Cannabis for Chronic Pain Introduction Chronic Pain Is a Blessing Disguised as a Curse
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 (1757–1827)

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 I’d 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 level—i.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 didn’t 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 couldn’t 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 I’d just been shot or stabbed in my belly. (I’m assuming the pain was similar since I’ve fortunately never had either experience. I’ve since been told by a patient who’s 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 body’s response—to 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 mind’s 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 didn’t I do them? And why didn’t 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 health—this 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 I’d 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 it’s always there, like a jammed switch that won’t turn off. (Medically, it’s defined as pain that persists beyond three months.) And if the pain level remains at a level 5 or higher, then you’re 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, I’ve 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 I’d 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 I’d 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 they’d been prescribed. In some cases, they’d been taking a variety of opioids for many years and had developed dependence or, even worse, an addiction.

After first trying the conventional route during the first week, with disappointing results, I began using medical marijuana. It was miraculous! It consistently reduced the pain to tolerable levels of 3 to 4, allowing me to continue functioning at a reasonably high level. Although I always had pain, and zingers too during the first couple of months (they only occurred when I had not taken marijuana), I was successfully able to shift my focus, at least enough to have a life beyond shingles. I did not miss a day of work because of the shingles, and I was able to resume hiking.

By the second week of my struggle with shingles I was taking at least one medical marijuana product daily, and by week seven, my usage had increased to between five and six products per day! I was amazed with both its potency as an analgesic and my ability to function (the medical marijuana products most effective for pain are somewhat lower in THC—tetrahydrocannabinol, the psychoactive component—and higher in CBD—cannabidiol, the non-psychoactive analgesic and anti-inflammatory, than marijuana for recreational use). These are the two most common and most medicinal of the eighty or more cannabinoids in cannabis, and they work synergistically to relieve pain. What I personally experienced and researchers have also found is that the psychoactive effect of THC is somewhat mitigated by both CBD and severe pain—you don’t get too high and are able to focus on your work.

Through a trial-and-error process and the valuable feedback I’d received from my patients and from medical marijuana dispensary owners and employees, my cannabis medicine chest came to include a vaporizer (inhaling without smoke), tinctures (liquid extract placed under the tongue), edibles, hash oils (concentrates dispensed in a syringe and ingested), transdermal patches, topicals, and tablets. Each method of administration had its own list of benefits and minimal liabilities.

Although marijuana was great for relieving the pain, I knew it wouldn’t cure the problem. “But surely I’m not at risk for post-herpetic neuralgia,” I thought—i.e., shingles pain persisting beyond three months. “That only happens to old and unhealthy people.” Or so I thought. Wishful thinking!

Soon after exceeding the three-month mark, I began hearing stories of people who had suffered for a year or more. One woman told me her mother had had it for more than seven years and it never resolved. She died with it in her mid-eighties. My fear increased, and the more anxious I became the more the pain increased. At this point I was also becoming somewhat depressed.

I renewed my commitment to rid my body of this virulent virus. I tried a variety of alternative therapies recommended by several of my holistic medical colleagues, including David Perlmutter, MD, perhaps the world’s most highly respected holistic neurologist (author of Grain Brain and his latest book, Brain Maker). Some of the recommendations I followed included: high-dose vitamin B12 injections, adenosine monophosphate (AMP) injections, high-dose IV vitamin C, acupuncture, Healing Touch, and neurofeedback, along with a host of supplements that I ingested daily, several of which were supposed to help with nerve healing. I suspect several of these treatment modalities helped in reducing baseline pain levels, but none of them made the dramatic difference I was hoping for.

There is no question that medical marijuana (cannabis is the botanical name for the herb) has been by far the most effective therapy for quickly relieving the pain. Beside the pain relief, while its effect lasted I actually felt quite good and enjoyed a nearly normal life. Rather than being completely overwhelmed by the pain, I found it possible with cannabis to shift my focus to working, exercising, playing with my grandchildren and my wife, and maintaining my responsibilities at home. I would describe it as having a decent life while living with chronic pain.

I had learned more than three decades earlier that through suffering with a chronic illness I was able to transform my life in ways I could never have imagined (or planned). Though in retrospect, chronic sinusitis seemed like a mild discomfort relative to the shingles, perhaps my most valuable lesson from it was that a health crisis can provide an excellent opportunity for turning lemons into lemonade. You may or may not cure the problem, but the lessons learned are vital to healing your life. I know it may seem counterintuitive, but chronic illness, dis-ease, and pain can potentially be a blessing, as long as you’re open to that possibility.

It took me years to first recognize this truth. After an ENT specialist delivered his dismal prognosis in 1980, telling me “You’ll have to live with it,” I had spent nearly seven years developing a holistic medical treatment to cure chronic sinusitis. Although the dietary changes and supplements, indoor air modification, and daily nasal hygiene practices were helpful, it wasn’t until I worked with a spiritual psychotherapist, Myron McClellan, for a full year (1986) that I was able to cure this so-called incurable condition. Chronic sinusitis is considered the world’s most common respiratory condition, and conventional medicine has no consistently effective treatment for either curing or even significantly improving it.

What I learned through curing sinusitis via the body-mind-spirit connection was that unconditional love is life’s most powerful healer, and the perceived loss of love is our greatest health risk. I realized that anything is possible and that pain and dis-ease are messengers. They get our attention like nothing else can. They’re alerting us to largely unconscious emotional and spiritual pain resulting from the loss of love from ourselves (we tend to perceive it as the loss of love from others). This in turn weakens our immune system, which then becomes a significant contributor to our physical pain and dis-ease. In short, love heals and the loss of love makes us sick and causes pain. Fortunately we currently have a multitude of studies supporting the science of connection—the healing power of love.

Yet in spite of the fact that I’d been teaching these holistic healing principles to my patients and physician colleagues for the past three decades, they quickly faded from memory as soon as the shingles took over my life. My single-minded focus was to get rid of the pain.

However, once the baseline pain level subsided to below a 5, I was ready to address the issues in the tissues. In relieving the pain and at the same time heightening my awareness, medical marijuana helped me tremendously to better understand why I had contracted this virus at this particular time, and to recognize what I needed to learn from what had initially appeared to be a horrendous catastrophe. If it is your intention to address the emotional and spiritual causes of your dis-ease while learning invaluable lessons from your pain, cannabis can be a highly effective facilitator. “The Issues in the Tissues” section of each of the chapters in Part II will help you begin this process, and Part III will discuss it in more depth.

It’s now nearly two years since I began this intensive life-changing course with shingles. I have to assume there’s more for me to learn since I’m still enrolled and the pain is still present, although it rarely exceeds a 2. It’s almost always there, but rather than it being all-consuming, I frequently have to shift my attention to even notice it.

Given this major improvement, it’s been more challenging to stay fully engaged in the “shingles healing program,” even though I’m already aware that the pain has served as a powerful catalyst for profoundly changing my life for the better. In spite of the precedent with sinusitis more than thirty years ago, it still amazes me that as I continue to heal, I’m feeling blessed by the shingles virus and its intense physical pain. It has brought me a number of gifts, lessons I might never have received otherwise. They’ve taken me to dimensions of mental, emotional, social, and spiritual health I’ve never felt before.

First and foremost I learned to surrender and accept that as hard as I might try, I am not in control of my life. This is certainly not the first time I’ve been given this lesson, but it has surely been the most uncomfortable. Bad things do happen to good people, but never accidentally. There’s always a reason and something meaningful to learn from them. “OK, I get it now. I truly understand what it means to let go and let God. Please God, no more of these lessons. I’m with you. Lead on.”

My capacity for humility, compassion, and forgiveness is far greater than it was pre-shingles. I’ve slowed down, simplified my life, am less angry and fearful (especially of pain), and much to the delight of my wife, a much better listener. Just a few short months ago I found myself fixated on relieving the pain, and now I feel almost overwhelmed with gratitude. I’m grateful for simply being alive at this incredibly exciting time and playing a meaningful role in humanity’s and the Earth’s evolution. I’m eternally grateful for my wife and family, loving friends, and the opportunity to serve others as a healer and teacher.

Perhaps shingles’ greatest gift has been the inspiration to write this book and help others struggling with chronic pain. Cannabis has been a godsend in both relieving my pain and helping to heal my life. I’m hoping that the following pages will serve you as a guide to your own healing from the plague of chronic pain.

In Part I, I’ll provide you with a comprehensive presentation of the most current information on how to use medical marijuana most effectively and safely. Part II will briefly present a state-of-the-art integrative holistic medical treatment for the most common chronic pain conditions (both physical and emotional), using medical marijuana as a complement to the treatment program.

I have treated more than seven thousand chronic pain patients using medical marijuana, and I have reviewed the scientific literature and studies in my quest to develop a standard of care that is both safe and effective. Yet every individual is unique, and reactions can certainly vary to medications, supplements, and medical marijuana. Although there are no known fatalities directly attributable to cannabis, before beginning any new course of treatment, I recommend that you consult with your physician. Keep him or her informed of your progress and report any uncomfortable or adverse side effects that cause you concern.

Remember that the possession and use of cannabis is still illegal under federal law. Neither medical marijuana nor the majority of the supplements recommended in Part II has been evaluated by the Food and Drug Administration. But I can assure you that they are considerably safer than a multitude of pharmaceutical drugs that have been approved by the FDA.

I’ve changed the names and some identifying details of the patients described in the “Patient Stories” presented in Part II.

In Part III you will learn to integrate cannabis into a holistic approach for self-empowerment, to move beyond temporary pain relief into a life-changing healing process. You’ll develop a far greater capacity for practicing exceptional self-care, becoming fully conscious, fully alive, and high on life! Enjoy the journey, dear reader. I’m at your service.

—Dr. Rav