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Cannabis in treating Chronic Pain and Menstrual Cramps

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Cannabis in treating Chronic pain and cramps

Millions of people have intake of drugs in the form of medicines, but when it comes to cannabis, eyebrows are raised. Implication of this lies with cannabis, being treated as a stigma in this country. Medicinal cannabis in India, is still an unearthed treasury, in anticipation of recognition. Cannabis in India, has always been associated with a sense a skepticism and delusion. Bringing out the truth about the credibility of medicinal cannabis and establishing its authenticity, although is a far-reaching consequence, however, is not impossible. In November 2018, the Council of Scientific and Industrial Research’s Indian Institute of Integrative Medicine, an Indian government collaboration research body, released statements declaring the process of three natural cannabis-based drugs being produced to treat patients from suffering from diseases like cancer to relieve the chronic pain that cancer patients suffer from in the aftermath of their radiotherapy and chemotheraphy, seizures and epilepsy. In September 2019, the Indian government, finally gave a green signal for cannabis research to be conducted in the country. In a country where breeding, holding and selling of cannabis is prohibited, such steps account for a major boost towards unearthing the benefits of medicinal cannabis.

What is chronic pain


Chronic pain has several roots and they’re broadly categorised into neuropathic and nociceptive pain. While the source of neuropathic pain is the nervous system and is usually recursive, nociceptive pain, is the most prevalent form of pain, resulting from tissue injury, such as, cuts, fractures, etc. or the sporadic pain that one suffers from post-surgery. Depending on whether the pain is neuropathic or nociceptive, the pain is either severe or mild, resepectively. Chronic pain, is one such syndrome, whose medications and treatment depends on the severity of it. Pain killers, i.e, analgesics, are presribed usually for mild pain but severe pain, that prevails for a period of time, strong opioids are used. Opioid medication however comes with the physiological side effects such as nausea, sweating, excessive tension,etc. as well as with the threatening potential of it being addictive. Fatal overdose of opioids cause extreme complicacies.

How cannabis works to eliminate chronic pain


This is where medical cannabis comes into the picture. It is not possible to overdose on cannabis. Research has established that Cannabis’ primary constituents, THC and CBD, effectively contribute towards relieving chronic pain in patients of migraine and cancer. Cannabis is also found capable of healing tissue injuries. THC, retaining semblance to the endocannabinoids produced within the body naturally, imitates it and activates the receptors in the brain. This leads to instigation of the brain’s reward system which downsizes the pain. THC also has warranted qualities and characteristics of that of analgesics, that work towards relieving the pain. U.S FDA, i.e, Food and Drug Adminstration approved, Dronabinol, a synthetic THC, is capable of producing lasting effects on decreasing pain. Cannabis strains such as Cannabis Indica, Cannabis Sativa as well as hybrids have been linked with pain-relief ability. However, it has always been intimated that THC in cannabis, when consumed in any form, should be taken along with higher level of CBD in it, as CBD is known to moderate the side-effects of THC. CBD, through studies, is also found to have properties of that of analgesics. It is also works as an anti-inflammatory cure. However, to minimalise the side-effects, it is important to understand the regulation of the ratio of THC and CBD in cannabis, that is being consumed for the purpose of chronic pain relief. This prevents the patient from getting addicted to cannabis. At the same time, it allows the patients to siginificantly reduce their opioid usage.

Cannabis and period pain


Cannabis being used to ease the pain of menstrual cramps, dates back to ancient times. Until recently the Queen of England, was advised to take cannabis to deal with her menstrual cramps. Reports state that New York is planning on adding dysmenorrhea, the official term for menstrual pain, to its list of medical ailments that have legal access to medical cannabis. Such measures are primarily based on research evidence that female reproductive tract, especially the uterus and the lining of the uterus, have profusion of cannabinoid receptors. With cannabis intake, cannabis constituents bind to these receptors and they get activated, alleviating pelvic pain. Menstrual cramps are majorly catalyzed by inflammatory hormones, called prostaglandins. As we have already read in the previous section about the anti-inflammatory benfits of cannabis, it also helps in reversing this effect of the hormones. These hormones also affect the nervous system in a manner, that it multiplies the pain felt in the body. Higher levels of these hormones lead to heavy contraction of the uterus, which causes intense pain. Researchers across the world have discovered that CBD is successful in preventing the production of these hormones during menstruation. Added to this, is the advantage of THC in cannabis, which is known for its relaxing effect. Since cannabis is known to work on tissues, they activate receptors entrenched in the tissues leading to unlaxing of the muscle tissue contractions, that cause the pain.

Takeaway


At present, there is much scope for research into the effect of cannabis on women health issues. However, the journey has begun. Although, there has been anecdotal, case-studies and surveys based evidence, there is a lack of scientific evidence, when it comes to clarification and deeper understanding of how cannabis intake could contribute in repressing the pain, which women suffer from during their menstrual cycle.

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Trailokya Vijaya Vati: Providing relief in multiple joint pains

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Abstract: This is a clinical case study of a 72-year-old female with multiple joint pains and Rheumatoid arthritis in both upper and lower extremities and how Trailokya Vijaya Vati helped her cope with the condition and add quality to her life.

Ayurveda Perspective 

The description of AMAVATA dates back to 1500 BC in Rigveda. The main pathogenic event in RA is the formation and deposition of AAMA which is the causative factor for inflammation.
Restoration of AGNI and management of SHOOLA are the two basic principles in the treatment of AMAVATA. The TIKTA rasa and USHNA guna of Vijaya makes it is choice of drug for the treatment of RA and multiple joint pains.

 Introduction

Rheumatoid Arthritis is a long-term, progressive, and disabling autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and other body organs.
RA usually affects the hands and feet first but it can occur in any joint. It usually involves the same joints on both sides of the body.

The symptoms of RA tend to come and go. During a remission, they can disappear, or they can be mild. However, during a flare, they can be severe. The joint damage that occurs with RA can make it difficult to perform daily activities.

Case Report

Patient description

This patient with the age of 72 Years had rheumatoid arthritis and multiple joints pain in both upper and lower extremities. She was walking with a tremendous amount of pain, and her gait could quickly tell how excruciating the pain was there for her to bear. She also complained of digestive disturbances and disturbed sleep.

Case history

This old lady was on potent pain killer as Voveran 50mg and Ultracet daily. The adverse side effects of these pain killers were visible on her body with her gut became acidic as she presented with severe gastritis pain whenever she took chemical pain killers to combat her pain issues. To beat gastritis and pain, she also started to take modern anta acids that troubled her digestion.

Treatment plan

Medicines to be used – Trailokya Vijaya Vati. After a thorough clinical examination, she was prescribed with TrilokayaVijayaVati with one tablet three times a day for a period of seven days initially.

Expected outcome of the treatment plan

The expected outcome was to relieve her of the pain, inflammation, improve digestion, and that the patient should get a sound sleep. 

Actual outcome

Even this small duration of a week was sufficient enough in this case to witness the painkilling effects of Cannabis or Vijaya. The one week use of ‘TrilokayaVijayaVati’ helped her not to consume synthetic pain killers, her quality of sleep improved with no pain induced nights, her digestion got enhanced during the process. She presented with an improved gait and walk when she walked into the clinic after a period of one week.

Discussion

As mentioned in Ayurveda the line of treatment was decided with an aim of restoration of AGNI and management of SHOOLA. 
The patient got relief from most of her complaints within a week of starting with the treatment.

Conclusion

In the last 50 years, extensive research has been done on RA and multiple joint pains associated with it by modern medicine but the etiology and a standard line of treatment are still developing. New research has revealed various biological agents that have provided relief to a significant number of patients. However, these agents are very expensive, require close monitoring, have side effects, and need to be used indefinitely. 

A result from several small studies suggests that in people with RA, Cannabis has helped to curb morning pain, improve sleep and lower inflammation in joints. Hence the use of Cannabis in the treatment of RA and Multiple Joints Pain can be further promoted as it is also a cheaper and an effective alternative to the other available drugs.

Case study shared by Dr. Preeti Chhabra, Consultant Ayurvedacharya

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How Ayurveda can help to manage long-term pain in Osteoarthritis?

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Abstract: Osteoarthritis commonly referred to as OA is the most common joint disease and one of the most widespread of all chronic conditions managed in General Practice. Whilst its prevalence increases with age, a significant number of adults experience symptoms of OA earlier in life. Most cases of OA are not extraordinary, yet the individual experiences of the affected can help a health practitioner to fully understand the impact of the diseases in the overall population.

This case report was triggered by a patient who was eager to tell her story and also reach out to the others suffering from OA- as to how a simple Ayurveda drug helped her to manage her long term pain effectively. As the importance of narrative medicine is increasingly being recognized to have a positive impact on patients and also helps clinicians to strengthen their practices, a summary of this case highlighting the use of Trailokya Vijaya Vati was made.

Introduction

Osteoarthritis occurs when the cartilage that cushions the ends of our bones in our joints gradually deteriorates.

OA has often been referred to as a “wear and tear” disease. But besides the breakdown of cartilage, OA affects the entire joint. It causes changes in the bone and deterioration of the connective tissues that hold the joint together and attach muscle to bone. It also causes inflammation of joints.  

The pain and limited mobility in OA occurs as a result of destructed cartilages. Left bare of their padding, bones rub painfully against each other – particularly in the hands, spine, knees and hip. 

For years, there have been very limited treatment options available for OA. The treatments include pain management, steroidal injections, physiotherapy and surgery as a last resort. Out of these pain management is the best sought treatment as PAIN itself is a major symptom in this condition.

 Case Report

Patient description

A 48 yr old female was presented with complaints of pain in both knees for 8 years, since the last 3 months the pain had aggravated from moderate to severe to highly intolerable which was leading to increased anxiety and also restless sleep. The pain would increase on an activity like walking or climbing up the stairs and would be relieved by rest. 

Case history

The patient has no history of fall or trauma. She walked without a walking aid but requires support when there is a peak in pain. 

She has been on analgesics since when she doesn’t exactly remember, taking periodic physiotherapy sessions as advised by the doctor. She took Intra-articular injections a couple of times but the relief was temporary (6-8 months).  She was recently advised bilateral knee replacement by her doctor and she decided to give it a last go through an alternate option! The pain was her only concern.

Recently the severity of the pain was so intense that it was impossible for her to use stairs and she is sedentary most of the time. 

Physical Examination

  • BMI – 30 (Obese)
  • Gait – Antalgic
  • Fell – Mild crepitus is felt upon moving both knee joints.
  • ROM – Restricted and Painful
  • Blood Results – ESR and CRP raised

Treatment plan

Medicines to be used – Trailokya Vijaya Vati. After a thorough clinical examination, she was prescribed with Trilokaya Vijaya Vati with one tablet two times a day for a period of seven days initially.

Expected outcome of the treatment plan

The expected outcome was to relieve her of the pain and that the patient should get a sound sleep. 

Actual outcome

Within a week, she began to notice a distant difference in her pain.

Discussion

The treatment was focused on effective pain management as that was the only factor troubling the patient at this given point. The patient was not ready to undergo surgery thou she was counseled that she might need one over a period of 5 years or so. 

She was also prescribed other drugs effective on OA and mild exercises. Trailokya Vijaya Vati not only helped the patient with pain but also gave her a sound night’s sleep. The patient also reported being less cranky throughout the day. 

Conclusion

For years, treatments for OA have majorly being planned on physiotherapy, steroidal injections, and joint replacement surgery. But as pain management is now emerging as an individual branch, there has been an increased focus on pain management in the treatment of OA. 

Unlike Rheumatoid Arthritis, OA hasn’t had any major breakthroughs that have dramatically improved its medical treatment. Drug development for OA has been slow because the disease itself follows a slow process. 

Dr. Anirudha  Mohite, Consultant Ayurvedacharya

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How Ayurveda helps in managing menstrual cramps

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Ayurveda in managing menstrual cramps

Abstract: This case study assesses the use of Trailokya Vijaya Vati highlighting cannabis in the pain treatment during periods (menstrual pain/cramps) medically termed as Dysmenorrhoea. 

Menstrual cramps or period pain is caused largely by hormones called prostaglandins which are released from the lining of the uterus, the hormone also causes inflammation which aggravates the pain. Recent studies suggest that the female reproductive system has cannabinoid receptors and hence cannabis can prove effective in the treatment of menstrual pains, also that Cannabis has anti-inflammatory properties.

This is a case of a 21 yr old female with a known case of polycystic ovarian syndrome (PCOS) with bilateral renal calculus and how Trailokya Vijaya Vati helped her assuage the pain in a matter of just 7 days of treatment.

Ayurveda Perspective 

According to Ayurveda, during the menstrual cycle, the APANA VAYU which is connected to the VATA DOSHA and is responsible for the downward flow of the energy and mass to the pelvis aggressively works to cleanse uterine lining.  The increased VATA DOSHA hence causes SHOOLA (RAJASHOOLA)

Vijaya is having Tikta Rasa Ushna Virya it has laghu Tiksnha Guna and Katu Vipaka. Hence it pacifies the Vata Dosha and helps in the treatment of VATAJA SHOOLA. Ayurveda Rasatarangini has attributed 29 pharmacological indications for Vijaya in which RAJASHULA is included.

 Introduction

Cannabis is believed to have therapeutic uses for a variety of illnesses, including but not limited to chronic pain, headache, epilepsy, symptoms of multiple sclerosis, and gastrointestinal disorders. 
The science around cannabis and its ability to relieve menstrual pain are scarce but strongly promoted. 

The diversity of approaches for the consumption and use of cannabis might help increase its popularity. Ideally, as more people use cannabis for period pain, researchers will produce more science about the risks and benefits in hopes that we learn all about the amazing herb. And the possibility cannot be denied that Cannabis might be the only preferred drug/herb available worldwide for Dysmenorrhea in the mere future. 

Case Report

Patient description

A twenty-one-year-old girl was a known case of polycystic ovarian syndrome(PCOS) with bilateral renal calculus. 

Case history

She was also suffering from dysmenorrhea (excessive painful menses) and metrorrhagia (excessive bleeding).  Adding to all these troubles were her mood swings and anxiety episodes, making her health a subject of concern to her parents and directly impacting her studies. Her menstrual cycle was extending up to seven days a month with an entire week going in this pain every month. 

Sonography results

Her whole abdomen ultrasonography revealed hemorrhagic cysts in her bilateral ovaries. 

Treatment plan/ Medicines to be used – Trailokya Vijaya Vati

To overcome the pain and get the cysts removed naturally, she started her treatment at ‘The Ayurvedic Thyroid Clinic’ Pune, in the month of August 2020.  To beat her pain issue, she was kept on ‘TrilokayaVijayaVati’ in the month of October 2020, with a dose of one tablet two times a day. 

Expected outcome of the treatment plan

It was expected not immediately but gradually that the patient would find relief with her pain and also that she should be able to carry out her daily activity with some ease.

Actual outcome

Within a week of administering her ‘TrilokayaVijayaVati’, she started to feel relieved in terms of her menstrual cramps and pain like never before. Although the patient is still on the medication for PCOS, her immediate concern was this menstrual pain unbearable for her. The use of ayurvedic pain killer in the form of the classical formulation of ‘TrilokayaVijayaVati’ her pain reduced considerably, and she was motivated to continue with further treatment as her faith strengthened in the process. She believed firmly with the evidence as what ‘TrilokayaVijataVati’ did for her, even Meftal-Spas could not do.

Discussion

The treatment was decided on the basis of the predominance of VATA DOSHA involvement and pain management. The Vijaya as mentioned has anti-inflammatory properties and is also an effective VATAGHNA herb. It helps in reducing the pain gradually but effectively.

Conclusion

Cannabis is believed to have therapeutic uses for illnesses and pains, including menstrual discomfort. Researches are still scarce, but some studies show the effectiveness of cannabis on the relief of menstrual pain. 

Dr. Vikrant Patil, Consultant Ayurvedacharya

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