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CBD Oil and Lyme Disease

The amount of chronic pain I’ve experienced in the wake of Lyme Disease is astounding—astounding and debilitating—mostly as it relates to disrupted sleep.

As a former pain management specialist, I find this ironic. Karmic even. It’s as if I sold my practice only to become one of my patients.

Now if you’ve been following my work since last summer, you know I’ve tried a lot of different treatments—from narcotics, to steroids, to acetaminophen, to NSAIDS (all bad for me, all with bad side effects). Then I tried multiple injections, Low-Dose Naltrexone, teas, tinctures, and other botanical treatments (all with short-term relief, no-relief, horrific expense, or bad side-effects).

So for the last two weeks I’ve been experimenting with cannabidiol (CBD oil). So far, so good. I have only had to take Motrin twice in the middle of the night since starting a regimen of 20 mg CBD each evening.

I remain cautiously optimistic.

The cannabidiol I use is a supercritical CO2 extraction from hemp aerial plant parts. It contains essentially no THC, so this is not some form of pot, thank you very much. (THC-Free cannabidiol is legal in all 50 states.)

I got the idea of trying CBD from my colleague, Dr. Bill Rawls. He wrote what has become my new favorite book on Lyme Disease: Unlocking Lyme.

The fact that CBD has the potential to relieve pain without causing euphoria or intoxication makes it interesting from a medicinal point of view. In fact, CBD-rich cannabis may be the ideal option for acute management of pain and sleep dysfunction associated with Lyme disease and fibromyalgia. —William Rawls, MD.

CBD is just one of 113 cannabinoid compounds that can be isolated from cannabis. How it works is still being elucidated. But we do know it modulates both CB1 and CB2 receptors throughout the body, which makes it good for both neuropathic pain and inflammatory pain (it decreases the cytokine storm of Lyme Disease, for example).

But it also appears to have more subtle effects, like modulating the serotonin system (via the 5-HT1A receptor), thus decreasing the anxiety associated with chronic pain.

This is important. Because, as any chronic pain sufferer will tell you, anxiety is what happens when you feel trapped inside a body that won’t stop torturing you. It’s like claustrophobia, only worse—because you’re not just stuck in a closet, you’re stuck in a closet with needles and spikes.

In my case, I couldn’t even breathe without pain due to intercostal inflammation. So the anxiolytic effects of CBD have been especially helpful.

We’ll see how this goes. It remains to be seen whether or not this treatment will stop working for me over time (tachyphylaxis). I’ll keep you posted. For now, I find it interesting and promising.

As always, check with your doctor before trying anything new like CBD oil. These are natural substances, but they are also powerful medicines, which may interact with other medicines.

12 Weeks Later.

Okay here’s a quick update.

I did have to increase my CBD dose over time to get the same results. all the way up to 60 mg. So there does appear to be some potential for tachyphylaxis here. CBD is expensive at this dose so I’m less enthusiastic about it now than I was at first. But it IS helpful.

For me, CBD is an adjunctive treatment. That means it is something I use in addition to physical modalities like sauna, contrast baths, and electrical stimulation, and physical practices like yoga, shoulder range of motion, and gentle strengthening with resistance bands, as well as mindfulness practices like meditation, breathwork, and gratitude poetry, AND resilience training like reframing, refocusing on growth, affirmations, etc.

I’m also pursuing an injection strategy for the body part with the most structural damage: my left shoulder.

What I’m trying to say is this: I doubt whether CBD would be a stand-alone treatment for people with severe pain. But it may help them avoid having to resort to opioids if they are committed to a program of total wellness, including mindfulness, modalities, mobility exercises, procedures, and a willingness to remodel their inner narrative—to believe they can get better. To believe—dare I say it—that they can feel amazing again. That’s what I’m going for.

References:

Fine, P. G., & Rosenfeld, M. J. (2013). The Endocannabinoid System, Cannabinoids, and Pain. Rambam Maimonides Medical Journal, 4(4), e0022. http://doi.org/10.5041/RMMJ.10129

Rawls, William (2017). Unlocking Lyme: Myths, Truths, and Practical Solutions for Chronic Lyme Disease (Kindle Locations 3101-3102). FirstDoNoHarm Publishing. Kindle Edition.

Cover Photo by Esteban Lopez on Unsplash

Marc Wagner M.D.

Marc Wagner is a physician and writer, relentlessly pursuing the stories and reasons behind human flourishing.

A New Treatment for Pain? The amount of chronic pain I’ve experienced in the wake of Lyme Disease is astounding. Here are my results with CBD so far…

Can medical marijuana help treat Lyme disease? A doctor’s perspective.

by Daniel A. Kinderlehrer, M.D.

I have a confession to make. I proposed a talk on medical marijuana at ILADS because it would force me to learn everything I could on the topic. I live in Colorado where it seems there is a dispensary on every corner, and many of my patients have been using medical cannabis. But the huge assortment of products is confusing, and I wanted to give specific recommendations to help patients get the most benefit. Here is what I learned.

Marijuana has 483 phytocannabanoids, which are naturally occurring compounds that can affect many body processes such as appetite, mood and sleep. Most people have heard of one of them—THC, or tetrahydrocannabinol—the psychoactive component of marijuana. THC can make you high, giddy, or euphoric, and provide seemingly awesome universal insights that may appear quite trivial the next day.

Some strains of marijuana now available are not your father’s weed—they have a much higher THC content. It’s important to choose the appropriate strain for your needs, and some people may want to avoid THC entirely. However, it has been clearly established that THC is quite beneficial for pain, sleep, nausea, appetite, and PTSD, so there are medically valid reasons for choosing it.

Most of the non-THC phytocannabanoids fall into the category of cannabidiols, or CBDs. CBDs were once considered to be physiologically inactive unless paired with THC, but it turns out that is not the case. There is compelling scientific research documenting its independent activity, and now there is extensive clinical experience as well.

Did you know that we make our own CBDs? All vertebrates going back 600 million years on the evolutionary tree have an endocannabanoid system, which modulates immune and nervous system function. CBDs are potent anti-inflammatory agents, they regulate neurotransmitters, and they may enhance immune competence. CBDs decrease neuroinflammation and are neuroprotective. They can significantly reduce pain and anxiety.

Marijuana is not the only product that supplies CBDs. Hemp, a variety of cannabis that is used to make rope, fabric and paper, contains CBDs. Hemp has less than 0.3% THC, and is not psychoactive.

There are two strains of cannabis: indica and sativa. Indica is great for pain but is sedating, so it is best used in nighttime. Sativa is activating, can increase energy, and is better suited for daytime use. The difference between indica and sativa is another ingredient, terpenes. Terpenes modify the activity of CBD and THC. There are also a number of hybrid strains now available that essentially cross categories.

If your problem is pain, consider taking CBDs in the form of hemp oil in the daytime. My patients have had excellent responses to a liposomal sublingual extract (taken under the tongue), and it is activating, not sedating. In the evening, you can take a marijuana extract with equal parts THC and CBD, since these together will have additive pain-relieving effects. There are a number of delivery systems available, including smoking, vaping, edibles and sublingual extracts. I recommend the extracts since the onset is reasonably quick, usually in about 30 minutes, and the dose can be easily titrated by adjusting the number of drops under the tongue.

Both hemp-derived CBD and marijuana are available as balms that can be applied topically to relieve pain. Whether taken systemically or applied locally, these products can help many patients significantly decrease their need for pain medication. In fact, states that have legalized medical marijuana have experienced a 25% decrease in opiate overdose deaths. That’s right. This scourge, which took 42,000 lives in 2016 (66,000 including all drug overdose deaths), was significantly reduced by the availability of marijuana.

For sleep, take a THC-dominant indica strain. THC is not only sedating, it increases the time spent in the deeper stages of sleep, so sleep is more restorative. If your problem is difficulty falling asleep, use a short-acting vehicle like vaping, which kicks in within 15 minutes. Vaping is high-tech smoking without the ill effects of the smoke. Alternatively, use a sublingual extract, which has an onset within 30 minutes. Both of these will hang around for up to an hour.

If your problem is staying asleep, then take an edible. It takes 60-90 minutes to get into the circulation, and hangs around for an average of 3-4 hours. I don’t recommend cookies or candy, as they usually have a lot of junk in them—you can take pure THC tablets. The average dose is 10mg, but start with 2.5mg to see how well you tolerate it.

If you have problems with both sleep initiation and maintenance, you can take sublingual extract or vape to fall asleep, and a THC tablet to stay asleep. The table below includes some considerations for choosing among the available options.

While THC is only available in states that have legalized medical marijuana, CBD from hemp oil is available everywhere—although the attorney general in Nebraska seems to be confused about that. You can buy it on the Internet, travel across state lines, and I have even taken it out of the country when I traveled to Israel to visit my daughter.

CBD can lessen anxiety, without any of the psychoactive giddiness of THC. CBD is anti-inflammatory—it not only decreases pain, it can improve energy, cognitive function and general well being. When I started selling it in my office, it went flying off the shelf. The full effects of CBD from hemp oil do not kick in for two to three weeks.

While properly administered marijuana has been extremely effective in helping people with PTSD, in some people it will make anxiety worse. Similarly, THC can help depression in some people, but in others can make depression worse, particularly if it is abused by chronic users. If you develop tolerance to the benefits of cannabis because of chronic use, it is important to take a drug holiday. Pregnant women should not take marijuana.

The legal status of marijuana is dicey. It is unjustifiably classified as a Class I controlled substance by the Food and Drug Administration, in the same category as heroin, and the Obama administration declined to enforce federal laws regarding marijuana in states where it was legalized and properly regulated. The current administration is trying to change that, but I predict it will be like trying to put toothpaste back in the tube.

The analgesic, anti-inflammatory and neuroprotective properties of cannabis make it extremely valuable as an adjunct to the treatment of tick-borne diseases. There is a lot of research available on the medical uses of cannabis. A couple of good resources are listed below.

Kowal MA et al. Review on clinical studies with cannabis and cannabinoids 2010-2014. Cannabinoids 2016;11(special issue):1-18

Dr. Daniel Kinderlehrer specializes in the treatment of tick-borne disease in Denver, Colorado. He has found that properly administered medical marijuana and CBD from hemp oil have been extremely beneficial for many of his patients.

A Colorado Lyme doctor reports that properly administered medical marijuana and CBD from hemp oil have been extremely beneficial for many of his patients.