Managing Chronic Pain With Medical Marijuana

By Auldyn Matthews

5 min read

Accepting that something so stigmatized could be helpful for Keegan took a while for me to get over. When we got married, I knew I'd do anything and everything I could to help with his disease and chronic pain. It took a while for us to accept that medical marijuana was a route to try, and boy am I glad we pushed through the stigma. Medical marijuana has changed Keegan's life radically.

Yes, that sounds dramatic, but it's proven to be a key tool in the AS treatment toolbox. Right now, Keegan's on Humira to help slow down disease progression, but he has pain every day. And most likely, that pain will never go away. Before medical marijuana, we tried NSAIDs like Aleve and Motrin, Celebrex, and some opioids. However, none of it helped Keegan. Even the opioids did little for his pain and we were both worried about addiction.

Getting a medical marijuana license

The same year, Pennsylvania passed the law for medical marijuana. Shortly after, we moved to Philadelphia and Keegan got a license. To get a license, we started with his rheumatologist. She wrote a letter so the doctor who'd "certify" (not prescribe, as it's not covered by insurance) Keegan knew that she recommended it as a pain relief treatment. Finding doctors who were certified was a bit confusing. There's a list of doctors online but we didn't know who to call. The most important was to know which condition in Pennsylvania Keegan would fall into. It is "Severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain." (Note that each state's laws are different, so Google your state's medical marijuana laws.)

Tip #1: Get a doctor's recommendation

Get a recommendation for medical marijuana from a rheumatologist, if they're willing. It helped prove to Keegan's pain management specialist the severity of his AS and chronic pain.

Once his rheumatologist recommended medical marijuana for this condition, we sought out a pain management specialist. The cost of the initial appointment surprised us. Medical marijuana isn't covered under insurance, so everything is out of pocket. The new patient appointment was $250. Keegan got the appointment and was out within 20 minutes and in a week had a card to go to a dispensary.

Tip #2: Ask questions at the dispensary

Don't be afraid to ask questions at the dispensary. Think of the employees there like pharmacists; they're there to answer questions.

I've never been inside the dispensary--only Keegan is allowed. But from what he says, it can be a bit overwhelming. In Pennsylvania, there are a bunch of medical marijuana treatment options, including:

Tincture: Oil that a patient puts under their tongue.
Vape cartridges: Oil that can be used in a vape pen. Right now, this is controversial as many don't know what additives are in vape cartridges and whether they cause lung injuries.
"Flower" or dry herb: Dried marijuana plant that is ground and vaped in a herb vaporizer. (Different from an oil or cartridge vaporizer.)
Injection: Syringe with medical marijuana that's injected.

Tip #3: Experiment to find what works

Try and try and try until you find what works for you. (Or you've exhausted all options.)

Medical marijuana's effects are unique to each person. There are 2 strains: Indica and Sativa. Within those 2 strains, there are many variations, just like garden flowers. What may work for Keegan may not work for you, and that's totally fine. At his first visit, Keegan asked for types that will help with chronic pain and sleep. The employee picked out a few Indica variations to try out. Keegan saved on his phone which variations worked well for him and which didn't. Keegan's biggest takeaway: It can take time, effort, money, and patience to find medical marijuana that worked well for him.

Keegan's advice for a first-timer

Be okay with being nervous and find a safe space when medicating: Taking medical marijuana for the first time, Keegan was feeling a bit uncertain and anxious given what we grew up learning about marijuana. It's okay to be uncertain. The best thing to do is to find a safe environment to try it for the first time. For Keegan, that was with me at night in our living room watching YouTube.
Find your tolerance: Each person tolerates different levels of CBD and THC, the chemicals in marijuana. THC is the most important to keep an eye out for. Start at low levels and work your way up. For Keegan, he has a very high tolerance and needs high THC. However, that could make another patient have a bad experience.
Medicate before bed: It helps Keegan immensely with his sleep. Before medical marijuana, I felt Keegan toss and turn. Not anymore! He finds using a tincture before bed helps him.
Different ways of consuming medical marijuana may change the effect: Keegan finds a milder, yet deeper pain relief with the tincture. Dry vaping helps him with acute pain, especially throughout a flare-up.
Take more than usual if a flare-up or inflammation comes on: CBD, the other chemical in medical marijuana, can help with inflammation. Keegan's found that taking a bunch if he feels a flare-up coming on helps reduce the overall sensation but also the inflammation in his body.

Can medical marijuana help ankylosing spondylitis pain?

Before medical marijuana, we saw improvements in Keegan's pain with Humira, a biologic. However, every day still brought on the pain. And that was without a flare-up going on. Now, he uses medical marijuana throughout the day. Mornings are particularly rough. He wakes up stiff and nauseous, which medical marijuana helps with immensely. He can start the day without waiting 2 to 3 hours until his body is ready to move.

When I asked Keegan how medical marijuana affects his pain, he told me "it doesn't get rid of the pain." Rather, he describes it as a pain management tool. Medical marijuana does 2 things for him: 1. It dulls the pain and changes the sensation so it's easier to manage and 2. Distracts him from the pain. This makes managing sharp and acute pain much easier. It also means he sleeps better and is able to actually rest at night. For me, it's a huge relief to see him happier and more relaxed. As a caregiver of someone with AS, seeing him with less pain and enjoying some moments of the day is all I hope for.

Have any of you tried medical marijuana to treat pain or AS symptoms? How has it gone for you?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The AxialSpondyloarthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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Rene Member
Hi Dance, Sorry for my late reply. I found that the medical marijana (MM) targets my specific needs. For example, at night I take a cannabinoid mixture that doesn't contain CBD. I follow this with a THC 0:1 just before bed. This helps the THC to promote sleep (along with the other cannabinoids in the first formula). For pain during the day, a 1:1 dosage works for average pain days. I double the dosage when I have flare-ups related to stress, which seems to work if I am being mindful about my symptoms. Having lived with pain for so long and assuming it was due to injuries from an active lifestyle and normal aging, I inadvertently and unfavorably learned to ignore the pain until it became overwhelming. Treating extreme pain isn't how plant medicine works for my AS. It can help with the pain, soften it in this situation. However, the plant seems most beneficial for treatment if I take it ahead of the worse symptoms, or consistently administer an appropriate, but lower dosage. In regard to your state marijuana laws, I'm envious😉 You certainly have more options. When I've traveled to states where edibles are legal, I've tried to replicate the formulas from recreational dispensaries and that didn't work. In my state, the medical marijuana can't be delivered through smoke. When I use the recreational smoke at night and choose an Indica strain, symptoms improve overall, but I still experience more interruption in sleep than with my current medical regimen. I'm only two months in, so I can follow up with my case in the future if effects wear off or if the cost starts to overshadow the benefits of my prescriptions. One other note, the smoking is damaging to my lungs, so that's not great for AS. I wish the edibles were cheaper. There is a real need to pass regulatory laws so that we can get access, apply insurance coverage and health savings, and promote and fund research onthe benefits that this natural drug offers. On another note, I've continued to inform my rheumatologist of my drug of choice to treat my condition. They are always silent on this. Non-judgmental, perhaps, but also they just don't know anything about plant medicine. We've discussed the benefits of the drugs they prescribe but they seem to always deemphasize the risks. I find this troubling and want to learn more about this in order to make informed decisions with my care team going forward. I'm not opposed to medication, but my first prescriptions harmed my GI tract, so I'm more cautious as I proceed through this maze. If I decide to take a prescription later this year, I most certainly want to understand how it works and whether or not it can be taken with my current MM prescription, which is helping me sleep better than I have in 16 years. Best wishes to you,<inline-mention username="Dance" user-id="6886975"/> .
Dance Member
Hi Rene, would you mind elaborating on the benefit of medical over casual use? I use it regularly, but haven't bothered to get a medical card as it's now legal recreationally in my state, so I can visit a dispensary and even grow it in my backyard. Do you think there is still a benefit to going the medical route?
Rene Member
I've started medical marijuana and have found that it helps improve sleep, pain and mood. It's been nearly a year since my diagnosis of AS, but I've had symptoms far longer and have tried many complementary medicine approaches, such as acupuncture. Besides physical therapy, this is the only treatment that has been significantly helpful for overall functioning besides NSAIDS (which caused significant abdominal side effects). While other pharmaceuticals may help, I feel more comfortable with this treatment for now because I'm comfortable with risks associated with cannabis. My hope is that the plant medicine continues to work. I thought I'd share here in case anyone else with AS is considering medical marijuana. It has many advantages over casual use of cannabinoids, in part due to titration and specific combinations that can help target individual issues.
Auldyn Matthews Moderator & Contributor
Hey James! Didn't know that about the UK. Each of Keegan's rheumatologists here is a big fan of it as a chronic pain treatment, especially compared to opioids, for Keegan. It sucks that something that could be so useful isn't accessible in the UK yet. It's the biggest thing that helps with his sleep! (And painsomnia!)
James Hollens Moderator & Contributor
This was a very fascinating read. I have heard a lot of people mention to me that they have found a lot of relief from this but it is something that I have had a chance to try myself yet. Sadly we aren't as progressive over in the UK and this hasn't been legalised yet - but it is something that I am interested in trying to see if it can benefit me at all. Thanks for sharing, James (Community Member)
Lisa Marie Basile Moderator & Contributor
I love this, Auldyn. Thank you for the excellent information on how to get the marijuana and also all the types. I will definitely be sharing this with others. I don't like marijuana — way too many horrific experiences (I'm what you'd call a paranoid human) — but I do use (as of late) CBD. I find it really, really helps with pain and flexibility. I find it takes the edge off about 60%. It's wild. I never, ever thought I'd use it. But you're right, the stigma and nonsense around cbd and marijuana is unfair. It's a plant with tons of associated benefits if you use it correctly!

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