DEAR DR. ROACH: I have severe pain from osteoarthritis. I am able to get some relief with one tablet of 5/325 Norco a day. My doctor is trying to wean me off Norco, and some days I can manage with a half-tablet. To help control my pain, I have been using hemp oil with the Norco. I take up to three tablets a day. Hemp oil seems to be a new trend in combating severe arthritis pain. Would you please comment on this? — E.B.
ANSWER: Osteoarthritis is the most common form of arthritis. While there is no cure, the pain often can be managed with judicious exercise, pain relievers like Tylenol and anti-inflammatory medicines like naproxen (Aleve) and ibuprofen.
Opiates, like hydrocodone (Norco is a brand of a combination of acetaminophen and hydrocodone), are not usually used for people with osteoarthritis; they are less effective, have serious side effects, can lead to physiological tolerance and tend to lose effect over time. Some joints affected with osteoarthritis are treated with joint replacement.
Hemp oil contains many components of Cannabis sativa (marijuana), depending on the plant and on how it is extracted. No hemp oil sold legally in the U.S. contains THC, the primary chemical in marijuana responsible for the euphoria or "high." However, other components of hemp oil have been shown to improve arthritis pain and inflammation. There is not yet enough high-quality data for me to recommend using hemp oil to treat arthritis. Further, it is difficult to know whether one is buying hemp oil with high amounts of cannabidiol (one component proven to have some potential for benefit).
Despite the unknowns, hemp oil has some promise and should be further studied. Opiates like hydrocodone are not a good choice.
DEAR DR. ROACH: I would really like some information about trigeminal neuralgia. I have had this problem for about six weeks, and it is very painful at times. For about two weeks, I was on gabapentin, but it didn't help. My primary doctor didn't want me to take this, but can't seem to tell me much about this condition. — C.F.
ANSWER: Trigeminal neuralgia is a type of facial pain. It is more common in women and in older people. Most cases are caused by an artery deep in the brain compressing the trigeminal nerve. The major symptom is sharp, intermittent pain in the distribution of one of the three branches of the trigeminal nerve: forehead and scalp (called V1); cheek and upper lip (V2); and ear and jaw (V3). Some people have constant pain, and the severity is variable, but it can be excruciating.
Most primary care physicians have never seen more than a handful of cases, if any, and may not be current on treatment, so I would strongly suggest finding an expert in the condition.
Medications can help: antiseizure medicines, like carbamazepine (Tegretol) or oxcarbazepine (Trileptal), can reduce the severity of the pain, but medical treatment usually is only partially effective. People who do not get adequate relief from pain medication (and it may take a long time to find the right medicine, or more likely combination of medicines, at the right doses) should consider evaluation for surgical treatment. The most effective surgical treatment is microvascular decompression, which is usually effective, but its benefit may not last forever.
Even without treatment, some people will gradually get better, only to relapse at a later time.
I can only begin to explain this complicated disease. I'd recommend that you get more information at these websites: www.livingwithtn.org, www.tnnme.com and www.fpasupport.org.
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