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

Marijuana and Sex

Let me first start off using evidence to dispel the myth about the association between marijuana use and sexual frequency. The CDC in the US surveyed 28,000 women and 23,000 men. They concluded that Marijuana use is independently associated with increased sexual frequency by 20% and does not appear to impair sexual function, motivation or performance (Journal of Sexual Medicine). 

The most common issues pertaining to sex based on gender are low libido (30%) or early finish (premature 20%) for men and low libido and difficulty achieving satisfactory intimacy (difficulty achieving quality and frequency of orgasm) for women. Ninety percent of issues in relationships comes from family of origin, culture, religion, background. Ten percent is born out of the relationship itself. When both parties are aware that their issues may be coming from their background and communicate, it can heal childhood wounds (Dr Israel Helfand, Sexpert).

Pain during sex is more common than we think just not discussed. A survey reported by “Healthy Women,” a nonprofit health information service, showed that 62% of 555 women indicated that they experienced pain during intercourse. Among 308 respondents, 69% did not know that the problem is treatable.  Of 335 respondents who reported frequent pain during sex, 73% described the pain as moderate to severe.  The survey also found that 33% of 314 women indicated they were avoiding sex altogether and 60% of 337 menopausal women responded that they had never mentioned painful sex to a health care provider.

Some people have traumatic, habitual, societal or other closures in their body that prevent them from experiencing pleasure. Some people just have not experienced pleasure yet. Some people want to enhance the intimacy, connection, and pleasure they have. We are educated in most areas of our life, but there is no real sexual/relational/intimate education. We mostly see what our parents do and then fumble through our first few relationships. Many people have had a lack of intimacy in their upbringing and no sexual/sensual education as they started relationships. Life these days is increasingly disconnected and often the emphasis in relationships is on making money or raising kids—intimacy only becomes a goal when the relationship already suffers. 

Men and women have both feminine and masculine traits, but in a polarized (meaning sexually oriented) relationship one partner takes on the feminine expression and one takes on the more masculine expression and the radical differences in orientation create a strong arc of sexual polarity. The further the “poles” are apart, the stronger the sexual attraction.  In long term relationships, partners often become very much the same—we start to like the same things, do the same things—over time, the couple resonates rather than polarizes and hence has less sexual chemistry.

“Often relationships get stale when the purpose is not defined or has changed in one partner.”  Therefore, the more clarity and definition we can apply to the way we love, have sex, and create will enhance the experience. If you have a masculine essence, you prefer the structure of time and space over the wild chaos of existence. You enjoy activities that result in a blissful moment of nothingness. You enjoy creating schedules, objectives, and accomplishing goals. Your whole life is aligned with your purpose. If you have a feminine essence, you love the chaotic swirl of life, nature, bliss, color, texture, flavor, and communion. You love to relate, exchange, dance, celebrate, adorn and deepen into the fullness of existence.  Once you have defined your “home base,” your sexual essence, you can begin to practice the bodily expression of that essence as a gift to your partner. Breath, relax, practice eye contact, connect heart to heart, mix it up and create a safe space.

Sex differences are found at a cellular level; stress and drugs play a role.  Women are more strongly affected by cannabis. It has been proposed that women may have more pain relief but increased anxiety from using cannabis. One study showed female rats push the lever more than males to infuse the drug that activates the CB1 receptors. THC the psychoactive cannabinoid binds to the CB1 receptor and this may be because these receptors are located in the emotional and reward- related areas of brain processing (amygdala). THCs effects are strongest when estrogen levels are high. Estrogen actually increases the amount of Anandamide, our endogenous cannabinoid or natural occurring cannabis molecule in our bodies.

In the US, nine states and Washington DC have legalized cannabis for adult use, 30 states for Medical purposes. People who smoke cannabis may be among the most successful, dampening the idea about being lazy. Sixty four percent who tried CBD in the bedroom said it improved sexual experiences (survey Remedy Review). CBD can help anxiety, reduce pain due to dryness, increase blood flow and nerve sensation.

At the University of Missouri, 133 sexually active women in an ObGyn practice were surveyed; 29% used cannabis before sex, 68% reported more pleasurable, 72% said it increased their erotic pleasure, 62% stated it enhanced the quality of orgasms. A small quantity of cannabis increases libido which in turn releases positive endorphins and vaginal lubrication; this may be due to anxiolytic effects. There are no contraindications with Viagra or Cialis. Foria in collaboration with Staci Gruber PhD an associate professor at Harvard Medical School is conducting a study that will track the results of 400 women using Foria Relief CBD enhanced lubricant to address pain and other symptoms of menstruation. Cannabis suppositories provide menstrual relief without the side-effects typical of ibuprofen or opioids and unlike other cannabis products, vaginal suppositories provide direct, localized relief — typically without any psychoactive effects.

Seventy percent of smoker’s state there is an “enhancement in pleasure and satisfaction” (Elsevier’s journal of Pharm Research). Cannabis could interact with receptors in the vagina and clitoris to produce heightened sensation. Is the vagina designed for absorption; it may take 30-90 min to feel the effect of topicals so it should be planned in advanced.

Most importantly, we need to be consciously engaging with our bodies finding a deeper, greater pleasure. Our body is our greatest ally and an underutilized resource when making decisions connected to pleasure and intuition (Boehm, The Wild Woman’s Way: Unlock you Full Potential for Pleasure, Power and Fulfillment). The mind body connection is a portal to unlocking who we truly are. Energy gets stuck; we need to relieve tension and be mindful of sensation. It is time to reclaim our natural states of aliveness and pleasure through connecting to and feeling our body. Less social media and electronics may lead to more intimacy but if you need to move that energy cannabis can kick start the process.

Michelle Weiner, DO, MPH
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).