High Impact Chronic Pain & Cannabinoids – What’s The Latest?

CF 185: High Impact Chronic Pain & Cannabinoids – What’s The Latest? Today we’re going to talk about…. But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

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You have found yourself smack dab in the middle of Episode #185 Now if you missed last week’s episode , we talked about predicting frailty and we talked about a 30-year study on disc degeneration. Fascinating stuff as always. Make sure you don’t miss that info.  Keep up with the class. 

On the personal end of things…..

This is the season of big. Big stuff happening these days.  I have some cool stuff on the horizon in 2022 I’m looking forward to. It looks like I’ll be joining a high-level group of doctors that’ll be meeting virtually throughout the year and in-person 4 times a year to get the best, most current evidence-based guidelines and to solve each others’ biggest practice issues. More information to follow but I can’t emphasize how pumped I am to get that rolling. The worst part is that I have to wait until 2022.

But honestly, that’ll be here before we know it. If you’ve been following along lately, we are going through this Nurse Practitioner medical integration and our NP starts here in our clinic on August second.

That’s more than HUGE!

I released my first book on June 8th called ‘The Remarkable Truth About Chiropractic: A Unique Journey Into The Research’ which is live and for sale on Amazon and from my website at www.chiropracticforward.com as we speak  It’s a hell of a good reference for practitioners and content creators. It has mostly current research divided into sections for quick reference and it’s some of the most impactful and significant research you’ll find for our profession. Go get a copy. Then we have an intern coming from Parker University to hang out with us through the Fall semester. That’s a first for me. We’ll see how it goes. He seems like a great dude with a cool little family. It should be a good deal.

We also have a trip coming up to Washington DC at the end of August, the TCA. Reds me to put together an hour-long presentation on research for their Leadership Conference, and some friends just asked me to officiate their wedding vow renewal.  So, how’s your Summer going? In terms of numbers, I’m frustrated. I hear Chiros telling me how they’re right back where they were and all that good stuff. Not me. I’m still at about 140 a week right now. I averaged 185 a week before the Rona jacked everything up.  If you had any big breakthroughs as far as getting people to return, email us at [email protected]  and I’ll share in the next podcast. Maybe we can help all of our listeners get back to where they were. 

It sure can’t hurt. I know that. Takers eat well but givers sleep well. Be a giver and I’ll help spread the word.

Item #1

The first one today was spurred because of a question that popped up in our private Facebook group last week. I posted an article I wrote that I give to all of my chronic pain patients in my clinic. It’s basically a dive into chronic pain and the current thinking.  In the article, there is a mention of how pain pathways that are laid down become permanent. One of the questions by a group member was that, if it’s true that the pathways are permanent, then doesn’t that go contrary to the idea of neuroplasticity.

If you don’t know what that is, that’s the ability of our central nervous system to adapt to new normals or adapt to training and to change and function in ways that overcome certain challenges.  So if we have neuroplasticity, how can pathways be permanent, basically. 

What a great question. I hadn’t considered this before. After thinking on it a bit, my response was, “Can’t we have neuroplasticity yet still permanent pathways that give us a tendency toward chronic pain? You can have all kinds of neuroplasticity (thank God) but won’t the CNS still store the information/memory/etc? I went on to add that, “I believe that’s the thinking behind the original teaching.

Dr. James Lehman also describes ‘high impact chronic pain’. These are essentially people who tend to have chronic pain forever and can only control it through periodic treatment/therapy. That would also imply that neuroplasticity is complicated and may have its limitations. Something that we can definite leverage in our favor, but not a cure all?” So, following my comments, Dr. Lehman shared this research article focusing in on High Impact Chronic Pain.

Thank you to Dr. Lehman for the research citation and thank you to Nathan for an excellent question.  If you’re not in our Chiropractic Forward Facebook group, go do that.  IT’s called, “Prevalence and Profile of High-Impact Chronic Pain in the United States” by Pitcher et. al. (Pitcher MH 2019) and published in the Journal of Pain in February of 2019…..it’s a little steamy but not quite hot enough for my beloved sound bite. Damnit. 

Why They Did It

They say, “The multidimensional nature of chronic pain is not reflected by definitions based solely on pain duration, resulting in high prevalence estimates limiting effective policy development.  The newly proposed concept of high-impact chronic pain incorporates both disability and pain duration to identify a more severely impacted portion of the chronic pain population yet remains uncharacterized at the population level.” So it’s basically chronic pain AND disability rather than just chronic pain. 

How They Did It

As such, we used the 2011 National Health Interview Survey (N = 15,670) to 

  1. assess the likelihood of disability in the overall chronic pain population, 
  2. estimate the prevalence of High-Impact Chronic Pain, and 
  3. characterize the disability, health status, and health care use profile of this population in the United States.

What They Found

  • Overall, chronic pain, defined as pain experienced on most days or every day in the previous 3 months, was strongly associated with an increased risk of disability after controlling for other chronic health conditions
  • disability was more likely in those with chronic pain than in those with stroke or kidney failure, among others.
  • High-Impact Chronic Pain affected 4.8% of the U.S. adult population, or approximately 10.6 million individuals, in 2011.
  • The High-Impact Chronic Pain population reported more severe pain and more mental health and cognitive impairments than persons with chronic pain without disability, and was also more likely to report worsening health, more difficulty with self-care, and greater health care use.

Wrap It Up

High-Impact Chronic Pain clearly represents a more severely impacted portion of the chronic pain population. Understanding this heterogeneity will contribute to developing more effective legislation promoting safe and cost-effective approaches to the prevention and treatment of chronic pain.  PERSPECTIVE: High-Impact Chronic Pain is a powerful new classification that differentiates those with debilitating chronic pain from those with less impactful chronic pain. By addressing the multidimensionality of chronic pain, this classification will improve clinical practice, research, and the development of effective health policy.




Item #2

OK, I’m about to be uncool…..I get it. Unless you happen to be in pain and benefit from it, I’m about to take a recently unpopular stance here. Old buy coming through. But I’m Gen X so don’t pull that, ‘OK, Boomer,’ BS on me. It’s powerless against the forces of research so don’t even try it.  Look, admit that you can’t follow only the research you like that confirms your biases and ignore and discount only the ones you don’t like that fly in the face of your beliefs or preferences. 

Let’s be clear, if opioids are the only thing that can possibly help with pain, why wouldn’t we use that. It’s a tool, albeit a dangerous one, but a tool we have at our disposal. The same goes for cannabinoids. I support it being used for medical purposes 100%.

So don’t misunderstand. What I cannot get behind is its recreational use. I never understood why folks need to have a completely altered reality by partaking in drug use, really of any kind, all day every day. Now, I get it….some folks have had awful experiences. It calms them. Helps them deal with it. Some have sleeping or anxiety disorders. I get it. And let’s be clear, I like to drink beer on the weekends here and there and I partake in some shots as well too. That’s definitely some altered reality but it’s few and far between. 

I’m talking about the wake and bakes that just have a normal life but they like it so they do it every day? I’m a no on this. You’ll never convince me that inhaling smoke of any kind daily is healthy, good for you, productive, or conducive to a better life long-term. You can’t do it. Because it’s not possible.  Not only that, but you are influencing your children when they go to copying your behavior.  So…..here I go being uncool.  This one is called “Association of Cannabis Use During Adolescence With Neurodevelopment” by Albaugh et. al. (Albaugh MD 2021) and published in JAMA Psychiatry on June 16, of 2021 a smoking steamy plate of Shazam. 

Why They Did It

The authors wanted to answer the question, “To what extent is cannabis use associated with magnetic resonance imaging–measured cerebral cortical thickness development during adolescence?”

What They Found

  • In this cohort study, linear mixed-effects model analysis using 1598 magnetic resonance images from 799 participants revealed that cannabis use was associated with accelerated age-related cortical thinning from 14 to 19 years of age in predominantly prefrontal regions.
  • The spatial pattern of cannabis-related cortical thinning was significantly associated with a positron emission tomography–assessed map of cannabinoid 1 receptor availability.

Wrap It Up

Results suggest that cannabis use during middle to late adolescence may be associated with altered cerebral cortical development, particularly in regions rich in cannabinoid 1 receptors.


Item #3

I’m just going to drive the depths of my uncool-ness to new depths here, folks. Don’t mind me.  This one is called, “Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status” by Han et. al. (Han B 2021) and published in JAMA Psychiatry on June 22, 2021. Ouchy wa wa. 

Why They Did It

During the past decade, cannabis use among US adults has increased markedly, with a parallel increase in suicidality (ideation, plan, attempt, and death). However, associations between cannabis use and suicidality among young adults are poorly understood. The authors wanted to answer the question, “Are there associations between cannabis use and suicidality trends in young adults, and do they vary as a function of sex and depression?”

How They Did It

They examined 281 650 adult participants in the 2008-2019 National Surveys of Drug Use and Health data

What They Found

Past-year suicidal ideation and plan along with daily cannabis use increased among all examined sociodemographic subgroups (except daily cannabis use among current high-school students), and past-year suicide attempt increased among most subgroups. 

Wrap It Up

From 2008 to 2019, suicidal ideation, plan, and attempt increased 40% to 60% over increases ascribed to cannabis use and major depressive episode. Future research is needed to examine this increase in suicidality and to determine whether it is due to cannabis use or overlapping risk factors. Alright, that’s it. I’ll try to be cooler next week. In fact, I KNOW I’ll be cooler next week because we have the amazing Dr. Brett Winchester coming up as a guest so don’t miss him. He’s on the top of the mountain. Let’s find out how he got there, shall we? Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 


Remember the evidence-informed brochures and posters at chiropracticforward.com. 

Purchase Dr. Williams book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!


Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!


Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 


We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  


  • Albaugh MD, O.-G. J., Sidwell A, (2021). “Association of Cannabis Use During Adolescence With Neurodevelopment.” JAMA Psychiatry.
  • Han B, C. W., Einstein EB, Volkow ND, (2021). “Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status.” JAMA Netw Open 4(6): e2113025.
  • Pitcher MH, V. K. M., Bushnell MC, Porter L., (2019). “Prevalence and Profile of High-Impact Chronic Pain in the United States.” J Pain 20(2): 146-160.


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