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Neuropathic (nerve) pain

Cannabis has been used to treat neuropathic, i.e. nerve pain {call-out, text:Pain caused by damage or disease affecting the somatosensory nervous system} associated with diabetes, HIV, or other causes. Diabetes – One study on cannabis and neuropathic pain symptoms associated with diabetes found a dose-dependent reduction in pain intensity in response to inhaled cannabis in patients with diabetic peripheral neuropathy.1 The strongest effects on pain reduction were seen at the highest dose of flower containing 7% THC. A study by Selvarajah and colleagues using a commercial cannabis oromucosal spray containing THC:CBD in a 1:1 ratio, however, showed no improvements in diabetic patients.2 HIV – In a study by researcher Abrams and colleagues, HIV-positive patients found relief from pain by smoking one cigarette of cannabis flower containing 3.56% THC three times per day.3 Other causes – There have also been studies with patients that suffer from neuropathy related to other causes. Generally, these studies also suggested improvements in nerve pain measures associated with taking cannabis.4, 5 Most studies have been performed with a commercial oral-mucosal spray nabiximols (Sativex) containing THC:CBD in a 1:1 ratio and generally showed positive results on pain relief.6, 7, 8 If the starting dose of 2.7 mg THC + 2.5 mg CBD was not effective, patients could try higher doses (up-titrate) until they found the effective dose, or until they could not tolerate the side-effects (see titration schedule). References:
  1. Wallace, Mark S.; Marcotte, Thomas D.; Umlauf, Anya; Gouaux, Ben; Atkinson, Joseph H. (2015). Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. Journal of Pain, 16(7), 616--627.
  2. Selvarajah, Dinesh; Gandhi, Rajiv; Emery, C. J.; Tesfaye, Solomon (2010). Randomized Placebo-Controlled Double-Blind Clinical Trial of Cannabis-Based Medicinal Product (Sativex) in Painful Diabetic Neuropathy: Depression is a major confounding factor. Diabetes Care, 33(1), 128--130.
  3. Abrams, D. I.; Jay, C. A.; Shade, S. B.; Vizoso, H.; Reda, H.; Press, S.; Kelly, M. E.; Rowbotham, M. C.; Petersen, K. L. (2007). Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology, 68(7), 515--521.
  4. Koppel, B. S.; Brust, J. C. M.; Fife, T.; Bronstein, J.; Youssof, S.; Gronseth, G.; Gloss, D. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(17), 1556--1563.
  5. Whiting, Penny F.; Wolff, Robert F.; Deshpande, Sohan; Di Nisio, Marcello; Duffy, Steven; Hernandez, Adrian V.; Keurentjes, J. Christiaan; Lang, Shona; Misso, Kate; Ryder, Steve; Schmidlkofer, Simone; Westwood, Marie; Kleijnen, Jos (2015). Cannabinoids for Medical Use. Jama, 313(24), 2456.
  6. Langford, R. M.; Mares, J.; Novotna, A.; Vachova, M.; Novakova, I.; Notcutt, W.; Ratcliffe, S. (2013). A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis. Journal of Neurology, 260(4), 984--997.
  7. Nurmikko, Turo J.; Serpell, Mick G.; Hoggart, Barbara; Toomey, Peter J.; Morlion, Bart J.; Haines, Derek (2007). Sativex successfully treats neuropathic pain characterised by allodynia: A randomised, double-blind, placebo-controlled clinical trial. Pain, 133(1), 210--220.
  8. Serpell, M.; Ratcliffe, S.; Hovorka, J.; Schofield, M.; Taylor, L.; Lauder, H.; Ehler, E. (2014). A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment. European Journal of Pain, 18(7), 999--1012.