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Cannabis and Neuropathy: Alternative Treatment Options for Nerve Pain Relief

Explore the potential benefits of cannabis in managing neuropathy symptoms. Learn about different treatment approaches, cannabis products, and dosing considerations. Discover how to obtain a cannabis card for legal access.

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Cannabis and Neuropathy: Alternative Treatment Options for Nerve Pain Relief

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  1. Cannabis and Neuropathy Dr. Nick Salamie PharmD, RPh PDI Medical

  2. What is Neuropathy?

  3. Acquired Neuropathy Causes

  4. Symptoms/Subtypes

  5. Mainstream Treatments • Pain Relievers • OTC medications • Opioids • Anti-seizure medications • gabapentin (Neurotin) • pregabalin (Lyrica) • Topical Treatments • Capsaicin • Lidocaine • Antidepressants • Tricyclic antidepressants • duloxetine (Cymbalta) • venlafaxine (Effexor)

  6. Mainstream Treatments: Side Effects • Tramadol • Constipation (24-46%) • Nausea (24-40%) • Headache (18-32%) • Gabapentin • Dizziness (16-20%) • Fatigue (11-15%) • Somnolence (16-20%) • Duloxetine (Cymbalta) • Nausea (23-25%) • Fatigue (10-11%) • Somnolence (10-12%)

  7. Endocannabinoid System • Found in all animals • CB1 and CB2 receptors • Located all over body • Anandamide and 2-AG • Balance In the body • Pain Modulation • Phytocannabinoids as treatment • THC • CBD

  8. THC • One of the major therapeutic cannabinoids • Beyond the psychoactivity • Anti-inflammatory • Analgesic • Neuroprotective • Increased Potency via Gastrointestinal absorption • Side Effects • Anxiety • Dizziness • Rapid Heartbeat

  9. CBD • Second most prevalent therapeutic cannabinoid • No prevalent psychoactivity • Eliminates some of THC’s adverse effects • Sedation • Hunger • Therapeutic value • Anti-inflammatory • Anti-convulsant • Anxiolytic • Side effects • Headache • Diarrhea • Agitation • Sedation • CBD more effective with THC: “Power Couple” • Hemp vs. Whole Plant CBD

  10. Cannabis Treatment Approaches

  11. Meeting the Patient • Start Low, Go Slow • Drug Interactions • Product selection and initial strategy • Minimum Effective Dose • Follow Up

  12. Dosage Forms • Inhalation • Combustion • Vaporization • Ingestible • Edibles • Oils (RSO) • Tablets/Capsules • Sublingual/Buccal/Oromucosal • Topical • Transdermal

  13. Cannabis Oils/RSOs • Best medical dosage form • Whole Plant/Full Spectrum Extract/Herbal Shotgun • Varying Cannabinoid Profiles • Different CBD:THC ratios • Acidic Cannabinoids: THCa, CBDa, CBGa • “Varin” Cannabinoids: THCV, CBDV • Less abundant Cannabinoids: CBN, CBG, CBC • Terpenes Captured • Beta-Caryophyllene

  14. Beyond THC and CBD for Neuropathy

  15. Getting Your Cannabis Card • Formal Diagnosis of 1 of the 41 qualifying conditions • Conditions that Cause Neuropathy • HIV/AIDS • Cancer • Fibromyalgia • Lupus • RA • Completion of Physician Written Certification Form by Licensed Physician • Fingerprint/Background Check • Completion of Forms and Payment • Provisional Registration

  16. References • Backes, Michael, et al. Cannabis Pharmacy: the Practical Guide to Medical Marijuana. Black Dog & Leventhal Publishers, 2017. • Bersten, Melani PharmD, RPh. “Advanced Medical Cannabis: Dispensing and Dosing Considerations.” Powerpoint File. • Duloxetine. Adverse Effects. Medscape Mobile App. WebMD, LLC. • Gabapentin. Adverse Effects. Medscape Mobile App. WebMD, LLC. • Goldstrich, Joe D MD, FACC. “Unleashing the Full Potential of Cannabis’ Antineoplastic Benefits: Reimagining the Concept of Full Extract.” Powerpoing File. • “Neuropathy.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/14737-neuropathy. • “Neuropathy Management and Treatment.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/14737-neuropathy/management-and-treatment. • “Peripheral Neuropathy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Aug. 2017, www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/diagnosis-treatment/drc-20352067. • Russo, Ethan B., and Jahan Marcu. “Cannabis Pharmacology: The Usual Suspects and a Few Promising Leads.” Cannabinoid Pharmacology Advances in Pharmacology, 2017, pp. 67–134., doi:10.1016/bs.apha.2017.03.004. • Tramadol. Adverse Effects. Medscape Mobile App. WebMD, LLC.

  17. Questions?

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