I recently did a podcast with Jonathan Geiman of “The Joe Health Show”, a program designed to inform and educate on the mechanics of food and other supplements for the body.
It ended up being a fantastic conversation, which happens when the host asks well-informed questions. Jonathan and I covered the topic of cannabis in-depth when, at one point, he asked me another excellent question, “Are there any studies regarding cannabis use for neuropathy?”
Since I did not have the answer on hand, I told him I would write my next post on the subject so everyone gets to benefit. So, here we go.
Neuropathic Pain
Millions of people suffer from daily, chronic pain. There are actually several definitions or “types” of pain, and its origin will determine how it is treated. I write about the subject of pain in Chapter 8 of my book, The Cannabis Prescription. Here is an excerpt from page 125 that describes the three main categories of pain:
“Nociceptive Pain—pain due to injury or physical damage
Neuropathic Pain—nerve pain
Inflammation—activation of the inflammatory process (rheumatoid arthritis, psoriatic arthritis) causing acute/localized or systemic/chronic inflammation that leads to pain”
Nerve pain, called neuropathy or neuropathic pain, is often described by patients as burning, numbness, tingling, or an increase in sensitivity to the point that the patient cannot tolerate even a bedsheet touching their skin.
The available pharma drugs approved to treat neuropathy are extremely limited. Below are the most frequently prescribed medications for nerve pain:
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gabapentin (Neurontin)
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pregabalin (Lyrica)
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duloxetine (Cymbalta)
Physicians may prescribe older anti-psychotic or anti-seizure medications as well, but these drugs were not specifically developed to treat nerve pain and often provide a plethora of negative side effects such as weight gain or extreme sedation.
Cannabis for Neuropathic Pain
Cannabis has shown great potential as a treatment option for neuropathy. CBD is a potent anti-inflammatory, while THC has anti-inflammatory actions as well. In fact, with over one hundred cannabinoids found in cannabis, many cannabinoids have anti-inflammatory properties, including CBD, THC, and CBG.
CBD can be taken orally or applied topically. A 2020 study published in Current Pharmaceutical Biotechnology showed a significant reduction in peripheral neuropathy of the lower extremities with the use of a topical CBD product (250mg in 3oz).
“Our findings demonstrate that the transdermal application of CBD oil can achieve significant improvement in pain and other disturbing sensations in patients with peripheral neuropathy.” *
A 2013 study sponsored by pharma giant GW Pharmaceuticals—the maker of Sativex, an oromucosal THC:CBD spray—concluded that “clinically important improvements in pain, sleep quality and SGIC of the severity of their condition are obtained with THC/CBD spray. THC/CBD spray was well-tolerated, and no new safety concerns were identified.” **
Sativex is available in the UK for the relief of multiple sclerosis (MS) symptoms and the treatment of severe neuropathic-related cancer pain.
In my experience, many patients can find substantial relief with the use of CBD without THC. Unfortunately, the results are inconsistent, and patients with more severe symptoms often require additional cannabinoids like THC.
I have seen patients with severe sciatica do well with sativa THC mixed with CBD; but I have also seen CBD-only oral products worsen a patient’s symptoms, as in the recent case of a 91-year-old woman who only found relief with 15mg of an indica-THC tablet.
Patients interested in CBD to treat their neuropathic pain should find a top-quality American-made CBD product (TribeCBD.com is a good one) and follow a regimen like this one:
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Start with 10mg every 6 to 8 hours.
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Continue for 3 days.
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If not effective, increase the dose to 20mg every 6 to 8 hours.
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Continue for 3 days.
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If not effective, increase the dose to 30mg every 6 to 8 hours.
You can see the pattern. The stopping point is when side effects become overbearing (mild, chronic headache or mild stomach cramp/ache) or your budget is tapped out. Over-the-counter CBD supplements can quickly become cost-prohibitive at higher dosages. The CBD products available in the medical dispensaries, like Connecticut, are actually much cheaper than over-the-counter supplements.
The goal is to find the optimal dose for your body; lower and higher dosages are not more effective than finding the “sweet-spot” when dosing CBD.
If high-dose CBD is found to be ineffective, it is at this time you would want to introduce another cannabinoid, typically THC. Products that contain THC are only available at a cannabis dispensary.
The bottom line is this: It can take time to find an effective treatment for neuropathy when using cannabis. The first step is the use of CBD or another non-psychoactive cannabinoid, usually with little to no THC. If patients need more pain relief, a switch to THC or a CBD:THC combination product may work better. There is always a multitude of treatment options available in a dispensary.
Follow this link to additional international studies on cannabis use for neuropathy: https://www.cannabis-med.org/index.php?vt=neuropathy&lng=en&tpl=search&s_site=on&s_iacm=on&s_can=on&s_journal=on&s_def=on&s_faq=on&Suchen=Search
(*) Dixon H Xu, Benjamin D Cullen, Meng Tang, Yujiang Fang, The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities, Randomized Controlled Trial, Curr Pharm Biotechnol 2020;21(5):390-402. DOI: 10.2174/1389201020666191202111534
(**) M. Serpell, S. Ratcliffe, J. Hovorka, M. Schofield, L. Taylor, H. Lauder, E. Ehler, A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment, European Journal of Pain, 22 November 2013.