NEUROPATHY: CAN ONE FIND RELIEF WITH CANNABIS?

Neuropathy

CAN ONE FIND RELIEF WITH CANNABIS?

BY DR. LASZLO MECHTLER

It is estimated that over one billion people globally suffer from neuropathy and its associated symptoms, making this condition an undeniable problem. Affecting approximately 30% of the US population alone, chances are you or someone you know will be diagnosed with neuropathy at some point during their lifetime. While most prevalent in those over the age of 50, neuropathy affects people of all ages. Tell-tale signs of this condition include tingling, numbness, pain, and muscle weakness. The underlying causes of neuropathy may be a result of trauma/ injury, prolonged nerve pressure, compression, inflammation, continuous/repetitive motions, use of certain medications, and/ or other diseases. The wide variety of underlying causes of neuropathy can make it challenging to treat, especially since these etiologies or causes tend to overlap. However, even if a cause is identified, successful pain management varies from individual to individual, requiring trials of various pharmaceutical interventions such as anticonvulsants (gabapentin), antidepressants (amitriptyline), opioid analgesics (oxycodone), analgesic lotions to find the most optimal multimodal therapeutic option. While these pharmaceuticals are often successful in treating the patient’s symptoms they can also come with a host of undesired side effects that may deteriorate the patient’s quality of life including but not limited to fatigue, cognition issues, and worst yet addiction. As such, patients and physicians are increasingly looking for other options that both treat the underlying symptoms and avoid the potential side effects associated with current pharmaceutical interventions.

This quest has led many physicians to depart from these so-called standard pharmaceutical interventions in favor of medical cannabis products (inclusive of marijuana and hemp preparations). This is possible as the more than 1,200 chemical substances found in/ on the cannabis plant, like other analgesics, act on receptors that lead to the perception of pain. In acting on these receptors cannabis is able to

block pain signaling and can either complement one’s current therapy which is not providing adequate relief or in some cases allow patients to completely replace current medications in their comprehensive care plan. Some of its known mechanisms of action include the inhibition of the cyclooxygenase-2 enzyme, increase in serotonin, inhibition of L-type calcium voltage-gated channel, and an increase in GABA, all mechanisms targeted by widely used analgesics today. As a result cannabis, ie. THC and CBD and the other 142 cannabinoids within the cannabis plant can provide therapeutic benefits by modulating various pathways of pain in the body. Though with its many chemical components the impact of cannabis goes far beyond just pain signaling and impacts the body in ways that are not yet fully understood. With limited clinical information regarding the use of medical cannabis in the treatment plans of those diagnosed with neuropathy, my team and I undertook a study evaluating clinical outcomes of more than 900 patients aged 22-90 in our clinic suffering from neuropathy who were using cannabis as part of their comprehensive treatment plan. The results were rather impressive with 85.0% of patients reporting symptom improvements. Furthermore, 25% of patients who were utilizing opioids were able to reduce their consumption. Of note was the low rate of side effects associated with cannabis use at 28% with the vast majority of these minor in nature. Only two patients discontinued cannabis therapy due to side effects which as a provider indicates not only do patients find clinically meaningful benefits, but that side effects associated with medical cannabis are well tolerated. I should also note that cannabis therapy was added to the patient’s current treatment plan, thus many were already established on standard

It is clear that cannabis therapy has a place in the comprehensive treatment plan of those suffering from neuropathies

pharmaceutical interventions. Initiation of cannabis therapy did allow for some patients to reduce or completely discontinue standard interventions such as gabapentin and pregabalin (Lyrica®). The vast majority of patients achieved these results using a single cannabis product which was typically a 1:1 (THC:CBD) tincture. When coupling these results with the many anecdotal reports of benefits, it is clear that cannabis therapy has a place in the comprehensive treatment plan of those suffering from neuropathies. Impacting patients of all ages and walks of life, the potential of this plant in this population is extremely promising, though randomized placebo-controlled trials are needed to fully elucidate how this therapy can be used in widespread clinical practice. Should one be interested in pursuing cannabis therapy as part of their care plan it is vitally important that they consult a knowledgeable clinician who is able to help guide their treatment decisions.

Laszlo Mechtler

MD, FAAN, FEAN, FASN, FAHS

Medical Director, DENT Neurologic Institute Chief, Neuro-Oncology Roswell Park Cancer Institute Medical Director, Jushi Dr. Laszlo Mechtler is Professor of Neurology and Oncology at the State University of New York at Buffalo. He is UCNS certified in Neuroimaging, Neuro-Oncology and Headache Medicine. Dr. Mechtler is the Medical Director of the DENT Neurologic Institute.