Welcome to part 2 of Choosing pain meds. To learn about choosing opiate pain medications, how to pick IV or PO pain meds, or why pain can be so dang hard to treat, check out last week's episode.

There are two different pain pathways (for this talk): 

• the neurotransmitter substance P and its friends who are released in response to tissue damage. 
• stretching nociceptors that represents the discomfort, inflammation or more specifically stretching of our visceral organs.  

These pathways are different kinds of painful stimuli in the brain & are hard to express. Thus descriptive pain categories like : throbbing, cramping, achy, bloating, pulling, sharp, stabbing, burning, shooting and so many more.

In school we learn “textbooks patterns” of pain (like crampy episodic RUQ pain = gallbladder) but these patterns are imperfect == atypical presentations of diseases

To discuss specific agents refer to the PDF Pain Chart

BONUS: Marijuana Info

More & more patients will be looking to us --the medical professionals-- for information and opinions. It is important to educate ourselves with facts, regardless of opinions. To start there are two different chemical compound categories.

1. Terpenoids which are found the in glands of the cannabis flower that help influence the uptake of the other categories
2.  Phytocannabinoids: THC & CBD. Both of these compounds have benefits and serious SE but neither of them are currently regulated.

• THC: found in 1964, effects include: increased appetite & muscle relaxation, decreased nausea/vomiting & pain/inflammation  SE: dizziness, somnolence, dry mouth, anxiety, psychosis, cyclical vomiting
• CBD: found in the 1940s with same structure as THC but in a different structure, has no addiction potential (can't bind to the receptor), studies found significant positive use in: epilepsy, anxiety, huntingtons disease, ALS, MS, arthritis. It also stops conversion of THC into metabolite that causes psychosis.

Right now, CBD is legal to sell anywhere and is what most of my patients are asking about.  

My concern with prescribing CBD: The FDA does not regulate quality of brands, so you don't know what your patients are getting.

To learn more about the topic, I go to Harvard’s answer page. I took their continuing medEd class for $200 and I found it politics and opinion-free.

To learn about choosing opiate pain medications, check out last week's episode. Or if you would like handier notes for on-shift or in-clinic reference: PDF Pain Chart

Do you have questions? feedback? topic suggestions? Leave me a comment below and I'll get back to you.