There are several ways to use medical cannabis. These include oral, sublingual, vape, smoke, and topical. In many cases, patients use one method of administration only. In this case study, we present a patient who successfully used cannabis oil sublingually and topically to alleviate pain from a trapped nerve. Sublingual dosing of cannabis oil occurs when it is placed under the tongue. Topical treatment means applying cannabis oil to the skin where it can be absorbed at the site of the problem. In general, topical application is used for pain relief or relief of skin conditions.
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Neuropathic Pain

At Weedwell™, pain is one of the most common reasons people consider cannabis therapy. Pain can come in many ways and from a multitude of conditions. One example of a type of pain is neuropathic pain. This common type of pain is the result of a problem that directly affects nerves. It is often chronic, meaning it lasts more than 6 months. Typically, the nerves produce a type of pain that is described as burning, stabbing or shooting. It can also be accompanied by numbness and tingling.

A 64-year-old patient came to Weedwell™ seeking pain relief. There was burning pain felt in the elbow, wrist and hand. The patient was hoping cannabis could help relieve the pain so surgery could be avoided.

Clinical Exam:

To begin the process, the doctor explored the patient’s current symptoms and past medical history. This information helps the doctor understand what the patient is feeling and how various treatments have or have not worked. It also allows the doctor to assess the potential benefits and harms of cannabis treatment. After assessment, it was decided that cannabis could be a potential treatment for the pain.

Next, it is the doctor’s practice to complete a thorough review of the patient’s medications. This is done to identify any potential interactions with either CBD or THC.  In this case, no clinically significant interactions were present and the decision to treat with cannabis was deemed appropriate. Treatment proceeded while monitoring for possible issues. An example of a potential cannabis interaction is CBD and Tamoxifen as discussed in a previous Case Study

After examination, the diagnosis was the ulnar nerve was entrapped at the elbow. This caused the burning pain that went down into the hand. Starting a treatment with cannabis was deemed to be safe with a trial dose.

Treatment: Cannabinoids for Neuropathic Pain

Treatment was to start in three parts:

  • Sublingual CBD administered once daily
  • A mix of THC:CBD administered sublingually at night and
  • Topical application of CBD over the site of pain

The basis for this treatment plan is related to another study. There is existing good quality evidence that topical cannabis can help with neuropathic pain. CBD has shown some effectiveness in treating the pain associated with nerve entrapment in the jaw. Previously we wrote an article about the use of topical cannabinoids for the effective treatment of TMJ (link) which references studies to support its use.  In this case, topical application of CBD could help the arm pain.

Results:

At the follow up appointment, the patient reported a great decrease in pain symptoms. The treatment above was followed but the patient felt strongly that the topical application of CBD oil over the site produced the best results. As a result of this treatment, the patient is no longer considering surgery as a treatment option. In addition to that, there were no unwanted effects due to cannabis and the patient’s medications.

Take Home Points:

Many patients have come to seek therapy with cannabis after traditional therapies have not helped. In other instances, the side effects of the treatment outweigh the benefits. There are several ways to treat conditions using cannabis

  • Vaporizing for quick effect,
  • sublingual oil for a longer steadier dose and
  • topical application are different ways of using cannabis.

In some cases, use of one of these above methods of administration may not provide the same relief as the administration of cannabis in more than one way.

Medications can produce unwanted effects with both THC and CBD. Most times, CBD produces the unwanted effect. This is because CBD can block medication breakdown at the liver. Knowing that, it is always best to speak with a doctor or nurse practitioner who is familiar with cannabis before using cannabis to treat your medical condition. These practitioners can adjust dosing or provide an alternative medication that will work with cannabis.

be well.

Holland, Kimberly (2020). What You Should Know About Neuropathic Pain. DOI:

https://www.healthline.com/health/neuropathic-pain#symptoms

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