Physical pain can be part of withdrawal, and it can start weeks after you stop smoking.

Hi everyone,

I'm writing this in the hopes that someone who is planning to quit will be better prepared than I was for what it's like to go through withdrawal. I'm in debt to u/pawsleaves for his posts, as well as this thread at uncommonforum. They are what helped me understand what was happening to me. I wish I had figured it out sooner and spared myself over a month of terrible health anxiety.

"Everyone knows" that withdrawal from marijuana is mild and doesn't include any physical symptoms. At worst you get some mood problems and insomnia, right? This is what I believed when quitting, and I was wrong. Withdrawal *hurts*. If you're in physical pain after quitting, there's a good chance it's caused by withdrawal.

My symptoms:

• Joint pain. The worst was in my shoulders, but also in my elbows, wrists, hips, knees, and ankles. I don't have any restricted movement, and the pain actually seems to be more in the muscles / tendons that attach near the joint, than in the joint itself. But it feels like "joint pain" most of the time.
• Chest pain. I feel sharp pain in my left side, kind of in the ribs under my armpit, that comes and goes and moves around. Sometimes it's under the armpit, sometimes it feels like it's in the diaphragm. I also have pain where the ribs connect to the sternum on both sides, very similar to costochondritis. This moves around as well.
• Muscle pain. This is worst in my upper back and shoulders, especially underneath my left shoulder blade, but also flares up in my lower back, down my arms, and in my legs (less often). The muscles feel very sore and tender, like I've been working out, but I haven't. Rubbing them helps, as does physical activity to loosen them up. Painkillers seem to help as well. Again, moves around day to day.
• Headaches. Mostly low-grade but last all day sometimes.

For me, all these symptoms came on about 3-4 weeks after I stopped smoking. I had been a daily smoker for over 17 years, on a nights and weekends basis. Probably went through a gram of flower a week or less -- not a super heavy user by the standards of this subreddit, but very regular and consistent every night after work and several times a day on weekends, for almost 2 decades with no breaks longer than a couple weeks. Never touched concentrates, rarely used edibles / tinctures. I sometimes quit for a few weeks at a time for travel and never had any serious issues, so I thought I knew what quitting for longer would be like. I was totally unprepared for the physical symptoms I encountered, and developed very bad health anxiety as a result when I began experiencing them. The first 3 weeks after quitting I felt basically normal, maybe a little irritable, but then things rapidly deteriorated.

At about 3 weeks after quitting, I came down with a bad case of bronchitis with a dry raspy cough, and a week or so later began noticing more and more physical symptoms. In retrospect, I am not sure whether this was a coincidence or if the illness brought on the symptoms of withdrawal / made them worse. What I do know is that I went to the doctor once a week for 6 weeks, had many blood tests, a chest x-ray, and other diagnostics done, and none of them showed anything wrong with me. I was completely convinced that my pain and other symptoms (see below) were caused by lingering effects of the illness, and was freaking out worse and worse when doctor after doctor told me there was nothing wrong with me.

At first I was convinced I had pneumonia / pleurisy from the respiratory infection, which would explain the chest and back pain. A pulmonologist I was referred to eventually convinced me this couldn't be true, but was sympathetic that I might have had pneumonia earlier that had since cleared up. But if it was cleared up, why were my back and chest still hurting? He didn't know. I got tested for hemochromatosis, which would have explained the fatigue and joint pain. Negative. Next I latched onto the idea that I had walking pneumonia caused by mycoplasma pneumonia, which would explain the joint and muscle pain. I convinced a doctor to give me a Z-pack to treat it, but weeks later the symptoms had only improved mildly, and a diagnostic test for the bacteria came back negative. At that point I started considering more exotic ailments I might have, like MS, or that the virus had done nerve damage somehow. I also noted how closely my pain overlapped with the symptoms of fibromyalgia (which has no known cause), and was considering trying to get a diagnosis for it, just to have an answer.

It was around this time (10 weeks post quitting, "sick" for 6 or 7 weeks) that I discovered this forum and learned about PAWS. I spent a lot of time reading u/pawsleaves excellent posts, for which I will always be grateful, as well as the uncommonforum thread I linked above. The puzzle pieces clicked into place. I might have been sick a month ago, but what I was feeling was not caused by a virus or infection. It was caused by withdrawal.

Other physical (but non-pain) symptoms of my withdrawal:

• Dizziness / "wooziness", often paired with nausea and a sinking feeling in my stomach. Made me feel like I needed to lie down. Worst in the morning, but flared up throughout the day. The nausea killed my appetite.
• Muscle fatigue / unsteadiness. I never felt out of breath or like I was about to collapse, but just generally weak and unsteady on my feet.
• Hot and cold flashes. Burning up one moment, freezing the next. Sweating with clammy palms.

For the first 2 months experiencing these symptoms, I had very bad health anxiety, convinced that something was very wrong with me that needed fixing. One day home sick, the anxiety was so bad I was convinced I was having a heart attack and checked myself into the ER. A very patient ER doctor assured me I hadn't had a heart attack, and recommended that I talk to someone about anxiety. I spent the next 6 weeks looking for answers online, but it wasn't until learning about PAWS that things started to actually make sense. After a week of reading, I was feeling much better, because I finally had some answers about why I was feeling the way that I was. I believe my anxiety would have been much reduced (or at least not focused on the idea of my having a terrible disease) if I had just understood that withdrawal could cause these symptoms.

It's important to note that not everyone goes through what I have. But enough people obviously do that, at this point, I'm satisfied with withdrawal as an explanation. And that peace of mind is really invaluable.

It's crazy to think that I used a drug daily for 17 years without understanding what it was doing to me, physically, besides making me feel happy / sleepy / horny. I didn't know anything about the endocannabanoid system or how many parts of the body's homeostasis processes it helps regulate. If you're interested in learning more, I strongly recommend reading this osteopthic paper about what the endocannabanoid system does in the body. It helped me come up with some plausible-seeming hypotheses for why I and other people experience these symptoms quitting after long-term use. The TL;DR is that when you're putting external cannabanoids into your body on a regular basis, your body adjusts to this as the new normal. Then when you stop, it takes your body a while to find the right balance again. I don't know enough about medicine to say whether this would be primarily due to your body no longer producing enough natural cannabanoids, or if the recepters themselves become less sensitive due to chronic over-exposure, or some combination thereof. But it's uncanny how many of the symptoms of withdrawal are related to the functions of the endocannabanoid system:

• Inflammation and Connective Tissues: endocannabanoids reduce inflammation in the joints. Medicinal marijuana helps relieve the joint pain of arthritis sufferers.
• Temperature regulation: responsible for hot and cold flashes in withdrawal
• Nociception and Pain: There are CB2 receptors throughout the body's peripheral nervous system, and these receptors actively dampen pain in the surrounding tissue. "CB2 signaling decreases the release of activators and sensitizers from neighboring mast cells and macrophages. Functioning of the endocannabinoid system at the peripheral terminal of the nociceptor provides the “first line of defense against pain.”
• Hunger and Feeding: should be self-explanatory

Of course, there are very many CB1 receptors in the brain itself, which are probably responsible for the more mental and emotional aspects of withdrawal (mood, sleep, anxiety) that are more typically associated with marijuana. But again, those are the things people already seem to know about and expect. For me, the real surprise in quitting wasn't how my brain responded, but how my body did. It caught me completely off guard. My mental symptoms would have been much more bearable if I understood what was happening to me physically.

I hope this finds someone who needs to read it. I wish I had read something like this when I first quit.