Medicinal cannabis and painful sensory neuropathy

Schmerzhafte periphere Neuropathie umfasst mehrere Symptome, die die Lebensqualität der Betroffenen stark beeinträchtigen.
Dazu gehören Allodynie (Schmerzen, die durch Lichtreize ausgelöst werden, die normalerweise nicht Schmerzen auslösen) und verschiedene Missempfindungen auch als Gefühlsstörungen bezeichnet: z. B. Stromschlaggefühl, „Nadeln“, Empfindungen von Kälte oder Wärme, Taubheit, und andere Arten von unangenehmen und schmerzhaften Empfindungen. Häufige Ursachen einer peripheren Neuropathie sind Diabetes, HIV / AIDS, Rückenmarksverletzungen, Multiple Sklerose und bestimmte Medikamente oder Giftstoffe.Bei der Behandlung werden meist trizyklische und selektive Serotonin-Wideraufnahmehmmer (SSRI) verschrieben, also Anti-Depressiva, Antikonvulsiva (z.B. Barbiturate, Benziodiazepine), Opioide und bestimmte topische Mittel. Viele Patienten profitieren allerdings nur teilweise von dieser Behandlung und einige vertragen die Medikamente nicht oder wollen sie nicht nutzen aufgrund ihrer Nebenwirkungen. Deswegen ist der Bedarf an wirksamen Medikamenten und einer effektiven Behandlung in diesem Bereich sehr hoch.

Animal studies and patient testimonials have long indicated that cannabis can be an effective medicine for the treatment of pain and specifically peripheral neuropathy pain. Recently, the Center for Medicinal Cannabis Research (CMCR) at the University of California completed five placebo-controlled II-phase trials. Smoked and vaporised cannabis was used.
Another study from Canada, which included patients suffering from HIV neuropathy and other neuropathic pain, also looked at the issue. In each case, the efficacy of cannabis was found to be comparable to, and in some cases better than, conventionally used medications.
The side effects were only minor and included drowsiness, mild difficulty concentrating and fatigue. Serious side effects (e.g. severe anxiety, paranoia, psychotic symptoms) were not observed.
Neuropathic pain is generally very difficult to treat. Cannabinoids present in cannabis are known to interact with CB1 and CB2 receptors in the nervous system and have analgesic effects.
The Californian study showed that even a mild treatment with THC (only 3.53% THC) was found to be successful by 61% of the participants. Even a weak dose of 1.29% THC led to a visible improvement for 57% of the participants. The third group had only received a placebo with traces of THC, with 26% of the participants noticing success.

Tetrahydrocannabinol (THC) is not the only cannabinoid with known analgesic effects. The cannabinoids Cannabidiol (CBD) and Cannabichromene (CBC) also has analgesic effects. These mutually reinforce each other when used in combination.

As recent studies show, cannabis and THC can provide improvement in nerve pain, such as that found in multiple sclerosis. In a British study with 66 multiple sclerosis patients suffering from neuropathic pain, the effectiveness of cannabis extract was examined. The patients increased the dose according to their tolerance. After a four-week treatment period, the intensity of the pain of those treated with cannabis was significantly reduced. In addition, sleep also improved. The cannabis extract Sativex was approved in Canada in 2005 for the treatment of nerve pain in adult patients with multiple sclerosis.
Patients with a severance of the plexus of nerves supplying the arm and shoulder (brachial plexus) experience complete paralysis of the arm muscles and loss of sensitivity. Such injuries can be caused, for example, in sports and motorbike accidents. Those affected experience a stabbing and burning pain stimulus in the respective arm, which often lasts for many years. In a study involving 48 patients with such injuries, it was observed that the use of cannabis led to a significant improvement in pain compared to the placebo group.
Cannabis is thus able to relieve various types of nerve pain. Because nerve pain can often only be treated unsatisfactorily with opiates and other painkillers, cannabis could represent a promising and alternative treatment option.

Moreover, cannabis not only works for pain associated with multiple sclerosis, but also improves spasticity, bladder and sleep problems. As summarised by a group of pain specialists on the online research platform MedPanel, cannabis and its cannabinoids represent the most significant new approach to treating neuropathic pain. The potential of cannabinoids with its strong analgesic effect, the broad effect on the central nervous system, the low side effects and the possibility of use in combination with various other forms of treatment show new ways in treatment.

Cannabis strains that have proven successful in the treatment of neuropathic pain:

Agni Kush( Cannamed)

• 20% THC, 4% VBD, 0.9% CBC, 0.4% CBN
• very strong analgesic effect
• Anti-inflammatory, relaxing, sleep-inducing
• for the evening and the night
• Colourful variety with fruity aroma
• 500 g/m², 650 g/plant
• 8-9 weeks flowering / mid-October

Acapulco Gold (Barney's Farm)

• 23% THC
• very good analgesic effect
• Anti-inflammatory and muscle relaxing
• for the evening and the night
• fruity aroma
• 500 g/m²
• 10-11 weeks flowering / mid-October

Canadian Kush (medical Seeds)

• 25% THC
• Most popular variety for pain treatment
• Very low tolerance development
• for the evening and the night
• Sleep-inducing and muscle-relaxing
• large resin content, ideal for concentrates
• 550 g/m²
• 60 days flowering / beginning of October

CBD Queen (Cannamed)

• 9% THC
• 11% CBD
• analgesic and anti-inflammatory, antispasmodic
• No psychedelic effects
• Specially developed for use during the day
• 650 g/m²
• 9 weeks flowering time / beginning of October

Hindu Kush (Sensi Seeds)

• 19%
• very good analgesic effect
• Muscle relaxing and mentally stimulating
• for the evening
• sweet aroma
• 100% Indica
• 45-52 days flowering
• 450 g/m²

Centre for Medicinal Cannabis Research. http://www.cmcr.ucsd.edu.
Pain Clinic Office, Gartnavel General Hospital, University of Glasgow, UK. A double-blind, randomised, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment. 2014 European Pain Federation - EFIC®.

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