Rav Ivker - Cannabis for Chronic Pain: A Proven Prescription for Using Marijuana to Relieve Your Pain and Heal Your Life

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To my beloved Harriet, who for the past fifty years has taught me most of what I know about the art of loving

Joy and Woe are woven fine, a clothing for the soul Divine. Neath every grief and pine, runs a joy with silken twine. Human beings are made for joy and woe, and when this we rightly know, through the world we safely go.

William Blake, an English poet, painter, and printmaker (17571827)

I awoke with the pain hitting me like a bolt of lightning, as if I were being electrocuted. I had never felt a pain like this.

The diagnosis was easy. The grotesque blistering rash resembling chicken pox protruding from purplish skin along the left side of my abdomen and around my left flank to my back was unmistakable.

During my forty-four years as a family doctor Id seen many patients suffering with shingles and this was a classic textbook case. The pain I experienced on that early-spring morning in March 2015, which I rated a 7 on a scale of 1 to 10, would soon progress to an 8 or 9 as my baseline pain leveli.e., it never went below an 8. This baseline persisted for another two months.

By the end of that first week and lasting for another four weeks, I had 10s and even 10+s (off-the-chart pain)! I referred to the latter as zingers . Fortunately when they hit me they didnt last long. But my memory of them will remain vivid for the rest of my life. The zingers were flashes of excruciating pain, far beyond the baseline of an 8 and greater than a 10. I couldnt imagine a pain worse than this. They came out of nowhere, with absolutely no warning, and literally took my breath away, and I yelled as if Id just been shot or stabbed in my belly. (Im assuming the pain was similar since Ive fortunately never had either experience. Ive since been told by a patient whos endured both that the pain from shingles is actually worse than a gunshot.)

The zingers were totally incapacitating, and caused me to spontaneously curl up in a fetal position. This reflexive movement was my bodys responseto try and protect itself, to stop the pain, and to prevent it from recurring, all at the same time.

In the flick of a switch that traumatized me, along with my T-10 spinal nerve, my former life disappeared. I had been transformed from a vibrantly healthy sixty-eight-year-old guy to a survivor cowering in fear of the jolts of pain. My minds sole focus was riveted on relieving the agony. It was all-consuming.

To describe this as a humbling experience would be a gross understatement. For someone who had enjoyed a high degree of control through most of my adult life and had treated more than seventy thousand patients, I was now rendered completely powerless to affect what was happening to my body.

I found myself in a desperate situation, at the mercy of a vicious and relentless microscopic organism. I had absolutely no control of how my body reacted to the zingers. I was unable to stifle the screams and remain a silent sufferer. It felt like I was wearing an electrocuting belt strapped around my waist that was always turned on. And manning the control switch was a deranged, sadistic individual who took great pleasure in turning up the current to the max and zapping me whenever he chose.

My initial reaction to this horrific situation was to feel anger with myself. I was highly self-critical for having allowed myself to become so stressed that my immunity broke down to a point where I contracted the virus. I know lots of stress management techniques. Why didnt I do them? And why didnt I get the shingles vaccine? Such a simple preventive measure that I had failed to do. I also felt anger with God for allowing this to happen to me. What did I do to deserve this?

Shame was also included as part of my emotional pain; shame for being so physically weak that I had become vulnerable to the virus, when the primary focus of my personal and professional practice for the past thirty years had been optimal healththis was a long way from that state of well-being. I grieved and cried over the loss of my physical strength and vitality and a relatively happy life. They were gone, and I had no idea if Id ever regain them. I had great empathy for the vast majority of my patients who were also suffering with chronic pain. But perhaps the emotion that I was least able to express was fear . I was afraid of the pain itself, and of the unknown. How long would it last? Would I be able to relieve the pain enough to work, to play with my grandkids, and to enjoy my life again?

Enduring chronic pain is like being tortured without any letup. Chronic means that to some extent its always there , like a jammed switch that wont turn off. (Medically, its defined as pain that persists beyond three months.) And if the pain level remains at a level 5 or higher, then youre presented with a formidable challenge in shifting your focus to anything else for more than a few minutes. The degree of difficulty in diverting attention away from the pain increases exponentially with each higher numeric rating. For me, pain beyond a 6 made it nearly impossible to function well. Other than the zingers that occurred throughout the first month, the pain persisted at a baseline level between 8 and 9 for more than two months and was never lower than a 5 baseline for the first six months. This was the case only when not using medical marijuana.

Never in my life had I experienced chronic pain or any pain even close to this intensity. As an athlete, Ive certainly had my share of physical pain from broken bones, bruises, sprains, and strains, but nothing lasting longer than two or three weeks. Whatever the injury was, I usually noticed a slight pain reduction almost daily. The shingles pain, however, was constant and the improvement measured in weeks and months. During the first nine months, it would typically take from seven to nine weeks to reduce the baseline pain level by one degree. I learned during medical school that nerves can take an exceptionally long time to heal, but now I had been given an opportunity to personally experience just how slow that process can be.

The pharmaceutical options (primarily opioids) offered by my physician colleagues were not helpful. They were minimally effective at reducing the pain, but their side effects (drowsiness, nausea, constipation) only added to my misery and I was unable to function the way I needed to. I started to feel as if Id been cursed as a result of having done something really awful and been given this virus as the worst possible punishment.

I cringe at the thought of what my life might have been like had I not decided to self-medicate with medical marijuana. Up to that point Id seen more than six thousand patients suffering with chronic pain who were using medical marijuana as their primary analgesic. These patients were either seeking a state license to use it for the first time or, the majority of cases, renewing their license, which in Colorado is required annually. I heard repeatedly from my patients how much more effective (with no adverse side effects) cannabis was in relieving their pain than the narcotics theyd been prescribed. In some cases, theyd been taking a variety of opioids for many years and had developed dependence or, even worse, an addiction.