Marijuana and Neuropathic Pain

Medical Cannabis and Neuropathic Pain


Neuropathic pain is the result of damage to the nerve fibers in the brain and spinal column..  Three common conditions associated with acute and chronic neuropathic pain are: diabetic neuropathy found in the hands and feet, post-herpetic neuralgia (shingles), and cancer..  Sciatic nerve pain is also a common complaint in older adults and cyclists. Lastly, neuropathic pain can occur as the result of herniated discs within the spinal column that pinch the nerves as they exit the spine out to control the muscles and sensory nerves of the body.  Neuropathy is described as a feeling of pins and needles, burning, numbness, tingling, and shooting sensations that can stay localized or radiate down the arms or legs.  This type of pain also includes numbness or complete lack of feeling.


Neuropathy resulting from diabetes is a result of exposure to excess blood sugar over a protracted period of times, damaging the nerve fibers in the extremities of the body - arms and legs.  An injury to the spine can also result in pain that radiates down one or both legs leading to numbness of the feet.  Nerve damage is a common side effect of certain types of chemotherapy and radiation, and pain can continue years after treatment has ended..


Pharmaceutical Treatments for Nerve Pain


More than 20 million people in the United States have been estimated to have some form of peripheral neuropathy, but this figure may be significantly higher - not all people with symptoms of neuropathy are tested for the disease and tests currently don’t at all forms of the disease.


The most commonly used medications to treat neuropathy are anti-inflammatory over the counter medications like Advil and allege (NSAIDS), opioids, anti-seizure medications, and some anti-depressants.  All of the prescription level medications have side effects that many people cannot tolerate. 


The three most commonly prescribed medications are Lyrica, Cymbalta, and different kinds of SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors).  The most common side effects of these drugs are fatigue, sedation, weight gain, and impaired cognition.  Cymbalta carries an additional warning showing and increased risk of depression and suicide. 


These are the reasons many people are starting to look to more holistic treatments like medical cannabis for neuropathy.


Cannabis As Treatment for Neuropathy


Cannabinoids mediate their effects through activation of endocannabinoid resceptors to decrease inflammation leading to nerve pain..  This amelioration can be achieved through topical application of cannabis or through ingestions or smoking it (systemic use).  The best products for treating nerve pain are high in CBD and haver low levels of THC, although higher levels of THC may be needed for more severe types of pain. 


We have had great success treating neuropathic pain with low dose THC when patients use it consistently at the prescribed dosages..  We have frequently had success where prescribed pharmaceuticals have failed..  This may, in part, be due to the ability of THC to reduce anxiety, which contributes significantly to the experience of pain. 


Treatment for neuropathy should begin with CBD-isolated products first - usually at a dose of 25-75 mg per dose.  Patients who need more relief should then slowly add THC (2-5 mg) until pain is consistently controlled. 


Moderate to severe neuropathy pain should be treated by sublingual auroral delivery because inhaling CBD/THC may make it difficult to find an effect dose of CBD, the most potent component of cannabinoid treatment for neuropathy. 


If moderate levels of CBD with low levels of THC - for example 25mg CBD/5mg THC - are inadequate, the final step when treating severe nerve pain is high dose CBD (50 - 75 mg per dose) with moderate to high doses of THC as tolerated.  The products are the strongest options available for treating neuropathy but also produce the most euphoria, so they may not be appropriate for some patients during working hours.


If nerve damage is localized, such as in the hands and feet, patients can begin treatment by applying topical CBD (with added THC is necessary() to the area every few hours.  Topical treatments like this avoid systemic exposure to the medication, or they can be combined with oral medications to increase potency and improve pain treatment. 



Dr. Allison Kendrick

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