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Medical Marijuana for Peripheral Neuropathy

by Jessica Robinson-Papp MD, MS, FAAN Mount Sinai Medical Center, and
Sara Dehbashi, MD, Neuromuscular Fellow, Mount Sinai Medical Center

Medical marijuana use is becoming more common in the U.S. due to legalization in many states. The U.S. federal government still considers all forms of marijuana illegal, however so far they have mostly not interfered with medical marijuana activities that are legal under state laws. Given that peripheral neuropathy and neuropathic pain are complicated conditions that are challenging to treat, we aim to review the effectiveness, roles and risks of medical marijuana in the treatment of peripheral neuropathy in this article.

What is marijuana?

The term marijuana refers to strains of the cannabis plant that contain substances, called cannabinoids, that can have effects on the human body.

What is medical marijuana?

Medical marijuana refers broadly to marijuana products that are used for medicinal purposes. The exact definition of medical marijuana varies by state. Some states allow actual marijuana (i.e., the plant material) for medicinal use, whereas in other states (e.g. New York), medicinal products are derived f rom the marijuana plant, and sold in different forms (e.g. tinctures or pills). Marijuana is comprised of over 400 chemical entities with more than 60 cannabinoids. The two main cannabinoids are:

  1. Tetrahydrocannabinol, or THC: the psychoactive compound in marijuana (the substance that produces the high). THC occurs naturally in marijuana; there are also synthetic forms of THC that are prescription medications (e.g. dronabinol).
  2. Cannabidiol, or CBD: This substance does not produce any psychoactive effects. Since it has low abuse potential, CBD-containing products are less tightly regulated than THC. In some states CBD can be sold as a supplement or topical treatment. A prescription medication form of CBD (Epidiolex) recently became available in the U.S. but is only approved for the treatment of certain forms of epilepsy.

What is recreational marijuana?

Recreational marijuana refers to marijuana that is used for recreational purposes. In most states use of marijuana for recreational purposes is illegal. In states where recreational marijuana is legal, the actual product itself is typically not different from products used for medicinal purposes.

What is synthetic marijuana?

Synthetic marijuana also sometimes called “fake weed” contains human-made chemicals that are either sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes. Some of these products contain chemicals similar to those found in the marijuana plant. However, it is important to know that these drugs may affect the brain much more powerfully than marijuana, and that their effect can be unpredictable, and in some cases dangerous and even life-threatening.

How does medical marijuana work?

The THC and/or CBD contained in medical marijuana binds to specific cannabinoid receptors in the brain and peripheral nervous system which is likely the way in which it is able to alleviate chronic pain (1).

Currently, there is a debate about the so-called “entourage effect” which refers to the idea that compounds other than cannabinoids in marijuana (i.e. terpenes and flavonoids) are important in its therapeutic effects. This idea has wide lay-popularity, but little scientific evidence to support it.

How is medical marijuana administered?

Legal routes of administration vary state by state. For example, in New York state, medical marijuana can be used as a vapor, tincture or pill. In other places the natural leaf form is available and smoking or conversion to an edible product is allowed.

What are the dosing recommendations? (9)

It is important to know that medical marijuana products vary widely and so no consistent recommendations can be made on dosing. A general common sense approach recommended by some doctors is “start low, go slow, and stay low.” One study (8) found that 25 mg herbal cannabis with 9.4% THC, administered as a single smoked inhalation three times daily for five days, significantly reduced average pain intensity compared with a 0% THC cannabis placebo in adult participants with chronic post-traumatic or postsurgical neuropathic pain.

What conditions does medical marijuana treat?

State laws differ on the conditions that can legally be treated with medical marijuana. The National Academies of Sciences, Engineering and Medicine (NASEM) published a comprehensive review of the literature in 2017 for all indications (not just neurological), which is available here. In summary, medical marijuana is most often allowed to be used in debilitating conditions such as neuropathy, spinal cord injury with spasticity, multiple sclerosis, epilepsy, ALS, chronic pain, Parkinson disease, Huntington’s disease, HIV/AIDS, and cancer; and for controlling symptoms and conditions such as muscle spasms, severe nausea, cachexia, PTSD, etc.

For many of these conditions there is inadequate information to conclusively assess the effects of cannabinoids. Studies have shown significant efficacy in 3 main medical conditions, which are: 1) chemotherapy induced nausea and vomiting; 2) chronic pain, including neuropathic pain, and 3) multiple sclerosis related spasticity.

One of the neuropathic pain conditions that has been evaluated by randomized, double-blind studies, is HIV-neuropathy, in which studies have shown promising effects on pain (2).

What are the major risks of taking medical marijuana?

It is important to know that medical marijuana (unlike opioid pain medicines) is not lethal in overdose, and trials done in humans so far have overall shown an acceptable safety profile. The evidence suggests that smoking cannabis (unlike tobacco) does not increase the risk for certain cancers (i.e., lung, head, and neck) in adults, but is associated with chronic cough.

Some other side effects as listed below, have been reported.

  • Impairment in learning, attention and memory with acute use, which may persist
  • Developing or worsening substance use disorders including alcohol, tobacco and other illicit drugs
  • Psychiatric effects, such as development of social anxiety disorder, increased risk of suicidal thoughts, increased risk of schizophrenia and other psychoses, and worsening of pre-existing bipolar symptoms with daily use
  • Lower birth weight in pregnancy
  • Reduced future achievement in adolescents

What are the laws and regulations surrounding marijuana?

Currently, a total of 34 states in the U.S. have approved a comprehensive, publicly available medical marijuana programs, in addition to approved efforts in 12 states that allow use of medical marijuana products for medical reasons in limited situations (full list available at this website.)

However the U.S. federal government still considers marijuana illegal.

What is the efficacy and cost-effectiveness of medical marijuana in neuropathic pain?

As previously indicated, the scientific literature demonstrates some efficacy of medical marijuana/cannabis in the treatment of chronic neuropathic pain. Clinical trials of different routes of administration (sublingual, oral, smoked, and vaporized) have demonstrated analgesic benefit in the treatment of this costly and disabling condition (3,4,5), and some treatment guidelines for neuropathic pain recommend consideration of cannabinoids as a second or third line agent (6,7).

As expenses for medical marijuana are not covered by health plans and are out-of-pocket, knowing the cost-effectiveness of medical marijuana may impact patients’ decisions regarding its use. Based on a recent published article (7), inhaled cannabis appears to be cost-effective when used as second or third-line treatment in chronic neuropathic pain.

What is medical marijuana, how does it work and is it an option for patients trying to managing the pain of peripheral neuropathy.

Neuropathy

Updated on April 13, 2020. Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer

Neuropathy is a painful and debilitating condition that affects various parts of your body. While traditional therapies can help treat the underlying condition and manage the pain somewhat, many patients with neuropathy still experience pain and other symptoms. Using cannabis for neuropathy is an alternative treatment option to consider if you cope with the condition and can’t find relief from traditional therapies.

Cannabis and Neuropathy Treatment

Treating neuropathy pain with medical weed is often an effective option for patients. If you don’t find enough relief from traditional treatment methods, consider incorporating marijuana into your routine. An experienced medical cannabis doctor can assess your medical history to recommend appropriate strains and amounts to manage your pain effectively.

While you may find pain relief from a number of marijuana strains, certain strains are well known for easing neuropathy pain. Those strains include:

  • White Widow
  • Purple Kush
  • Chem Dawg
  • Super Silver Haze
  • Jack Herer

Keep in mind that some strains are more potent than others. While this is beneficial in knocking out your pain, it may also be a little more than you expect if you aren’t used to using medical marijuana. Purple Kush and Chem Dawg, for instance, are quite powerful. Work with your marijuana doctor to decide on the strains that are ideal for you.

When discussing potential strains with your doctor, it’s important to understand the fundamental differences between the two main types of medical marijuana strains. Medical cannabis is described as being either Indica or sativa. These two kinds of medical weed offer the pain relief you want for your neuropathy. However, they also have some distinctions.

Indica strains have a sedating effect and help you relax. They are effective in treating pain, as well as anxiety, insomnia and muscle spasms. If you have trouble sleeping due to your neuropathy, consider an Indica strain for use at night.

Sativa strains tend to have the opposite effect. They boost your mood, creating an uplifting feeling with a more cerebral-based effect. In addition to pain, sativa strains may also help treat depression, ADD, fatigue and mood disorders. If you feel low on energy or need to stay alert during the day, sativa may be a better option.

You can, however, use both types of medical marijuana depending on your situation or needs. Choose a sativa strain for daytime use and an Indica strain for nighttime use, for example.

The method of ingestion is another consideration when using medical marijuana to treat neuropathy. The various methods offer different pros and cons. Comparing the differences helps you determine which method is best for your situation. You don’t have to choose a single method. Many medical marijuana users use multiple ingestion forms depending on the time of day and their unique needs.

The primary methods of using medical cannabis include:

  • Smoking: Most people think of smoking when they think of medical marijuana. The main benefit of smoking medical weed is the immediate pain relief you experience. As soon as you inhale the marijuana, you start to feel the effects.

For someone suffering from severe pain, that immediate relief is so important. However, smoking does come with drawbacks, including its effect on the lungs. The high temperature required for combustion also creates byproducts that may be harmful.

  • Vaporizing: If you don’t like the idea of smoking medical marijuana, consider vaporizing. In this method, a machine heats the medical cannabis to create a vapor. The heating temperature doesn’t cause combustion so that it may provide a healthier alternative. Vaporizing offers fast relief like smoking.
  • Edibles: If you like food, edible medical marijuana may be an excellent option. You can find edible medical cannabis in almost any form, from snacks to gum. You’ll have to wait longer to feel the effects of medical weed with this method though.It can take 30 minutes to a few hours to feel pain relief. For someone in pain, that wait can be unbearable. The benefit is the length of the effects. Pain relief lasts longer with edibles than with smoking or vaporizing. This lasting effect is particularly beneficial at night when you want to sleep without waking until morning.
  • Topical: Another option to consider for neuropathy medical marijuana treatment is a topical application. This method allows you to apply medical cannabis to a particular area, which is helpful if you feel the neuropathic pain in one specific area of your body.

Side Effects of Medical Cannabis for Neuropathy

If you’re currently taking pain relievers to manage your neuropathy pain, you likely know the potentially severe side effects of them, including liver damage and addiction. Many patients want the pain relief without the side effects, which is why they explore the possibility of using medical marijuana.

While medical cannabis is a natural alternative, it’s important to understand it does come with some side effects. Most people consider those effects to be mild and minor compared to the possible side effects of prescription medications.

Some of the possible side effects you may feel with medical marijuana include:

Most of the symptoms are easy to manage. Some can even be a positive. If you toss and turn at night, the sleepy effect caused by medical weed can help you fall asleep, for example. If your appetite has been low, increasing your hunger can help you get the nutrients you need.

Find a Medical Marijuana Doctor Near You

If you or a loved one suffers from neuropathy, medical marijuana may be an effective treatment option for managing your symptoms. At MarijuanaDoctors.com, we can help you connect with experienced medical cannabis physicians in states where medical marijuana is legal. Search for a doctor now to improve your quality of life through pain relief.

Information About Medical Marijuana & Neuropathy

  • Medicinal Cannabis vs. Transcutaneous Electrical Nerve Stimulation (TENS) to Treat Neuropathy
  • Plasma Exchange vs. Medicinal Cannabis to Treat Neuropathy
  • Using Medicinal Cannabis to Manage Neuropathy-Related Chronic Pain

What Is Neuropathy?

Neuropathy refers to nerve damage that results in pain, weakness and numbness. Neuropathy isn’t a disease on its own, rather, it’s an effect of an underlying condition that causes the nerve damage. The condition affects the peripheral nerves, which is why it’s also known as peripheral neuropathy.

The peripheral nerves are located outside of your central nervous system. In other words, the damage pertains to nerves outside of the brain and spinal cord. Peripheral nerves carry information from the central nervous system throughout the body.

Nerve damage can happen in different types of nerves, including:

  • Sensory nerves: These nerves receive a variety of sensations, including pain, temperature, vibration and touch. Damage to these nerves can interfere with how you feel those sensations.
  • Motor nerves: These nerves control muscle movements. This type of damage can affect the muscles by causing weakness or issues with coordination.
  • Autonomic nerves: These nerves play a role in blood pressure, heart rate, digestion and bladder functions. You may notice difficulties in those processes if the condition affects these nerves.

A common cause of neuropathy is diabetes mellitus. The condition affects more than half of people with diabetes. Other potential causes of neuropathy include:

  • Infections, including Lyme disease, shingles, HIV and Epstein-Barr virus.
  • Alcoholism
  • Traumatic injury
  • Autoimmune diseases, such as Sjogren’s syndrome, rheumatoid arthritis, lupus and Guillain-Barre syndrome.
  • Certain medications
  • Tumors
  • Inherited disorders
  • Exposure to toxins
  • Vitamin deficiencies

Different types of neuropathy exist and depend on how many nerves the underlying condition has damaged. The types neuropathy include:

  • Mononeuropathy: In this form of neuropathy, only one nerve is affected. This type often happens due to a traumatic injury or prolonged pressure on a particular nerve. Carpal tunnel syndrome, for example, is one type of mononeuropathy caused by the compression of a nerve.
  • Multiple mononeuropathy: The damage affects two or more nerves in different areas in this form of neuropathy.
  • Polyneuropathy: In this kind of neuropathy, the damage extends to multiple nerves in various parts of the body. This form of the condition is the most common. Typical causes include diabetes, vitamin deficiencies and certain illnesses.

Neuropathy affects approximately 20 million Americans, yet the extent of it varies significantly depending on the cause, type and each patient’s unique case.

Symptoms of Neuropathy

Specific symptoms of neuropathy vary drastically from one patient to the next, primarily due to the location of the damage and the type of nerves that are affected.

Possible symptoms of neuropathy include:

  • Numbness, tingling and prickling in your hands, feet, arms and legs.
  • Freezing or burning pain.
  • Sharp, jabbing or throbbing pain.
  • Sensitivity to touch.
  • Coordination issues.
  • Weakness
  • Paralysis

Additional symptoms may occur when the autonomic nerves are affected. Those symptoms include:

  • Heat intolerance.
  • Changes in sweating.
  • Problems with bowel, bladder and digestive functions.
  • Blood pressure issues resulting in dizziness or lightheadedness.

Some complications can arise from neuropathy and include:

  • Burns due to the inability to feel changes in temperature.
  • Skin trauma due to numbness.
  • Infection, particularly in the feet, if you cannot feel injuries and leave them untreated.
  • Falls due to balance and coordination issues.

Diagnosing neuropathy often requires different tests to find the core cause. The diagnosis starts with a medical history and exam. This process helps the physician determine possible underlying conditions that could have led to neuropathy. Other possible tests include:

  • Neurological exams to look at reflexes, muscle issues, sensations and coordination.
  • Blood tests to diagnose diabetes, vitamin deficiencies and immune problems.
  • CTs or MRIs to identify tumors, herniated discs or other abnormalities.
  • Nerve function tests to measure the nerve’s response to electrical signals.
  • Nerve biopsy to check for abnormalities.
  • Skin biopsy to check for nerve fiber endings.

Determining if you have neuropathy, as well as the underlying cause of it, is the first step toward beginning a treatment plan to manage your symptoms, whether through traditional therapies or alternative ones, like medical marijuana.

Traditional Treatments for Neuropathy

Traditional treatments manage the actual cause of neuropathy. If an autoimmune disorder is to blame for the nerve damage, for example, the treatment might focus on managing that disease. Or, if you experience neuropathy due to a vitamin deficiency, your primary care provider will work on resolving that.

When resulting from a treatable condition, like a vitamin deficiency, the symptoms of neuropathy often decrease with proper treatment, such as by raising your vitamin levels through supplements.

Another important part of the treatment process is to manage the pain that often accompanies neuropathy. Pain relief is particularly helpful in cases where it’s difficult to treat the primary cause of neuropathy. Pain relief is available through a variety of treatments, including:

  • Transcutaneous electrical nerve stimulation (TENS)
  • Plasma exchange
  • Intravenous immune globulin
  • Physical therapy

Pain-relieving drugs are used to treat neuropathy pain in many cases as well. Over-the-counter drugs may work for mild cases of neuropathy. Those with more severe pain may need a prescription painkiller. Opioids may be prescribed. However, those medications come with some potentially dangerous side effects, including addiction.

In some cases, surgery helps correct conditions that cause neuropathy. Surgery, for instance, relieves pressure on the nerves when a tumor is pressing on them. By removing the pressure, doctors can help ease your neuropathy symptoms.

Why Medical Marijuana for Neuropathy Is Effective

One of the major benefits of weed is its pain-relieving effect. Research studies and anecdotal evidence show decreased feelings of pain in patients that use medical marijuana.

Medical cannabis appears to relieve various types of pain, including headaches, chronic pain and neuropathic pain. Taking marijuana may not cure the underlying condition causing your neuropathy, but it may help you manage the pain sensations.

Chemicals called cannabinoids, which are present in medical marijuana, interact with the body to provide pain relief. Tetrahydrocannabinol (THC) and cannabidiol (CBD) seem to have the greatest effect on pain. These two chemicals activate receptors in your body’s natural endocannabinoid system.

The endocannabinoid system is responsible for many functions in your body, including the immune system response that causes inflammation. Medical marijuana strains containing THC and CBD help the body lower pain levels by binding to the receptors of your endocannabinoid system to prevent inflammation which can make it easier to handle your neuropathy.

Another benefit of medical weed is its relaxing effect. Maintaining a relaxed feeling can help reduce the amount of pain you feel. You may also find it easier to sleep by using certain strains of cannabis that have a sleep-inducing effect. When combined with pain relief, the drowsiness may help you get a better night’s sleep.

Research on medical marijuana and neuropathy is limited because of federal regulations, but several studies show a positive correlation between cannabis use and pain relief for neuropathy.

The Neuropathy Journal highlights several studies about medical marijuana treatment for neuropathy, including:

  • A 2007 study that found HIV patients experienced reduced neuropathic pain.
  • A 2014 study from American Academy of Neurology that identified reduced pain, burning and numbness in multiple sclerosis (MS) patients.
  • A 2016 study that demonstrated medical marijuana might be an effective alternative to pain relievers for some people.

Medical cannabis may give you the pain relief you need to improve your quality of life. By minimizing or eliminating the pain, you’re able to go about your daily activities without debilitating pain. Reducing that pain makes you feel better overall so that you can enjoy life.

See how medical marijuana could help relieve your neuropathy sympotms. Find patient reviews on local doctors and information on treatment options.