Peripheral neuropathy is a generalized term for diseases that affect the nerves outside the brain or spinal cord. Damage to these nerves can express as numbness, burning sensations, pins and needles and/or sensory sensitivity (enhanced pain from heat, cold or touch). Neuropathic pain is different from inflammatory pain because it arises out of damage to the nervous system. Diseases that can cause neuropathic pain include Parkinson’s disease, diabetes, shingles, MS, or HIV. Chemotherapy treatment can cause neuropathic pain from the treatment’s destructive nature, as the human body loses cells alongside the cancer cells. Neuropathy is difficult to treat; it is not the direct result of inflammation like that of a physical injury or arthritis. If neuropathy was the direct result of inflammation responses, treatments like NSAIDs or steroids would be effective. Neuropathy from HIV or chemotherapy has poor clinical outcomes when treated with common prescription medications: gabapentin, antidepressants, SSRI’s or opioids.(1-3)
To elucidate the neuropathic pain-relieving effects of cannabis, let’s take a look at the results of human clinical trials testing inhaled cannabis for HIV sensory neuropathy (HIV-SN).
1. Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial.
In 2007, UC San Francisco conducted a study testing inhaled cannabis’ pain-relieving effects on HIV-associated sensory neuropathy with 50 patients completing the trial. The double blind, placebo-controlled study had randomly-assigned patients smoke 3.56% THC cannabis joints or
identical placebo joints with zero THC. The subjects ingested three pre rolled joints (every day) for five days. Smoked cannabis reduced daily pain by 34% with no serious adverse events reported. After the first smoked cannabis pre-roll, pain was initially reduced by an average of 72%, with an overall daily pain reduction of 34%.
2. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial.
In 2009, UC San Diego conducted a double blind, placebo-controlled study onHIV-SN-qualifying patients who were unresponsive to at least two analgesics (gabapentin and opioids). Patients continued using standard therapy for their HIV-SN while adding cannabis. Patients started at 4% THC and then titrated up to 8% or down to 1% THC based on their tolerability to cannabis, as determined by feedback from the participants. The 28 participating patients averaged 30% overall pain reduction.
3. Cannabis for peripheral neuropathy: The good, the bad, and the unknown.
In 2015, an article in The Cleveland Clinic Journal of Medicine reviewing clinical trials of human cannabis use in treating neuropathic pain was published, of which the two HIV-SN trials mentioned above are cited. The other trials included neuropathy from trauma, diabetes and spinal cord injury. Every trial used inhaled whole-plant cannabis for measuring immediate pain relief. The review found that one out of every five patients treated with cannabis had a 30% pain reduction in neuropathic pain.
Cannabis, as seen in human clinical trials, is a promising treatment option for neuropathic pain from HIV-related neuropathy. The researchers in these trials used THC-rich cannabis (with no reported CBD content), measuring an average pain reduction of 30%. An increasing number of
chronic pain sufferers are turning to cannabis as a source of pain relief with fewer side effects then alternative prescription options. While THC-only cannabis products are effective pain relievers, optimal pain relief often contains CBD, with a measurable synergistic pain-relieving effect when combined with THC.(3) CBD-rich cannabis products with low to moderate THC content may provide better long term treatment options for chronic neuropathic pain.(3)
These statements have not been evaluated by the FDA. Nothing said, done, typed, printed or reproduced by Torrey Holistics is intended to diagnose, prescribe, treat or take the place of a licensed physician.
References:
1. Abrams, D. I., Jay, C. A., Shade, S. B., Vizoso, H., Reda, H., Press, S., … Petersen, K. L. (2007). Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo- controlled trial. Neurology, 68(7), 515–521. https://doi.org/10.1212/01.wnl.0000253187.66183.9c
2. Ellis, R. J., Toperoff, W., Vaida, F., Van Den Brande, G., Gonzales, J., Gouaux, B., …Atkinson, J. H. (2009). Smoked medicinal cannabis for neuropathic pain in HIV: A randomized, crossover clinical trial. Neuropsychopharmacology, 34(3), 672–680. https://doi.org/10.1038/npp.2008.120
3. Modesto-Lowe, V., Bojka, R., & Alvarado, C. (2018, December 1). Cannabis for peripheral neuropathy: The good, the bad, and the unknown. Cleveland Clinic Journal of Medicine. Cleveland Clinic Educational Foundation. https://doi.org/10.3949/ccjm.85a.17115
