Cannabis for Peripheral Neuropathy: Upsides, Downsides, and Unknowns

Many of us are familiar with the terms “neuropathy” or “peripheral neuropathy”: Damage to nerves outside the brain and spinal cord. Peripheral neuropathy often presents as weakness, numbness, tingling or pain in the extremities and it’s a major health concern. It’s currently estimated that some 20 million Americans suffer from neuropathy, though the actual number may be much higher. 

As such, neuropathy treatment is a high priority amongst clinicians, and one potential treatment—using medical cannabis—is causing a good deal of excitement in the world of pain management. Given the cannabis plant’s demonstrated pain-fighting properties, cannabis and neuropathy would seem to be a natural fit. But thus far, the research is mixed, with some positive outcomes, some less good, and some remaining to be fully understood.

That said, if you or someone you love suffers from peripheral neuropathy, you may want to consider the use of cannabis to manage the symptoms. In today’s article, we’ll share the latest research on the condition, as well as suggesting some possible routes of treatment involving cannabis and neuropathy.

Neuropathy: Roots of a Potentially Debilitating Nerve Disorder

As we hinted above, peripheral neuropathy often presents as painful or unusual sensations in the hands and feet. The symptoms can range from a gentle tingling to painful, stabbing pain that makes it difficult to focus on anything else. They might include:

• A gradual onset of numbness, prickling, or tingling in your feet or hands, which can spread upward into your legs and arms
• Sensations of sharp, jabbing, throbbing, or burning pain
• An extreme sensitivity to touch
• Pain during activities that normally don’t cause pain, such as pain in your feet when putting weight on them or when they’re under a blanket
• Lack of coordination and unexplained falling
• Generalized muscle weakness
• A feeling like you’re wearing gloves or socks when you’re not
• Potential paralysis if motor nerves are affected

Neuropathy can result from any of several causes, including:

• Diabetes: Statistically, more than half of people with diabetes develop neuropathy
• Vitamin deficiencies: Healthy nerves depend on vitamins B1, B6, and B12; vitamin E, and niacin 
• Traumatic injuries: Injuries from vehicle accidents and other causes can damage or sever nerves
• Infections: These include Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, and HIV/ADS
• Autoimmune diseases: These include Sjogren’s syndrome, lupus, rheumatoid arthritis, and several others
• Congenital (inherited) causes: Disorders such as Charcot-Marie-Tooth disease are inherited forms of neuropathy
• Exposure to toxins: Industrial chemicals, pesticides, and heavy metals such as mercury or lead can cause neuropathy

Physicians use several types of diagnostic tests to determine the cause of the neuropathy. These may include a standard blood test to uncover vitamin deficiencies, diabetes—a major risk factor for peripheral neuropathy—abnormal immune system function, and other causes. Additionally, specialized tests such as electromyography (EMG) can record electrical activity in your muscles to determine if you’ve suffered nerve damage. 

What if these tests uncover nerve damage? Unfortunately, nerves take a long time to heal, and sometimes the injuries are so severe that a complete recovery isn’t possible. At present, the standard neuropathy treatment models follow several lines, including medication-based and therapeutic interventions. At present, the standard medications used to treat symptoms of neuropathy include:

Pain relievers: One common approach centers on the use of over-the-counter NSAIDs such as ibuprofen to combat mild pain. In more extreme cases, doctors may prescribe prescription painkillers such as tramadol or oxycodone. Unfortunately, these drugs come with the risk of dependence and/or addiction, not to mention other side effects such as lethargy or disorientation. 

Anti-seizure medications: These drugs—including gabapentin and pregabalin, an anti-epilepsy drug—may relieve the symptoms of neuropathy. However, their side effects include drowsiness and dizziness.

Topical creams: Perhaps surprisingly, topicals containing capsaicin—the active ingredient in hot chili peppers—can provide relief from symptoms of neuropathy. However, some patients find they can’t tolerate the mild burning sensation imparted by such creams. Alternatively, lidocaine patches can provide spot relief at the site of symptoms, though their side effects can include drowsiness, dizziness, and numbness at the site the patch is applied.

Antidepressants: Interestingly, some antidepressant medications—including amitriptyline, doxepin, and nortriptyline—can relieve the pain associated with peripheral neuropathy by interfering with pain-sensing mechanisms in the brain and spinal cord. In addition, the serotonin and norepinephrine reuptake inhibitor duloxetine and the time-release medication venlafaxine can also mitigate the pain of peripheral neuropathy brought on by diabetes. Side effects of such drugs can include nausea, dizziness and drowsiness, and decreased appetite, among others.

Cannabis and Neuropathy: Hope for an All-Natural Treatment?

Sadly, many patients feel that the standard neuropathy treatments are lacking in effectiveness, especially taking into account the sometimes onerous side effects. This brings us to the topic of cannabis and neuropathy. As we referenced earlier, given the demonstrated pain-fighting effects of many of the compounds in cannabis, it might seem that medical cannabis was the obvious choice for neuropathy treatment. Is it? Here’s what the current research tells us:

Upsides: Overall, research supports the hypothesis that cannabis can provide effective and sustainable relief from neuropathic pain. One study from 2009 found that cannabis helped control such pain, as well as improving mood and daily functioning. A similar paper published the following year found that cannabis reduced the intensity of pain while improving quality of sleep. 

Downsides: Like any medication, cannabis does impose its own side effects. One study on cannabis and neuropathy found that while the intensity of pain was markedly reduced, at high doses, some test subjects experienced cognitive impairments in learning, attention, memory, and psychomotor speed. Other studies appear to confirm this, with those subjects using higher-potency smoked cannabis experiencing proportional side effects including throat irritation, headache, dizziness, and fatigue. 

Unknowns: To some extent, the side effects reported in such cannabis and neuropathy trials are unsurprising, given the known effects of cannabis ingestion. But what isn’t as clear is whether or not using other routes of administration besides smoking—for instance, cannabis oral solutions, tablets, or other forms—would help relieve some of the negative side effects, particularly those associated with inhaling its smoke.

What’s more, while the administrators of some of the studies we cited adjusted test subjects’ dosages during the course of the trials, we know from our long experience designing effective cannabis-based therapies that finding the ideal dosage often takes time, patience, and a willingness to experiment to find the optimal results for each person’s goals, needs, and personal physiology. 

If you or a loved one is interested in pursuing cannabis-based neuropathy treatments, one thing to keep in mind is that cannabis is biphasic, meaning that its effects vary based on dosage. And as several studies have demonstrated, most of us experience greater relief from symptoms by using less cannabis.