Yesterday I burned my hand cooking. In an incautious moment, while making a caramel sauce, one false move sent a tiny molten blob of sugar flying – landing on the back of my hand at the base of my thumb. Ouch! Like any good cook, I kept stirring to prevent burning the food. What I was left with was a great batch of matzah crack (google it) and a small but painful second degree burn (see photo).
Around bedtime it was really bothering me, and I was concerned that I would not be able to sleep. It’s amazing how sometimes the smallest injuries are the most painful. I considered my treatment options. I could put on some bacitracin, an antibiotic ointment, but I wasn’t worried about infection in this closed wound. I could use some topical lidocaine to numb it, but the pins-and-needles of lidocaine, to me, are often worse than the pain of the wound. Then I remembered I had a cannabis salve given to me by a company that shall remain nameless. It contains 1mg of THC and 1mg of CBD in each 200mg “serving”, it clearly has some other unlisted ingredients as well, and a base that I would guess is largely hydrogenated coconut oil. What the heck, I’ll give it a try!
You know what? It worked! The pain was almost entirely gone immediately after I applied it. I was super pleased and got a good night’s sleep. This morning, of course, the effect had worn off, and it hurt again. So, I reapplied and it felt better. But this got me to thinking, as I too often do, about what’s really going on.
Medical Marijuana and the Placebo Effect
First, we know that THC and CBD don’t penetrate skin. This was particularly evident, as I wrote a few years ago, when applying this same salve to a pulled muscle in my back – helpful at first, but no longer once I realized the effect had to be placebo (and proven to be placebo when thinking about it caused it to stop working). However, a burn is “on” the skin, and that skin is then damaged, so perhaps the cannabinoids would penetrate that.
Second, the effect was immediate. That’s generally a red flag. Few medications work instantly. Lidocaine usually takes a few seconds at least, but perhaps this was in that ballpark.
We also know that any inactive salve can produce placebo pain control. Perhaps the benefit here isn’t from the cannabis, but just from the ointment. This could be because the ointment covers the wound and keeps air from drying or otherwise irritating the wound. Or it could be that by simply applying the ointment, the “massage” stimulates a feedback “gate” that decreases the pain. This is like when we rub our knee after we bump it on the desk or our thumb after we hit it with a hammer.
The point of my article is not to conclude how this works or whether it is a pure placebo. I can’t do that. My experience cannot tell us that. I am only one person and I can’t be both a subject and the control in my experiment.
The point of this article is two-fold. The first is to exemplify the ways in which personal experience is not scientific, and cannot and should not be used to make healthcare decisions. The second is to say that my experience is my own, and that feeling better is, well, feeling better. It’s hard to argue with less pain.
This sets up a contradiction that is hard to wrestle with. Are placebos a reasonable medical tool and/or product? How do you advise patients about the use of products that may, or may not, be a placebo? What does it say about our intelligence and education if we willingly accept placebo products, at least without stopping to think about the possibility that we’re being duped?
It is my impression that our society has moved into a dangerous ant-intellectual era. Thinking is somehow something to sneer at. This has led to the increasing disdain for scientifically proven medicines in favor of well-packaged “quick fixes”. But ultimately the goal of science is simply to separate the things that really work from those that don’t. Which leads to my philosophy on placebos with which, you can see, I’ve wrestled with for some time. If someone comes to me using a product that is clearly a placebo but they are getting benefit, I won’t undermine that benefit. That would not be in the best interest of that person. On the other hand, if they ask me what would be best, or if they should consider a particular type of product, I will answer with the best factual information available (and be honest about what is not yet known as well). Similarly, if I’m asked in public or in the press about a product, I’ll always answer with the best information I have.
People often ask if I’m pro or anti cannabis. I’m neither. I’m pro patient.
Consult with Our Massachusetts Medical Marijuana Doctor About Managing Pain with Cannabis
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