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

Multiple Sclerosis and Cannabis

Multiple sclerosis (MS) is defined by the National Multiple Sclerosis Society as an extremely disabling disease affecting the brain and spinal cord in which T-cells from the immune system attack the central nervous system. Specifically, in MS the cells that are attacked include myelin (which form fatty sheaths that protect nerve fibers), oligodendrocytes (cells that produce myelin), and other underlying nerve cells. Damage to myelin sheaths produces severe scars or lesions on the nerves, these in turn interrupt the electrical impulses needed for normal motor function, this is referred to as sclerosis. The damage is caused by activated T-cells which travel to the central nervous system, secrete inflammatory chemicals and recruit other damaging immune cells. About 200 people are diagnosed with MS weekly; it typically affects women more frequently than men, usually between the ages of 20 and 40 years old. People diagnosed with MS experience a variety of symptoms including loss of vision, difficulty walking or inability to walk, loss of motor control, inflammation, difficulty focusing, severe lack of energy, depression and even paralysis. There is currently no cure for MS, however, there are multiple studies and clinical evidence that show inhalation or ingestion of medical cannabis can be highly effective in treating MS due to its analgesic and anti-inflammatory effects by use of the endocannabinoid system.

Research shows that muscle tone is under the tonic control of the endocannabinoid system; CBagonists reduce spasticity, while antagonists such as Rimonaband (SR141716A) exacerbate it. The CB1 receptors are densely represented in cortical and basal ganglia areas sub-serving motor control and their corresponding cerebellar counterparts. The endocannabinoid functions are also prominent in interneurons of the spinal cord and neocortex that may relate to pathophysiological mechanisms of spasticity. Medical cannabis has peripheral-paracrine function from glia, histiocytes, and macrophages. It triggers activation of endorphins by use of central CB1 receptors tightly coupled with Mu receptors. Medical cannabis interrupts pain signals at dorsal root ganglion and neurons. THC induces analgesia by inhibiting neurons activated by pain by binding to presynaptic CB1 receptors. CBD binds to TRPV1 and inhibits inactivation of Anandamide to mediate desensitization. Inhibition of CB2 receptors causes anti-inflammatory responses. There is also a psychotropic euphoric effect, short term memory reduction which mitigates stress.

During a clinical study, it was found that cannabis-based medicines are clinically effective treatments for spasticity in MS, with a mean of 48% improvement in spasticity when taking Nabiximols over 16 weeks period. Numerous other clinical trials from the United States, Canada and Spain, some involving placebos and mainstream pharmacological treatments, concluded that smoked or ingested medical cannabis was superior in reducing central neuropathic pain and other MS symptoms. Yet another two-year long clinical study showed that using a combination of THC/CBD resulted in a halt in the progression of the disease by deactivating the immune system’s attack to the central nervous system, without resulting in evidence of tolerance. Other benefits from the use of medical cannabis for MS include appetite stimulation, decrease in gastrointestinal inflammation which causes constipation, decreased spasticity and depression, protects eyesight by reducing inflammation around optic nerves, and relieves nausea and vomiting.  I have had incredible success thus far recommending Cannabis to my MS patients with a subsequent decrease in their pharmaceuticals and improvement in quality of life.

Michelle Weiner, DO, MPH & Diana Chavez
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).