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

Psychedelics

A Psychedelic Renaissance is underway causing a paradigm shift where science and spirituality meet. Psychedelics literally means “mind manifesting.” Cannabis is now legal for medical purposes in 33 states. Entheogens are psychoactive substances in a spiritual context such as psilocybin (magic mushrooms), MDMA (ecstasy), mescaline derived from peyote (Ayahuasca), ibogaine, mescaline, DMT. They are classified as Schedule 1 drugs yet the government is greenlighting research. Rapid changes to embracing psychedelic substances by mainstream medicine is happening.  With research not just anecdotes, we are understanding that altered states of consciousness can lead to profound insight, psychospiritual exploration, personal development, and emotional release.

There is science showing how these substances can dampen our Default Mode Network (DMN) which is responsible for our personal narrative, and times of daydreaming and activate the 5HT2A receptors which serotonin binds to involved with mood, perception, and sleep. These medications can help us be more present and let our rigid thinking that allows us to be trapped in our personal narrative fade. We can depattern and adapt, finding purpose and meaning, living closer to our flow state or “in the zone” continuously and sustained. Psychedelics are intrapsychic tools so we can turn our attention inward. Dr. Stanislav Grof said “psychedelics are to the study of the mind and psychology what the microscope is to biology and the telescope is to astronomy.” They allow us to open the door of perception.

Psilocybin has been decriminalized in Denver, Oakland, Chicago and Santa Cruz. It may be possible for a natural substance to help avoid psychiatric drugs that have so many paradoxical side effects; prescriptions for antidepressants have doubled over the past ten years. A component of depression is a fixation on the past. We can address the root cause, reset the brain from maladaptive thoughts so patterns can be unlearned while promoting neurogenesis.

Ketamine is a legal dissociative and an anesthetic that was approved by the FDA in 1970 and quickly became one of the most widely used anesthetics in the world. It has the ability to anesthetize patients quickly and safely and is FDA approved for depression since 2019 with few side effects. Ketamine therapy can relieve various types of depression, suicidal thinking, post-traumatic stress disorder (PTSD), anxiety, obsessive-compulsive disorder (OCD), other mood disorders, and chronic pain conditions. In my practice, a full course of therapy consists of a series of 6 intramuscular sessions done over three weeks with each treatment session lasting 60- 90min. Alternatively, we can use infusion therapy for more severe pain conditions such as CRPS or oral troches for those who prefer to use the medication at home. Ketamine is an NMDA receptor antagonist and an AMPA receptor stimulator. AMPA stimulation is necessary for increasing brain derived neurotrophic factor (BDNF) which in turn stimulates the formation of new receptors and synapses. It dampens the fear response in the amygdala. This process is critical for making connections between neurons and is often severely compromised among those suffering from PTSD, depression, and mood disorders.

Psilocybin under supported conditions can cause mystical experiences, enduring long term changes, positive mood and behavior and attitude. Research conducted at John Hopkins using healthy volunteers shows life changing experiences from just a few sessions in which 67% rated using psilocybin as one of the top five most personally meaningful and spiritually significant events of their lives and 79% said it increased their well-being or life satisfaction. Psychedelics are helping to break addictions. Another study using three psilocybin sessions with therapy in 15 cigarette smokers showed at six months, more than 80% abstinence when the known rate for stopping nicotine is 15-30% with other treatments.  In 51 cancer patients, psychosocial distress and end of life anxiety was assessed using psilocybin. Ninety two percent at five weeks showed clinically significant improvements for high dose and at six months, 80% continued to show relief.

Other companies such as Usona at the Institute in Madison, Wisconsin is conducting research on major depressive disorder and Compass in London is studying psilocybin for treatment resistant depression and eating disorders. Microdosing mushrooms is also a hot topic using one tenth a normal dose every three days has been proposed for depression, increasing creativity helping to build successful leaders.

Other research using LSD on alcoholics, dementia and end of life anxiety is underway. The Beckley foundation in London is doing a microdosing LSD study using Jim Fadiman’s technique. Another promising study using MDMA in PTSD patients in a Phase II trial showed at 12 months post only one MDMA session, 2/3 did not even qualify for the diagnosis of PTSD anymore. MDMA research is underway for conditions such as Autism and social anxiety. Thank you, Rick Doblin, founder of Multidisciplinary Association for Psychedelic Studies (MAPS) in 1986 and Michael Pollan, author of How to Change your Mind for all of their efforts to move plant medicine forward.

Using therapy during sessions seems effective if you have a trusting relationship with the therapist, are prepared in advanced and in a safe environment.  Psychospiritual exploration helps us change our personal narrative and dissolve our ego. This journey of healing will help change our relationship to our thoughts. The importance of unity and transcendence to help us recalibrate and become more compassionate will awaken our society to feel joy and gratitude again.

First step is to decriminalize and start the conversation. Once these drugs are FDA approved, we can target the health issues for the masses that western medicine and pharmaceuticals have created by using nontoxic alternatives.  SET, SETTING, DOSE and SUPERVSION are of the utmost importance. Cannabis for many is a daily medication. Psychedelics show great promise for long lasting effects with one to three high dose sessions. Dr. Joe Dispenza said, “The body doesn’t know the difference between an experience and a thought, you can literally change your biology, neuro-circuitry, chemistry, hormones and genes by simply having an inner experience.” As for right now, Ketamine is legal and available and despite off label, I have seen remarkable results for my patients with depression, PTSD, addiction and pain.

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.

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).