Dr. Michelle Weiner, DO, MPH

Dr. Michelle Weiner, DO, MPH

Dr. Michelle Weiner, is an Interventional Pain Management Physician board certified in Physical Medicine and Rehabilitation. She completed her residency and fellowship training at the University of Miami. Her specialty is focused on prevention, treatment, reversal of health deterioration, increasing function and managing pain. Dr. Weiner focuses on diagnosing and treating spine and musculoskeletal pain as well as chronic migraines at the Spine and Wellness Centers of America

Cannabis and Autism

Often times, patients that I am certifying for Medical Cannabis or recommending Cannabidiol (CBD) oil to ask if this may be an option for a family member. Autism is one of those diagnoses I hear a lot of people inquire about however not many feel comfortable pursuing treatment. As a Certified Recommending Cannabis Physician in the state of Florida, I would like to clear the air and educate you on the current evidence that exists.

Autism is a brain development disorder that begins within the first few years of life, more common in boys. As a “spectrum,” Autism affects individuals in different degrees. It affects communication and social skills. The CDC estimates that 1.5% of children in the U.S. have been diagnosed and has increased tenfold over the past 40 years.

The etiology of Autism is still unknown however more evidence has evolved recently.  Risk factors may include maternal illness during pregnancy, parents age at conception or difficulties during pregnancy or birth. These factors in conjunction with genetic factors may influence risk. Stanford University researchers concluded that symptoms of Autism may be caused by a gene mutation that blocks the body’s natural production of endocannabinoids and interferes with the way the cannabinoids communicate. In addition, Autism related mutations in mice resulted in deficits in endocannabinoid signaling. This study published in the journal Neuron in 2013 concluded that “alterations in endocannabinoid signaling may contribute to autism.” 

It has been proposed that Autism may actually be a deficiency of one’s endocannabinoids or the body’s form of Phytocannabinoids like THC and CBD.  In this sense, one would have to supplement with a dose of cannabis to combat this deficiency and maintain homeostasis. A study in the Journal of Autism and Developmental Disorders in 2013 revealed a link between the immune cells in children with Autism and the Endocannabinoid System (ECS). CB2 receptors are increased in times of inflammation or changes in immune function. Immune dysfunction is related to Autism therefore the use of cannabinoids that target the CB2 receptor might help symptoms.

While we are discussing Autism, a common pediatric disorder I wanted to touch on the effects of cannabis and CBD on Attention Deficit Hyperactivity Disorder (ADHD).  It is important to break the stigma that cannabis interrupts focus and concentration. It has been shown in a small clinical trial that 100% of people studies with ADHD who tried CBD therapy had a reduction in impulsivity, improved concentration and better sleep. The mechanism is most likely its effects on dopamine which may be deficient in the brains of patients with ADHD.

To clarify, CBD, the non-psychoactive part of Cannabis has been most heavily studied in the pediatric population. The cerebral cortex is the part of the brain needed for higher functions like risk assessment and abstract reasoning and it develops until the early twenties. During our childhood, our brains develop most of the neural connections and in our teens these pathways are reinforced. The human brain also has gyrations are folds that increase surface area and are related to IQ. High levels of THC use has been shown through fMRI to decrease white and grey matter that the brain develops and increases cortical thickness. This can be helpful in patients with Autism which may be caused by hypergyration. Pure THC has been given to children in studies conducted in Israel for example for nausea and committing is cancer patients with no adverse effects.

There are few approved medical treatments for autism and many pharmaceuticals have a multitude of side effects. According to the Autism Research Institute, some of the symptoms that cannabis has improved included “anxiety, generalized rage, tantrums, property destruction, and self-injurious behavior.” 

So, all parents must ask themselves is using cannabis worth the risk. There currently is not enough substantial evidence for some physicians to feel comfortable recommending cannabis to the pediatric population for conditions like autism unlike disorders such as epilepsy which has sufficient research. Many studies have not been replicated and there are no studies that show Cannabis produces irreparable harm. Dosing is important especially in this population and must be done with a Cannabis educated Physician. However, in my opinion, once a patient has tried and failed other conventional methods and the condition is affecting the individual and/or the family’s overall quality of life I would believe using a natural herbal medicine would be a viable option. The benefit/risk ratio seems so benign compared with so many other pharmaceuticals.

Again, I will reinforce that Medical Cannabis and CBD should no longer be a schedule 1 drug so that Physicians and Scientists are able to conduct double blind placebo controlled human clinical trials.  A lot of the research is retrospective, conducted on animals or anecdotal however, this should not be dismissed. 

SPINE AND WELLNESS CENTERS OF AMERICA

Original Article: HighLife Magazine

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Virtual Reality Effects on Pain Perception: Implications for Pain Management

Current Status: Pending

Literature suggests that the use of virtual reality distraction for adjunctive pain control has been successful. In clinical settings and experimental studies, participants immersed in a virtual reality experienced reduced levels of pain, general distress/unpleasantness and reported a desire to use virtual reality again during painful medical procedures.

There has been research into the use of virtual reality distraction for adjunctive pain control with significant success. There has been growing evidence for the use of EEG for the measurement of pain. It has also been suggested that virtual reality could be used an alternative to marijuana and opioids for pain management. Further implications have been seen specifically among chronic pain sufferers. This is especially interesting since there is a reduced risk of addiction as is seen associated with marijuana and opioid use. This study aims to investigate the effect of virtual reality distraction on pain perception.

Additionally, we intend to create a body of open source content for potential use by other investigators utilizing similar tools. 

The intervention has the potential to relieve chronic pain sufferers of their pain with a non-invasive mechanism and minimal risk. The participants may experience a temporary decrease in the perception of pain during the course of the experiment or a distraction from said pain.

Pending IRB approval at UM

Seniors Over 60 With Chronic Pain Using Medical Marijuana

Current Status: Active

 

The purpose of this study is to identify what is effective and safe for older adults with chronic pain to develop an understanding of what educational materials are required for facilitate access to appropriate products at medical marijuana treatment centers (MMTC). 

Survey older adults (> 50 years) with chronic pain who have MM access cards and receive their product from state-approved dispensaries to document: demographic/health data; patterns of use; product specifics; pain effects on daily life; pain-related medical conditions; education prior to MM purchase; helpful and problematic effects of MM use. 

The proportion of Florida’s population that is 60 and older is growing more rapidly than other components of the population. Musculoskeletal disorders with associated chronic pain are a common problem in later life. Symptom management in older adults, including chronic pain management can be challenging (Briscoe, 2018). Medications, especially opioids, can increase the risk of confusion, constipation, falls and injury (Briscoe,2018). Medical marijuana (MM) is often recommended by doctors in the treatment of these medical conditions, guided by state law that defines qualifying conditions.

Medical marijuana use among older adults is growing at a rate more rapid than younger age groups (Lum, et al, 2019). The 2016 National Survey on Drug Use and Health estimated a 2.9% prevalence of marijuana use among this older population. However, the survey did not ascertain if use was for medical or recreational purposes (Han et al., 2016). Older adults may have important differences in pathophysiology, pharmacological interaction of medications, comorbid conditions, and toxicological responses to cannabis.

There is little evidence to evaluate the differences associated with medical marijuana use among older adults, such as individual reasons for use and problems arising with use (Haug et al., 2017).

Chronic pain is a major public health problem. Approximately 178 million (41%) adults in the U.S. age 18 and older suffer from at least one painful health condition (Nahin, et al, 2019).

In Florida, there are 327,492 medical marijuana card holders and chronic non-malignant pain was the No. 1 diagnosis for which patients are registered (The Florida Department of Health, Office of Medical Marijuana Use, 2020). Yet, it is not a qualifying condition, creating challenges for physicians wishing to support patient use of MM for chronic pain.

Chronic pain accounted for nearly 34 percent of diagnoses at certified dispensaries (The Florida Department of Health, Office of Medical Marijuana Use, 2019).