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Dr Neel Umapathy: Cannabis can be a godsend for chronic pain

Pain specialist Dr Neel Umapathy is one of Mamedica’s highly experienced specialist consultants. Here Dr Umapathy lifts the lid on why prescribing cannabis is different from other drugs, and why it could make a huge difference for chronic pain patients. Dr Umapathy is an ENT surgeon, who specialises in facial pain, including cancer pain, migraines and neck and shoulder pain.

Once I learnt about cannabis, it was a revelation…

Somebody suggested to me that I should work with medical cannabis. I said, ‘Not a chance, I’m not prescribing cannabis.’ So they said, ‘Why don’t you just look it up and see what you think,’ and I got into Professor Mike Barnes’ course – and it was a revelation, really. Medical cannabis is a different thing altogether. That’s how I started.

It makes me happy when patients can stop using traditional medication…

The really positive part is the ability to help people who are struggling pretty much on their own, seeing many specialists and not getting anywhere. They are mainly chronic pain patients, they have tried traditional medication, and they feel this is a godsend – it actually relieves their symptoms. That makes me happy. One of the ways that we measure relief is that they can reduce and in some cases completely drop their traditional medication.

I’ve seen a huge range of patients, in every age group from their 20s to their 80s, and one of the commonest feedback I get is that once they use cannabis, their lives are normal again, they’re able to live normally.

It enables patients to live normal lives…

Cannabis enables patients to live normal lives. Chronic pain patients are pretty much not socially active. I’ve seen a huge range of patients, in every age group from their 20s to their 80s, and one of the commonest feedback I get is that once they use cannabis, their lives are normal again, they’re able to live normally.

Cannabis helps the whole patient…

When patients suffer from pain, they’re often anxious about it: they can’t do anything else, that causes a lot of anxiety. That leads to poor sleep. So they’re all linked to each other. This is where medical cannabis really comes in. It covers a whole lot of things, it gives the pain delay. It controls the anxiety, it helps patients sleep, and they eat better. Quite a lot of things change.

Cannabis could change how we treat chronic pain…

Most patients we treat have chronic pain. Chronic pain is not a symptom. It is a disease in itself. It is a serious condition. In America and Canada, they have lots of data saying that up to 20% of the population suffers from chronic pain. It is a billion dollar cost to society if you can tap into it. I’m now adding to my qualification by doing an MSc in pain management. And it gives me a much better understanding of how pain is managed elsewhere, and what else we can do to help them.

One patient had cluster headaches for 10 years and cannabis cured him…

I had a patient who had had cluster headaches for 10 years. He had tried all sorts of medication, and we prescribed him 10 grams of flower. We’re now stopping his other medications, as our prescription has made him so happy. That was really great.

We listen to patients, and have open and honest conversations…

There’s no hard, randomised control trials when it comes to cannabis. The experience of patients helps to inform consultants, which can inform future patients. There’s open and honest feedback, with no blame culture. We learn as we go along. I try combinations of THC and CBD rather than just one or the other. I try to be balanced. My patients, if they don’t have any previous experience, once they’ve tried a month or two, they will have their own understanding of how they want to go further.

There is still a stigma around medical cannabis…

There is still a stigma around it definitely. It’s strange. Because when you think of the immense amount of clinical research and scientific evidence that supports the use of cannabis, for there still to be this kind of underlying sort of stigma, it’s really interesting within the medical profession. There’s always two sides. Some people easily adapt to the new changes, some people are waiting and some will never change.

It may take five or 10 years, but change will happen in the NHS…

To achieve change in a widespread way in the NHS, several things need to happen. Drug companies should raise awareness, educate doctors and patients. We need to build evidence around medical cannabis and its role in treating all these various conditions. It’s a positive upward spiral. Because the fundamental thing about the NHS is the patient-centred approach. If more patients demand that this is what they need, it will eventually happen. It may take five or 10 years, but it will happen.