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Paige Riesenbeck

Professor Bell

Eng.1201.516

3 March 2021

Chronic Pain Research

I had been a cheerleader for about eight years, and at the age of thirteen, I experienced an

injury that damaged the nerves and cartilage in the left knee. Per my physicians, I had

“hyperextended and dislocated my knee all at the same time”. The doctors explained that I would

be on crutches for only six weeks and wear a knee brace for ten weeks; this continued for almost

five months. Prior to physical therapy, I was unable to move my knee to walk. By the fourth

month mark of physical therapy, I regained 90% of my range of motion. Through this

experience, my depression and anxiety grew increasingly worse and were creating other issues.

The doctors didn’t believe that I was having so many side effects; medications were not helping,

and my pain continued. This same pain was keeping me up at night which made me feel even

worse. I was taking eight different medications, and several were two to three times a day. I

eventually discontinued all my medications at the same time and refused to restart them.

When addressing the problems with my doctors they would look at my mom verifying

that I was telling the truth. My doctors eventually diagnosed me with both, Chronic Regional

Pain Syndrome and Ehler-Danlos Syndrome. Initially, I was unable to walk upstairs and this

continues to be a struggle without pain. When the doctors refused to support me to have a better

lifestyle without medications, we took matters into our own hands. At the age of sixteen, I started

using CBD oil from a gas station to aid in the decrease of swelling in my knee. After mentioning
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this to a member of my team of doctors at Children’s Hospital, she referred me to a medical

marijuana specialist, Dr. David Zainey. Zainey was able to review my years of medical history,

approve my diagnosis and help in creating my new medical plan outside of medications.

Dr. Zainey then signed off for me to receive a medical card, but since I was still only

sixteen, I would have to have my mom as a caregiver. Before starting to take THC, I did a lot of

research to make sure I knew what I was taking and how it could affect my body. I was instantly

able to see results and control my pain. There is no cure for a chronic illness, but this taught me

quality of life by making my daily pain manageable without all the medications and side effects.

As of today, I have had my medical card for almost a year now. I do not require to wear a knee

brace all the time, I am also able to participate in more activities than I was prior to this treatment

method. My pain is still present, but I can now pace myself and be aware of how I will feel after

a particular activity. This injury had changed my life and with medical marijuana, I now have a

new normal.

Chronic Pain is long-term, with having more side effects than most normal pain. This

kind of pain will never go away meaning that it has no cure. It is very hard to manage without

help from a doctor and a lifestyle change. Chronic pain is a prolonged amount of pain after an

injury or underlying disease. Pain from a surgery, a sprain etc. should only last between four to

eight weeks; exceeding this is considered chronic. Due to the nature of this it can be found in

many patients, though it can be different for everyone. This pain can be found in the spine,

joints, hips, and even migraines. There are two causes of chronic pain, along with two different

types, I and II. Type I Chronic Pain is caused by a sprain or fracture that prolongs the pain;

Neuropathic Pain. Type II occurs when there is a broken bone or infection but also when the

nerves have been damaged, so badly there is no healing them; Nociceptive Pain. The question is,
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what can be done to improve the quality of life with this disease? Having no cure for this kind of

pain, the patient will go through more than what you would think. Being able to have

management over the pain in physical therapy, medications, change of lifestyle, and self-

awareness allows the patient to have a higher quality of life.

Chronic Pain is also known as CRPS, Chronic Regional Pain Syndrome. Chronic

meaning constantly reoccurring pain can be so dreadful and unmanageable that many take their

own lives to escape from the pain. Many patients often feel abandoned when having this disease

because many do not believe that they are in such great pain. This kind of pain is more difficult

to live with then can be imagined. The location of an individual's chronic pain can and will limit

the amount of movement and flexibility along with the strength that one will have. This impacts

the socialization and the ability to be independent, this leaves patients to ask for help to do

simple tasks. Leaving the patient to be discouraged and not excepting of the idea of a simple task

because they know that they will not be able to complete it. Overall decreasing the quality of life

and have a lack of attendance to social events. This causes anger and more negative emotions on

one's relationships and cause higher stress levels. We can create a baby with egg and sperm

underneath a microscope, we can remove cancer cells that are in the brain, but we cannot heal

chronic pain. The science behind chronic pain is very complex with involving the nervous

system. In current day, science has come a very long way, while we are very knowledgeable

about many other topics chronic pain is one that we are not. Treatments involving a complex

system can be hard to maintain per each patient.

With Chronic Pain being in the joints, building the muscle around the targeted areas

would aid in reducing the pain. For example, if there is Chronic Pain in an ankle due to an injury

it was because of dislocating it in any form. Building the muscle around the ankle will help to
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prevent it from dislocating again. Preventing this would reduce the motion from repeating itself

and reliving the pain from when it first occurred. Not giving the damaged nerves a chance to

retrigger the nerve endings would also reduce swelling and other side effects. These nerve

endings send messages to the brain that single that there is pain. For example, when you start to

smell something tasteful, you think about what it would be. That is the same action as the nerves

in the joint thinking the body is injured. Physical therapy is then encouraged by doctors to help

the muscles around the join to learn a new pathway. This is to limit the joint from displacement

and start building muscle memory. While this plan might seem like a better path, giving the

damaged nerves time is not a full solution to the pain because after any amount of given time a

patient could plateau. According to Lucy P. an Ortho Rehab Specialist, plateauing is when

physical therapy no longer is a benefit. There is only so much muscle that can be built around the

joint until the patient has maxed out. Although with everything that has been stated previously,

with there being Chronic Pain in all different areas of the body, physical therapy isn’t always an

option.

As stated in one article there are two different types of chronic pain. Neuropathic Pain is

when the nerves themselves are damaged. The other type, Nociceptive Pain, occurs when an

injury activates your pain receptors in your brain, and they cannot turn themselves off. This type

can also be broken down into another two categories, Visceral and Somatic. Visceral

Nociceptive Pain occurs when there is an injury to a major organ while Somatic Nociceptive

Pain occurs in the joints, (Tennant). When the nerves are damaged it can be hard to diagnose due

to not being able to physically see the problem. This pain leads others to doubt and think patients

are faking having a serious problem. This disbelief from close friends and family can lead to a

loss of support system and can cause a diagnosis of depression.

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When losing your support system, we see the mental state of patients down spiral.

Elizabeth Gerardi has been diagnosed with Chronic Pain due to a car accident. Elizabeth was a

patient that found drugs as an outlet but not in a positive way for every long. She took her pain

into her own hands which meant being on unsafe drugs that could have ended her life if she

would have stayed taking them. This led to family and friends believing that she had an

addiction. She asked for a divorce from her husband that ended her first marriage and lost trust in

the ones around her. When finding the right doctors that would listen to her systems, she was

able to get her life back on track. Her way of coping with the pain is to block the nerves. This

can be done in many ways but what works best for her is an epidural. Her doctor has her come in

once a month to implant this nerve block by injection into her spine. She since then has

remarried, has a stepdaughter, and birthed two kids. Being a stay – at – home mom to three kids

will put a beating on the body. She has been clean of drugs for going on four years and plans to

stay sober. Elizabeth is example of what this disease can do to patients, while some by not be

able to get the help that she did.

As stated in the article “Chronic Pain and Mental Health”, “Chronic pain affects every

aspect of your life, including your mental health. Sometimes patients are so focused on

alleviating the physical aches that they neglect to address the psychological effects of their

chronic pain”. This article goes into depth about the many mental side effects that can be caused

by chronic pain. Depression, anxiety, insomnia, and guilt can all be caused, while it is not

surprising, chronic pain can keep you from many of activities and social events. This separation

is enough to create abstinence from less socialization and cause frequent anxiety attacks. For

some Chronic Pain can also make sleeping very difficult. The pain around the joints can wake up

a patient in their sleep which will lead to them not being able to stay asleep or go back to sleep.
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In extreme cases, this can create heavy insomnia. Many people believe that having these

disorders can also psychologically increase the pain, (Florida Medical Clinic).

Doctors have found ways to cope with this disease, this includes opioids, physical

therapy, and group therapy. Opioids are a pain killer that will reduce the amount of pain that the

patient is in. There are commonly prescribed after a surgical procedure and are only for short –

term usage. Pain has been proven to be one of the prime issues for medicine. Finding what

dosages of which medications works best together for the patient is time consuming. The opioid

will reduce the amount of pain signals that are sent to the brain giving the person pain. This gives

them the opportunity to go back to their pain – free lifestyle. Doctors are practicing medicine; the

human body naturally will adapt to what is being taken, for example Tylenol. When these over

the counter medications no longer help, victims of Chronic Pain go to doctors for something

stronger to reduce the pain. With our bodies naturally adapting this leaves the patient with long

term side effects, which we call this disease Addiction.

Although there are always side effects to medications, opioids are highly addictive. When

we realized that these pain killers are what’s killing many people due to overdoses, we needed a

solution. Many people have researched the use of medical marijuana for chronic pain. “In the use

of cannabis and cannabinoids to treat chronic non-cancer pain is escalating because of their

potential to diminish opioid dose requirements”, (Yvette). There are two components in

medicinal marijuana which have been proven to reduce pain. CBD helps with inflammation

while THC helps with nausea and increases appetite. This helps in numerous ways with many

symptoms of having chronic pain. When a joint has inflammation around it, this is applying

unnecessary pressure on the joint causing an increase in pain. When pain rates are elevated, it

can lead to additional side effects like a loss of appetite and an increase in headaches. This is
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further proof that one diagnosis can lead to other signs and symptoms that could potentially end

in other rash medical conditions.

There are also downsides to this idea. According to Sue Berkinshaw, marijuana has the

“highest potential for addiction”, (Birkenshaw). The side effects help so well to reduce the pain

that the side effects can be addictive, this makes prescribing it even harder. Many people’s

reservations about this are that marijuana is still a drug. THC and CBD themselves are not

addictive which is why this is the safer medical plan to have. The use of marijuana for medicinal

purposes is still fairly young and therefore, long – term effects of which way you consume it

have not been studied thoroughly, (NIH). This being said, society continues to see this as a drug

even though there are many states that have legalized it. Currently in Ohio it is illegal to have

possession of cannabis, which is causing a lack of movement on the insurance company’s

coverage. With it being still illegal insurance companies can’t pay for doctor’s visits or

perceptions. It is only legal to have in Ohio if a doctor has given approval or an Ohio Medical

Card. No one is certain when the insurance companies will be able to pay for this resource. Due

to this these patients that do have medical cards are required to pay out of pocket for this

particular medication, rather than opioids.

While all of what has been previously been stated are valid concerns, pain is not

something these patients choose. Patients that have been living with Chronic Pain for so long,

have seen multiple doctors, who prescribed many types of medications that they start to feel

helpless. Medical marijuana is showing that patients can get control of their pain, with less side

effects and obtain a healthier quality of life. Overall Chronic Pain is not the same for everyone,

meaning that one treatment plan is not sustainable for every individual. This is a serious disease
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that does not get the amount of support needed to live a healthy lifestyle. Chronic Pain is A

heartbreaking and dreadful disease that one should not have to live with on their own.

This is a pain chart, a Chronic Pain patient ranged between four and six.

This demonstrates the thoughts of what Chronic Pain patients have.

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The graphic shows a visual of how Chronic Pain works.

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Works Cited

Birkenshaw Sue, “The Hidden Dangers of Medical Marijuana”, Narconon, 20 Aug. 2014, The

Hidden Dangers of Medical Marijuana (narconon.org).

Cirino, Erica. “What Causes Chronic Pain?” Healthline, 2017,

www.healthline.com/health/chronic-pain.

Dr. SkaribasExpert Pain CareDr. Skaribas is recognized as a leader in the field of interventional

pain medicine in Houston. “How Chronic Pain Spreads.” Dr. Skaribas, 29 June 2020,

www.expertpaincare.com/2020/06/29/how-chronic-pain-spreads/.

Jacques, Erica. “8 Ways to Manage Your Chronic Pain.” Verywell Health, 2020,

www.verywellhealth.com/living-with-chronic-pain-2564411.

Ingraham, Paul. “A Historical Perspective On Aches and Pains.” Www.PainScience.com, 9 Aug.

2018, www.painscience.com/articles/historical-perspective-on-aches-and-pains.php. 

Mayo Clinic. “Am I Vulnerable to Opioid Addiction?” Mayo Clinic, Mayo Foundation for

Medical Education and Research, 16 Feb. 2018, www.mayoclinic.org/diseases-

conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372.

Mayo Clinic Staff. “Taking Pills for Chronic Pain?” Mayo Clinic, Mayo Foundation for Medical

Education and Research, 9 Jan. 2021, www.mayoclinic.org/chronic-pain-medication-

decisions/art-20360371.
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Nevada Pain. “Causes of Chronic Pain.” Chronic Pain Relief-Nevada Pain,

nevadapain.com/pain-conditions/common/chronic-pain/. Accessed 2021

NHS Inform. “Chronic Pain.” Illnesses and Conditions | NHS Inform, 2020,

www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/chronic-pain.

Tennant, Forest. “Types of Chronic Pain.” Practical Pain Management, 2015,

www.practicalpainmanagement.com/patient/resources/understanding-pain/types-chronic-

pain.

“The Psychological Impact of Chronic Pain.” Florida Medical Clinic, 21 Feb. 2020,

www.floridamedicalclinic.com/blog/psychological-impact-chronic-pain/.

Science X Staff. “CDC: 20.4 Percent of U.S. Adults Had Chronic Pain in 2019.” Medical Xpress

- Medical Research Advances and Health News, Medical Xpress, 4 Nov. 2020,

medicalxpress.com/news/2020-11-cdc-percent-adults-chronic-pain.html.

Yvette C. Terrie, BS Pharm. “Medical Cannabis for Chronic Pain.” U.S. Pharmacist – The

Leading Journal in Pharmacy, 19 Mar. 2020, www.uspharmacist.com/article/medical-

cannabis-for-chronic-pain.

“Is Marijuana Safe and Effective as Medicine”, NIH, July 2020, Is marijuana safe and effective

as medicine? | National Institute on Drug Abuse (NIDA).