What is neuropathic pain? This is the type of pain that is generally caused by and originating in the nerves themselves. It is from damage to the peripheral nervous system due to illness, injury, or disease. Neuropathic pain is often chronic and can encompass anything from a mild disturbance that is quite tolerable, or it can become disabling or totally incapacitating. Symptoms can be burning, tingling, numbing or shooting pain sometimes accompanied by muscle weakness. Neuropathic pain can occur spontaneously, unlike nociceptive pain. Nociceptive pain, in contrast, originally occurs as a result of an accident or bodily injury or trauma and can diminish in time through healing. Chronic back pain, arthritic joint pain, MS, fibromyalgia, sciatica, diabetic neuropathy, and a host of other diseases can cause neuropathic pain. Inflammatory pain is a direct result of inflammation and can also be contributing to neuropathic pain. Often chronic and quite painful, patients with neuropathic pain will often require several modes of therapy to achieve the highest rate of success. This would include regular medical supervision, chiropractic care, surgery, laser therapy, acupuncture, physical therapy, OTC or prescription medications, narcotic analgesics, yoga, meditation, use of topical creams and lotions, and use of alternative medicines such as cannabis. Other treatments are also employed in desperate individuals or cases of severe pain.
The use of medical cannabis for neuropathic pain is an important topic for researchers around the globe, and also a common condition for patients who receive certification in Maryland. This mode of organic plant therapy using cannabis can be provided through the certified cannabis providers in our state. Numerous groups and organizations are conducting research in test tubes with animal models, and also using humans in regard to treating pain. For example, in some of my own research with the International Cannabinoid Research Society, in conjunction with the Imperial College of the UK and the International Association for the Study of Pain (I.A.S.P.), we are extracting data from studies worldwide on pain. One such study “Actions of the FAAH inhibitor URB597 in neuropathic and inflammatory chronic pain models” from Sydney Australia is one of the thousands being analyzed by researchers, most of which are using mice or rat models. This study indicates that if you inhibit the enzyme FAAH, then the action of cannabinoids on the CB1 and CB2 receptors provides extended analgesia in inflammatory pain states in animal models without any psychoactive side effects. However, it should be noted that in some cases the psychoactive effects directly contribute to pain reduction through both inhibition of pain transmission at the neuronal level, and can also act as a mental distractor for pain.
Generalized guidelines for prescribing medical cannabis for pain can be difficult and somewhat experimental due to the wide variety of pain types and each individual’s response. In addition, there are many compounds in cannabis that aid in the overall reduction in pain (cannabinoids, terpenes, flavonoids, plant phenols, sterols, etc..) and each patient can respond differently to each specific compound.
Both THC and CBD are analgesics and have been shown to relieve pain through several different mechanisms. Also, there are therapeutic effects from other cannabinoids such as cannabichromene, for example, and the terpenoid beta-caryophyllene. Rapid relief of some types of neuropathic pain can be accomplished by vaping or smoking. Often it is best to combine cannabis with a small dose of OTC pain relievers like Tylenol or ibuprofen. Cannabis and CBD in particular can potentiate pain medicine and allow it to be more effective, or allow a lower dose of the pharmaceutical agent. This mechanism of action where CBD can potentiate other pain medicines, including narcotics, is due to competitive enzyme inhibition. In simple terms, the enzymes (CYP40 groups) that metabolize most pain medicines are also used to metabolize CBD. Therefore, if you take CBD concurrently with pain medicine, the metabolism of the pain medicine is inhibited because the enzyme also has to metabolize the CBD and this allows less enzyme to breakdown the pain medicine thus prolonging its blood level and increasing its effectiveness. Caffeine also can help relieve pain when taken with other analgesics.
A more prolonged effect to reduce pain can be achieved with cannabis edibles or tablets. Topical application of THC: CBD creams with a 1:1 ratio can often be effective when applied to a painful joint or vertebrae. RSO, or Rick Simpson Oil, is a strong cannabis derivative that can also be a potent agent to treat neuropathic pain but may have unwanted side effects predominantly due to the high THC content. Some medical patients using cannabis for pain will require a high dose of THC. This can be referred to as the MTD, or maximum tolerated dose. With cancer patients, sometimes it is necessary to use a large THC dose – the MTD- to achieve pain relief. This dose of THC is often limited because of excess psychoactivity and can range from 5 -200 mgs. In cases of CBD, there is no associated psychoactivity therefore large doses are quite tolerable – for example 50 -1,000 mg. It is also interesting to note that high doses of THC are better tolerated for psychoactivity when administered with an equal or greater amount of CBD.
The response of patients to the use of cannabinoids for chronic neuropathic pain is widely varied. The majority of individuals obtain moderate pain relief through the use of medical cannabis, but it can take time and experimentation to determine the best dose and specific mix of plant compounds for each patient. In some cases, direct pain reduction is minimal, but I have seen many patients have noticed a more favorable sleep pattern and thereby reduce their pain in general due to increased rest and rejuvenation. In other cases, patients will report a strong reduction in pain, often comparable to prescription medications but without the negative side effects. Cannabis should be considered to be an adjuvant or supplemental therapy, and often best used in conjunction with other drugs or therapies for maximum relief of neuropathic pain.
Dr. Stanley R. Manstof
12201 Greenridge Drive
Boyds, Md. 20841
*MMCC Certified Provider
*American Academy of Cannabis Physicians
*Member Americans for Safe Access
*Technical Writer and Editor
*Member Society of Cannabis Clinicians
*International Cannabinoid Research Society
*Certified Patient Caregiver
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