Medical Marijuana, The Answer to Joint Pain?

Hello HopeGrown Readers, especially the tall ones!

I'm Little Jon, founder of Vertically Balanced - a website created to promote a holistic approach to wellness issues tall people face. The nickname 'Little Jon' was given to me by my circle of friends as a super original shout-out to my 6'7” frame. I've decided to embrace it since I really have no say in the matter.

I would like to dive into a serious debate going around medical circles right now regarding the impact of medical marijuana in treating different forms of arthritis. I am so grateful to HopeGrown for allowing me this forum to share my personal story and talk about this hot topic. What an amazing resource this place is, not just for educational purposes but for practical solutions as well. This particular topic is especially relevant to me as I currently suffer from advanced osteoarthritis in my left knee.

It was spring of 2011 and I was wrapping up my senior year of college basketball at MCLA in the mountains of Western Massachusetts. My freshman and sophomore years there had been a learning experience - I didn't start playing the game until I was 18 because I had grown up overseas and over there: SOCCER IS LIFE. What I quickly realized was that I wasn't quite ready for the talent level I faced during my first couple years of college. We went 1-24 my sophomore season. YIKES.

Thousands of hours of practice, fitness training and yoga (not easy for a 6'7” guy!) along with earning the captaincy during year two, helped catapult myself and my teammates to a 17-8 mark heading into Senior night. We had the best record at MCLA in 25 years, a home playoff game just a few nights away, and my grandmother on her way to watch me play for the first time. I had also just seen my dream of playing professionally overseas realized when I agreed to go to sign with a team in Israel after graduation.

As was the case every year I had been there, the day before Senior night the team held a light practice to prepare for the upcoming game against Bridgewater State. I hit the ground running that night, proud of what we had accomplished together as a band of brothers and the work it had taken to get to that point.

On a routine play I had executed over a thousand times in my career, I went up in the air and landed directly on the leg of a teammate. Upon impact, my ACL, MCL and meniscus gave way. Career over.

I tell this story because I'm now 28 years old - four years and three knee surgeries removed from that fateful day and I'm still feeling the effects. Osteoarthritis has become such a huge part of my life that not a day goes by without feeling some type of reminder.

Arthritis refers to the inflammation and swelling of joints, the area where bones connect, which provide support to the body and assist in maintaining mobility. Osteoarthritis is a degenerative joint disease that affects your cartilage. It's actually the most common chronic condition of the joints. Healthy cartilage allows bones to glide over each other and helps absorb shock of movement. With osteoarthritis, the top layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together. The rubbing causes pain, swelling and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint (my second surgery was to remove bone spurs - not fun.) Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage (third surgery: scope to clean out floating pieces.) The other type of arthritis, rheumatoid arthritis, is caused by an overactive immune response in the body.

Arthritis is an uncomfortable and often unavoidable disease that often results in severe symptoms:

• Injuries that don’t heal properly
• Carpal tunnel syndrome and peripheral neuropathy (tingling or numbness in extremities)
• Plantar fasciitis (inflammation of the forefoot)
• Persistent joint pain
• Locked joints
• Morning stiffness

Joints of the body most commonly affected by osteoarthritis are the hands, knees, hips and spine, and symptoms include pain, swelling, and stiffness. Osteoarthritis is the cause of approximately 69.9% of hospitalizations (approximately 814,900 in the United States in 2006) that result from arthritis complications. According to the CDC's osteoarthritis page:

• [Osteoarthritis] of the knee is 1 of 5 leading causes of disability among non-institutionalized adults.
• About 80% of patients with [osteoarthritis] have some degree of movement limitation.
• About 40% of adults with knee [osteoarthritis] reported their health “poor” or “fair.”

Once I knew what it was, I went on the attack. I changed my workouts completely to focus on non-impact training. I took swimming lessons, spin classes, and spent hours and hours trying to ice my knee to take the swelling down but to no avail. The day after a long day at work felt like spending hours inside a torture chamber, every step I took invoked shooting pain up my leg and every time I stopped I could feel my knee throbbing.

I visited countless doctors to deal with this and each time they shook their head at how swollen my knee was. They had given me specific instructions for physical therapy, and even assigned me a personal trainer to monitor my progress. Finally - seven months ago, they told me I wouldn't play basketball again.

The news stung. In a world where we are making so many strides medically, I couldn't wrap my mind around the fact that as a healthy young man, I was being forced to retire from the sport I loved.

I decided to pour myself into my career - really anything to take my mind off it. But every morning I would feel the stiff reminder in that knee that life had sent me down a different path than the one I wanted. That's when I stumbled across a very interesting study published in PloS ONE in February, 2013.

A team of researchers led by Professor Victoria Chapman at the Arthritis Research UK Pain Centre at The University of Nottingham have shown that selectively targeting one of the molecules involved in the body's natural pain-sensing pathways, called cannabinoid receptor 2 (CB2) can also reduce pain in animal models of osteoarthritis. This works in part through the central nervous system (spinal cord and brain.) The compound used in this study, called JWH133, is a synthetic cannabinoid molecule manufactured in a laboratory and is not derived from the cannabis plant.

When the research was extended to humans, studies of the human spinal cord tissue showed for the first time the presence of this receptor and, interestingly, that the amount of receptor was related to the severity of the osteoarthritis. This provides evidence from patients that this drug target may have clinical relevance to osteoarthritis pain.

In the rat model for osteoarthritis pain, researchers found:

• an increase in CB2 receptors in neurons and microglia (essential supportive cells for neurons)
• markers of central sensitization (i.e. a heightened response to pain as a result of pain neuron “irritation”/activation by surrounding tissue damage or swelling) including spinal astrogliosis (an increase in overactive astrocytes [supportive cells of the nervous system]) and increased activity of metalloproteases (connective tissue degrading enzymes) in the spinal cord
• the presence of more severe knee cartilage disease was associated with a decreased amount of CB2 mRNA (a receptor-making template)

Results of cannabinoid stimulation included the following:

• JWH133, a compound that stimulates CB2 receptors (i.e. a CB2 agonist) helped to reduce behavior associated with pain and spinal neuron response to pain stimuli, and prevented increases in IL-1β and TNFα (inflammation markers).
• Administration of the CB2 agonist directly to the spine helped to prevent osteoarthritis-type pain responses.
• Administration of the CB2 agonist reduced central sensitization.

Totally confused yet? To put it simply, activating the cannabinoid receptors that are drastically reduced in osteoarthritis patients reduced inflammation, thus reducing pain and allowing the individual to lead a higher quality of life. Furthermore, since patients with late stage osteoarthritis have drastically reduced levels of the CB2 receptor "message" in the spine, increasing levels of the CB2 receptor "message" might greatly reduce the severity and rate of progression of the disease.

Really interesting stuff here! Could it be that the answer to one of the most debilitating diseases around has been in front of us the whole time? I immediately contacted my former teammate who suffers from osteoarthritis as well and shared the news. We've decided to take a wait and see approach, to hear about possible human testing and then take it from there.

Researchers are recruiting 20 people in Halifax to take part in a “groundbreaking” study — a Health Canada approved medical cannabis clinical trial. The study is looking at the use of vaporized marijuana in the management of osteoarthritis of the knee. It's the first one to really compare various types of marijuana with differing amounts of THC and CBD. I'm fired up to know there are more medical professionals who are making this a priority.

I went to my grandmother's house last weekend and she asked me how my knee was doing. I said "Nonny; I've got hope for a cure in the future. That alone makes the physical pain tolerable."

Time will tell of course, but it's quite possible that medicine has finally taken a step in the right direction with regard to osteoarthritis. I wrote this blog for all you tall people out there suffering from this debilitating disease so that you may share in the hope that I've come to find. And twenty years from now we will be talking about how osteoarthritis was kicked to the curb.

Thank you again to HopeGrown and all their faithful readers - you guys rock! If you would like any further information on this topic - or any other topics relating to holistic wellness solutions for tall people please visit www.VerticallyBalanced.com

-Little Jon

Founder, Vertically Balanced.