Pain Management for the Young Adult Rheumatology Patient in an Era of Medicinal Marijuana Legalization.

Abstract

The young adult (18 to 23 years old) rheumatology patient has unique needs. While transitioning through a life stage that encompasses physical and emotional changes, these patients are also dealing with the challenges of coping with the many facets of chronic illness. Pain, a prevalent symptom of rheumatic disease, impairs physical, social, and emotional function, requiring a pain-directed treatment plan in parallel with disease modification. In the current context of the medical legalization of marijuana (herbal cannabis) worldwide, many young patients may be looking to this compound as a pain management option. Familiarity with marijuana as a recreational product that is socially acceptable for many youth may encourage therapeutic use, smudging the lines between recreational and medicinal use. Therefore the medical community must be knowledgeable about current evidence of benefits and risks of marijuana as a therapeutic option to competently advise these young people. Principles of pain management, generic to all pain conditions, should incorporate nonpharmacologic measures as a first step, with attention to good lifestyle habits, education to strengthen the therapeutic alliance, and promotion of coping strategies1. Without providing a detailed description of current pharmacologic treatments for chronic pain, any choice for the young adult must especially take into consideration effects on cognition, potential effects on the developing brain, and interactions with other substances. The pharmacologic treatment of pain should begin with use of the simple analgesics and thereafter with nonsteroidal antiinflammatory drugs (NSAID). Compliance with a regimen of continuous medication, especially with more frequent dosing as for some NSAID, remains a challenge. While not denying the need for pain management, the evidence to support opioid use to treat rheumatic pain is scant. Opioids should therefore be reserved for those with severe pain unresponsive to standard measures, and ideally prescribed for short time periods. Opioids are addictive. … Address correspondence to Dr. M.A. Fitzcharles, Montreal General Hospital, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: mary-ann.fitzcharles{at}muhc.mcgill.ca