on pregnancy. We just have no idea what they might be.
Caution should be exercised when using cannabis for patients who have history of atrial fibrillation, severe congestive heart failure, or history of cardiac or cerebral vascular insufficiency.
As medical professionals, we are available to answer questions surrounding cannabis and CBD use from a medical perspective. At inhaleMD, we are dedicated to treating patients through cannabis therapeutics. Our medical practices specialize in creating effective treatment plans for people seeking relief under the guidance of caring, well-trained physicians.
Cannabis medicine is unlocking new doors to treatment of pain and anxiety, and leading to new knowledge about human physiology. The pandemic, however, is creating vast need to catch up on delayed dental care. The intersection of these two phenomena is creating opportunities for dentistry to improve delivery of patient care.
ABOUT THE AUTHOR
Jordan Tishler, MD, is a cannabis specialist, President of the Association of Cannabinoid Specialists, as well as a graduate and instructor at Harvard Medical School. He’s been instrumental in the implementation and improvement of medical cannabis regulation in many states, including Massachusetts, New Hampshire, Connecticut, New York
How much cbd oil do i need for surgicalpain
Cannabidiol (CBD) fascinates most medical researchers. Patients in Torrance love its medical benefits and non-intoxicating characteristics. A few years ago, very few people knew about cannabidiol. Currently, there is a vast market for it. Thanks to the U.S Food and Drug Administration approval. So, what is CBD? Is there anything you should know before taking it? What are its various benefits? Read the article prepared by Pacific Pain and Wellness to learn more.
What is CBD?
You might have seen CBD (cannabidiol) as a booster to morning coffee or workout smoothie. So, what is cannabidiol? Why is CBD so popular?
It is a prevalent active ingredient of marijuana. Although it is an element of medical marijuana, it’s derived from the hemp plant related to marijuana.
According to the World Health Organization (WHO), CBD does not exhibit effects indicative of dependence potential or abuse in humans. Currently, there isn’t proof of health associated with challenges related to pure CBD use.
CBD is related to another medically active phytocannabinoid (tetrahydrocannabinol). THC results in the high which bhang is famous for. Both THC and CBD have essential therapeutic characteristics. However, CBD doesn’t make you intoxicated or feel stoned. It is because the two components act differently on various receptors in your body or brain.
CBD neutralizes or lessens the psychoactive consequences of THC, hinging on the amount of the compound consumed. The fact that cannabidiol is:
- easy to make,
- and therapeutically potent,
makes it perfect for cautious patients and those using bhang for the first time .
How Does Cannabidiol Work?
THC and CBD interact with human bodies in different ways. One of them is augmenting and mimicking the effects of endogenous cannabinoids. Endogenous cannabinoids compounds are similar to compounds found in marijuana.
The discovery of the endocannabinoid system has advanced the understanding of disease and health. It has significant implications for almost all medical science and assists in explaining why THC and CBD are versatile compounds.
The endocannabinoid system regulates various physiological processes, such as:
- Energy level
- Intestinal fortitude
- Blood pressure
- Immune activity
- Glucose metabolism
- Bone density
- How you experience stress, pain, and hunger
So, what occurs when the endocannabinoid system fails to function properly. What are the effects of an overactive or chronically deficient endocannabinoid system? You will feel sick. CBD regulates the endocannabinoid system and enhances endocannabinoid tone, and sometimes slows down disease progression.
Is CBD Legal?
Although cannabidiol is readily accessible in many states, its legal status is uncertain. States have rules and regulations authorizing cannabidiol with different levels of limitation. Although the federal government puts cannabidiol in one category as marijuana, it does not habitually enforce it. In 2015, the U.S. Food and Drug Administration eased the regulatory requirement, allowing researchers to do trials.
Today, you can get CBD products online with no medical bhang license.
The government’s position on cannabidiol is unclear and hinges whether CBD originates from marijuana or hemp. The legality is anticipated to change. Currently, there is consensus in Congress to make the hemp crop and its purposes legal.
Ways to Take CBD
Cannabidiol is available in various forms, allowing you to design your way of use to your specific need and preference. Discussed below are the common types of cannabidiol:
- Vaping: Vaping is a direct route. It provides a straight shot to the bloodstream through the lungs. That means you will feel the effects immediately. You can also experience the effects more strongly since there is no filtration. Vaping effect can last between ninety minutes to three hours, depending on the person.
- Spray: CBD can also be sprayed directly to your skin. The spray is gentle and does not leave the oily consistency that comes with balms. This makes it ideal for treating rashes, skin irritation, and burns.
- Bath salts or soaks: Soaks are bath salts that induce a soothing and calming effect. More often than not, they are infused with essential oils that make baths more relaxing and enjoyable.
- Edibles: Gummies are the most popular edible types of cannabidiol. Typically, they come in standard doses (five milligrams). Other edible products include powder to dissolve into a smoothie, CBD infused water, and chocolates.
- Lotions and creams: Topicals are used to treat joint and muscle pain. Additionally, they can treat skin diseases such as psoriasis and eczema.
- Tinctures and oils: CBD oil is made when cannabidiol is extracted from marijuana and infused with a carrier oil like hemp seed oil or coconut oil. Tinctures and oils are liquids infused to herbs to be eaten. You can also put in your beverages or food. Since oils and tincture are absorbed through small capillaries below your tongue, they maximize the amount of CBD available for use by your body cells. It is because metabolic loss through your digestive system is completely bypassed.
What are the Benefits of CBD?
The advantages of cannabidiol continue to make controversial headlines in the medicine and wellness field. With more researchers, doctors, and patients experiencing the various benefits, it is probably a matter of time before CBD becomes a legal product.
Helps Those with Addiction
A 2015 review of research published in Substance Abuse indicates that CBD could benefit people with drug addiction.
Nevertheless, the effect of cannabidiol is different in every addiction. For instance, CBD oil showed a reduced impact in minimizing opioid symptoms in THC’s absence. On the contrary, CBD alone effectively minimizes addiction in users of psychostimulant drugs such as:
Helps with Seizures
In 2018, the United States Food and Drug Administration approved Epidiolex for seizure treatment related to Lennox-Gastaut syndrome and Dravet syndrome in children below two years of age. Both conditions are rare genetic disorders that cause deadly seizures that start during the first year of life.
Outside the disorders, the effectiveness of CBD on seizure treatment is not certain. Even with Epidiolex, it isn’t certain whether the anti-seizure effects could be attributed to CBD.
It is believed that cannabidiol interacts with most seizure medications and improves their concentration in your blood. It makes the drug more efficient and extends its half-life.
Lowers Blood Pressure
Khalid A. Jadoon, Garry D.Tan, and Saoirse E.O’Sullivan investigated if cannabidiol reduces blood pressure. 600 mg cannabidiol was administered in nine healthy male subjects. The study monitored cardiovascular parameters.
Men who took cannabidiol had reduced blood pressure after and before stress, reduced stroke volume, and increased heart rate. When it comes to cold stress, subjects who took CBD had blunted blood pressure and increased heart rate with low peripheral resistance.
The study proved that one dose of cannabidiol assists lower resting blood pressure and blood pressure response to cold stress.
Alleviates Cancer-Related Signs and Symptoms
As a cancer patient, you have to endure living with sleep deprivation, pain, and depression. Moreover, your treatment will cause nausea and vomiting. Fortunately, CBD assists relieve the symptoms. Some patients find it difficult to respond to conventional pain medications like opioids, and those who do might be addicted to the medications.
According to research, CBD offers an alternative treatment method that is non-intoxicating and more effective. CBD could reduce pain approximately thirty percent more effectively compared to conventional medication or THC.
In another research, scientists administered CBD daily to patients for five days after chemotherapy. Those who received the medication experienced a forty-nine percent reduction in nausea and vomiting.
CBD and Skin Care
CBD products have tremendous benefits, such as treating eczema and psoriasis. It is because it has antioxidant properties. Therefore, it can repair damages to your skin caused by free radicals such as ultraviolet rays or environmental pollutants.
Can Treat Acne
Acne affects approximately nine percent of the global population. It develops when dirt, dead skin, or excess oil accumulate and clog your skin pores. As a result, the bacteria which live in your hair follicles multiply and result in inflammation—the bacteria build-up results in red blemishes on your skin. To prevent acne, you should always clean your face and use oils that don’t clog the skin. CBD products contain anti-inflammatory properties that stop oil production.
Lowers the Risk of Being Obese
According to an article published in the American Journal of Epidemiology, a study conducted showed that subjects who took marijuana had approximately one-third lower obesity rate. This comes despite claims that bhang users consume many calories daily because of ghrelin stimulation by THC. Ghrelin increases both appetite and carbohydrates metabolism.
Assists Alzheimer’s Patients
A study that paid attention to using cannabidiol to treat Alzheimer’s discovered that CBD contains effects that could treat nervous system disorders. The study’s efficacy was due to cannabidiol’s antioxidant properties and the ability to protect nerve cells against damage and deterioration. Moreover, CBD substantially lowers adverse effects and improves the cognitive ability of Alzheimer’s patients. Although there is no current evidence, CBD could be the key to assisting the patients and slowing down the condition’s progression.
Improves Your Digestive System
Since the FDA approved CBD, medical practitioners recommend using it. Your digestive system and the gut are essential to your general health. Additionally, the gut houses organisms like parasites and bacteria.
Here are how CBD can help improve your gut health:
- Controls digestive processes such as appetite, hunger, satiety, and salivation
- Prevents stomach swelling and bloating
- Aid in treating IBS, Crohn’s disease, and Colitis
- Prevents abdominal pain, diarrhea, and constipation
Bhang has alleviated and treated pain for many years. And recently, researchers have found out that specific elements of marijuana like CBD are accountable for the pain-relieving effect.
As previously mentioned, your body has an endocannabinoid system that regulates appetite, pain, immune system, and sleep. Endocannabinoids are neurotransmitters that bind to CBD receptors in the nervous system. Research has proved that cannabidiol reduces chronic pain by:
- Affecting endocannabinoid receptor activity
- Interacting with neurotransmitters
- Reducing inflammation
A study discovered that CBD injections reduced pain response to surgical incision in rats. It was also found in another study that CBD treatment substantially lowered inflammation and sciatic nerve pain in rats.
A combination of THC and cannabidiol is also linked to manage and treat pain associated with arthritis and multiple sclerosis. A study involving forty-seven people who have multiple sclerosis studied the effects of taking Sativex for a month. Sativex is an oral spray and is approved to treat multiple sclerosis pain. The subjects reported experiencing improvements in muscle spasms, walking, and pain.
Reduces Depression and Anxiety
The WHO reports that while depression is a leading contributor to the world’s disability, anxiety is ranked sixth.
Typically, the conditions are treated with medication that comes with numerous side effects, such as:
- Sexual dysfunction
Also, medications such as benzodiazepines could be addictive. They might also result in substance abuse.
CBD oil seems promising as far as treatment for the mental conditions is concerned.
In one study, fifty-seven subjects received either a placebo or oral CBD ninety minutes before undergoing a public speaking test. It was discovered that a three hundred mg CBD dose was the most effective at reducing anxiety. The one hundred and fifty mg dose, six hundred mg dose, and placebo did not reduce the mental condition.
Determining the Right CBD Dosage
CBD dosage depends on numerous factors such as:
- Your weight
- The health condition you are treating
- The concentration of CBD in one capsule, pill, gummy, or drop
- Your body chemistry
In short, there are many variables to put into account when deciding the right dosage. However, it is crucial to speak with your physician about how much CBD to take and the potential risks. After your doctor advises you, be sure to follow their recommendation, particularly if you are taking prescription medications with CBD like Epidiolex.
Should your doctor fail to recommend, it is wise to begin with a smaller dosage and gradually increase it. You can start with twenty to forty mg per day. After one week, increase the amount by five mg. Continue doing this until you treat the symptoms.
It is wise to keep track of the CBD’s amount you are taking and whether the symptoms are improving. Be sure to note it down in a note application on your smartphone or a paper.
Products like capsules, pills, and CBD gummies tell patients the available amount in one serving. For instance, the packaging on a bottle of capsules could show five mg of CBD in every capsule.
And if you are using CBD oil, it might have a dropper. The packaging could specify how much cannabidiol is available in one drop. Sometimes, it is difficult to determine the amount in one drop because the packaging indicates the whole bottle’s total amount. Generally, one drop is approximately 0.005 millimeters. That means a ten-milliliters bottle has two hundred drops.
What are the Side Effects of CBD?
According to clinical research conducted by Kerstin Iffland and Franjo Grotenhermen in 2017, CBD oil has side effects. The type and seriousness of the side effects vary with individuals. The symptoms include the following:
- Changes in appetite
- Mood swings
- Dry mouth
- Changes in alertness
Additionally, it can result in increased production of liver enzymes. Persons suffering from liver conditions must use CBD products with care, following the physician’s recommendations. The doctor should also monitor their liver enzyme level regularly.
Expectant mothers should avoid taking CBD oil. According to research conducted in 2018 by the American Academy of Pediatrics, pregnant women should avoid using bhang during pregnancy. It is because of the potential risks to the fetus’ development. While it is not clear how cannabidiol contributes, it passes via the placental barrier.
Also, other aspects of CBD that remains unanswered include:
- What takes place with the sustained cannabidiol use?
- What CBD dosage can trigger risks?
- Does consumption method affect intake?
- How does cannabidiol affect breastfeeding children and developing fetuses?
- Does cannabidiol have an impact on male fertility?
Although most studies have proved that CBD oil is instrumental for pain relief, more research, particularly involving human subjects, is essential. CBD is promising because of its non-intoxicating effects and has few side effects compared to other pain drugs.
If you are considering using CBD products to treat your health condition, make sure you talk to your doctor to know the most suitable option.
CBD could interact with some medications, especially those used to treat epilepsy. It inhibits the P450 enzyme that some drugs use for metabolism. Interfering with the enzyme, CBD might reduce the effectiveness or intensify the toxicity of the drugs.
Common drug interaction with CBD include the following:
- Anticonvulsants such as Trileptal and Tegretol
- Anti-arrhythmia drugs
- Antifungal drugs
- Antipsychotic drugs
- Atypical depressants
- Immune-suppressive drug
- Macrolide antibiotics
- Migraine medication
- Benzodiasepine sedative
- Rifampin drug
- Opioid painkillers
Most interactions are mild and don’t need treatment adjustment. Some might need separation of doses for hours or drug substitution. To prevent the interactions, consult with a qualified doctor about your drugs regardless of whether herbal, recreational, over-the-counter, or prescription.
Find a Qualified Pain Management Expert Near Me
Research has suggested that CBD is an option for treating and managing chronic pain, anxiety, cancer-related symptoms, and preventing obesity. However, without adequate human research, it is hard to know the right dosage, and since CBD is mostly available as an unregulated product, it is hard to tell what you’re getting. As a result, it is essential to speak with an experienced medical doctor before trying CBD. At Pacific Pain and Wellness, we can listen to you, work with you to restore pain-reduced life, and offer sustainable relief. For more information on CBD, call us today at 310-437-7399.