Neuropathy is a painful, often debilitating condition caused by nerve damage. As we'll soon see, the origins for neuropathy are diverse, but the symptoms are uniformly agonizing no matter the origins of the disease.
Neuropathic pain merits it's own section outside of other chronic pain because of the unique comorbidity of the pain of neuropathy and other emotional and cognitive symptoms. Sleep disturbances (37%-60% prevalence), cognitive impairment (11.4% prevalence), emotional disorders (33%-42% prevalence), pain-related fear, or deficits in social behavior are all comorbid manifestations of neuropathic pain (source) (source) (source).
On top of that, neuropathic pain patients have lower labor productivity, use more health resources, and are more likely to develop mental disorders compared with those with other chronic pain (source).
In this article we'll cover the basics on neuropathy, including causes, symptoms, and current acceptable treatments. Then we'll talk about the role of the endocannabinoid system in the nervous system, and how we can use cannabis hemp/CBD to supplement the endogenous endocannabinoids and bring our nervous system back to homeostasis.
At the very end, we'll go over specific products that neuropathic pain patients have seen improvement with as well as where to get them.
Let's get started. As always, feel free to skip ahead using the table of contents below.
Nerve damage resulting in neuropathy can come from many different origins. Most cases of neuropathy are the result of another underlying condition such as diabetes, or the result of the treatment of an underlying condition, like chemotherapy.
While the type of neuropathy will depend on (1) how many nerves are affected, and (2) how far away from the brain and spinal cord the nerves are located.
Contrarily, while the types and causes of neuropathy span a wide range of possibilities, the symptoms of neuropathy are mostly uniform.
First let's talk about the types of neuropathy you may be experiencing.
Types of Neuropathy
The popular terminology for neuropathic pain is confusing, so I wanted to take a second to lay out the different types of neuropathy, and highlight the types that we'll focus on in this article and throughout the website. (Note: There are 100's of identified types of neuropathy. We are only covering the largest buckets here)
- Peripheral Neuropathy - this type of neuropathy is characterized by the damage of nerves located rather far away from your brain and spinal cord. Peripheral neuropathy is seen in the outer limbs of the body like your feet and hands.
- Proximal Neuropathy - a subset of peripheral neuropathy, this type involves nerve damage at your thighs, hips, glut area, and shoulders is usually referred to as proximal neuropathy.
- Cranial Neuropathy - cranial neuropathy occurs when any of the twelve cranial nerves (nerves that exit from the brain directly) are damaged. For example, damage of the optic nerve would result in optic neuropathy.
- Autonomic Neuropathy - this type of neuropathy occurs when the nerves in your autonomic nervous system (the heart, digestion, sweat glands, bowel and/or bladder, etc) are damaged.
- Motor Neuropathy - this type of neuropathy occurs when motor nerves are damaged, leading to weakness and loss of motor control.
- Sensory Neuropathy - when sensory nerves are damaged, tingling, burning, and other painful sensations occur.
- Focal Neuropathy - also called mononeuropathy, this type is characterized by the damage of a single nerve, as opposed to polyneuropathy, where more than one nerve is damaged. One type of mononeuropathy would be optic neuropathy (mentioned above), given the assumption no other nerves are damaged.
We could definitely break it down further, but that's outside the scope of this article. It's important to note that the first three types of neuropathy has to do with location, while the next three are categorized by the type of nerve damaged. The last type indicates how many nerves are affected.
***You could have a case of peripheral neuropathy affecting the autonomic nerves. This would be called autonomic peripheral neuropathy. If both motor and sensory nerves were affected, this would be called sensorimotor polyneuropathy.***
The types of neuropathy that we're most concerned with are peripheral and proximal neuropathy. For our purposes, we will refer to both of these types of neuropathy as peripheral neuropathy, as both types occur away from the brain stem and spinal cord (Medicine Plus). Just know that we can further distinguish between neuropathic pain occurring in our most outer extremities, and pain occurring closer to the core of the body.
The remaining content in this article will be concerned with peripheral neuropathy, although most of the principles outlined can apply to any of the above types.
Next we'll talk about the causes of peripheral neuropathy.
Peripheral Neuropathy Causes
There are a lot of ways nerve damage can come from. Even so, most of the people we see who complain of neuropathic pain come for just a few originations (Foundation for Peripheral Neuropathy):
- Diabetic Peripheral Neuropathy - cases of peripheral neuropathy originating from diabetes accounts for 60% of all cases of neuropathic pain.
- Idiopathic Peripheral Neuropathy - 23% of cases involve neuropathic pain of unknown origin.
- Chemotherapy-induced Peripheral Neuropathy - 10% of Americans are suffering from chemo-induced neuropathy.
- Aids/HIV-induced Peripheral Neuropathy - 2% of all cases of neuropathy can be traced back to HIV or HIV/Aids drug treatments.
The remaining 5% of all cases of neuropathy can be attributed to the many other causes of nerve damage:
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Peripheral Neuropathy Symptoms
The painful symptoms of peripheral neuropathy are unique and hard to miss. According to The Foundation for Peripheral Neuropathy, the most reported primary symptoms include:
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How many of the above symptoms, and at what intensity, you will experience depends on the nerves damaged. For example, it's unlikely you'll have abnormal sweating patterns if only sensory nerves are damaged. In that case, you'll experience most of the symptoms listed above that involve the senses.
However, more likely than not you'll have damage in more than one type of nerve, leading you to experience any of the symptoms above.
Risk Factors For Peripheral Neuropathic Pain
Even if you don't have a full-blown case of neuropathy right now, you may be showing some signs of pre-neuropathy. If that's the case, these risk factors are even more important for you to know so you don't accelerate the progression of your neuropathy.
Risk factors that contribute to nerve damage and the development of peripheral neuropathy are as follows (Mayo Clinic):
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As you can see, most of the risk factors (but not all) correspond directly to causes mentioned above and eventual development of peripheral neuropathy. If you have one or more of the above risk factors, make sure you do everything you can to bring down the risk factors that are under your control, and begin a program of prevention to halt the probably progression of neuropathic pain.
And although most neuropathies are incurable, some of the damage can be reversed IF you catch it early.
The Research: Neuropathy & The Endocannabinoid System
The endocannabinoid system plays an important role in pain control and the physiopathology of neuropathic pain. The mechanisms underlying the manifestation neuropathic pain are complicated and only relevant if you're a molecular biologist. Once neuropathic pain is present, the endocannabinoid system is involved in it's modulation in the following ways:
- In the brain, specifically the thalamus, CB1 receptors are responsible for reducing the number of pain messages your brain will receive and process, whereas in the cortex and limbic system, CB1 receptors are responsible for modifying the emotional and cognitive components of neuropathy.
- In the brain stem, CB1 receptors inhibit the number of pain messages sent out to the body.
- At the spinal cord level, CB2 receptors are thought to be responsible for reducing nerve's sensitivity to stimuli.
- Lastly, but perhaps most relevant, is the role of CB2 in inhibiting the transmission of pain signals to the brain.
The presence of the endocannabinoid system in the nervous system and immune system means that exogenous (external) cannabinoids (like from cannabis) can be used to facilitate normal neuropathic pain modulation, and strengthen anti-pain mechanisms in the body.
Most of the clinical studies done evaluating the effectiveness of cannabis is done with synthetic cannabinoids developed in laboratories and sanctioned by our federal bureaucracy. Even so, most trials have demonstrated the possible effectiveness of cannabinoids to treat neuropathy.
Trials conducted with whole cannabis show great promise, such as a 2008 human double-blind study of smoked cannabis and a placebo which resulted in positive analgesic effects with peripheral neuropathic pain (source).
A UK study in 2004 using Sativex THC:CBD in a 1:1 ratio delivered as a spray resulted in a mild reduction of neuropathic pain, improved sleep, and no major adverse side effects, whereas whole-plant extracts containing CBD:THC in a sublingual spray produced significant pain relief (source) (source).
Before giving you product recommendations, let's go over the currently accepted treatments for peripheral neuropathy and see how they hold up next to cannabis treatments.
How Cannabis Hemp/CBD Compares to Modern Medicine
Current medication for treating neuropathy is only moderately effective. Every FDA approved medication for neuropathy comes with occasionally intolerable side effects. What follows are all the current treatments for neuropathic pain (even unconventional treatments).
Medication
Oral
As is usually the case, most of the currently approved medications aren't uniformly successful in treating the conditions they're approved for, and comes with a host of unwanted adverse side effects. Current oral medications used include (eMedicine Health):
- OTCs: Over the counter medication
- Antidepressants - The tricyclic antidepressants amitriptyline (Vanatrip), imipramine (Tofranil, Tofranil-PM), and desipramine (Norpramin, Pertofrane) as well as other antidepressants such as duloxetine (Cymbalta), venlafaxine (Effexor, Effexor XR), bupropion (Wellbutrin), paroxetine (Paxil), and citalopram (Celexa). Duloxetine has been approved by the U.S. Food and Drug Administration (FDA) specifically for treating diabetic peripheral neuropathy.
- Anticonvulsants - pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR), and lamotrigine (Lamictal). Pregabalin has been FDA-approved for the treatment of diabetic neuropathy.
- Opioids - controlled-release oxycodone and tramadol (Ultram) (limited efficacy)
Topical
Topical medications are usually used as a secondary treatment in addition to the above medications. Those commonly used include:
- Capsaicin cream
- Lidocaine patches (Lidoderm, Lidopain)
Other Current Treatments
Many patients see little to no relief using oral or topical medications, leading them to seek alternative solutions.
- Acupuncture
- Surgery
- Spinal or peripheral nerve stimulation (Neuromodulation)
- Physical Therapy
- Braces and other orthotics
The Verdict
In terms of safety, convenience, and cost, CBD and other cannabis therapies seem to be a good gamble, especially if you're currently experiencing painful neuropathy without an effective treatment method. According to studies, cannabis based medicines are as effective, or more effective than traditional treatment options with no harmful side effets. There are some concerns about the mental effects of high-THC cannabis on neuropathy patients, and so dosing should be done carefully, with precision, and with close attention to cognitive changes after dosing.
Tips For Treating Neuropathy With Cannabis
Now that we know CBD can be effective for neuropathic pain, let's talk about the specifics. We'll go over which strains you should look out for (if possible), the best delivery methods for treating neuropathy, and which type of delivery method you should go with.
If you're currently taking opioids right now for neuropathic pain, don't worry about that. A number of studies have shown that using CBD can reduce the amount of opioids needed and all the complications that come with taking high doses of opioids. You and your doctor can talk about weaning off of opioids as the effects of CBD on your body become more apparent.
First, let's go over some factors that you should keep in mind if you can, and then we'll talk about the different ways you can take CBD for neuropathy. These are simply the mechanisms the medicine can take to alleviate your pain. Once we go over the delivery methods, I'll immediately recommend a few different products you might want to go with.
Strains, Terpenoids, & Cannabinoids For Neuropathathic Pain
As with most conditions that can be treated with cannabis, the main players are THC and CBD. According to Cannabis Pharmacy, "high-CBD varieties work particularly well for neuropathic pain, while high-THC varieties may be better for general distraction from conventional pain or sleep support."
Strains with high concentrations of CBD include Harlequin, Cannatonic, and ACDC. An added benefit to using strains with a high concentration of CBD is the reduction of the intoxicating effects brought on by THC. These strains may also provide anti-inflammatory benefits and specifically enhance neuropathic pain relief. Other strains with even lower THC content may be warranted if intoxication is a no-go. In this case, try ACDC.
Other cannabinoids such as CBG have demonstrated analgesic effects and can enhance the effectiveness of your medicine.
In terms of terpenes, Myrcene has known analgesic and sedating properties. Beta-caryophyllene is also a powerful anti-inflammatory and works synergistically with THC. If THC isn't an issue for you, try Purple strains with high levels of linalool to get added benefits of anxiety reduction and more analgesia.
Now let's talk delivery methods.
CBD Dosing For Neuropathy
Getting relief from neuropathy using cannabis based medicines is not an exact science. Some of our readers come to us with stories of near instant relief. Most of the testimonials we hear are from individuals who've been taking CBD for more than 2 weeks. We recommend experimenting with your dosage for at least one month. Start low, and titrate up daily until you get the relief you're looking for. Some people feel relief after 2mg of cannabis. Others take 40mg-120mg every day.
Starting low will ensure you don't spend more money than absolutely necessary, you don't build up a tolerance that lowers the efficacy of your treatment, and it ensures you don't accidentally consume an amount that will result in the opposite effects of what you're looking for. What too much is depends on everyone, which is why we can only say: start low, go slow.
If you don't have any experience with cannabis, start at 2mg. If you do, start at 10mg. Then increase your dose every couple of days by 20%, or everyday by 5%-10%.
Best Delivery Methods For Neuropathic Patients
The four methods you'll want to consider for neuropathic pain are oral-mucosal, inhalation, ingestion, and topical. Which you choose depends on your own individual symptomatic experiences and personal preferences regarding inhalation.
It's likely that you'll get the best results by combining two of the methods; probably a topical and another method. We recommend going with just one at first, and then supplementing your treatment with an additional delivery method.
If you're not against inhaling vapor, starting with an inhalation product could be your best starting point, as it's been recorded that inhalation is one of the most preferred delivery methods because of how fast it hits your blood stream. Also, it's easy to evaluate the effects right away. You can take a dose, wait 15 minutes, and take another one.
Although clinicians say that you should only use the inhalation method when you don't see benefits from other mediations, but we believe that may be left over bias from ancient preconceived notions and disapproval of recreational use.
If you would rather not smoke, then starting with a tincture is your best bet. Even if you're new to cannabis, we recommend starting with a 500mg bottle for neuropathy. If you do have cannabis experience, a 750mg or even a 1000mg bottle to start.
For peripheral neuropathy in your hands or feet, topical products can help you find some additional relief. You can apply them as often and as liberally as you want.
Lastly, if you're having trouble sleeping through the night, or if you feel like you need medicine that stays in your system longer, taking a capsule, or eating a gummie is just the ticket for you. Edibles last longer and are converted into a metabolite that's stronger than the original cannabinoids. The downside to edibles is an inability to control your experience once you've taken the dose. If you take too much and have a bad experience, there's nothing you can do but hang on and ride it out. It's going to suck, but no one dies or is harmed by the experience. Even if you have experience with cannabis, start at the smallest possible dosage when consuming edibles.
So we know what our optimal delivery methods are, and we know how to start the dosing. Instead of sending you off to fend for yourself, I'm now going to provide a list of recommended products based on our research, and our readers' experience with the product's ability to treat neuropathy.
Recommended Hemp/CBD Products for Neuropathy
The products listed below aren't the only medications that can be effective in treating neuropathy. They are products with at least one anecdotal record of someone reporting success using it to treat some kind of neuropathic pain.
We've given you one option for each delivery method discussed in the previous section. Unless otherwise indicated, all products come in a variety of quantities and strengths. If you want to go stronger or not as strong as the product shown, you'll be able to change your options once you get to the retailers website. For a larger selection of products, see our recommended products page.
Endoca makes capsules with up to 50mg of CBD in each. We recommend going with capsules instead of softgels to start out since capsules can be taken apart, and the internal contents removed to experiment getting your exact right dose. These capsules are full-spectrum, CO2 extracted, and vegan.
Elixinol's new rapidly dissolving Hemp Oil Liposomes recent enhancements to cannabinoid delivery. Liposomes are carriers of hemp oil – they ensure it can pass through bodily membranes with ease. Liposomal CBD can be mixed with water or taken directly under the tongue as a spray.
4 Corners's vape liquid comes in three concentrations. Their 1,000 mg “Orange Label” bottle can fill a 1.5 ml vape cartridge 20 times. If you don't have a cartridge, you'll need to buy some hardware, which they recommend getting here. This vape product is made with VG, not PG. Use code TUP10 to get 10% off your purchase.
Koi's CBD lotion sounds more like a skin care product than a pain reliever, but multiple verified buyers left reviews raving about the difference it made in their nerve pain. This lotion is made with CBD isolate, meaning there's zero THC, but that doesn't matter as much since this product won't enter your blood stream.
More Posts About Cannabis Hemp/CBD & Neuropathy
Want more? See the list below for more posts about using CBD for peripheral neuropathy.
CBD and Neuropathy: Almost Magical Pain Relief Benefits
This post was last updated on 9/10/2018. Burning fingertips, sensations of walking on glass, and sleepless nights. Living with neuropathic pain is no way to live at all. Yet thousands of people like you and me have to deal with, largely unpredictable, bursts of pain. You’re not alone if you feel like your whole life…
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