Peripheral Neuropathy

Benefits of Cannabis: Cannabis helps with relieving the pain symptoms, muscle spasms and the inflammation associated with peripheral neuropathy.

Risks of Cannabis: There are no specific risks of cannabis in this patient population, but if the patient has difficulty ambulating, cannabis may increase the risks of falls.

Suggested Initial Therapy [Topicals]: topical administration can be effective for many patients, but repeated applications throughout the day can be inconvenient. A full plant CBD topical can be effective, but many patients require a CBD:THC of 15:1 to 1:1 for it to be effective. Apply as needed to affected areas.

Suggested Initial Therapy [Inhaled Cannabis]: flower mixing is preferred for the inhalation route of administration as it allows composing the balance of cannabinoids and terpenes in ratios likely to be effective. CBD flower can be combined with THC flower to obtain a 1:1 ratio of CBD:THC. This can be used on an as needed basis to control symptoms. CBG flower may be added to see if it is beneficial. Myrcene and β-caryophyllene terpenes are preferred.

Suggested Initial Therapy [Tinctures]: The chronic symptoms of peripheral neuropathy will be best addressed using tinctures. CBD and THC should be used, the addition of CBG may help to decrease inflammation/pain symptoms.

• CBD Tincture: start at 16 mg dose of a whole plant extract, use every 12 hours. The CBD will help with inflammation, depression, anxiety and pain symptoms.
• THC Tincture: use an “indica” THC tincture to fully leverage the entourage effect. Start at a 5 mg THC dose administered with CBD and CBG tinctures (if using). The THC will help relieve some nerve pain symptoms, and help to decrease inflammation.
• CBG Tincture: CBG may help with some of the inflammation associated with peripheral neuropathy. Start at 8 mg CBG tincture administered with the THC/CBD tinctures.

Titration of Doses: after 7 days of therapy, adjustment of dose may be considered. Tincture doses are modified based on response. The THC tincture should be titrated up first to about a 15 mg dose as tolerated. Subsequent increases will also include CBD, and CBG if using.

Adjustment of dose should be considered based on the patient's response every week or two. If side effects are experienced, the last dose administered which was well tolerated should be used.

DISCLAIMER: Information provided is for educational purposes to assist medical cannabis patients in using the medication. These statements have not been evaluated by the FDA and cannabis is not approved by this agency for the use in diagnosis or treatment of any diseases.

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