PAIN

Question 1

List 3 herbal supplements and their indication

Answer 1

Arnica – osteoarthritis
Cayenne – neuropathic pain
Lavender essential oils – low back pain
Devil’s Claw, Glucosamine + Chondroitin – conflicting evidence

Question 2

INDICATION for medical cannabis

Answer 2

Refractory severe neuropathic pain OR palliative pain

NOT for general pain (ex. Back pain, fibromyalgia, headache, acute pain, OA, RA)

Question 3

5 CONTRAINDICATIONS to medical cannabis

Answer 3

Substance abuse 
Psychatric issues (Anxiety, schizophrenia) 
Liver disease 
Kidney disease
Bad COPD or Asthma

Question 4

Driving safety for smoking, ingesting or “a high” with medical marijuana

Answer 4

0 driving until:
3-4 hrs after smoking
6hr after ingestion
8 hrs after euphoria

Question 5

3 Side effects of medical marijuana

Answer 5

Drowsy, memory impairment, decreased function

Question 6

Principles to prescribing / dosing medical marijuana

Answer 6

Trial standard Rx first (>/3 for neuropathic pain, >/2 for palliative pain)
1 inhalation OD-QID (100-400 mg / day) of dried marijuana
Monitor S/E
Sign a drug agreement

Question 7

INDICATIONS TO DISCONTINUE medical marijuana

Answer 7

Inadequate pain relief (<2/10 points on pain scale)
Side effects
Addiction / Diversion

Question 8

Recommended daily limits for opioid naive treatment of non cancer chronic pain

Answer 8

Restrict to <50 mg - >90 mg morphine equivalents / d