If you live with chronic pain, you have probably heard the same suggestion more than once:
“Have you tried CBD?”
Or THC.
Or medicinal cannabis.
For some people, cannabinoids may be part of an appropriate chronic pain treatment plan.
But they are not the only option.
And they are certainly not the only conversation worth having.
If you are concerned about the side effects of CBD or THC, worried about driving or working while using cannabis, unsure about the evidence, or simply looking for alternatives, interventional pain management may offer another pathway.
The first question isn’t:
“What should I take for my pain?”
It may be:
“Where is my pain coming from?”
CBD and THC are not right for everyone
CBD and THC are often promoted as natural treatments for chronic pain.
But natural doesn’t automatically mean effective.
Or safe.
Or appropriate for you.
The evidence for cannabinoids varies depending on the type of pain, the product, the dose and the individual. Some people may benefit, particularly with certain types of neuropathic pain, but cannabinoids do not work for everyone.
There can also be practical concerns.
THC may cause drowsiness, dizziness, impaired concentration and impaired coordination. This can have implications for driving, operating machinery and some workplaces.
CBD can interact with other medications, and there are also concerns about the quality and consistency of some commercially available products.
And sometimes the biggest problem is much simpler:
They don’t provide enough pain relief.
That doesn’t mean CBD or THC are necessarily bad treatments.
It means they are one option among many.
What are the alternatives to CBD and THC for chronic pain?
This is where interventional pain management can become part of the conversation.
Interventional pain management uses targeted procedures to investigate and, in selected patients, treat specific sources of pain.
Instead of treating chronic pain as one condition, it asks:
Is there a particular nerve, joint or structure generating the pain?
Depending on your diagnosis, treatment options may include:
- Radiofrequency ablation for spine or joint-related pain
- Epidural injections for nerve irritation and severe sciatica
- Botox injections for tight pelvic floor, headaches, TMJ pain
- Stellate ganglion block for over active nervous system
- Ketamine infusions for widespread and persistent pain
- Lignocaine infusions for resistant nerve pain
Not every treatment is appropriate for every patient.
That’s important.
The goal isn’t to find a procedure that treats pain in general.
The goal is to find out whether there is a treatment that makes sense for your particular pain.
Chronic pain is not one condition
This is where personalised pain treatment matters.
Back pain caused by an irritated nerve is different from osteoarthritis.
Osteoarthritis is different from pelvic pain.
Pelvic pain is different from neuropathic pain.
Persistent pain after surgery is different again.
And treating all of these conditions in exactly the same way doesn’t make much sense.
A good pain assessment asks more specific questions:
Where is the pain?
What does it feel like?
What makes it worse?
What makes it better?
Is a particular nerve or structure involved?
Can that source of pain be tested?
Is there a treatment that could target it?
These questions can sometimes lead to a very different treatment plan.
A nerve block can sometimes be both treatment and diagnosis
One of the advantages of interventional pain procedures is that some treatments can provide diagnostic information as well as temporary pain relief.
For example, if a particular nerve is suspected of contributing to your pain, a diagnostic nerve block can temporarily numb that nerve.
If your familiar pain improves significantly during the expected period of the block, that response may provide useful information.
It doesn’t provide all the answers.
But it can help your specialist understand whether that nerve is likely to be involved.
And sometimes a better diagnosis is the beginning of a better treatment plan.
The goal isn’t simply to reduce your pain score
There is another reason to think beyond medication.
Pain changes behaviour.
You stop exercising.
You walk less.
You sleep poorly.
You avoid activities.
You become cautious.
Your confidence in your body can disappear.
So the goal of chronic pain treatment shouldn’t always be:
“How do we get your pain from eight out of ten to four out of ten?”
A better question might be:
“What would you do if your pain gave you more room?”
Perhaps you would walk further.
Return to exercise.
Sleep better.
Go back to work.
Play with your children.
Travel.
Return to physiotherapy.
Do something you stopped doing because of pain.
Sometimes a targeted pain procedure can create a period of relief that makes rehabilitation easier.
That can be more important than the pain score itself.
Interventional pain management is not a replacement for rehabilitation
A procedure isn’t necessarily the finish line.
It may be the beginning of something else.
Pain relief can create an opportunity to move.
Movement can rebuild strength.
Physiotherapy can restore function.
Graded activity can rebuild confidence.
Better sleep can improve resilience.
Psychological support can help reduce fear and avoidance associated with persistent pain.
The best chronic pain management plans are often multimodal.
In other words, they use more than one strategy.
The procedure may be the bridge.
Not the destination.
Why haven’t you heard about these treatments?
Pain care can be fragmented.
One clinician focuses on medication.
Another focuses on exercise.
Another focuses on surgery.
Online advertising focuses on products.
And the patient is left trying to put the pieces together.
This can make it difficult to understand the full range of chronic pain treatment options.
Interventional treatments also require careful diagnosis.
For example, radiofrequency treatment may be appropriate for selected patients when the clinical assessment and diagnostic blocks suggest a particular source of pain.
Other spinal injections may have little role in routine chronic back pain.
An epidural injection may be considered in specific circumstances, such as acute, severe sciatica.
The message isn’t:
“Everyone with chronic pain needs a procedure.”
It is:
“The right treatment depends on the right diagnosis.”
Are interventional pain procedures safe?
Every treatment has potential risks.
That includes CBD and THC.
And it includes interventional procedures.
Depending on the procedure, risks can include temporary soreness, bleeding, infection, medication reactions, numbness, weakness, nerve injury or failure to achieve lasting pain relief.
Implanted treatments such as spinal cord stimulation have additional surgical and device-related risks.
That is why a proper consultation matters.
Before undergoing an interventional pain procedure, you should understand:
- Why the treatment is being recommended
- Whether there is evidence supporting its use for your condition
- The potential benefits
- How long the benefit might last
- The potential risks
- What recovery involves
- What alternatives are available
- What happens if the treatment doesn’t work
This is shared decision making.
Not a one-size-fits-all solution.
What if you don’t want CBD or THC?
You don’t have to.
You don’t need to be against medicinal cannabis.
You don’t need to believe that cannabinoids never work.
You simply need to know that they are not your only options for pain relief.
If you have persistent pain and CBD, THC or medication hasn’t provided the answer you’re looking for, consider asking a different question:
“Could there be a specific source of my pain that can be identified and treated?”
Sometimes the next step isn’t another medication.
Sometimes it isn’t another supplement.
Sometimes it isn’t another scan.
Sometimes it’s finding the right target.
And finding the right target can change the conversation.
You have more options than you think
Chronic pain can make your world smaller.
The right treatment can sometimes help make it bigger again.
For some people, CBD or THC may be useful.
For others, they may not be appropriate or effective.
And for appropriately selected patients, interventional pain management may provide another medically supervised approach to managing chronic pain.
The important thing is not choosing a particular treatment before you have been assessed.
It is understanding your options.