Although most PBS-listed opioids are used for acute pain treatment, 23% are still used as part of long-term treatment strategies.  One particular area which consistently requires a long-term and holistic treatment approach is chronic lower back pain, as well as neck pain. In Australia, around 3% of all GP visits are motivated by back pain: it is the second leading cause of disease burden in the country.  Treatment strategies for general back pain can encompass exercise, physiotherapy, massage, heat-packs, and weight loss: but when these methods fail, the complaint can be escalated to be considered chronic, and pain relief medication may need to be integrated. Opioids are considered the last line of defence against chronic back pain, and yet they are still one of the most prescribed back pain relief medications in primary care. 
As well as analgesia, opioid effects include respiratory depression, cough suppression, euphoria, sedation, constipation, and of course withdrawal and addiction. Over time, the effectiveness of an opioid dosage can decrease due to desensitisation and opioid-induced hyperalgesia.  As effective as opioids may be in treating chronic pain, it is therefore vital to apply strict risk stratification measures to ensure that patients to not become habitual or dependant.
In addition, because problematic opioid use is dose dependant (the rate of dependence or abuse increases from 0.7% to 6% between low-dose therapy and high-dose therapy patient groups ) it is important to implement opportunities and strategies to decrease or remove opioid drugs from the patient’s ongoing regime.
Top tips for talking to your doctor about Medical Cannabis
Chronic pain sufferers across Australia can now access medical cannabis as part of their overall treatment plan. While research into the effectiveness of the plant based medicine is still limited, early evidence showing promising results has led the Therapeutic Goods Administration (TGA) to allow prescriptions for treating conditions such as chemotherapy-induced nausea and vomiting, epilepsy, multiple sclerosis, chronic non-cancer pain and palliative care (https://www.tga.gov.au/medicinal-cannabis-information-consumers).
Until recently, cannabis was stigmatised and strictly prohibited by lawmakers around the globe so it comes as no surprise that you might feel a little uneasy when talking to your doctor about medical cannabis and pain. Below, we outline our top tips for having a open and honest discussion with your doctor about cannabis and pain relief.
Do your homework
New research around pain and cannabis is underway all over the world to examine the success of medical cannabis to treat many different health conditions, including chronic pain. If you think that it might be useful for your condition, then read up on any research which might have been carried out and be sure to raise it with your doctor. Sites like the TGA have the most up to date research and advice for physicians and patients.
Don’t be embarrassed
There are cultural perceptions of cannabis and it’s recreational use which might make you think it’s not for you, or make you feel awkward at the prospect of raising it with your doctor. Put those thoughts aside and think of medical cannabis as no different to paracetamol or aspirin when having a discussion about pain relief. It’s something that could potentially help your pain, but it will be the doctor that should help you decide.
Be open and transparent
If you’ve already experimented with cannabis for your pain relief, but perhaps not legally, don’t keep that from your doctor. Just be honest and tell them that you have tried it, already experienced some success and would be interested in further pain relief treatment. It might help your doctor to better consider why it might be suitable for you.
Respect your doctor’s advice
Your doctor is a highly trained medical professional with experience in pain medications and will not prescribe anything without first considering what’s best for the you as the pain patient. Currently, research into medical cannabis for pain relief is still limited so doctors will naturally consider all areas of treatment as well as medical cannabis. Work with your doctor and be open to different pain relief treatment plans which could also help your pain treatment.
Get a second opinion
If you doctor is unwilling to consider medical cannabis as a treatment for your pain and you are still interested in how it might help you then consider seeing another doctor who might have a more open approach to treatment options for pain.
Access to medical cannabis
Is it likely you will get prescribed medical cannabis for your condition? The answer is, it depends on your condition/s, your current medications and your doctor.
If you suffer from one of the conditions on the TGA’s website it is more likely you will qualify.
To learn more about accessing medical cannabis you can go to to the patient section of our website – https://www.cymra.com.au/patients/ or this infographic from the TGA will also help (https://www.tga.gov.au/sites/default/files/tga-infographic-how-to-access-medicinal-cannabis.pdf)
2. “https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/treatment-and-management-of-back-problems,” [Online].
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