Vitamin D has long been referred to as “the sunshine vitamin,” and with good reason. The ultraviolet rays of the sun are tasked with providing people with the majority of the vitamin D they need for good health. But a recent decline in outdoor activity rates, combined with inadequate vitamin D intake in food, have resulted in a rise in vitamin D deficiency across the globe.

Vitamin D is a crucial part of good health. In this guide, you’ll find everything you need to know about vitamin D, including:

• What vitamin D does in the body, including symptoms of deficiency
• Major research-backed benefits
• Where to find vitamin D in foods and elsewhere
• How to determine the proper dose for you
• Safety information if you’re supplementing with vitamin D

What Does Vitamin D Do? 

Contrary to its name, vitamin D is not actually a vitamin. It is a prohormone — a precursor to a hormone — and it is present it nearly every tissue in our body. This prohormone is fat soluble. It can be found in some foods, through vitamin supplementation, and in the rays of the sun (hence its nickname).

There are two main types of vitamin D. Both of these are naturally occurring in the presence of the sun’s ultraviolet-B (UVB) rays.

1. D2 (ergocalciferol): Produced in plants and fungi
2. D3 (cholecalciferol): Produced by animals, including humans

Other than what produces them, these two types of vitamin D do not differ in any major way. The body uses each form in a similar fashion. The small intestine is responsible for absorbing and assimilating vitamin D. It does its job better in the presence of fat. Fat is not required to use vitamin D, but it does help the small intestine to work more efficiently. 

One of the things that is also different about vitamin D as compared to other vitamins is that age or body condition does not affect how we absorb it. We are just as good as absorbing vitamin D when we are young and fit as when we get older and are carrying a few extra pounds.

Further, vitamin D is a crucial part of our diet. It helps us to absorb calcium and phosphorous to build strong bones. This is one of the reasons that vitamin D is added to milk. It also helps to bolster healthy immune system function and can protect against many diseases, including type 1 diabetes.

Research is now beginning to uncover a host of other benefits. These include vitamin D’s ability to:

• Help ease pain
• Regulate mood
• Help with sleep issues
• Shore up a weakened or compromised immune system 

With just a few exceptions, vitamin D is well-tolerated in the body. It is safe and offers very few risks or side effects. Supplementing a regular diet with sunshine and a vitamin D pill may be a great way to improve general overall health. It can also combat a growing global problem: vitamin D deficiency.

The symptoms of a vitamin D deficiency 

Nearly 42% of adults in the U.S. do not get enough vitamin D through exposure to the sun, food, or supplementation. In children, an estimated 10% are vitamin D deficient. An estimated 60% more are ingesting suboptimal levels of vitamin D daily.

The risk is higher for people with the following circumstances or conditions:

• Lower levels of education
• Obesity
• Hypertension
• Overall poor health
• Location relative to the equator (less sunshine equals higher risk)
• Conditions that impact absorption (e.g., Crohn’s or celiac disease)
• Diet with few animal products (i.e., vegans or vegetarians)

People with darker skin (including those living close to the equator) are at high risk of vitamin D deficiency. The same melanin in their skin that provides protection from skin cancer can also prevent the absorption of sun-based vitamin D. Finally, people who do not regularly consume milk that is fortified with vitamin D are also at risk.

So, what are the symptoms of vitamin D deficiency? Symptoms can quickly progress from mild to serious disease and can include:

• Extreme fatigue and general tiredness
• Experiencing regular infections and illness
• Pain in the bones
• Pain or chronic soreness in the back
• Depression
• Slow-healing wounds
• Bone loss
• Muscle pain
• Confusion or disorientation
• Hair loss

Children with prolonged vitamin D deficiency can develop rickets. Babies of nursing mothers with vitamin D may also develop this condition.

Most people who have vitamin D deficiency are not even aware of it. The symptoms are subtle and non-specific. Many healthcare providers may not even think to test for it.

The good news? Vitamin D deficiency is remarkably easy to remedy, and the benefits of restoring the body to balance are ample. Let’s look at those benefits in more detail.

Major Vitamin D Benefits 

It’s crucial to maintain the appropriate level of vitamin D in your body. Vitamin D makes for strong bones and overall good health. It also has some surprising benefits for pain, depression, anxiety, sleep disorders, and immune health.

Vitamin D for pain

Could a simple vitamin supplement or extra 20 minutes in the sun a few times a week really change life with chronic pain?

More research is showing that adding vitamin D for pain might be one of the missing links in pain management.

• A 2017 study noted that observational studies seemed to indicate that low levels of vitamin D were associated with both more pain and higher doses of opioids to manage it
• Another 2015 study noted a statistically significant decline in pain score measurements when vitamin D supplementation was given to patients with chronic musculoskeletal pain
• Adding vitamin D to palliative care for cancer patients reduced pain, improved well-being, and reduced infections
• A preliminary study in 2021 indicated that vitamin D reduced pain and helped to prevent temporomandibular joint disease (TMD)
• Vitamin D supplementation was linked to pain relief in patients with neuropathic pain caused by type 2 diabetes

Vitamin D was also examined in a major review of studies that looked at the role of nutraceuticals in the treatment of chronic pain. Vitamin D deficiency was clearly linked to pain in osteoporosis as well as other kinds of pain (e.g., fibromyalgia and rheumatoid arthritis).

The research seems to indicate that at a baseline, adequate vitamin D is crucial in pain management. Some studies recommend additional supplementation to achieve pain relief.

Vitamin D for depression

Sifting through the research regarding vitamin D for depression is challenging.

There already exists a strong connection between lack of sunshine and depression. Seasonal affective disorder (SAD) is caused by changing seasons and waning sunlight, with symptoms of depression and fatigue. Adding vitamin D can help increase the production of serotonin in the brain while decreasing inflammation. These are two keys to help treat depression.

But could the symptoms of depression — either due to SAD or clinical depression — be caused by lack of vitamin D?

Maybe.

A 2020 review of studies found a relationship between depression and vitamin D deficiency, but the directionality (which came first) was unclear. Two factors might indicate that depression is caused by vitamin D deficiency. First, there are ample vitamin D receptors in the area of the brain that regulates mood. Vitamin D also plays a role in inflammation — one of the key features of depression in the brain.

However, another long-term study on the effects of vitamin D supplementation to decrease or reduce the risk of depression found no difference between a placebo and vitamin D. Research into this complex relationship is ongoing.

While low vitamin D levels appear to be a common factor among those who suffer from depression, it’s not clear that simply adding a supplement will treat depression. This was especially true for those who are not vitamin D deficient.

A final thing to consider when looking at vitamin D and depression: circumstances.

For example, the COVID-19 pandemic sent researchers back into the lab just as people across the globe went on lockdown. Depressive symptoms in the U.S. increased threefold during the lockdowns. Ample research conducted during the pandemic appears to indicate that lack of vitamin D from sun and food sources have contributed to an increase in depressive symptoms. This includes an increased inability to deal with stress.

Vitamin D for anxiety

Another potential benefit of vitamin D comes in the form of helping to manage anxiety.

Calcidiol is a by-product of vitamin D breakdown. In people with anxiety and depression, low levels of calcidiol indicated that there was an inadequate level of vitamin D. And, as with depression, low serotonin and high inflammation levels increase the likelihood of anxiety in a broad range of people.

But does adding vitamin D for anxiety help treat it? Recent studies appear to indicate that it could:

• A 2020 study found that in patients with both anxiety and depression, depression remained largely the same as with a placebo but anxiety levels dropped dramatically after receiving a vitamin D serum for six months
• Vitamin D was also credited with a decrease in negative emotions related to both anxiety and depression
• In people with generalized anxiety disorder, vitamin D helped reduce the severity of symptoms
• A study of women with diabetes found their mood improved, anxiety diminished, and inflammation reduced when supplemented with vitamin D for four months
• Children receiving dialysis are more likely to have low vitamin D levels that lead to anxiety

Anxiety can be a debilitating, life-altering condition. Supplementation with vitamin D can be one tool for helping treat this challenging condition.

Vitamin D for sleep

Since vitamin D is found in nearly every tissue of the body, and it regulates the production of feel-good hormones and the immune system, it stands to reason that vitamin D deficiency could affect sleep.

A systematic review in 2020 looked at sleep disorders, PTSD, and depression during and after pregnancy. It found a direct correlation between low vitamin D levels and an increase in sleep disorders and PTSD.

An earlier systematic review of studies in 2018 laid the groundwork for the connection between low levels of vitamin D and poor sleep. Researchers looked at nine studies with almost 9,400 participants and found that vitamin D deficiency:

• Significantly increased the risk of sleep disorders
• Was associated with poor sleep quality
• Caused short sleep duration and sleepiness
• Could significantly increase the risk of unhealthy sleep

Vitamin D for sleep is still a big area of exploration in science. Researchers agree that vitamin D plays a role in healthy (and unhealthy) sleep. But they also agree that there is a need for more interventional, scientifically-valid studies.

Vitamin D for immune health 

Vitamin D has a direct effect on our immune systems. As expressed on the immune cells, vitamin D can help modulate our immune system’s response. This connection is very clear, and the lack of vitamin D results in the heightened possibility of any kind of infection and an increase in autoimmunity disorders.

In some astonishing research specific to COVID-19, it appears that low vitamin D levels are associated with an increased risk of COVID-19 infection.

But even before COVID changed the way we looked at our immune systems, a large-scale, long-term study found that supplementing with vitamin D prevented respiratory tract infections, especially for people who started with a deficiency. Vitamin D works to protect respiratory health and could prevent infection in two ways:

1. It supports the production of antimicrobial peptides in the epithelium of the respiratory system
2. It reduces the inflammatory response

The second factor is not just beneficial in the fight against COVID. Reducing the body’s inflammatory response is associated with:

• An overall reduction in disease
• Decreased risk of mortality
• Increased quality of life

In terms of COVID-19, the best protection against this disease remains vaccination. Not only does it protect the vaccinated person, but it also prevents the spread of the virus to others.

There’s no arguing the science. COVID-19 vaccinations are still the best option to protect yourself and your family against severe infection and even death. Vitamin D can’t replace that. However, maintaining the proper levels of vitamin D in your body is a good way to support your overall health, year-round. Talk to your doctor about your options for vaccination, then look into testing your vitamin D levels to ensure you have adequate support there, too.

Other vitamin D research

When something as simple and safe as a supplemental vitamin shows such great promise, researchers make other connections as they study its effects.

A few of the most recent research findings include the following studies.

Adding a simple vitamin D screening when testing for colorectal cancer (and then supplementing those with deficiencies) may protect against colorectal cancer in people under 50.

In animal studies, vitamin D deficiency increased the risk of addiction to both opioids and ultraviolet rays. Researchers found that supplementation restored the balance.

Researchers in Germany found that vitamin D supplementation for all Germans over 50 could result in up to 30,000 fewer cancer deaths per year and an additional 300,000 years of life gained. They also calculated an annual savings in healthcare costs of the equivalent of $300 million USD.

A study of female outdoor workers over 50 found that they had a reduced chance of breast cancer. This observational study found that those working outside for 20 or more years had a 17% lower risk of a breast cancer diagnosis. It’s worth noting that this is just a preliminary study.

There is so much more to learn about vitamin D and the potential it holds. While it can be difficult to perform diet-related research with its myriad of complexities, vitamin D in particular promises to provide real benefits to our bodies and overall health.

If you’re interested in improving your vitamin D levels, keep reading to learn about the best sources for getting it – in food or supplement form.

What Are The Best Vitamin D Sources? 

Even though the body can use both types of vitamin D, the most recommended form is D3. This is the type that your body produces by itself when exposed to sunlight. It is also the same type that is found in animal proteins.

Let’s look at how to get vitamin D in the foods you eat and in supplements.

What foods have vitamin D?

Even though humans can naturally produce vitamin D, few foods are naturally rich in this vitamin. Most food-based vitamin D is added to foods (labeled as “fortified”). The majority of your dietary vitamin D will come from fortified food.

For omnivores, the best way to get vitamin D is through fatty fish and fish liver oils. There are also small amounts of vitamin D in egg yolks, cheese, and beef liver. Certain cultivated mushrooms also have vitamin D as well. These mushrooms are exposed to high amounts of ultraviolet light that causes them to produce vitamin D.

Oily fish is the most powerful source of vitamin D in food. If you do eat fish, make sure to reference a program like Seafood Watch which can help you find ecologically-friendly options.

For example, salmon is a widely available and popular fatty fish that also happens to be a good source of vitamin D. One 3.5 ounce serving of Atlantic salmon contains 66% of your daily value. But sustainably sourced wild salmon goes even further. One 3.5 ounce serving of wild caught salmon provides 124% of your daily value of vitamin D. If you have a choice, choose wild, but don’t pass up farmed salmon.

Two other oily fish, herring and sardines, are less commonly eaten in the United States but provide another great source of vitamin D. A 3.5 ounce serving of fresh Atlanta herring provides 27% of your recommended daily allowance. Canned sardines provide just slightly less at 22%.

Meatier fishes like halibut and mackerel provide nearly double that amount.

Want something quick and easy? Cod liver oil is a great option. It can be taken as a supplement or by the teaspoon in a liquid. One teaspoon of cod liver oil gives you a whopping 56% of your recommended daily allowance. Cod liver oil also offers plenty of vitamin A, at 150% of the recommended daily allowance for per teaspoon. Another benefit of cod liver oil is that it is high in omega-3 fatty acids. If you take this form of vitamin D supplementation, be careful not to take too much. Vitamin A can be toxic in high amounts.

Canned tuna is another convenient way to add vitamin D to your diet. It’s easy to store, and it is a versatile pantry staple. One serving of tuna provides 34% of your daily recommended allowance. Keep in mind that pregnant women should avoid tuna as it contains methylmercury. This toxin, found in many species of fish, can cause serious health problems if it builds up in your body. Choose light tuna and eat no more than six ounces per week.

Fortified foods are great for vegetarians or vegans. They are also a good option if you do not like the taste of fish. Fortified dairy and non-dairy milk can be a good source of vitamin D. Each provides between 10-22% of your recommended daily allowance.

If you’re not a milk drinker, orange juice is another option. This is an especially good choice for people who are lactose intolerant (an estimated 75% of the world) or have a milk allergy (another 2-3% across the globe).

Choosing fortified orange juice not only provides vitamin D, but can also provide added calcium. Vitamin D helps calcium to be absorbed into the body. One cup of orange juice with your breakfast starts your day with 12% of your recommended daily allowance of vitamin D. Add a bowl of fortified cereal or oatmeal, and you’ll be well on your way to getting the vitamin D you need.

Vegetarians and vegans may struggle to get enough vitamin D in their food alone. Vegetables are not a source of vitamin D, nor are nuts and seeds. Some options for those on a plant-based diet, though, include:

• Fortified tofu
• Fortified soy yogurt
• Beans, including white, black, lima, pinto, calico, and kidney beans
• Chickpeas
• Split peas
• Lentils
• Shitake mushrooms

The volume of vitamin D from these sources is not enough to meet the recommended daily allowance. Talk to your doctor about possible solutions if animal protein is not part of your diet.

Other natural sources of vitamin D

Sensible daily exposure to sunlight is one of the best ways to boost natural vitamin D production. Take five to ten minutes, two or three times a week, to expose bare skin to sunlight. This might be a quick walk with bare arms during lunch or a morning cup of coffee outside.

Because vitamin D breaks down quickly, you’ll need to be consistent with your exposure. But consider this: not only are you making natural vitamin D, but you are also reaping the ample benefits of time spent outdoors. It’s a win-win.

Keep in mind that there are some people with an elevated risk of skin cancer. Extra time outdoors may not be advised. Wearing sunscreen helps minimize this risk, but it also blocks the ultraviolet rays that prompt the production of vitamin D. One option is to spend time outside in the early morning and evening. The sun is not as intense at this time, and it may be safer to venture out without sunscreen.

As always, if you have concerns, talk to your doctor.

Using vitamin D supplements

Even though food and sunlight are the most organic ways to get your recommended daily allowance of vitamin D, supplements might be the only option for people with restricted diets or limited ability to access sunlight.

And for people taking higher doses of vitamin D under a doctor’s supervision, vitamin D supplements are the only way to get the required amount. Keep reading to learn more about how to find and choose the right supplements for you.

How To Take Vitamin D Supplements 

Tapping into the benefits of vitamin D is all about making the effort to include the appropriate daily amount into your life. If you aren’t sure whether or not you need more vitamin D, talk to your doctor about getting a test to measure your levels.

How to get more vitamin D 

In a perfect world, everyone would have adequate access to sunshine in bodies that readily absorbed ample amounts of daily vitamin D. While this is the reality for some, unexpected global lockdowns, illnesses, and the general trials of daily living can sometimes compromise our ability to get the amounts that we need. Further, some people may need it in the darker winter months when there are fewer hours of sunlight, and not in the summer.

Additionally, vitamin D is scarce in foods and breaks down quickly in the body. If we need higher levels, the challenge rises accordingly.

There’s no sense in dwelling on a “perfect” scenario. Whatever helps you get exactly the vitamin D your body needs is a good solution. Sometimes that’s more sunlight, sometimes it’s more fortified foods, and sometimes it’s a supplement. These are all great options to help you maintain good health.

How to choose a supplement

It’s always important to work with your doctor when choosing the vitamin D supplement that’s the best one for you. They’ll be able to point to reputable brands and types of supplements that would work best for you.

When you’re thinking about the type of vitamin D, D3 is the natural type produced by your body. In general, adding more nutrients to your diet with D3 is preferred because it’s the more potent and recognizable type in the body.

When it comes to the best form of vitamin D, you have plenty of options. You can choose a tablet, a pill, a liquid, or dissolvable powders. If you struggle to swallow pills, vitamin D powder might be a good choice for you. Not only is it easier to take, but it can also be added to drinks or food during meals.

Which form you choose is largely a matter of preference. A small-scale study found no significant differences between the use of liquids or tablets and absorption by the body. Further, finding the option that works best for you and your daily routine is key. Ongoing compliance and daily use are the best ways to realize the benefits from your vitamin D supplementation.

Finally, another relatively new option is vitamin D-fortified skin care products, like lotions or serums. These might be the best option for people who struggle to absorb vitamin D through exposure to sun or through diet. People with this challenge include those faced with the following conditions:

• Crohn’s disease
• Celiac disease
• Cystic fibrosis
• Pancreatitis

But because these products are relatively new, research on them is new as well. A very small study of vitamin D-fortified skin care products suggests, but does not prove, that vitamin D3 is truly safely and effectively absorbed through the skin. No side effects were noted in this study. At the very least vitamin D-fortified skin care products will make for softer skin.

How much vitamin D should I take daily? 

To determine how much vitamin D you should take daily, talk to your doctor. They can advise you on the proper amount for you based on medications, underlying risks, and pre-existing conditions that may benefit from an increased dose.

Generally speaking, the recommended daily amount (RDA) of vitamin D is as follows:

• Children to 12 months: 400 international units (IU)
• People aged one to 70: 600 IU
• People 70 and older: 800 IU

This amount can be achieved mostly through diet, but a supplement can help, too.

When should I take vitamin D?

When you take vitamin D can also affect your body’s response. Because vitamin D is fat soluble, taking it with a large meal that includes healthy fats like olive oil, avocados, or nuts can help your body reap more of the benefits. Avoid trans fats, like those common in fried or packaged foods. 

Additionally, the time of day actually does matter, too. A small study in 2013 found that vitamin D may reduce the secretion of melatonin. This is the hormone that naturally helps us sleep. Taking a supplement too late in the day could actually cause poor sleep.

Some people find that taking supplements with breakfast helps them to remember to take them and encourages them to start the day with a healthy meal. Consistency is key, so develop a plan that works for you and stick with it.

Can I take too much vitamin D? 

While the benefits of getting adequate vitamin D are many, there is a risk of taking too much. The Journal of the American Medical Association (JAMA) published a research letter in 2020 indicating that there has been a nearly 3% increase in people taking unsafe amounts of vitamin D (more than 4,000 international units (IU) per day) in the period from 1999 to 2014. In that same time, the number of people taking 1,000 IU or more a day increased by 18%.

Dr. JoAnn E. Manson, the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School, lists the potential side effects or risks from such dramatic doses of this potentially beneficial vitamin:

• A 2010 study published by JAMA said that taking high amount of vitamin D is associated with an elevated risk of falls and fractures
• Too much vitamin D can lead to hypercalcemia (too much calcium build-up in the blood, with a risk of deposits in the arteries or soft tissues)
• A higher risk of kidney stones in older women
• The potential to be toxic at extremely high doses

The warning signs of overdose include nausea, vomiting, and weakness. You might also experience stomach pain, diarrhea, or constipation. Long-term, excessive vitamin D supplementation can lead to bone loss and kidney failure.

The good news is that it is virtually impossible to overdose on vitamin D included in foods or by sunbathing. The research shows that supplements are the primary cause of overdose and potential toxicity.  

If you do experience symptoms of vitamin D overdose, stop taking supplements immediately and call your doctor. Because of these issues, it’s also important to talk to your doctor to ensure that you both have a deficiency that needs to be managed and the best amount to use for your body.

Does vitamin D interact with other medications?

It’s important to talk to your doctor before adding vitamin D if you are taking any of the following medications:

• Aluminum-containing phosphate binders
• Phenobarbital and phenytoin
• Atorvastatin
• Calcipotriene
• Cholestyramine
• Cytochrome P-450 3A4 (CYP3A4) substrates
• Digoxin
• Diltiazem
• Orlistat
• Thiazide diuretics
• Steroids
• Stimulant laxatives
• Verapamil

These medications can interact in various ways with vitamin D. This includes limiting the body’s ability to absorb it and resulting in excessive calcium in the blood.

How To Get Started With Vitamin D 

To get started with vitamin D supplements, keep in mind that vitamins often need other vitamins to work well. They depend on each other, and sometimes providing more of one means you’ll need additional of the others, too.

For example, some researchers believe that fat soluble vitamins work together. Make sure your vitamin A and vitamin K intake is keeping up with your vitamin D supplementation.

Magnesium, a mineral that controls over three hundred of the body’s functions, is often low among people across the globe. While you are supplementing vitamin D, make sure you’re getting enough magnesium, too.

Getting started with vitamin D will likely be just one step on your journey to wellness. Whether you’re supplementing a minor vitamin deficiency or treating a major health condition, it’s important to work with your doctor to develop a personal, individualized plan of treatment. This might include not only vitamin supplementation, but also other complementary therapies such as acupuncture, chiropractic, and massage.

Managing your health in a way that looks at the entire body system, rather than a collection of symptoms, is the best way to approach wellness.

Taking a holistic approach with vitamin D supplementation means taking the time to evaluate your overall health and goals. This is a great way to improve all aspects of your life, even when managing complicated conditions such as chronic pain or mood and sleep disorders.

If you’re suffering from chronic conditions, like chronic pain, in Arizona, we can help. Contact Arizona Pain to learn more about treating your chronic pain.

Lower back pain is a common condition, with up to 80% of the U.S. population suffering from it at some point. Up to 25% of lower back pain originates in just one place: the sacroiliac joint. This critical juncture in the pelvis provides both stability and small movement that helps us ambulate without wobbling or falling over. As we age, the structures in this region of the body, commonly helped along by childbirth or other conditions both acute and chronic, cause this joint to weaken and fail. This leads to debilitating pain and a feeling that your knees might literally buckle underneath you. But there is help for a compromised SI joint. The posterior sacroiliac fusion (PSiF) procedure is a minimally invasive solution to a life-altering pain condition. Here’s what you should know.

What Is The Sacroiliac Joint?

The sacroiliac joint is one of the largest joints in the body. It connects your spine to your pelvis and consists of: 

• The sacrum: A bony triangle at the base of the spine, just above the tailbone
• The ilium: The upper point on the pelvis and one of three bones that make up the hip bones 

The bones of this joint are not exactly matched, but they fit together and are supported by muscles and ligaments. The inside of this joint is lined with cartilage, and extra space between bones and other structures is filled with lubricating fluid. Floating in these open spaces are nerve endings, too.

The match of bones and tendons is a complicated puzzle that lends stability to the pelvis but also allows for the movement needed to keep us upright and to give birth.

What Causes SI Joint Pain?

Sacroiliac joint pain is characterized by not only hip pain but also pain that occurs in the lower back, buttocks, and pelvis. This pain can be radiating or feel like burning in the pelvis.

Other symptoms might include:

• An increase of pain when moving from seated to standing
• Numbness and weakness in the legs
• A feeling of instability in the legs
• Stiffness or limited mobility in the pelvis

Some people find that their sacroiliac joint pain gets worse when:

• They stand for long periods of time
• Their weight isn’t balanced over both legs
• They climb stairs or run
• They take larger than normal steps

SI joint pain can be caused by both acute and chronic conditions.

Childbirth 

In the weeks and months before childbirth, a hormone called relaxin causes the ligaments in the hips to get very loose. This ligament laxity is normal and necessary to allow the pelvis to open for vaginal birth. 

Although this loosening is typical and healthy, the additional weight of pregnancy coupled with a change in a pregnant person’s gait may cause injury or damage to the joint that does not heal after childbirth. People who are pregnant are most at risk for SI joint pain, and their risk of developing arthritis in this joint is higher, too.

Osteoarthritis

Osteoarthritis is a form of wear-and-tear inflammation that occurs as the joint wears down over time and with use. Cartilage that protects the joint thins, and lubrication decreases. This causes painful, bone-on-bone rubbing in the joint that can be debilitating.

Ankylosing spondylitis 

Ankylosing spondylitis (AS) causes the immune system to attack itself. This creates inflammation in the body, primarily in the SI joint. In extreme cases, this autoimmune disorder creates new bone that painfully and improperly fuses joints together.

This condition is chronic and can also affect the internal organs and the eyes.

Injury

Tucked as it is inside the strong bones of the pelvis, most injuries to the SI joint occur in full-contact sports or falls.

Uneven gait

How we walk affects everything, and the SI joint is no different. Some people develop an uneven gait to compensate for another injury, while others simply fall into an uneven walking pattern that they don’t even know they have.

Pregnant people experience this when they compensate for a growing belly. In many cases, SI joint pain due to a temporary change in gait during pregnancy resolves itself after birth.

How Can A PSiF Procedure Help?

The PSiF procedure is a SI joint stabilization surgery that has been available since 2014. For many people whose pain has not responded to more conservative treatments, it can relieve pain and restore the proper level of mobility in the joint.

This SI joint stabilization procedure is minimally invasive and can be performed through a small incision in the back. This is typically safer than the traditional lateral approach. From start to finish, the procedure usually takes less than 30 minutes, and patients leave the surgical center the same day.

The procedure is very simple. You’ll change into a surgical gown that opens in the back and position yourself face down on the table. This procedure is done under local anesthesia, but talk to your doctor if you are nervous about feeling pain. They may be able to offer you a mild sedative prior to the surgery. 

Once the surgical site is cleaned and numbed, your doctor uses fluoroscopy to guide a piece of donor bone to the site that requires stabilization. Here’s how.

• The joint is lined up using a seeker guide pin so that the sacrum and iliac bones are at the proper angle and depth.
• A small incision is made so that the other surgical tools can be placed.
• A drill opens up a small hole in the bone.
• An allograft implant — an implant from a donor — is attached to an inserter device. 
• The pain specialist places one implant at a time. These are usually less than three centimeters each. The joint may require one or two implants secured with an epoxy to encourage fusion.
• Once the implants are in place, the small incision is closed with stitches or staples.

The PSiF procedure is best for people who have not found relief with typical treatments for SI joint pain that include:

• Rest
• Ice
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Improving gait and posture

Your doctor may recommend a diagnostic injection to confirm that the SI joint is the site of the pain. People who experience a 50% or more reduction in their pain after two injections are considered good candidates for the PSiF procedure.

PSIF procedure benefits

The benefits of the PSiF procedure include: 

• An increase in mobility
• A reduction of pain scores
• A low incidence of reoperation

Recovery time is a fraction of what it was with traditional lateral procedures, and the use of donor bone offers better rates of fusion success. 

The International Society for the Advancement of Spine Surgery (ISASS) released a statement acknowledging the 15 to 25% of lower back pain that originates in the SI joint and touting the efficacy of spinal bone fusion, specifically in a posterior approach, to treat it. They pointed out the low rate of surgical complications, the faster recovery times, and the improved patient outcomes.

PSIF procedure risk factors

The PSiF procedure is remarkably safe, but every procedure comes with risks. Common risks of this SI joint stabilization surgery include:

• Bleeding or bruising at the incision site
• Infection
• Increase in pain
• Nerve damage

Other risks of this surgery include the potential failure of the allograft bone to fuse with your bone. This procedure may also not relieve the pain you are experiencing, often due to a misdiagnosis of the cause of the pain.

Another potential risk is adjacent joint disease that occurs when the shock absorbing disc and cartilage is removed to place the implant. The pressure that was formerly absorbed in this area is then moved above and below the affected joint, which can cause more pain and degeneration in the lumbar spine and facet joints.

PSIF procedure recovery

Your pain specialist will provide you with specific recovery guidelines, but some general rules apply for surgical procedures.

You will need someone to drive you home on the day of your SI joint stabilization procedure. Take the day off to rest and relax. If you are prescribed pain medication, take it according to directions and do not exceed the amount prescribed.

If you experience pain after your prescription is completed, most people find relief with ibuprofen.

You may have soreness at the incision site. This is normal and should resolve within a few days. If the incision becomes more painful, gets red, or oozes, talk to your doctor, as this may be a sign of infection. Fever and a general feeling of being unwell are also cause for concern.

Avoid strenuous activity for two weeks, only returning gradually after your doctor gives you the greenlight. It’s important to allow yourself time to heal, so be patient if you are still experiencing soreness.

If your SI joint dysfunction is due to an uneven gait, your doctor may recommend physical therapy and gait training. This helps you to retrain your body to walk in a more balanced manner.

Everyone recovers at a different rate. People with strenuous occupations may not be fully cleared to return to work for a month or more, while others might be back at their regular activities in no time. Talk to your doctor about which recovery timeline you might expect.

Learn More At Arizona Pain

At Arizona Pain, we understand that SI joint pain can be debilitating. In addition to a wide variety of diagnostic tests and holistic treatments, we offer the PSiF procedure to relieve pain and help you get your life back. Get in touch to set up an appointment today.

Every time a promising new treatment for chronic pain appears, patients experience a fresh burst of optimism, because maybe this is the treatment that will finally offer relief. Perhaps this will be the magic missing piece to solve their puzzle of pain. Is CBD for pain that magic piece?

In this guide to CBD for pain, we’ll look at:

• What CBD is and how it works
• Where CBD comes from
• Potential side effects
• The research behind CBD for pain and other related conditions
• How to use CBD oil for pain

Of course, we can’t cover everything there is to know about CBD here. Your best option is to talk to a trusted doctor to learn more about how it could help you.

What Is CBD?

There is a lot of confusion about CBD oil. Not only is some of the jargon swirling around CBD confusing and often misused, but some marketing techniques have been misleading.

Cannabidiol, shortened to CBD, is one of over 100 cannabinoids found in hemp plants. Hemp plants can be divided into two basic categories: those developed for extracting CBD oil and those used for producing cannabis.

CBD comes from the Cannabis sativa L plant. The Cannabis sativa L plant has low levels of tetrahydrocannabinol (THC), the cannabinoid that produces intoxicating or euphoric effects. It is physically impossible to get high from the trace amounts of THC in the Cannabis sativa L plant.

On the other hand, Cannabis sativa, Cannabis indica, and Cannabis ruderalis are three species of plants in the family Cannabaceae that are most famous for producing different strains of cannabis flowers. These flowers have higher levels of THC and are sold as cannabis. THC can cause the stereotypical feeling of being “high,” but it can also come with a host of side effects.

Still confused? Think of it this way: although all cannabis plants have CBD as one of their cannabinoids, some cannabis plants are cultivated for lower levels of THC. Those plants are used to produce CBD oil. And some types of CBD are produced outside of the hemp plant completely, for example, grown on orange peels.

Because CBD oil has different effects on the body, many people are using it to treat their pain, sleep, and anxiety issues as we’ll discuss in this post. It’s also being used for other conditions, like seizure disorders.

How does CBD affect pain?

Think of CBD oil as the power switch for a system that already exists in your body.

The endocannabinoid system (ECS) is present in every person. This system is complex and not yet well understood, but its primary function is regulating homeostasis in a number of areas, including:

• Pain
• Sleep
• Metabolism
• Mood
• Inflammation
• Reproduction

The ECS utilizes cannabinoids as neurotransmitters that bind to receptors in the ECS to help regulate the functions above.

In many cases, the ECS functions in the body just fine, producing its own cannabinoids and working to achieve stability and balance. Our bodies naturally produce endogenous cannabinoids that help the ECS function. However, sometimes the production of endogenous cannabinoids slows, stops, or is otherwise disrupted.

CBD is an exogenous cannabinoid — it occurs outside of the body and inside the cannabis plant, along with its relatives, including:

• Tetrahydrocannabinol (THC)
• Cannabichromene (CBC)
• Cannabigerol (CBG)  

These are also known as phytocannabinoids. They can supplement and support the ECS when the body is unable to produce its own endocannabinoids.

So, what’s the connection between the ECS and pain?

Your ECS has two main cannabinoid receptors: CB1 and CB2. CB1 receptors are related to the central and peripheral nervous system. CB2 receptors are primarily in charge of the immune system. That’s a simplistic breakdown of a very complex system that is interwoven with other neurotransmitters and brain chemicals like dopamine and serotonin.

The cannabinoid receptors are found at nearly every level of pain pathway, from the spinal cord through the brain. CBD does not necessarily bind well to the endocannabinoid receptors, but it may inhibit the release of pain signals from neurotransmitters.

CBD may also simply trigger the body’s own regulation to help it achieve greater pain-free balance. Research is still being conducted on exactly how this works, but it appears that CBD has a modulating and regulatory effect on pain transmitters in the body.

Where does CBD oil come from?

CBD oil is available in four ways. Some pharmaceutical CBD oils are approved by the U.S Food and Drug Administration (FDA) for specific conditions. For example, Sativex treats spasticity related to multiple sclerosis that has not responded to other treatments, and Epidolex treats seizures. CBD in this form is available by prescription for those conditions only.

CBD oil is also a natural part of cannabis. The legality of cannabis varies across the U.S. Cannabis is legal is some states either medicinally, recreationally, or both, but it remains illegal in other states.

The 2018 Farm Bill made hemp with less than 0.3% of THC legal across the U.S. Hemp grown in compliance with this bill is the most common way to access CBD oil in its various forms. Hemp is still highly regulated by the FDA, moreso since a 2017 study revealed that as many as 70% of CBD products misrepresent the amount of CBD they contain. This over- or underrepresentation can make accurate, safe dosing difficult.

Finally, some manufacturers have found that CBD is also available from orange peel. Terpenes are volatile compounds found in essential plant oils, including cannabis. The terpene limonene is also found in orange peels and can be used to reconstruct CBD in the lab using a process called cyclic terpene assembly (CTA).

This process is proprietary, and to date, few manufacturers have the ability to use it. CBD oil reconstructed from orange peels has no THC, but is still currently regulated by the FDA.

Does CBD have any side effects or risks?

CBD oil for pain has been marketed as being without side effects and risk. While it’s true that CBD is remarkably safe, even in large doses, as with any medication there is the potential for side effects.

Some of the more common side effects include dry mouth, reduced appetite, drowsiness or fatigue, and diarrhea.

Two potentially serious but rare risks include the following:

1. Drug interactions: CBD has the potential to change the potency of blood thinners, heart medications, and immunosuppressants
2. Effects on male reproductive system: A study on male mice found that large doses of CBD reduced testes size, lowered fertility, and decreased sexual behavior

There was an earlier study that indicated liver toxicity when CBD was taken in large doses, but that study has since been debunked.

To prevent the risk of side events, it’s important to purchase high-quality CBD oil from a reputable source to ensure its purity and level of actual CBD. If you are on blood thinners, heart medications, immunosuppressants, or any other medications, talk to your doctor before taking CBD oil for pain (or other health conditions).

It is important to note that even with the risk of minor side effects, CBD oil remains remarkably safe and is well-tolerated by the vast majority of people who use it. Its limited side effects and the impossibility of addiction make it safer than most pharmaceutical treatments for chronic pain.

CBD And Pain: What We Know

One of the most promising areas of research is on CBD oil for pain. Not only does CBD oil appear to directly affect pain levels, but it’s also able to change a patient’s perception of that pain. In other words, even if pain levels were the same or just slightly less, the patients taking CBD were less bothered by the pain in general.

Here’s more current research on CBD oil for pain.

Neuropathic pain

Neuropathic pain that results from damage to either individual nerves or to the central nervous system can be incredibly challenging to treat. Shingles, peripheral neuropathy, and post-herpetic neuralgia are all examples of neuropathic pain.

A study in 2020 found that applying topical CBD for neuropathic pain yielded significant relief of both pain and other symptoms of peripheral neuropathy. Just a year earlier, a study in the journal Pain found that CBD oil relieved neuropathic pain in mice. The study authors concluded that CBD’s interactions with serotonin receptors helped to modulate and ease pain. They also noted the need for more research on this type of pain.

Fibromyalgia

One study found that an estimated 70% of people with fibromyalgia began supplementing or replacing their opioid pain killers with CBD oil during the COVID-19 lockdowns.

Of those who used CBD, 70 to 94% of them reduced or stopped taking opioids altogether. This suggests that not only did CBD oil relieve their pain, but it may also have helped ease opioid withdrawal symptoms. Always work with your doctor, though, before discontinuing use of any medications.

Arthritis

Arthritis is essentially inflammation in the joints of the body. There are over 100 types of arthritis, some that are a result of age and wear, and others that might arise due to immune response, injury, or disease.

Regardless of the cause or kind of arthritis, there is good research emerging for the use of CBD oil to treat arthritis.

Rheumatoid arthritis is an overactive immune response that attacks the joints of the body. A 2020 study found that using CBD for arthritis specifically targets the synovial fibroblasts that increase joint destruction in rheumatoid arthritis. The study found that CBD reduced synovial fibroblasts while increasing cellular calcium.

For painful joint inflammation, transdermal CBD for arthritis provided relief from swelling and increased the thickness of synovial lining in the joints of animal subjects in a 2016 study. Although this study was animal-based, there are encouraging parallels between this 2016 study and a 2018 study that found similar results for knee osteoarthritis in humans.

Migraine

A study in 2021 found that 86% of people who suffer from migraine were able to experience almost four fewer headache days per month by using CBD. This study was scientifically validated and provides hope for people who did not want to use THC as a migraine treatment option.

The Research On CBD And Sleep

For all of the uncertainty that CBD research might present, there is at least one clear connection. Chronic pain and sleep are intimately intertwined, with pain increasing sleeplessness and chronic pain intensifying with lack of sleep. In fact, a 2020 review of 16 studies reiterated how important sleep is in treating chronic pain.

Because the endocannabinoid system plays a role in regulating sleep and the circadian rhythm, it makes sense that CBD could help people struggling with sleep disorders and the related pain.

Do note, though, that the research on CBD and its effectiveness in treating sleep is still emerging.

CBD may treat a variety of sleep conditions

An earlier 2017 review of studies found that CBD showed promise in treating a variety of sleep disorders or conditions, including:

• Obstructive sleep apnea
• Chronic insomnia
• REM sleep behavior disorder and excessive daytime sleepiness
• Nightmares associated with PTSD
• Poor sleep in people with chronic pain

People with insomnia frequently turn to CBD

In a study that ranked the reasons why people used CBD, insomnia was ranked second, but only just missed the top spot. Anxiety ranked first, with 42.6% of people using CBD saying that was their primary reason, with 42.5% looking for help with sleep.

CBD can offer a respite from sleep issues

Despite the fact that a small trial of CBD in Parkinson’s patients did not relieve REM sleep behavior disorder in patients, researchers found an improvement in sleep outcomes between weeks four and eight of their eight-week study. While relief was brief, it was an outcome worthy of further exploration.

Does CBD Help Anxiety?

In 2015, four researchers gathered the available evidence regarding CBD and anxiety disorders. After analyzing the results, they concluded that CBD has incredible potential in treating a variety of anxiety disorders.

This is likely due to the way that CBD interacts with the central nervous system. CB1 receptors are key in how the body perceives and reacts to fear and have long been a target of anti-anxiety medications. Researchers have been studying the anti-anxiety effects of CBD since the early 1980s, but there has been limited large-scale studies on the effectiveness of CBD in treating anxiety disorders.

CBD worked to decrease anxiety that interfered with sleep

In 2019, researchers found in a small study that CBD was helpful for patients with anxiety and poor sleep. The study found that nearly 80% of patients reported a decrease of anxiety in the first month, and almost 67% reported better sleep (those results fluctuated over time).

CBD reduces PTSD-related anxiety

Another small-scale but significant study in 2019 found that 91% of people in the study reported reduced anxiety symptoms. Another outcome of this study was that PTSD-related nightmares were also reduced.

CBD For Other Health Challenges

Although good quality research on CBD remains relatively sparse, there is a growing interest in using this compound to treat two serious conditions: COVID respiratory illness and the rising epidemic of heroin and opioid addiction.

Does CBD treat respiratory COVID-19 symptoms?

COVID-19 remains an ongoing threat. Research from Augusta University in Georgia suggests that CBD oil might help treat one of the primary symptoms that occurs in severe COVID-19 cases.

Acute respiratory distress syndrome (ARDS) is inflammation in the lungs that occurs when the immune system overacts with what is referred to as a cytokine storm. CBD reduces specific cytokines that cause inflammation — which may help ease ARDS in severe COVID-19 patients.

Does CBD reduce cravings in heroin use disorder?

A 2019 study published in The American Journal of Psychiatry found that 400 to 800 mg of CBD administered three days in a row significantly decreased cravings and anxiety in people attempting to quit heroin.

This study was small and short term, but researchers found in their double-blind, placebo-controlled design that participants who took CBD had decreased heart rates and salivary cortisol — two key components associated with cravings and drug relapse.

CBD And Research: What Do We Know?

Does CBD offer a placebo, or is it a panacea? At this point, CBD is woefully understudied but holds serious promise. Current relevant research seems to indicate that CBD could potentially supplement or even replace treatments, like opioid medications, for a variety of chronic pain conditions.

But, with so many people turning to CBD oil for pain, CBD for anxiety, and CBD for sleep, why are there so few large-scale, scientifically-valid studies of this treatment? After all, the risk of side effects is low, and there is an ample supply of CBD in a variety of forms and dosages. 

There are several reasons.

CBD is still relatively new

CBD as a compound has only been isolated since 1940. When taken in context with all of the other research and medical advances since then, CBD has simply taken a backseat.

Further, although it has been legalized by the FDA, it is still considered a drug and can therefore not be legally included in food or as a dietary supplement.

High-quality, pure CBD is difficult to come by

Unless researchers develop their own seed, grow their own hemp, and extract their own CBD, large amounts of high-quality, uncontaminated CBD are not widely available. Growers have focused on THC so intensely that traditionally there hasn’t been enough CBD to ensure a regular supply.

This uncertainty of quality is also what makes it challenging for consumers to evaluate whether or not it works. Anecdotal evidence is unreliable because it’s impossible to know exactly how much CBD was actually consumed.

CBD is still an enigma

Cannabidiol is just one of many compounds found in hemp plants. Terpenes, cannabinoids, and flavonoids round out a full-spectrum CBD oil. With so many potentially beneficial compounds, it’s hard to know which one is actually causing the positive (or negative) outcomes in a study.

Although researchers are no strangers to challenging study designs, CBD has so many variable factors within the plant itself that simply designing a proper study that can be replicated is a hurdle.

Study cost

The U.S. Food and Drug Administration estimates that the cost of a CBD study per study participant is approximately $3,000. This is prohibitive for large-scale studies.

The interest in CBD research is growing, as are waving fields of CBD as growers begin to cultivate this complex plant. While these are key challenges, the potential benefits for building more robust data about CBD benefits is well worth the effort. We’ll continue monitoring this space to provide more information as it becomes available.

How To Use CBD Oil For Pain 

Using CBD oil for pain starts with a conversation. Talk to your doctor first to discuss if CBD oil for pain is something that will work with your current medications and treatments. You should not begin taking CBD oil for pain without discussing the appropriate form, dosage, and formulation.

Once you have this conversation, there are a couple of guidelines to follow when using CBD for pain.

Find the right approach for you

Key to successfully treating conditions with CBD is making sure you are taking the right approach for you.

CBD can be ingested in a variety of ways. Some of them are better for slow release, while others are best for acute issues of pain and anxiety. Each has pros and cons, including a varying rate of CBD’s bioavailability. Bioavailability is how much of the CBD actually makes it into the bloodstream for your body to use.

The CBD form that you select will depend on your:

• Personal preference
• Doctor’s recommendation
• Ability to be consistent with the dose

Here are four basic ways to ingest CBD oil for pain.

1. Topical CBD

Topical CBD comes in a variety of forms that can include:

• Creams
• Salves
• Lotions
• Bath salts
• Sprays
• Roll-ons

These topical forms of CBD allow you to target the exact area where relief is needed. CBD bath salts might cut a wider swath through the whole body, but the effects are meant to be acute and transitory.

Another topical form of CBD that differs slightly from the forms above is transdermal patches. These patches typically contain higher amounts of CBD and are meant to be worn for a period of time when the skin absorbs CBD. This allows for a whole-body effect (rather than the localized effects of the above topical applications).

As mentioned, one of the benefits of topical forms of CBD is that treatment can be localized and easily absorbed through the skin. Salves, creams, and lotions also provide moisturizing wherever they are applied. On the other hand, because they cover a wider area, these delivery methods require a higher level of CBD, which could raise the price substantially.

2. Oral CBD

Oral CBD is the most commonly-used form of CBD. You might take your oral CBD for pain in the form of capsules, gummies, edibles, drinks, or plain CBD oil.

There are a few reasons why this is the most common way to take CBD.

First, there are many different product options. If you want to take CBD orally but don’t like the earthy taste of the CBD oil, you can easily blend it into a smoothie, munch on a gummy, or take a CBD capsule.

Oral CBD also takes a while to release. This means that if you are taking a daily dose of CBD for chronic pain, an oral dose will take longer to move to the bloodstream. This provides extended relief.

Finally, oral CBD is very easy to travel with, especially in capsule, pill, or gummy form.

The major downside to this form of CBD is that it acts slower than other forms because it has to move through the digestive process to get into your bloodstream. This means that there is also not a consistent amount of CBD that gets to the bloodstream, and many factors can impact how much or how little CBD actually makes it.

3. Inhaled CBD

Inhaled CBD is another popular way to ingest CBD. Users can vape or smoke a dried CBD flower in a pipe or rolled cigarette.

Inhaling CBD in this way gets it immediately into the bloodstream for quick relief of symptoms. This form of CBD also offers the highest bioavailability of CBD, with up to 60% of beneficial compounds available. Most people who choose this method report relief in a few minutes, with effects that can last several hours.

But this form is not without its drawbacks. If you choose to smoke dried flower, there is the smoke that is released that smells much like cigarette smoke. Vaping only releases mist as you exhale, but vaping oil can have harmful chemicals. The health risks of vaping also not yet well understood (especially as compared to traditional smoking).

Finally, it’s very difficult to get a consistent dose of CBD in this method. Some people hold the smoke in their lungs longer. Some take a deeper breath. Some take many fast puffs, while others smoke less. It’s just not a well-regulated form of CBD oil.

4. Lingual

Lingual CBD (also referred to as sublingual CBD) is a form of oral CBD that is administered under the tongue by either a dropper or a spray. A spray makes it easy to take a dose of CBD by spraying the inside of your cheek, too.

This form of CBD is great in an acute crisis (i.e., if you are having a panic attack). The CBD is absorbed quickly through the mouth’s mucous membranes and has a higher bioavailability because nothing has to break it down or interferes with absorption.

What’s The Best CBD Dosage For Pain?

One of the most challenging aspects of treating any condition with CBD oil is figuring out what dose is best. It’s important to note that in the research above, participants were taking extremely high doses of CBD oil. Not only is this amount of CBD cost prohibitive for most people, but it also increases the risk of side effects. You should never take CBD oil for pain or other conditions without first talking to your doctor, and you should definitely not start out with such a high dose!

In general, the key to figuring out the dose that works for you is to start low and go slow.

Once you’ve gotten the okay from your doctor, start with the lowest dose of CBD oil available. Many people start with a 5mg or 10mg dose and move from there. It’s important to pay close attention to your response to that dose. You might note any changes in your symptoms but also some of the following:

• What time of day did you take the dose?
• What form of CBD did you use?
• Did you eat before you took your CBD?

In the case of chronic pain conditions with triggers (e.g., migraine and fibromyalgia), you might also note any triggers (i.e., weather, medications, etc.).

At this point, CBD dosing is not an exact science. It will most likely take a while to figure out which dose works best for you, so be patient.

It is also possible to have a positive reaction to CBD, and then suddenly find no relief. This is similar to what happens with other substances that you might consume daily. Consider caffeine. That first cup of coffee in the morning hits different than the second one. You begin to develop a tolerance to the effects of the caffeine.

Developing this tolerance can occur in one of three ways:

1. Behavioral tolerance: The effects become more psychological than physical (like mentally needing caffeine in the morning as part of a routine)
2. Metabolic tolerance: Less of the CBD is absorbed over time due to changes in body chemistry
3. Cellular tolerance: This occurs when cells are less responsive to the substance (why you need more caffeine over time to get the same response)

But it’s also worth noting that, unlike THC with the strong potential for tolerance, CBD actually has a better potential for what’s known as reverse tolerance. Over time and with regular use, researchers hypothesize that your cannabinoid receptors and neurotransmitters get better at their job and just need less CBD to produce the same effect.

Some researchers have noted also that CBD is less effective over time for sleep and anxiety, but they have not determined why or if increasing (or decreasing) the dose would help.

So, the best answer to the question of how to find the perfect dose is to start with a low-dose, high-quality CBD oil, pay attention to your body’s response, and make adjustments with your doctor to see if it’s going to work for you.

What Is The Best CBD Oil For Pain?

While it’s true that there are many options for CBD oil in the world, it’s also true that not all of them are created equal. The best CBD oil for pain has a few characteristics to pay attention to.

What type of CBD is it?

CBD oil is generally available in three types: isolate, broad spectrum, and full spectrum.

CBD isolate is pure CBD only. This compound is extracted from the cannabis plant and dried into crystal form. This crystal is tasteless and can be ground into powder for use in various ways. Some manufacturers might add additional, non-cannabis ingredients to tailor their CBD products to a specific treatment protocol or condition.

CBD isolate has the benefit of being 100% free from THC. Even in the small quantities allowed in legal CBD oil, THC can show up on a drug screen. For people concerned about ingesting any THC, this is a great option.

Broad spectrum CBD is the next step up from CBD isolate. Broad spectrum CBD preserves more of the cannabis compounds but still removes the THC. In cases where CBD isolate is not helpful, but THC of any amount is a concern, broad spectrum CBD might be a good substitution.

The final type of CBD is full spectrum CBD. Full spectrum CBD oil maintains all of the terpenes, flavonoids, and cannabinoids — including THC. These all work together with the CBD to produce what is known as the “entourage effect.” Each of these compounds enhances the effectiveness of the others.

Remember that CBD oil can have less than 0.3% of THC in it, and some researchers believe that it is best to include all of the beneficial compounds when selecting CBD oil. Where THC is not a concern, full spectrum CBD oil might be the best choice.

How is the CBD extracted from the plant?

There are a variety of different CBD extraction methods. The most basic is extraction by solvents (i.e., food grade ethanol, butane, or propane). This method is efficient and effective but can leave behind chemicals or extract bitter-tasting compounds.

CBD can also be extracted more gently by heating olive oil, but the result is more of an infused oil (rather than a concentrated CBD extraction).

Steam distillation requires a lot of plant matter to get a small amount of CBD, but the benefit of this method is profound. Steam distillation frees the majority of beneficial volatile compounds naturally, with no chemicals or additives. It is becoming popular, but the amount of plant needed means that CBD oil that uses this method is among the most expensive.

The final method, one that brings together sophisticated science and all-natural methods, is extraction by CO2. In a nutshell, CO2 is utilized at various stages to essentially manipulate the beneficial compounds out of the plant matter without any solvents or harmful chemicals. It is an environmentally-friendly process that requires expensive machinery and scientific know-how. Because of that, it is the cleanest, but most expensive type of extraction (and that expense is sometimes passed to the consumer).

What’s added in?

One of the ways that manufacturers can bring the cost of your CBD down is by adding other things into your CBD oil.

Some of these additions help to enhance the effects of the oil, while others function more as filler and actually dilute the effectiveness. This isn’t necessarily bad, just know what’s in the oil you’re purchasing. 

Does the manufacturer offer certified lab results?

With all of the potential for additions to extractions, how do you know what’s actually in your oil?

Look for a manufacturer that offers third-party lab test results. These results should be readily available and include batch numbers to identify what’s in your CBD oil. They should specify:

• The amount of CBD
• The percentage of THC
• The percentage of other volatile compounds
• Any additions, and how much
• Type of carrier oil

The label of your CBD oil may carry an abbreviated version of this information, but if you want to dig deeply into your CBD oil ask the manufacturer for their data.

How To Get Started With CBD Oil For Pain

Chronic pain is a complex condition, with many layers. Complementary medical treatments are meant to work within a larger and more comprehensive plan for pain management.

Getting started with CBD oil for pain always starts with a conversation with your primary care physician or pain specialist. While many people do experiment on their own, talking to your doctor before you take CBD oil can help you better understand how it can help with your pain!

Suffering from pain in Arizona? We can help at Arizona Pain. Contact one of our pain management specialists today for help!

The tailbone, a small triangular bone at the end of the spine, rarely crosses our mind. But this bone, officially referred to as the coccyx, can be the site of pain so excruciating that simple motions like walking and sitting feel impossible. If you are experiencing coccydynia, here are ten tailbone pain exercises that can help.

What Causes Tailbone Pain?

The coccyx consists of up to five fused vertebrae located just underneath the sacrum. The sacrum is a triangular bone near the end of the spine. There are muscles, tendons, and ligaments connected to the sacrum. In most adults, the tailbone curves slightly underneath you, but some people have a tailbone that curves either too much or not at all. Because the coccyx and the ischial tuberosities (bones at the bottom of the pelvis) bear the body’s seated weight, this anatomical difference alone can cause pain.

Other common causes of tailbone pain include:

• Injury: Injury caused by sports are a common cause of tailbone pain. This can include bruises, fractures, or trauma due to a fall.
• Repetitive strain: This is common in sports like rowing and cycling where the ligament is exercised too much, too often.
• Prolonged sitting: Sitting for prolonged periods of time can increase sensitivity in the tailbone.
• Pregnancy: A growing baby puts a considerable amount of stress on the entire body, and the tailbone bears the brunt of this extra pressure. Adding to the weight, the ligaments around the sacrum loosen in preparation for childbirth. This can cause pain, too.
• Childbirth: Stretching and tears of the ligaments around the sacrum during vaginal childbirth can also cause pain in the coccyx.
• Deterioration over time: As joints age they become more susceptible to inflammation and pain. 
• Abscesses or tumors: This is not a common cause but can occur.

Symptoms of Tailbone Pain

Tailbone pain symptoms can come on suddenly, or they can slowly advance to an unbearable level. Pain might last just a few days, or you may be feeling symptoms for weeks or even months. 

Symptoms to look for include:

• A dull ache or shooting pain in the coccyx
• Pain that increases when moving from seated to standing 
• Pain that increases with prolonged periods of sitting 
• Pain during bowel movements
• Pain with sexual intercourse 

This pain can lead to other related symptoms such as depression, poor sleep, and referred pain as your body tries to relieve tailbone pain by compensating with other muscles.

The good news is that with treatment tailbone pain is not usually chronic.

How To Relieve Tailbone Pain

For short-term tailbone pain (i.e., coccyx pain due to pregnancy or childbirth), there are a few ways to relieve tailbone pain.

• Donut cushions: These are helpful to relieve pain and pressure that occurs during vaginal childbirth. They can also be used as a nursing pillow when pain recedes. Some people prefer a v-shaped cushion.
• Sitz bath: A sitz bath helps heal any tears that occur during childbirth, but it can also provide warmth that relieves tailbone pain.
• Cold therapy: Ice packs placed in ten minutes on/ten minutes off intervals can help ease pain.
• Sleep position: Sleeping on your back can make pain worse (and lack of sleep can also make pain worse). Try sleeping on your side, using body pillows to maintain that position if needed.
• Non-steroidal anti-inflammatory drugs (NSAIDs): These help relieve both pain and inflammation. Talk to your doctor about when to take these if you are breastfeeding or having trouble with excessive bleeding.

These are also helpful to relieve tailbone pain not caused by childbirth, but for injuries and other tailbone pain causes, you’ll need to add other treatments, too.

10 Tailbone Pain Exercises To Try At Home

Exercises for tailbone pain stretch and strengthen the muscles and fascia in and around the glutes, lower back, and pelvis. They also strengthen the pelvic floor muscles for better support of the entire pelvic bowl.

These tailbone pain exercises should be practiced several times a week (daily if possible). Go slowly, and listen to your body. And always work with your doctor to make sure it’s safe to perform these exercises. The goal is to relieve tailbone pain, not increase it. Use props to ease into these, and back off if you feel discomfort that is not relieved by slow and steady breathing.

#1. Single-knee hug

This exercise safely and gently stretches the piriformis and iliopsoas muscles in and around the glutes. The piriformis muscle starts at the tailbone and can cause pain that resembles sciatica.

Lie on your back with both legs extended. Take a deep breath in, and on an exhale slowly bring one knee into your chest. Relax and breathe for three to five breaths before releasing and switching to the other side. 

#2. Figure 4

This deepens the stretch of the piriformis and also lengthens the glutes.

Lie on your back with both knees bent and feet about a hand’s width from your buttocks. Place your right ankle on your left knee. Thread your right hand through your legs and reach for your left hand around the back of your left thigh. This might be stretch enough. If you’d like to go deeper, take a deep breath in and on an exhale bring the whole shape towards your face.

To go even deeper than that, press your left thigh into your hands as you pull with your hands towards you. This changes the location of the stretch.

Hold for ten breaths, then release and repeat on the other side. 

#3. Hip flexor lunge

Tight hip flexors can cause pain in the lower back, buttocks, hamstrings, and hips. This stretch helps open and relax the whole area.

Start on all fours (you can pad your knees with a towel if needed). Bring the right foot in front to a lunge position. The knee should be directly above the ankle. Untuck the toes of your left foot. Bring your hands to the top of the right knee. You should feel a stretch in the front of the left leg, in the hip flexor itself. If you need more stretch, move the left knee back, making sure to keep the front knee over the front ankle.

Hold this posture for 30 seconds, then switch to the other side.

#4. Child’s pose

Child’s pose provides an excellent stretch in the lower, middle, and upper back. It is a good way to lower blood pressure and calm a racing mind.

Start on all fours. Untuck your big toes, bring them to touch, and open your knees wide. Take a deep breath in, then slowly lower your torso to the ground, sinking your hips back to rest on your heels. Extend your arms forward and rest your forehead on the ground. You can also rest on your forearms or place a block or bolster under your chest and forehead.

Another variation is to keep your knees together and fold forward, stretching your arms back along your sides. Breathe and relax here for at least 30 seconds and as long as you like. 

#5. Crossed knees stretch

This gently targets tender tissues and muscles that attach to the tailbone.

Lie on your back. Cross your right knee over your left. Inhale deeply, and on an exhale bring your knees towards your chest. If you cannot wrap your hands around your knees, use a belt or a towel. Relax and breathe in this stretch for 30 seconds. Release on an exhale and switch the cross of your legs to repeat. 

#6. Hamstring stretch

Tight hamstrings can cause additional pressure on the muscles and tendons around the tailbone. This helps to loosen them up. A strap or belt is helpful for this stretch.

Lie on your back with both legs extended. Bend your right knee and bring it into your chest. Loop your strap or belt around the ball of your foot, and slowly extend your leg towards the ceiling. Flex your foot (like you’re standing on the ceiling), and bend your knee as needed to feel the stretch in the belly of your hamstring. Hold this stretch for 30 seconds, then release and repeat on the other leg.

#7. Cat-cow 

This yoga for tailbone pain increases the flexibility of your spine and gradually loosens all of the muscles in the front and the back of your body. For best results, synchronize your breath with your movement. 

Start on all fours with your knees directly below your hips and wrists below your shoulders. As you inhale, drop your belly towards the ground and imagine your heart shining forward through your arms as your gaze moves towards the ceiling (cow). Exhale, pressing your hands into the mat, dropping your tailbone and pressing your navel towards the sky as your shoulder blades slide away from each other like the back of a scared cat. Repeat this movement slowly, following your breath for at least five breath cycles (and as many as feel good).

#8. Bridge pose

Bridge pose is a full-body pose that adds strength to your abdominal wall. A strong core means a healthy back, which translates into a healthy tailbone.

Lie on your back. Bend your knees and bring your heels a hand’s width away from your buttocks, knees pointing towards the sky and hip-width distance apart. Bend your arms and hug them to the side of your body, palms facing each other across your chest. Inhale, then on an exhale press into your feet, the backs of your arms, and the back of your head to lift your hips towards the sky. 

Relax your buttocks, allowing the strength of your legs and the pressure into the backs of the arms and head to support the stretch. Lift your chin to the sky, creating space between your chin and your chest. Breathe here for five breaths then lower slowly on an exhale. 

#9. Cobra

Cobra pose targets and strengthens the muscles of the lower back. It’s also great for relieving middle back pain. The key to this posture is relaxing the glutes and stretching the toes towards the back of your mat or the wall behind you as you lift up through the chest.

Come to lie on your belly with your hands beneath your shoulders. Inhaling deeply, use the strength of your middle back and press into your hands to lift your torso off the mat like a cobra about to strike. Reach the crown of your head towards the sky as you relax your shoulder blades down your back. Breathe deeply, pressing your belly into the floor as you inhale.

This posture can be intense. Stay here as long as you can maintain the correct alignment.

#10. Pigeon pose

Pigeon pose is an advanced yoga posture that can be physically and mentally challenging. Work to modify this pose using yoga blankets, bolsters, or blocks as needed to allow your body to slowly release into the posture.

Start on all fours. On an exhale bring your right knee to the outside of your right wrist, laying it down so that your shin is parallel with the top of your yoga mat. If it is too intense with the shin parallel, you can angle your shin so that the toes of the right foot are pointing towards your left hip (keep the right knee to the outside of the right wrist).

Keeping your hips square, begin to walk the left knee back until you feel a stretch in the outside right hip and the left hip flexor. Stay lifted up on your hands, or lower your torso down to the floor (or rest on your forearms). If your right hip is off the ground, place a blanket or a block underneath it for support. 

Breathe deeply and slowly, holding this pose for up to three minutes. Take your time coming out of it, then switch to the other side.

Yoga For Tailbone Pain

Yoga has many benefits for both the body and mind. These poses work the whole body, lengthening and strengthening muscles in a more gradual way.

In addition to the poses mentioned above (pigeon, cat-cow, child’s pose, bridge pose, and cobra pose), try the following yoga poses for tailbone pain:

• Triangle
• Extended side angle
• Bow pose

If you have never tried yoga before, it can be helpful to explore yoga for tailbone pain in a beginner’s class.

Find The Relief You Need

While physical therapy, yoga, and regular exercise can go a long way towards relieving tailbone pain, sometimes it’s just not enough. There are other treatment options that include:

• Nerve blocks
• Peripheral nerve stimulation
• Surgery

The pain specialists at Arizona Pain believe that successful treatment begins with a proper diagnosis and evaluation of the whole person experiencing pain. We then offer tailored, comprehensive treatment plans that can help you get your life back. When you are ready to experience a life with less pain, get in touch to schedule an appointment.

Whether it is a few uncomfortable gurgles as your head hits the pillow or a cramping, stabbing sensation that rips you out of sleep, stomach pain at night can be a real eye-opener. Not only is it uncomfortable while it is occurring, the impact on your sleep can have a negative effect on your overall health. Here’s what causes stomach pain at night — and steps you can take to relieve it.

What Causes Stomach Pain At Night?

It is important to understand a little bit about anatomy when discussing what causes stomach pain at night. The stomach is located in your upper abdomen on the left side of your body. At the top of the stomach there is a valve called the esophageal sphincter. The bottom of the stomach connects to the small intestine. Many people clutch just below their belly button when describing stomach pain, but it generally occurs much higher than that. If you are experiencing pain behind the belly button, it may be associated with another organ system.

However, there are many different issues that can cause stomach pain at night, even if they originate elsewhere.

Gas

If you are a human being who eats food and breathes air, chances are good you have experienced gas in your lifetime. It may be the minor effect of the food you eat, but some people experience this kind of stomach upset during periods of stress, too. 

Acid reflux

Occasional bouts of acid reflux are most often associated with a few eating habits:

• Eating a large meal 
• Drinking too much alcohol 
• Lying down after eating 

Some foods are more likely to cause acid reflux. For example, spicy food that is tomato-based and sugary treats can cause acid reflux. 

Chronic acid reflux that occurs more than once a week can lead to bigger health problems like inflammation and scarring of the esophagus, ulcers in the esophagus, and bleeding.

GERD

Gastroesophageal reflux disease (GERD) is a digestive order that occurs when stomach acid flows into the esophagus. Although this likely causes pain that resembles heartburn, you may also experience upper stomach pain at night at the top of the stomach opening near the esophageal sphincter.

GERD usually occurs right after eating and in conjunction with certain foods. Other risk factors for GERD are obesity and overeating.

Food poisoning

The fact that symptoms of food poisoning often subside within 36 to 48 hours is no consolation when you’re going through it.

Sharp, stabbing pain; nausea; and vomiting are symptoms of this brief but intense condition. You may also experience stomach cramps and an unsteady digestive system for days (and sometimes weeks) after a particularly intense episode.

IBS

Irritable bowel syndrome affects each sufferer differently, but one common thread is stomach pain. The cause of this chronic syndrome is not well understood, but it has symptoms that include:

• Constipation 
• Diarrhea 
• Stomach cramps and pain 
• Bloating 
• Gas 

A related condition is Crohn’s disease, a type of inflammatory bowel disease (IBD) that is chronic and can cause stomach and back pain at night.

Stomach ulcer

Stomach, or gastric, ulcers cause burning pain in the stomach area. Pain fluctuates and can be worse when the stomach is both empty and full. Because night is when the stomach is at its emptiest, ulcers can keep you awake.

Common causes of gastric ulcers include:

• Chronic stress
• Excessive use of non-steroidal anti-inflammatory drugs (NSAIDs)
• H. pylori bacteria

Peptic ulcers in the intestines can also cause stomach pain.

Gastritis

Gastritis is the formal name for inflammation and irritation of the stomach walls. If you were to send a camera down and look at your stomach, its walls would actually appear red and swollen.

Gastritis can cause not only pain but also nausea, vomiting, and gas. If left untreated, gastritis can lead to bleeding, ulcers, and even cancer. 

Gallstones

For an organ that is not considered essential to life, the gallbladder can certainly cause intense stomach pain. It sits beneath the liver and releases bile that is helpful in digestion. When secretions build up, gallstones ranging in size from a grain of sand to a golf ball can form. If these gallstones get stuck in the duct system, severe and crippling stomach pain can result.

Eating fatty foods increases the likelihood of developing gallstones. Some people do not require treatment. For others, surgery is necessary to remove the gallstones and relieve other symptoms that include: 

• Inflammation
• Nausea and vomiting
• Jaundice
• Fever
• Exhaustion
• Light-colored bowel movements

Diverticulitis

If you experience lower abdominal pain only at night, it’s possible you are having an attack of diverticulitis. Diverticulitis occurs when small pockets in the lower part of the large intestine become home to infection. This infection results in inflammation and pain as well as nausea and vomiting.

Food allergies

Food allergies and stomach pain go hand-in-hand. The body responds to the allergy-causing food with inflammation that can run through the entire digestive tract. In some cases, food allergies can be life-threatening and require immediate medical attention.

In others, stomach pain at night is one of many symptoms that can also include:

• Nausea and vomiting 
• Gas 
• Changes in mood 
• Fatigue 

Stomach cancer

Stomach cancer pain is some of the most intense and difficult cancer pain to treat. The early stages of stomach cancer often have no symptoms. As it progresses, you may have a feeling of fullness and bloating even when you haven’t eaten. You might also experience:

• Nausea and vomiting
• Heartburn
• Indigestion
• Intense pain

Stomach cancer is very rare. Many of these symptoms are also present in much less serious conditions, but talk to your doctor if you have concerns.

Chronic stomach pain

The most common causes of chronic stomach pain include:

• Gastroesophageal reflux disease 
• Irritable bowel syndrome (IBS)
• Spastic colon
• Crohn’s disease 

These can be episodic, occurring for a period of time and then going away, or they can be a constant source of pain and suffering.

Cardiac events

Rarely, stomach pain can be a symptom of a cardiac event. This is specific to those with myocardial ischemia and is also accompanied by other symptoms such as:

• Pain in the neck and jaw
• Rapid heartbeat
• Shortness of breath

Stomach pain without these other symptoms is likely caused by something other than a cardiac event.

How To Stop Stomach Pain At Night

Identifying the cause of your stomach pain at night is the first step in knowing how to stop it. For many minor conditions, making lifestyle changes can relieve pain entirely, but others require more specialized interventions.

Eat dinner earlier

The early bird special is a good idea when dealing with stomach pain at night. Eating dinner earlier gives your body more time to digest before you lay down for sleep.

Eat smaller meals

If you consume a large dinner and an extra helping of dessert every night, you’re asking a lot of your digestive system.

Instead of eating three large squares a day, try breaking your meals into smaller sizes, with the largest meal around lunchtime and a few healthy snacks sprinkled across the day. This keeps your blood sugar stable and doesn’t overload your digestion. It’s also easier on your system when it is naturally winding down for rest.

Avoid certain foods

Those spicy tacos with extra hot sauce aren’t doing your stomach any favors. Any existing pain or inflammation can be exacerbated by these types of irritating foods. While you don’t necessarily need to swear off spicy foods for good, taking a break can be helpful in easing stomach pain at night. Examine the foods you routinely eat at night to get a better idea of how what you eat is affecting your stomach.

Other foods to take a pause on include:

• High-fat foods
• Foods that produce gas (e.g., broccoli and legumes)
• Citrus fruits and tomatoes (and other high-acid foods) 
• Carbonated drinks 

If you routinely have a cocktail or glass of wine at dinner, abstaining can help heal stomach pain, too.

Drink more water

Drinking water can help treat a number of conditions that cause stomach pain at night, including heartburn and ulcers, both of which may be caused by excessive stomach acid that can be neutralized by water.

Additionally, water helps replace fluids lost by vomiting or diarrhea, two other symptoms that often accompany conditions that cause stomach pain.

OTC medication

Over-the-counter medications can go a long way to relieve pain and help you get a good night’s sleep. The medication you choose depends on your symptoms, but always check first with your doctor to avoid any complications with other medications you may be taking.

• Gas pain: Choose a medication with simethicone (e.g., Mylanta or Gas-X)
• Heartburn and acid reflux: Antacid and acid reducers (Tums, Pepcid AC and Zantac 75) can help buffer the acid.
• Constipation: Along with drinking plenty of water, add a mild stool softener or a laxative to get your digestive system going. 
• Painful cramping and diarrhea: Diarrhea and cramping and be relieved by medications with loperamide (Imodium) or bismuth subsalicylate (Kaopectate or Pepto-Bismol)
• General pain: Aspirin-free medications and acetaminophen are your safest bets, as other NSAIDs and aspirin itself can irritate and worsen stomach pain at night.

Prescription medications

For pain that is unrelieved by over-the-counter treatments and other lifestyle changes, prescription medications may help. This might include antibiotics for infections caused by diverticulitis, but it also may include stronger versions of OTC medications for stomach pain such as:

• Proton-pump inhibitors (PPIs)
• H2 receptor antagonists (H2RAs)

Elevating the head at bedtime

If you don’t have at least two hours after your last meal before bedtime, make sure to elevate your head while you sleep. This can be especially helpful for those who suffer from acid reflux and heartburn. 

When Should I See A Doctor For Stomach Pain At Night?

When considering visiting your doctor for stomach pain at night, there are a few things to keep in mind.

If you are attending a celebration or special occasion and eat and drink more than you normally do, a brief bout of acute stomach pain and digestive upset is to be expected.

However, if you lay down every night and are unable to sleep because of pain, it’s time to talk to your doctor. They may initially suggest nutritional or lifestyle changes, but it’s important to investigate any pain that occurs regularly. 

It can be helpful in the weeks before your appointment to keep track of what you’re eating and when, along with how often you have stomach pain at night and what other symptoms you might be experiencing. This helps your doctor understand potential causes, design diagnostic tests, and make treatment recommendations.

Things To Watch For

If you experience sudden onset of stomach or lower abdominal pain, you may want to consider heading to urgent care for treatment. There are a number of conditions that may not resolve on their own, such as dehydration caused by vomiting and diarrhea due to food poisoning or the rare instance of cardiac event. Stomach and back pain at night can also be a symptom of pancreatitis or pancreatic cancer and should be treated as an urgent medical condition.

Bottom line? If you are hurting and worried, call your doctor. 

And if your stomach pain at night is chronic and unrelieved, consider making an appointment with the Phoenix pain management specialists at Arizona Pain. We can help you get a good night’s rest. 

Opioid addiction and dependence have been rising steadily since 1999 in the U.S. The American Society of Addiction Medicine provides statistics on just how serious this issue is:

• Approximately 80% of heroin users started out taking prescription opioids.
• Heroin overdose deaths quadrupled from 2000 to 2013.
• Women have been impacted by both prescription pain medication and heroin overdose. Their rates of prescription overdose increased 400% between 1999 and 2010, with heroin overdoses tripling from 2010 to 2013.
• Limited access to and the expense of treatment has led people to choose heroin over medication-assisted treatment programs. 
• Adolescents are also affected, with nearly half of adolescents using prescription opioids for conditions other than pain being addicted to them.

Fortunately, there is a growing availability of medications like Suboxone and methadone that can help minimize the symptoms of withdrawal to make it easier to recover. It’s important to understand the differences between Suboxone vs. methadone to select the treatment option that will work best for you.

Suboxone vs. Methadone Explained

Methadone was first introduced in 1947 as a treatment for opioid use disorder (OUD). It was remarkably effective in terms of getting people off of prescription opioids and heroin and into recovery.

However, over time and with more research, it became clear that methadone had one specific downside: it carried with it the dangerous prospect of addiction to the very medication meant to treat it in the first place.

This sent researchers back to the lab to design a better option that was safer and had less chance of addiction. In 2002, Reckitt Benckiser released Suboxone as a replacement therapy. Suboxone had in it a system of checks and balances that treated OUD with less potential for addiction. With two medications working together, Suboxone was designed to specifically fight opioid addiction.

The Difference Between Methadone and Suboxone

The difference between methadone and Suboxone begins with a basic definition of what they are. Both are prescribed to treat addiction, but methadone is a generic drug and Suboxone is the brand name of an addiction treatment that includes both buprenorphine and naloxone. 

Both of these treatments require a doctor’s prescription and supervision. Of the two, only methadone is approved by the U.S. Food & Drug administration to also treat chronic pain. For treatment of opioid use disorder, both medications can only be accessed through an approved treatment program.

Beyond that, there are some differences in:

• Primary ingredients
• Basic actions
• Dosing and administration
• Efficacy when used for maintenance

Primary ingredients

Suboxone primary ingredients are buprenorphine and naloxone. Buprenorphine works to reduce cravings and withdrawal symptoms, while naloxone moderates its release so that there is no “high” associated with this medication.

Methadone is simply methadone. There is no other active ingredient.

Basic actions

It is critical to understand how opioids function in the brain before discussing the actions of Suboxone and methadone.

Opioids are agonists that bind to receptors in the brain, spinal cord, and other regions in the body. They can offer profound, temporary relief of severe pain, but not without a cost. In addition to pain relief, these medications provide a euphoric feeling that can change your brain over time. 

Additionally, as the body gets used to opioids it requires more to achieve both pain relief and the “high” of the medication. The effects — both pain relief and the euphoria that accompanies it — wear off faster, too.

Suboxone’s two medications are generally prescribed for the first part of opioid withdrawal to ease symptoms and reduce cravings. Buprenorphine is a partial agonist that also binds to opioid receptors, but in a more gradual way that is not as intense as opioids. The euphoric high is missing, and pain relief is longer-lasting. The naloxone in Suboxone is an antagonist. It blocks the effects on opioid receptors to protect against overdose. It eliminates the euphoria of opioids completely, an action that reduces cravings. The effects of naloxone are so powerful that it is used on its own to treat opioid overdose (as a nasal spray under the brand name Narcan). 

Methadone changes the brain and nervous system response to pain, too. When administered correctly, it can reduce symptoms of opioid withdrawal and block the euphoric effects that those who are addicted have come to crave. 

Dosing and administration

Dosing of Suboxone occurs once daily. For people in medication-assisted treatment (MAT) programs, taking Suboxone for pain is a safer alternative to opioid medications.

Suboxone is typically prescribed as a sublingual (under the tongue) or buccal (inside the cheek) film. Generic buprenorphine and naloxone are also available as an oral film or sublingual tablet (a tablet that dissolves under the tongue).

A basic maintenance adult dose might be once daily 16 milligrams of buprenorphine and four milligrams of naloxone as one dose. Because the half-life of methadone is longer, the risk of over-prescribing is high. The dose needs to be individualized to the patient precisely, and patients are monitored before, during, and after dosing to make sure there are no side effects.

Methadone can be prescribed as an:

• Oral tablet
• Oral solution
• Oral concentrate
• Injectable solution
• Oral dispersible (dissolved in water and then taken)

Adults taking methadone for opioid addiction generally start with 20 to 30 milligrams in a single dose per day. Your doctor will adjust this amount as needed, but generally it will not exceed more than 40 milligrams. It is critical to follow your doctor’s dosage.

Suboxone vs. methadone for maintenance

Both Suboxone and methadone can be taken in the first stages of treatment to minimize symptoms of withdrawal. They also both perform equally well in reducing opioid dependence when used long-term  in combination with other therapies (e.g., counseling and community support).

Methadone maintenance therapy (MMT) may be slightly more effective in terms of maintaining an opioid-free profile for people with comorbid substance use disorder and chronic pain, but the risk of addiction is high. There is an additional risk of liver injury and reduced attention span with long-term use of methadone.

Although it is not approved for the treatment of pain, Suboxone has less chance of dependence and may be safer long-term. It has even been classified by the U.S. Drug Enforcement Agency as a Schedule III drug with a lower risk of dependency.

Side Effects of Suboxone vs Methadone

Both of these medications can be life-saving in terms of helping people recover from opioid use disorders. However, in addition to side effects that mimic opioid withdrawal, they each have other potential side effects to be aware of. 

The list of side effects can be intimidating. It is important to note that research and doctors agree that the benefits of both Suboxone and methadone outweigh the risks of side effects for patients with opioid use disorder. Before taking either medication, talk to your doctor about any health conditions or concerns that you have.

Suboxone side effects

Suboxone comes with significant dental side effects that have recently been recognized as serious by the FDA. Buprenorphine dissolved in the mouth can lead to: 

• Tooth decay
• Cavities
• Oral infections
• Loss of teeth

You are at risk even if you have not had a history of dental problems. These risks can be minimized somewhat by proper administration that includes rinsing your mouth with water and brushing your teeth an hour after taking Suboxone. 

In addition to dental concerns, other potential side effects include:

• Back pain
• Headache
• Opioid withdrawal symptoms
• Blurred vision
• Constipation
• Nausea
• Vomiting
• Insomnia
• Depression
• Anxiety
• Mouth numbness or burning
• Headache
• Stomach pain
• Tongue pain

Serious side effects including difficulty breathing or swelling in the mouth or tongue require immediate medical attention. 

Methadone side effects

There is a long list of medications that can interact with methadone. It is critical to discuss any other health conditions you have and medications you are taking before beginning methadone therapy.

Short-term side effects can include:

• Agitation
• Nausea or vomiting
• Slow breathing
• Itchy skin
• Profuse sweating
• Constipation
• Sexual problems
• Weight gain
• Sleep changes
• Changes in appetite
• Headache
• Stomach pain
• Dry mouth
• Flushing
• Mood changes
• Vision issues

Serious side effects that require immediate medical attention include:

• Trouble breathing 
• Fainting or lightheadedness
• Hives or a rash
• Swollen lips, tongue, throat, or face
• Chest pain or a rapid heartbeat
• Hallucinations or confusion
• Seizures
• A hoarse voice
• Trouble swallowing
• Severe drowsiness
• Changes to menstrual periods

Can You Take Methadone And Suboxone Together?

The short and precise answer is no. Combining these two medications is dangerous and puts you at greater risk for overdose. 

Additionally, if you add Suboxone to an already-established methadone treatment, you have an immediate risk of withdrawal symptoms that include: 

• Watery eyes
• Runny nose
• Sneezing
• Profuse sweating
• Fever and chills
• Agitation and irritability
• Mood disorders (e.g., anxiety and depression) 
• Tremors 
• Rapid heartbeat
• Body aches 
• Abdominal cramping
• Loss of appetite
• Gastrointestinal issues (e.g., nausea, vomiting, and diarrhea)

These put you back to square one in terms of working through withdrawal and can lead to a relapse. This is not a case of “if some is good, more must be better.” Combining these medications can have deadly consequences.

Switching From Methadone To Suboxone

Switching from methadone to Suboxone (and vice versa) is not common if a patient is getting good results, but it does occur. Some reasons why a person would switch medications include:

• Relapse due to non-compliance with methadone program
• Poor results from methadone
• Addiction to methadone

The switch from one medication-assisted therapy to another can only be completed under a doctor’s close supervision. 

When switching from methadone to Suboxone, the methadone dose is tapered down to a certain amount before Suboxone can be taken at least 24 hours after the last methadone dose.

If a person is on a lower dose of methadone, the transition likely occurs without any increase in withdrawal symptoms or cravings. It is critical to monitor for both, as withdrawal can cause relapse. 

Find Resources For Opioid Addiction And Dependence

When considering suboxone vs. methadone, only your doctor can help you decide which is best for you. Is Suboxone the same as methadone? No. And what works for one person may not help another. 

Arizona Pain’s Mercy Care Center of Excellence can help. We have the tools you need to tackle chronic pain, substance use disorders, and mental health issues. The road to recovery is long and winding — we want to be with you every step of the way. Get in touch today to schedule an appointment to start getting your life back.

If you are suffering from chronic pain and starting to recognize the symptoms of depression, you’re not alone. And on the other hand, if you suffer from depression and notice an increase in pain from an old injury (or new pain popping up), you’ve got plenty of company there, too. Turns out, the relationship between pain and depression is bidirectional, with one intensifying or increasing the likelihood of the other. Is there a link between pain and depression? Yes — that’s why it’s critical to understand and treat both conditions. 

Pain And Depression Explained

Pain and depression are intertwined conditions. While it is not guaranteed that a person with one will develop the other, the presence of either increases that chance in a substantial way.

The comorbidity of these conditions is not rare. Some early studies indicated that up to 85% of chronic pain patients experience clinical depression. And those with depression induced by chronic pain have a poor chance of recovery from either condition. 

But what do these conditions look like?

Chronic pain and depression symptoms

Chronic pain is defined as pain lasting for three months or longer. It can result from a degenerative condition or a traumatic injury. The cause of the pain does not matter as much as the fact of its longevity. 

In addition to the pain itself, chronic pain often comes with other symptoms, including:

• Poor sleep
• Fatigue
• Mood swings 
• Anger and irritability
• Loss of stamina
• Decreased flexibility and range of motion in the body
• Sexual side effects 
• Gastrointestinal disruption

Depression is a clinical term used to diagnose a mood disorder that is much different from a day or two of sadness or grief after a loss. Symptoms can include:

• Loss of interest in daily life
• Changes in appetite (e.g., excessive hunger or loss of appetite)
• Loss of stamina
• Changes to sleep patterns (e.g., insomnia, restless sleep, or excessive sleepiness)
• Changes in weight
• Mood changes including hopelessness, despair, anger, and irritability
• Perseverating and rumination (going over the same thoughts)

How does mental health affect pain? People with depression can hold an extraordinary amount of tension in their body, leading to pain. They may also find themselves limiting their activity, which can lead to easier injury when they get moving again.

It’s also easy to see where these symptoms might overlap when a pain condition is diagnosed first. For example, fibromyalgia pain and depression are clearly linked both physically and mentally. Those who suffer from this whole-body pain condition find themselves desperately trying to find a comfortable sleeping position. Because of poor sleep, they may find that their fatigue makes it difficult to move through their day, causing an increase in stiffness and pain, plus lack of stamina. This then leads to a loss of interest in everyday activities. This lack of interest may cause a withdrawal from social activities and an eventual development of depressive symptoms. 

And, so the cycle continues. A diagnosis of both pain condition and depression is critical to break it.

Diagnosing pain and depression

Pain and depression are typically diagnosed in deep conversation with your doctor and a team of specialists, if needed.

A chronic pain diagnosis depends on the specific suspected condition. Lower back pain is one of the most common form of chronic pain, but its successful treatment depends on narrowing down the condition that causes it. This includes getting a detailed family history, conducting a physical exam, and ordering lab or imaging tests to reach a conclusion.

For depression, a trained therapist uses the guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. If you experience at least five of the following for two weeks, you may receive a diagnosis of depression.

1. Depressed mood more often than not
2. No pleasure in almost all, if not all, of your normal activities nearly every day
3. Weight loss or gain or significant change in appetite nearly every day
4. Slow thoughts and slower or less physical movement that others can observe
5. Lack of energy and fatigue nearly every day 
6. Feelings of worthlessness or guilt nearly every day
7. Reduced ability to concentrate or think nearly every day
8. Suicidal thoughts, a plan for suicide, or a suicide attempt

Are you suffering from chronic pain and depression?

Chronic pain sufferers know the daily trials that living with a pain condition can bring. Everything from reaching down to tie your shoes to hugging your children or getting groceries from the car can feel like an insurmountable obstacle. Over time, even the most determined people might find themselves feeling worn down.  

If you suffer from pain and are experiencing a change in mood, sometimes a depression checklist can help. This is not a substitution for a conversation with your doctor, but it’s a good place to start. 

The Relationship Between Pain and Depression

It’s clear in the research that there is a link between pain and depression. This link is physiological, and there are some important risk factors that set people up to experience both pain and depression.

Changes in the brain and the body

What makes this relationship more challenging is that the exact way in which pain and depression are linked is not yet identified. But there is plenty of evidence that the brain actually changes in people with chronic pain and depression — even if it’s not clear how or why.

What is clear is that pain and depression use some of the same neural pathways. The size of certain areas of the brain is also tied to the extremes of pain and depression experienced by those patients.

Other critical physiological links between pain and depression include:

• Decreased number of prefrontal cortex (PFC) synapses, which deals with pain processing and depression
• Decreased or maladaptive neuroplasticity in the brains of people with pain and depression

In addition to changes in the brain, pain that results in inflammation is also linked to depression. Inflammation is closely tied to the central nervous system — as noted above it affects the neuroplasticity of the response and can even predict how severe a depressive episode might be.

Risk factors for comorbid pain and depression

While not every person with chronic pain develops depression (or vice versa), there are some risk factors. Studies have shown that those most at risk of developing both conditions:

• Are middle-aged
• Are employed part-time
• Have female reproductive organs
• Are less educated

Some lifestyle factors might also increase your chances of these conditions, separately or together. Smoking, drinking, and substance abuse are strongly correlated with a rise in both pain and depression.

Pain conditions with the highest risk of depression

While it is largely individual in terms of which people living with chronic pain might develop depression, there are a few conditions at highest risk.

• Lower back pain, or any pain condition that significantly reduces your ability to function as normal, puts you at higher risk for depression.
• Fibromyalgia pain and depression may occur as a result of the longer time for diagnosis. People suffering from fibromyalgia also often have the stigma of an “invisible” illness where they look fine, but are suffering.
• Chronic gastrointestinal pain is associated with a higher chance of depression. This may also be due to social factors such as embarrassment or fear of bladder or bowel incontinence that causes a person to withdraw.
• Conditions that limit a person’s ability to complete their daily tasks or participate in activities they enjoy (e.g., joint pain) also put that person at risk for depression. 
• Chronic pain conditions that are difficult to treat may have a higher incidence of depression. These might include migraines or trigeminal neuralgia. 

Treating Pain and Depression

Getting a proper diagnosis of both pain and depression is the first step on the journey to wellness. Designing a treatment plan for both is the next.

Your doctor may start with lifestyle changes in diet and exercise. These holistic changes can ease symptoms of both pain and depression and promote an overall feeling of wellness, though they won’t treat the conditions directly. Some complementary therapies can benefit both pain and depression, including:

• Acupuncture
• Biofeedback
• Massage
• Chiropractic manipulation 

These treatments should also be combined with dedicated treatments for both pain and depression.

Chronic pain treatment options

Treating your chronic pain can help you not only feel physically better; it can also improve your mental health. 

Once you have a proper diagnosis of the cause of your pain, your doctor will develop a treatment plan that may include some or all of the following:

• Physical therapy
• Over-the-counter medications
• Interventional procedures
• Surgery

Antidepressant medications do double-duty as a first-line treatment for some forms of chronic pain. Those pain conditions that have been effectively treated with antidepressants include:

• Arthritis
• Diabetic neuropathy
• Postherpetic neuralgia
• Tension headache
• Migraine
• Face pain
• Fibromyalgia
• Low back pain
• Pelvic pain

Depending on your condition, you may also opt for interventional treatments like:

• Injections
• Nerve blocks (e.g., medial branch blocks)
• Peripheral nerve stimulation
• Spinal cord stimulator

Because each pain condition is individual, your treatment plan will be, too. 

Treatment for depression 

Treating depression effectively is one of the best tools to fight chronic pain. Fortunately, there are a variety of treatments that can help. Two common therapies include:

• Cognitive behavioral therapy: This changes the way in which a person thinks about their experience.
• Eye movement desensitization and reprocessing (EMDR): Offered specifically for people suffering from depression or post-traumatic stress disorder related to trauma, this essentially changes the way the brain organizes its response to a traumatic event.

Antidepressant medications are also used to treat both pain and depression. Because these work differently on different people these can take some time to adjust.

Your doctor may try some of the following to help manage your depressive symptoms.

• Selective serotonin reuptake inhibitors (SSRIs): These are the most common starting point, with few side effects. They are also prescribed commonly for standalone chronic pain. SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline, and vilazodone.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): This may be combined with other medications. Examples include duloxetine, venlafaxine, desvenlafaxine,  and levomilnacipran.
• Atypical antidepressants: Bupropion, mirtazapine, nefazodone, trazodone, and vortioxetine are not easily classified and may be used when other medications are not effective. 
• Tricyclic antidepressants: Tricyclic antidepressants come with more severe side effects and aren’t usually prescribed first. They include imipramine, nortriptyline, amitriptyline, doxepin, trimipramine, desipramine, and protriptyline.
• Monoamine oxidase inhibitors (MAOIs): MAOIs require a strict diet due to potential serious drug and herbal medicine interactions and side effects. MAOIs include tranylcypromine, phenelzine, and isocarboxazid.  

Some mood stabilizers or antipsychotics may be added to antidepressants. These can enhance the effects of the other medications. Some of these are temporary, while others are a permanent part of the treatment plan. 

Hormone balancing therapy may also help shift your depression. This treatment may be temporary but can help provide a more stable mental environment while other treatments are in progress. 

Find The Help You Need

The team at Arizona Pain has decades of experience dealing with both pain and depression. We understand how complicated dealing with the physical and mental aspects of pain can be, and we are here to help you get your life back.

With everything from comprehensive treatment plans through our outpatient program, the Mercy Care Center of Excellence, to targeted therapies designed to relieve pain, we offer personalized treatment for the most complex conditions.

Find the help you need to treat your pain and depression. Get in touch to set up an appointment today.

Opioid addiction is dangerous and challenging to treat. Even transitioning off of opioids can cause serious side effects and even death. When you’re ready to live life without opioids, medication-assisted treatment (MAT) using Suboxone for pain can help you safely navigate this change. It helps minimize the symptoms of withdrawal, making it easier to reduce dependence on opioids and reduce risk of side effects. But how does Suboxone work? Here’s everything you need to know. 

How Does Suboxone Work In The Brain And Body?

Suboxone is a medication that combines buprenorphine and naloxone to address two key aspects of addiction.

Buprenorphine is a partial opioid agonist. Although it binds to the main opiate receptor (the “mu” receptor) in the brain the same way that opioids do, its effects are much weaker than both prescription opioids and other narcotics such as heroin, morphine, or fentanyl. It does not cause the euphoria of opioids. 

Buprenorphine also has a ceiling — the effects of this medication do not increase if you take more of it. This reduces cravings, dependency, and side effects that are the hallmarks of opioid addiction.

Naloxone functions as a critical check on how Suboxone works in the body. Suboxone is meant to be taken orally, but if it’s injected it results in the withdrawal symptoms you are trying to avoid. This makes it less attractive to people who might otherwise attempt to boost the effects of Suboxone in the body.

Naloxone (Narcan) is also administered in cases of overdose. It counteracts the effects of opioids and can save lives when administered quickly.

How Is Suboxone Taken?

Suboxone is available in a variety of forms that include:

• Sublingual (under the tongue) tablet 
• Sublingual film 
• Monthly injection 
• Transdermal implant 
• Buccal film (in the cheek)

The most common form is a tablet or film that dissolves under the tongue in less than ten minutes. Make sure that the tablets or film is dissolved completely before eating or drinking anything. This ensures that all of the medication is ingested properly and quickly enters the bloodstream for the most effective prevention of withdrawal symptoms. 

The effects typically begin within an hour, peak within two to three hours, and wear off in three days. Your first dose is generally administered during the withdrawal period from opioids, with doses repeated once a day.

It is critical to take this medication only as prescribed by your doctor. Your doctor will also determine which form might work best for you. 

Suboxone’s Role In Chronic Pain Management

Because many who are suffering from opioid dependence started with opioids for treating chronic pain, it’s important to consider how Suboxone works for chronic pain management.  

The use of Suboxone in treating pain is not approved by the U.S. Food and Drug Administration (FDA), but some research has found that off-label use of Suboxone for pain is an effective way to not only treat pain but to also reduce the chance of opioid dependency.

These uses might include:

• Acute pain: Managing pain from surgery, trauma, or medical procedures
• Chronic pain: Neuropathic pain or pain from joints, back or cancer-related tumors 

Although Suboxone is not approved for use in chronic pain management, buprenorphine alone is approved for some types of pain.  

The extended-release skin patch and buprenorphine buccal film can be prescribed to treat moderate to severe chronic pain. These should only be prescribed for pain that cannot be managed in other ways and for which other treatments are inadequate. They are not appropriate for fast relief of acute pain from injury or trauma. A buprenorphine injection is also FDA-approved for pain that is severe enough to require an opioid analgesic.    

It is important to note that risk of overdose and death increases when Suboxone is prescribed to treat pain in opioid-naïve patients (those who are not currently using opioids). Using opioids long term — including Suboxone — may also result in opioid-induced hyperalgesia (OIH). This occurs when people become more sensitive to pain. 

Even with these risks, there are important potential benefits to consider for some types of patients.

• Chronic pain patients who swapped opioids for Suboxone reported a more than two point reduction of pain on a ten-point scale over two months.
• Patients with both opioid dependence and chronic pain were able to reduce their Suboxone use over time or stop altogether.
• Chronic pain patients with opioid addiction reduced their pain by more than 12% and were able to reduce their intake of other pain medications.

How Long Do The Effects Of Suboxone Last?

At 24 to 48 hours, Suboxone has a long elimination half-life. This is the period of time it takes for half of the dose to leave the body. The length of time Suboxone is detectable in the body depends on:

• Your age
• Your weight 
• The speed of your metabolism
• Any history of substance use or misuse
• The health of your liver

To manage addiction, many doctors recommend taking Suboxone daily for six months to a year (and sometimes longer). This does not take the place of other types of treatment to support recovery from opioid addiction, but it can minimize the withdrawal symptoms and cravings as you journey back towards wellness.  

Are There Suboxone Side Effects?

As with all medications, there are potential Suboxone side effects to be aware of. These can include:

• Headache
• Nausea
• Vomiting
• Sweating
• Constipation
• Insomnia
• Joint pain
• Muscle aches

Long-term use or misuse of Suboxone can also lead to symptoms that are similar to opioid withdrawal. These include:

• Shaking
• Mood disorders such as anxiety and depression
• Stomach cramps
• Diarrhea
• Irritability
• Anxiety
• Chills
• Nausea

Suboxone can also make you feel sleepy at first. In general, though, many people report feeling better— reduced cravings and withdrawal symptoms — after the first day or two. It can take some time to adjust to the medication, and everyone is affected differently. Stay in touch with your doctor, and let them know how you’re feeling.   

Drug interactions

It is important to make sure your doctor knows what other medications you are taking before you begin taking Suboxone. 

Suboxone has been linked to serious issues when taking the following medications:

• Benzodiazepines
• Lorazepam
• Temazepam
• Rifampin 
• St. John’s wort (an antidepressant herbal remedy)
• Cocaine 

Other medications that intensify the effects of Suboxone and should be avoided include: 

• Specific antibiotics
• Some antidepressants
• Antifungals
• ​Protease inhibitors taken for HIV infection

On the other hand, some medications decrease the effectiveness of Suboxone. These include:

• Certain seizure medications
• Rifampin
• Naltrexone 

Treating opioid addiction is challenging enough without a potentially life-threatening drug interaction. Be certain to disclose all of your medications to your doctor.

Is Suboxone addictive?

Because Suboxone contains naloxone, a medication that blocks the effects of buprenorphine at certain levels, you are less likely to become dependent on it. However, Suboxone is not meant to be a lifetime treatment for addiction or chronic pain. Long-term use or misuse of this medication can lead to dependence, with many of the same cravings and withdrawal symptoms associated with opioid dependence. 

For the best results and to minimize your chances of dependence, it is critical to follow your doctor’s directions for its use precisely.  

How Is Suboxone Different From Other Opioids?

The main way in which Suboxone is different from other opioids is that it is only a partial agonist of the opioid receptors in the brain. This means it simply does not produce the same euphoric effects of many other opioids such as heroin, fentanyl, and oxycodone. 

And although Suboxone does have a risk of dependence, the inclusion of naloxone and the “ceiling” of relief work together to make this medication less likely to cause overdose. The opioid receptors are not as activated as with other opiates, and those who overdose do so when Suboxone is combined with other sedatives such as benzodiazepines. These medications lead to slower breathing that can contribute to overdose. 

Another common misconception about people using Suboxone as part of medicated-assisted treatment for opioid dependence is that they aren’t really “in recovery.” This goes back to the early days of Alcoholics Anonymous when total abstinence was seen as the only way to treat substance abuse. 

In reality, Suboxone works for those recovering from opioid use disorder to reduce the physical cravings and withdrawal symptoms so that other aspects of treatment have time to work. Insisting that medication-free treatment is the only way to be in recovery places a burden on those who need care and support to rebuild their lives. It’s similar to blaming Type 1 diabetics for needing insulin to treat a physical imbalance — inaccurate and unhelpful. 

Will Suboxone Work For Me?

When trying to decide if Suboxone works for you, the best place to start is in your doctor’s office. Have a long conversation with your doctor that includes your feelings about your opioid use and how it has changed. They may be the one to approach you, especially if they notice a difference in your habits in refilling prescriptions. 

It can be more challenging to summon the courage to ask for help if the opioids you are addicted to are not prescription, but your doctor is trained to address this type of opioid use as well.

It is important to note that Suboxone is not the best treatment for everyone. Your doctor may recommend another path if:

• You are on other medications that are dangerous to take with Suboxone
• You exhibit physical dependence without the signs of addiction (e.g., obsessive thoughts about opioids, increased cravings, increased use, etc.)
• You aren’t interested in reducing your opioid use or you’re not dependent on them

The Road To Recovery

Patients with the best chance of recovery from opioid dependence know that a multi-pronged approach is needed. MAT with Suboxone is just one of the many types of supports that can help you get your life back. 

The Arizona Pain Mercy Care Center of Excellence program takes a holistic approach that addresses the needs of both mind and body. With appropriate MAT, counseling, community support, and follow-up tailored to each person who enters the program, we help treat patients with:

• Mental health issues
• Substance abuse
• Chronic pain

When you are ready to start on the path to recovery, we are here to help. We know the path is neither straight nor easy to travel, but we will be with you every step of the way. Get in touch to get started today.

If you have lived through or witnessed a traumatic event or series of events, you may already be familiar with the symptoms of PTSD. But even after the event has passed and your symptoms are identified, you may start to notice another complication: pain. Is there a link between PTSD and chronic pain?

What Is PTSD?

Post-traumatic stress disorder (PTSD) Is a complicated psychiatric disorder caused by experiencing or witnessing a traumatic event. This condition is largely associated with war and combat, but there are a variety of traumatic events that can lead to PTSD, including:

• Sexual assault
• Violent attacks
• Natural disasters
• Serious accidents
• Terroristic acts 

The event does not necessarily need to happen to the person affected. The stress of death, sexual violence, or injury can lead to PTSD. Even living in a stressful or violent environment can lead to PTSD.

This type of disorder has historically been assigned to veterans returning from combat, but PTSD is prevalent in every ethnicity, nationality, and culture. You need not go to war or live in a combat zone to develop symptoms of PTSD. There are no age limits or restrictions.  An estimated 3.5% of adults in the U.S. will be affected by PTSD annually, with one in 11 people diagnosed with PTSD in their lifetime. 

Although PTSD has the potential to affect everyone, women are twice as likely to have PTSD as men, and certain ethnic groups in the U.S. have much higher rates of PTSD than others.

PTSD symptoms

There are four main categories of PTSD symptoms. People may experience symptoms in each category, and they can range from mild to severe. 

1. Intrusion: Intrusion is more commonly referred to as flashbacks. These are memories or dreams that occur involuntarily. In the most extreme cases, these intrusive thoughts are so vivid that it feels like the event is occurring again. 
2. Avoidance: To prevent flashbacks, people with PTSD practice avoidant behaviors. They may change their routines to avoid certain people, places, activities, and situations that serve as triggers. Avoidance also includes a reluctance to discuss the traumatic event or their feelings about it. 
3. Alterations in cognition and mood: Mood disorders are common among PTSD sufferers. They include things like negative thoughts and feelings or an inability to feel happiness. Other types of mood changes include shame, guilt, and self-blame for the traumatic event. In some cases, those with PTSD may not be able to remember the event itself. 
4. Alterations in arousal and reactivity: Hyper-vigilance is being overly aware of what is happening around the person with PTSD. This leads to difficulty with sleeping and concentration, along with an overactive startle reflex. People may become more irritable and quick to anger.

The above symptom categories deal with the mental aspects of PTSD, but the physical symptoms are real, too. In a condition this complex, PTSD physical symptoms can range from minor challenges to debilitating blocks to your day.

People with PTSD may also experience:

• High blood pressure 
• Increased heart rate
• Fatigue 
• Muscle pain and tension 
• Nausea and other gastrointestinal symptoms 
• Headaches
• Joint pain
• Back pain 

Diagnosing PTSD

The symptoms above are not uncommon in the days following a traumatic event. A PTSD diagnosis occurs when symptoms:

• Last for a month or more
• Cause debilitating distress 

The diagnosis is made by taking a full patient history and assessing the impact of recent trauma. 

What Is Chronic Pain?

Chronic pain is different from the normal response to an acute injury. For example, when a person breaks a bone, there is a period of healing that can be painful. In most cases, when the bone heals and the cast comes off, the pain goes away. When pain does not recede and lasts for three months or longer, it becomes chronic. 

Chronic pain can occur over time as the body ages and normal wear and tear occurs. There are many causes of chronic pain, but some people may experience chronic pain before, during, and after cancer diagnosis and treatment or with other chronic illnesses including fibromyalgia and diabetic peripheral neuropathy.

In the most frustrating cases, there is no direct link between an injury or long-term wear and tear. This type of chronic pain is idiopathic — it has no obvious cause. 

Many people are living with chronic pain and don’t even realize it. An estimated 80% of people in the U.S. will experience chronic neck or lower back pain at some point in their lives.  Of all chronic pain sufferers, 25% are unable to go about their daily lives.

Symptoms of chronic pain

The symptoms of chronic pain are as wide and varied as the people who experience them. They can include some or all of the following:

• Sharp, dull, aching pain
• Radiating nerve pain
• Pain that comes and goes
• Pain that is constant 
• Pain that gets better or worse with movement 
• Extreme fatigue
• Gastrointestinal disorders 

The most challenging symptoms of chronic pain may not even be the pain itself. People with chronic pain suffer higher rates of depression and crippling anxiety. They are also at increased risk of developing other comorbid psychological conditions such as PTSD, as we’ll discuss here.

Diagnosing chronic pain

Getting a diagnosis of chronic pain can be challenging, and some sufferers wait for years to find relief. In some cases, a diagnosis occurs by taking a complete medical history and eliminating all other possibilities. Other potential tests look for musculoskeletal abnormalities and can include:

• X-rays
• CT scans
• MRIs

Your doctor may also order blood tests to rule out (or confirm) specific conditions.

Can PTSD Cause Chronic Pain?

When you consider the causes of PTSD, it is easy to see how this can lead to chronic pain, too. In many cases, traumatic events themselves are painful. Consider veterans wounded in combat or survivors of physical or sexual assault. When a person is injured in a traumatic event, and a diagnosis of PTSD follows, maladaptive coping strategies for both can increase pain. Injury that leads to chronic pain and the trauma that precedes it can also lead to an increased chance of both conditions worsening.

For people who witness a traumatic event without sustaining injury, PTSD can still cause chronic pain. Consider the muscles needed to maintain a constant awareness of your surroundings. This can lead to strains, tears, and damage to the muscles as they continue to keep the body on high alert.

Additionally, people who have witnessed a traumatic event, whether it has led to personal physical pain or not, may practice avoidant behavior. This avoidant behavior includes overestimating the amount of pain something might cause and then avoiding that activity. This results in a deconditioning effect that can lead to injury in a previously healthy person.

And since PTSD is associated with an increased risk of depression, this can lead to withdrawal from physical activity and other healthy habits that serve as a treatment for injury. Without regular exercise, pain can increase and become chronic.

Further research clearly shows that PTSD and chronic pain go together, and that PTSD itself can lead to chronic pain.

• Some studies indicate a near 100% occurrence of chronic pain in PTSD sufferers
• People with PTSD report more severe pain 
• People with PTSD as a result of an accident report higher rates of disability due to pain
• The presence of PTSD and chronic pain together made treating both exponentially more challenging, with fewer favorable outcomes

Turns out, both of these conditions together have a clearly negative influence on each other. 

How Do You Treat Chronic PTSD Pain?

Because treating one without the other is setting patients up for failure, it’s critical that both PTSD and chronic pain be addressed at the same time. 

So how do you treat chronic PTSD pain? With a combination approach that is customized and comprehensive for the specific patient. This may include all or a variety of the following treatments.

Medication

Medication includes both over-the-counter and prescription options as needed. In some cases, medications for treating PTSD-related depression may also result in a decrease in chronic pain. It is not well understood why antidepressants work on hard-to-treat chronic pain, but many people report good results. 

There are a variety of options, but the most common is tricyclic antidepressants. There are some side effects associated with these antidepressants, but starting at a low dose can prevent them from occurring.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) are also becoming popular due to their limited side effects. Other medications include non-steroidal anti-inflammatory drugs and other medications that can be used for better sleep and less anxiety.

Because there is limited evidence that opioids are effective for chronic pain, these are generally not prescribed. If they are, medication management is critical to prevent overuse or abuse.

Your doctor can determine which medications might be helpful in treating both PTSD and chronic pain, along with the other following therapies.  

Complementary care

Many people who suffer from both PTSD and chronic pain find that regular complementary care is necessary for relieving both physical and mental distress. These treatments include:

• Meditation
• Chiropractic care
• Biofeedback
• Acupuncture
• Diet and exercise changes
• Massage

Cognitive behavioral therapy (CBT) is a first-line treatment for both chronic pain and PTSD.  This type of therapy helps patients reframe negative, disruptive thoughts. It does not seek to eliminate negative thoughts but to put them in perspective and to right-size their role in a patient’s life. 

These treatment approaches may be helpful for PTSD sufferers who are not yet ready to fully discuss their traumatic event. They can occur in conjunction with specific treatments for chronic pain, too. 

Interventional pain procedures

Interventional pain procedures are targeted for specific types of chronic pain. The intervention depends on the type of pain.

For example, for PTSD and joint pain that does not respond to conservative treatments, joint injections may provide relief. Back injuries might be treated by spinal cord stimulation. Other common interventional pain procedures include:

• Disc denervation 
• Peripheral nerve stimulation
• Vertebroplasty and kyphoplasty
• Trigger point injections
• Intrathecal pump implants

Each of these treatments can help you live a life with less pain. Talk to your doctor about targeted approaches that might work for you. 

Living With PTSD And Chronic Pain

Living with PTSD and chronic pain can have a profound effect on your physical and emotional daily life. But you don’t have to suffer anymore.

Our Phoenix, AZ Mercy Care Center of Excellence program approaches complex conditions in a holistic way. We know that comorbid conditions need to be treated at the same time for the best chance at success. To this end, we address the entire person in front of us. Our goal is to help you get your life back if you’re suffering from the dual diagnoses of chronic pain and PTSD.

When you are ready to explore treatment options for PTSD and chronic pain, get in touch to set up an appointment.

During World War II, methadone was developed and prescribed for soldiers in extreme pain when morphine was scarce. This long-acting opioid was helpful in relieving pain during transport from the battlefield and after surgeries.  It was used for pain relief in the U.S. in the 1940s, but it wasn’t until the 1970s that doctors recognized its potential for treating opioid use disorder as well. But how does methadone work for pain and addiction? Here are some common questions people have about methadone treatment. If you suffer from chronic pain and substance use disorder, these answers can help you decide if this might be a good option to explore with your doctor.

What Is Methadone Treatment?

Methadone was introduced as a slow-onset, long-acting medication for pain but has been increasingly utilized as part of medication-assisted treatment (MAT) for substance use disorder. It can be especially helpful for people suffering from severe withdrawal symptoms. When combined with therapy and other types of treatment (e.g., community support and job assistance), methadone treatment can be a positive step on the winding path to recovery.

For people struggling with the dual issue of chronic pain and opioid use disorder, methadone offers a way through for both conditions. As a synthetic opioid agonist, methadone blocks pain receptors in the brain while reducing withdrawal symptoms and cravings. In addition, methadone blocks the euphoric feeling produced by other opioids like heroin, oxycodone, and codeine. These effects last up to 56 hours and can provide relief from both pain and the symptoms of dependence. 

Methadone itself does not produce the euphoric feeling of other short-acting opioids. For those who have developed an opioid use disorder, the combination of long-lasting pain relief and the lack of a euphoric “high” (and no subsequent “low”) can help them gradually reduce or eliminate their dependence.

So, why would a person be prescribed methadone for pain, addiction, or a dual-diagnosis of both?

• For the slow onset and long duration: It provides relief from pain and cravings gradually and lasts for a long time.
• When opioids for chronic pain don’t work: This can be a safer long-term pain therapy.
• When flexible dosing is important: Methadone can be taken at home or in a clinical setting.
• If Suboxone is not appropriate or doesn’t work for the patient: Certain health conditions are contraindicated for Suboxone, making methadone a better choice.

How Does Methadone Work? Dosage Information

As with all medications, your doctor will determine which methadone dosage is safest and most effective for you. Your dose may also change as you move through a medication-assisted treatment program.

Methadone is available as a pill, liquid, or powder. Tablets may be taken as a pill, or they might be dispersible — you’ll have to dissolve them completely in water or juice and drink all of the liquid for the full dose. 

The actual methadone dosage varies, but it’s generally not suggested to take more than 40 milligrams in 24 hours. Most patients will typically start at 20 milligrams or lower. Methadone maintenance doses can be higher, but it’s best to start at the lowest dose that provides relief.

The effects of methadone are gradual. Most people feel the effects of their dose 30 to 45 minutes after they take it. The peak effect occurs two to four hours after dosing. After a week, methadone deposited in the body’s tissues maintains a steadier level in the body. 

A prescription is required for methadone, and the form and dose may change as your therapy progresses. It is important to follow the dosage instructions exactly. Overuse can lead to dependence, but underuse can lead to relapse and may not provide pain relief.

It is also critical that you do not stop taking methadone without talking to your doctor. It is possible to have withdrawal symptoms if you are not being properly supervised, and this can lead to relapse in addiction. When your pain and opioid use disorder are well-managed, your doctor will develop a plan to slowly wean you or to move to a maintenance dose if that is best for you. 

Are There Any Methadone Side Effects?

As with any type of medication, it is important to be aware of potential methadone side effects. Even if the treatment duration is relatively short, patients may experience:

• Drowsiness
• Dry mouth
• Fatigue 
• Itching
• Nausea
• Vomiting
• Sexual impotence or lack of interest
• Gastrointestinal effects (e.g., constipation)
• Weight gain
• Difficulty urinating
• Swelling in the extremities
• Sweating
• Headache
• Changes to mood, including depression
• Dental issues

For some, these side effects are mild and transitory, but for others they can be debilitating as a person adjusts to the medication. 

Any of the following side effects are serious. If you experience them, seek immediate medical attention.

• Difficulty breathing
• Shallow breathing
• Drop in blood pressure that causes lightheadedness or fainting
• Hives or a rash
• Swelling in the face, lips, tongue, or throat
• Chest pain
• Accelerated heart rate
• Hallucinations 
• Confusion
• Seizures
• Changes to your menstrual cycle

Although methadone does have negative side effects, it is critical to understand that the benefits of methadone typically far outweigh the potential for side effects. Addiction to opioids and living in chronic pain that is unrelieved by other treatments leads to a greater incidence of mood disorders, early morbidity, and suicide. 

Long-term effects of methadone

While the benefits outweigh the risks in general, it is important to understand the long-term effects of methadone. These may influence how long you can take methadone.

• Addiction: This risk is highest when methadone is taken improperly or without a prescription. This includes snorting or injecting the powdered form.
• Sleep disorders: This includes not getting enough sleep or not getting restful sleep.
• Hallucinations: Hallucinations are rare but can occur with long-term methadone use.
• Liver damage: This is more common in patients with pre-existing liver damage due to hepatitis C or HIV infection.
• Brain damage: Brain function may be changed or impaired with long-term use. 

Many of these can be avoided by remaining under a physician’s care and taking the medication only as prescribed.

How Is Methadone Different From Other Opioids?

The biggest and arguably most important difference is the time frame of methadone versus other opioids. Methadone’s effects come on gradually and last for a long time. This contrasts with opioids such as oxycodone, fentanyl, and heroin with their lightning-fast but short-lived high that results in a crash and the sudden onset of cravings and other withdrawal symptoms.

Although there is a chance of misuse, methadone treatment for addiction under a doctor’s supervision is correlated with fewer relapses and a greater chance of recovery. Methadone also provides pain relief that is superior to morphine and can work better long-term for cancer pain.

Another commonly used medication for substance use disorder is Suboxone, a combination of buprenorphine and naloxone. The first reduces cravings for other opioids, and the second one blocks the high of opioids. These are not opioids, but work on the same opioid receptors in the body. This medication is virtually impossible to abuse or overuse, as there is a plateau at which the person taking it will not feel any effect at all.

But unlike methadone, Suboxone is not FDA-approved to treat both substance use disorder and chronic pain. Buprenorphine on its own can be prescribed for chronic pain, but Suboxone for pain is considered an off-label use. Suboxone can only be administered by a physician who is specially licensed for treating substance use disorders, but methadone can generally be prescribed by any licensed doctor.

Will Methadone Treatment Work For Me?

When it comes to methadone treatment, only you and your doctor can decide if it’s the best option for your chronic pain or substance use disorder.

Good candidates for methadone treatment include:

• People 18 years or older who are addicted to opioids
• Those undergoing surgery who are at risk for opioid dependence
• Chronic cancer pain patients
• Chronic pain patients with pain unrelieved by other medications
• People with chronic pain and substance use disorders
• People with high dependence on opioids who require long-term medication-assisted maintenance

Methadone is a safe treatment for people who are pregnant or breastfeeding, but consistent pre- and post-natal care is critical. Some babies experience withdrawal symptoms after they are born, but others have no evidence of effects from methadone.

There are some people who should not take methadone. These may include people who have:

• Heart disease or a heart rhythm disorder (e.g., arrhythmia) 
• Electrolyte imbalance
• Respiratory disease or breathing problems
• Previous head injury, brains tumors, or seizures
• Liver of kidney disease
• Difficulty urinating
• Issues with the gallbladder, pancreas, or thyroid
• Gastrointestinal obstruction

Additionally, methadone should not be taken if you are also taking:

• Sedatives (especially benzodiazepines)
• Suboxone
• Certain antibiotics
• Zidovudine
• Antifungal drugs
• HIV drugs
• Certain allergy drugs
• Urinary incontinence drugs
• Antipsychotics
• Diuretics
• Laxatives
• Heart rhythm drugs
• Benztropine and amitriptyline

In some cases, these medications amplify the effects of the methadone. In others, the interaction between methadone and the other medication increases the risk of side effects for both.

This list of medications to avoid is not exhaustive. Talk to your doctor about any medication you are taking, including over-the-counter drugs and herbal or natural remedies. They can help assess the potential risk of interactions.

Your Journey Towards Recovery

As part of a wraparound medication-assisted treatment program, methadone is associated with positive outcomes, lower relapse rates, and decreased rates of criminality and mortality. But the journey towards recovery takes time and is challenging. Long-term support is critical.

If you are struggling with substance use disorder and chronic pain in the Phoenix area, we can help. Our Arizona Pain’s Mercy Care Center of Excellence outpatient program utilizes a variety of medications and concurrent therapies to help you get your life back and your pain under control. We are with you every step of the way.

When you’re ready to learn more about methadone treatment for pain and addiction, get in touch.