Chronically Cannabis With Dr. Michele Ross: Which Strains Are Best for Chronic Pain?

The Mighty Community asked: “Are there specific cannabis strains that are better for treating chronic pain?”

That’s a great question and it’s also a really difficult question to answer. Cannabis has many different chemicals, like terpenes, and that’s what really distinguishes the strains that are out there. Most strains that you find in a dispensary are high in THC. There are usually not a lot of products out there that even have much CBD at all. There are CBD-only strains, like Charlotte’s Web for example, and then there are high-THC strains that are like 30 percent THC. Every once in a while you might find a strain that has 5 percent CBD in it, but what distinguishes these strains and especially the THC-heavy strains is the terpene profile.

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Terpenes add the flavor and smell to the strains, but they also have medical benefits too and make people feel different. Some will make you feel more sleepy, some will make you feel more alert, some will be better at relieving pain. The issue here is in the U.S. we don’t have a federally legal system (some states have legalized cannabis but the entire country hasn’t). So someone will recommend, “Try this Blue Dream, it’s great for pain,” and Blue Dream at one dispensary will have a certain amount of THC and a certain amount of different terpenes, but then you go to another dispensary in the same city and it’s completely different. You could go to another state and it’s completely different.

It’s hard for me to recommend per person that a certain strain will absolutely work. You could get 10 fibromyalgia patients and you could say to them, “Here’s a sampler box, 10 different strains, and you tell me which works best for your pain,” and they could all pick a different one. It’s really personal. We’re more than just our disease or our symptoms. Some of us are more anxious, some of us are more likely to go to sleep or be more affected by the blood pressure effects of the medicine. To me it’s not about a strain recommendation, it’s about figuring out which strain works best for you. And I think every single patient does have a strain that’s their magic fit. Unfortunately, it may take them a little bit of time to find that.

For me, I have fibro and a whole bunch of other conditions, so it took a while to figure out something I could smoke that didn’t flare up my sciatica. There are strains actually that make you more aware of pain. People think all cannabis relieves pain, but some of them can make you more present and realize, “Oh, there’s that burning hot poker in my back, whoopsie.” We all need different strains at different times.

There’s a myth around this I want to debunk. You will hear about the indica vs. sativa type in stores. A lot of times products will be labeled like, “This is sativa, it’s for daytime, it’ll wake you up, it’s not good for pain.” Or, “This is the indica, it’s good for pain, it will put you to sleep.” But most of the strains in the dispensary are actually mislabeled. You can have a sativa that’s great for pain and also will keep you awake. They used to differentiate that — if you wanted something for chronic pain, they’d say, “You’re looking for this indica which will make you sleepy.” It’s all meaningless.

Really what it comes down to is understanding what cannabinoids you like. If you’re looking for something to balance out pain, I think you do want to use a product rich in THC. But if you want to be awake and able to work with pain, you don’t want something with a terpene like myrcene that makes people sleepy. If you smoke something or use a product and you like it, you need to find out what terpenes are in it so you can go find other products with it and say, “this is what works for me and my pain.”

I recommend strain tracking, like journaling, where you write a product, what you like, what was the setting, what was the context, what dose you were using, and if this worked for you. As a chronic pain patient, your pain is different every single day depending on what you do. You have to make sure if you use a product and it didn’t jive with you, it wasn’t just because you were really stressed that day or walked too many stairs. It wasn’t the product that wasn’t a fit with you, it was just a bad day.

As a chronic pain patient myself, I was struggling to find answers and guidance. I realized that the budtenders are not really trained like pharmacists are. They know a little about the strains and there are a lot of dispensary workers who are very passionate about what they do, but they don’t have that medical background. In many states, they are not legally supposed to tell you medical things. And your medical-marijuana-recommending-doctor is usually not the same as your normal doctor, so usually, they’re just providing you paperwork with the legal ability to get your card. They don’t really know how to help you or they’re not legally allowed to tell you. Your own doctor doesn’t know about cannabis because they weren’t taught about it in medical school.

What we’re seeing is that if you want to just get high, you can go to the dispensary and they can tell you how to get high. There are many ways to do that. But if you are a very ill patient, perhaps with a rare disease, fibromyalgia or a condition they don’t understand, they don’t know what to do for you. It’s unfortunate that a lot of patients are left hanging.

There’s actually a field called cannabis coaching. We have health coaching in other fields, like weight loss coaches and mental health coaches, and now cannabis coaches. Your doctor can’t help you, dispensary workers can’t help you, but you still need to be guided on this journey from being canna-curious to being a cannabis user who’s in full control of your disease through cannabis. For a lot of patients, they’re not only thinking about cannabis for pain relief, they’re also thinking about getting off some of their medications. There is a process. You have to have a professional documenting, and it can be dangerous if you try to reduce your opioid prescription.

When you’re chronically ill, you may not be sure. Is it the new strain that’s not working with you that’s making you sick? It’s really important to work with a guide. When you go to a dispensary, you’re not working with them one on one. It’s a transaction — you go buy weed, maybe you go back the next time like, “That sucked, give me different weed.” That’s not a medical interaction, it’s really a transaction.

Glossary of Terms

Cannabis: Also known as marijuana, weed and pot, cannabis is a plant that can be eaten, brewed, smoked and vaporized. Its oils can also be extracted and consumed, or incorporated into topical creams. Cannabis is consumed for its psychoactive and pain-relieving properties. It is currently a Schedule 1 drug in the United States and is illegal at the federal level, but is legal for recreational and/or medical use in 33 states.

THC: Abbreviation for tetrahydrocannbinol, one of the compounds, or “cannabinoids,” found in cannabis. It is responsible for the plant’s psychoactive effects, since it binds to cannabinoid receptors in the brain responsible for pleasure and pain.

CBD: Abbreviation for cannabidioil, another cannabinoid found in cannabis. CBD is non-psychoactive and, unlike THC which binds to cannabinoid receptors, stimulates the body’s own endocannabinoid system. This can lead to physical benefits like reducing pain and lowering inflammation.

Endocannabinoids: Neurotransmitters produced by the body that bind to cannabinoid receptors. Endocannabinoids help control functions like pain and inflammation and maintaining homeostasis in the body.

Strain: A variation of cannabis that has been bred to enhance certain characteristics and compounds.

Terpenes: Aromatic oils secreted by the cannabis plant, which give its particular strain unique flavors and scents. Over 100 types have been identified. Terpenes also interact with other cannabis compounds to produce various physical and psychoactive effects.

Indica: A type of cannabis plant characterized by short stature and broad leaves, which grows better in a colder climate. Previously believed to offer relaxing and pain relieving-benefits, it’s now understood to offer similar benefits as other cannabis varieties.

Sativa: A type of cannabis plant characterized by its tall height, narrow leaves, which grows better in warmer climates. Previously believed to offer invigorating, energetic benefits, it’s now understood to offer similar benefits as other cannabis varieties.