Cannabis for peripheral neuropathy: The good, the bad, and the unknown
Cannabis may be an effective alternative or adjunctive treatment for peripheral neuropathy, an often debilitating condition for which standard treatments often provide little relief. Most studies show moderately improved pain from inhaled cannabis use, but adverse effects such as impaired cognition and respiratory problems are common, especially at high doses. Data on the long-term safety of cannabis treatments are limited. Until riskbenefit profiles are better characterized, doctors in states where cannabis therapy is legal should recommend it for peripheral neuropathy only after careful consideration.
Small clinical studies have found that cannabis provides benefits for peripheral neuropathy, including pain reduction, better sleep, and improved function, even in patients with symptoms refractory to standard therapies.
Adverse effects such as throat irritation, headache, and dizziness are common, and serious neuropsychiatric effects can occur at high doses.
Safety may not be adequately assessed in US trials because cannabis supplied by the National Institute of Drug Abuse is less potent than commercially available products.
M arijuana, which is still illegal under federal law but legal in 30 states for medical purposes as of this writing, has shown promising results for treating peripheral neuropathy. Studies suggest that cannabis may be an option for patients whose pain responds poorly to standard treatments; however, its use may be restricted by cognitive and psychiatric adverse effects, particularly at high doses. 1
See related editorial, page 950
In this article, we discuss the basic pharmacology of cannabis and how it may affect neuropathic pain. We review clinical trials on its use for peripheral neuropathy and provide guidance for its use.
PERIPHERAL NEUROPATHY IS COMMON AND COMPLEX
An estimated 20 million people in the United States suffer from neuropathic pain. The prevalence is higher in certain populations, with 26% of people over age 65 and 30% of patients with diabetes mellitus affected. 2–4
Peripheral neuropathy is a complex, chronic state that occurs when nerve fibers are damaged, dysfunctional, or injured, sending incorrect signals to pain centers in the central nervous system. 5 It is characterized by weakness, pain, and paresthesias that typically begin in the hands or feet and progress proximally. 4 Symptoms depend on the number and types of nerves affected.
In many cases, peripheral neuropathy is idiopathic, but common causes include diabetes, alcoholism, human immunodeficiency virus (HIV) infection, and autoimmune disease. Others include toxicity from chemotherapy and heavy metals.
Peripheral neuropathy significantly worsens quality of life and function. Many patients experience emotional, cognitive, and functional problems, resulting in high rates of medical and psychiatric comorbidities and occupational impairment. 4,6,7 Yet despite its clinical and epidemiologic significance, it is often undertreated. 8
STANDARD TREATMENTS INADEQUATE
Peripheral neuropathy occurs in patients with a wide range of comorbidities and is especially difficult to treat. Mainstays of therapy include anticonvulsants, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors. 9 A more invasive option is spinal cord stimulation.
These treatments can have considerable adverse effects, and response rates remain suboptimal, with pain relief insufficient to improve quality of life for many patients. 9,10 Better treatments are needed to improve clinical outcomes and patient experience. 11
CANNABIS: A MIX OF COMPOUNDS
Cannabis sativa has been used as an analgesic for centuries. The plant contains more than 400 chemical compounds and is often used for its euphoric properties. Long-term use may lead to addiction and cognitive impairment. 12,13
Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main components and the 2 best-studied cannabinoids with analgesic effects.
THC is the primary psychoactive component of cannabis. Its effects include relaxation, altered perception, heightened sensations, increased libido, and perceptual distortions of time and space. Temporary effects may include decreased short-term memory, dry mouth, impaired motor function, conjunctival injection, paranoia, and anxiety.
CBD is nonpsychoactive and has anti-inflammatory and antioxidant properties. It has been shown to reduce pain and inflammation without the effects of THC. 14
Other compounds in the cannabis plant include phytocannabinoids, flavonoids, and tapenoids, which may produce individual, interactive, or synergistic effects. 15 Different strains of cannabis have varying amounts of the individual components, making comparisons among clinical studies difficult.
THE ENDOCANNABINOID SYSTEM
The endogenous mammalian cannabinoid system plays a regulatory role in the development, homeostasis, and neuroplasticity of the central nervous system. It is also involved in modulating pain transmission in the nociceptive pathway.
Two of the most abundant cannabinoid endogenous ligands are anandamide and 2-arachidonylglycerol. 9 These endocannabinoids are produced on demand in the central nervous system to reduce pain by acting as a circuit breaker. 16–18 They target the G proteincoupled cannabinoid receptors CB1 and CB2, located throughout the central and peripheral nervous system and in organs and tissues. 12
CB1 receptors are found primarily in the central nervous system, specifically in areas involved in movement, such as the basal ganglia and cerebellum, as well as in areas involved in memory, such as the hippocampus. 12 They are also abundant in brain regions implicated in conducting and modulating pain signals, including the periaqueductal gray and the dorsal horn of the spinal cord. 16–20
CB2 receptors are mostly found in peripheral tissues and organs, mainly those involved in the immune system, including splenic, tonsillar, and hematopoietic cells. 12 They help regulate inflammation, allodynia, and hyperalgesia. 17
Modifying response to injury
Following a nerve injury, neurons along the nociceptive pathway may become more reactive and responsive in a process known as sensitization. 21 The process involves a cascade of cellular events that result in sprouting of painsensitive nerve endings. 21,22
Cannabinoids are thought to reduce pain by modifying these cellular events. They also inhibit nociceptive conduction in the dorsal horn of the spinal cord and in the ascending spinothalamic tract. 20 CB1 receptors found in nociceptive terminals along the peripheral nervous system impede pain conduction, while activation of CB2 receptors in immune cells decreases the release of nociceptive agents.
STUDIES OF CANNABIS FOR NEUROPATHIC PAIN
A number of studies have evaluated cannabis for treating neuropathic pain. Overall, available data support the efficacy of smoked or inhaled cannabis in its flower form when used as monotherapy or adjunctive therapy for relief of neuropathic pain of various etiologies. Many studies also report secondary benefits, including better sleep and functional improvement. 23,24
However, adverse effects are common, especially at high doses, and include difficulty concentrating, lightheadedness, fatigue, and tachycardia. More serious reported adverse effects include anxiety, paranoia, and psychosis.
Wilsey et al, 2008: Neuropathic pain reduced
Wilsey et al 25 conducted a double-blind, placebo-controlled crossover study that assessed the effects of smoking cannabis in 38 patients with central or peripheral neuropathic pain. Participants were assigned to smoke either high- or low-dose cannabis (7% or 3.5% delta-9-THC) or placebo cigarettes. Cigarettes were smoked during treatment sessions using the following regimen: 2 puffs at 60 minutes from baseline, 3 puffs at 120 minutes, and 4 puffs at 180 minutes. Patients were assessed after each set of puffs and for 2 hours afterwards. The primary outcome was spontaneous relief of pain as measured by a visual analog scale.
Pain intensity was comparable and significantly reduced in both treatment groups compared with placebo. At the high dose, some participants experienced neurocognitive impairment in attention, learning, memory, and psychomotor speed; only learning and memory declined at the low dose.
Ellis et al, 2009: Pain reduction in HIV neuropathy
Ellis et al 23 conducted a double-blind, placebo-controlled crossover trial in patients with HIV neuropathy that was unresponsive to at least 2 analgesics with different modes of action. During each treatment week, participants were randomly assigned to smoke either active cannabis or placebo, while continuing their standard therapy. Titration started at 4% THC and was adjusted based on tolerability and efficacy. Twenty-eight of the 34 enrolled patients completed both cannabis and placebo treatments. The principal outcome was change in pain intensity from baseline at the end of each week, using the Descriptor Differential Scale of Pain Intensity.
Of the 28 patients, 46% achieved an average pain reduction of 3.3 points (30%). One patient experienced cannabis-induced psychosis, and another developed an intractable cough, which resolved with smoking cessation.
Ware et al, 2010: Reduced posttraumatic or postsurgical neuropathic pain
Ware et al 24 performed a randomized crossover trial in 21 patients with posttraumatic or postsurgical neuropathic pain. Participants inhaled 4 different formulations of cannabis (containing 0%, 2.5%, 6.0%, and 9.4% THC) during 4 14-day periods. They inhaled a 25-mg dose through a pipe 3 times a day for the first 5 days of each cycle, followed by a 9-day washout period. Daily average pain intensity was measured using a numeric rating scale. The investigators also assessed mood, sleep, quality of life, and adverse effects.
Patients in the 9.4% THC group reported significantly less pain and better sleep, with average pain scores decreasing from 6.1 to 5.4 on an 11-point scale. Although the benefit was modest, the authors noted that the pain had been refractory to standard treatments.
The number of reported adverse events increased with greater potency and were most commonly throat irritation, burning sensation, headache, dizziness, and fatigue. This study suggests that THC potency affects tolerability, with higher doses eliciting clinically important adverse effects, some of which may reduce the ability to perform activities of daily living, such as driving.
Wilsey et al, 2013: Use in resistant neuropathic pain
Wilsey et al 26 conducted another double-blind, placebo-controlled crossover study assessing the effect of vaporized cannabis on central and peripheral neuropathic pain resistant to first-line pharmacotherapies. Dose-effect relationships were explored using medium-dose (3.5%), low-dose (1.3%), and placebo cannabis. The primary outcome measure was a 30% reduction in pain intensity based on a visual analog scale.
In the placebo group, 26% of patients achieved this vs 57% of the low-dose cannabis group and 61% of those receiving the medium dose. No significant difference was found between the 2 active doses in reducing neuropathic pain, and both were more effective than placebo. The number needed to treat to achieve a 30% reduction in pain was about 3 for both cannabis groups compared with placebo. Psychoactive effects were minimal, of short duration, and reversible.
Wallace et al, 2015: Use in diabetic peripheral neuropathy
Wallace et al 27 conducted a randomized, double-blind, placebo-controlled crossover study evaluating cannabis for diabetic peripheral neuropathy in 16 patients. Each had experienced at least 6 months of neuropathic pain in their feet. The participants inhaled a single dose of 1%, 4%, or 7% THC cannabis or placebo. Spontaneous pain was reported with a visual analog scale and also tested with a foam brush and von Frey filament at intervals until 4 hours after treatment.
Pain scores were lower with treatment compared with placebo, with high-dose cannabis having the greatest analgesic effect. Pain reduction lasted for the full duration of the test. Cannabis recipients had declines in attention and working memory, with the high-dose group experiencing the greatest impact 15 minutes after treatment. High-dose recipients also had poorer scores on testing of quick task-switching, with the greatest effect at 2 hours. 27
Research and market cannabis are not equal
Results of US studies must be qualified. Most have used cannabis provided by the National Institute of Drug Abuse (NIDA), 23–26 which differs in potency from commercially available preparations. This limits the clinical usefulness of the analysis of benefits and risks.
Vergara et al 28 found that NIDA varieties contained much lower THC levels and as much as 23 times the cannabinol content as cannabis in state-legalized markets.
Studies based on NIDA varieties likely underestimate the risks of consumer-purchased cannabis, as THC is believed to be most responsible for the risk of psychosis and impaired driving and cognition. 24,28
CBD MAY PROTECT AGAINST ADVERSE EFFECTS
Studies of CBD alone are limited to preclinical data. 29 Evidence suggests that CBD alone or combined with THC can suppress chronic neuropathic pain, and that CBD may have a protective effect after nerve injury. 30
Nabiximols, an oromucosal spray preparation with equal amounts of THC and CBD, has been approved in Canada as well as in European countries including the United Kingdom. Although its use has not been associated with many of the adverse effects of inhaled cannabis, 30–32 evidence of efficacy from clinical trials has been mixed.
Lynch et al, 31 in a 2014 randomized, double-blind, placebo-controlled crossover pilot study 31 evaluated nabiximols in 16 patients with neuropathic pain related to chemotherapy. No statistically significant difference was found between treatment and placebo. However, the trial was underpowered.
Serpell et al, 32 in a 2014 European randomized, placebo-controlled parallel-group study, evaluated 246 patients with peripheral neuropathy with allodynia, with 128 receiving active treatment (THC-CBD oromucosal spray) and 118 receiving placebo. Over the 15-week study, participants continued their current analgesic treatments.
Pain was reduced in the treatment group, but the difference from placebo was not statistically significant. However, the treatment group reported significantly better sleep quality and Patient Global Impression of Change measures (reflecting a patient’s belief of treatment efficacy).
META-ANALYSES CONFIRM EFFECT
Three meta-analyses of available studies of the effects of cannabis on neuropathic pain have been completed.
Andreae et al, 2015: 5 trials, 178 patients
Andreae et al 1 evaluated 5 randomized controlled trials in 178 patients in North America. All had had neuropathy for at least 3 months, with a pain level of at least about 3 on a scale of 10. Two studies had patients with HIV-related neuropathy; the other 3 involved patients with neuropathy related to trauma, diabetes, complex regional pain syndrome, or spinal cord injury. All trials used whole cannabis plant provided by NIDA, and the main outcomes were patient-reported pain scales. No study evaluated pain beyond 2 weeks after trial termination.
They found that 1 of every 5 to 6 patients treated with cannabis had at least a 30% pain reduction.
Nugent et al, 2017: 13 trials, 246 patients
Nugent et al 33 reviewed 13 trials in 246 patients that evaluated the effects of different cannabis-based preparations on either central or peripheral neuropathic pain from various conditions. Actively treated patients were more likely to report a 30% improvement in neuropathic pain. Again, studies tended to be small and brief.
Cochrane review, 2018: 16 trials, 1,750 patients
A Cochrane review 34 analyzed 16 trials (in 1,750 patients) lasting 2 to 26 weeks. Treatments included an oromucosal spray with a plant-derived combination of THC and CBD, nabilone, inhaled herbal cannabis, and plantderived THC.
With cannabis-based treatments, significantly more people achieved 50% or greater pain relief than with placebo (21% vs 17%, number needed to treat 20); 30% pain reduction was achieved in 39% of treated patients vs 33% of patients taking placebo (number needed to treat 11).
On the other hand, significantly more participants withdrew from studies because of adverse events with cannabis-based treatments than placebo (10% vs 5%), with psychiatric disorders occurring in 17% of patients receiving active treatment vs 5% of those receiving placebo (number needed to harm 10).
The primary studies suffered from methodologic limitations including small size, short duration, and inconsistency of formulations and study designs. Further evaluation of longterm efficacy, tolerability, and addiction potential is critical to determine the risk-benefit ratio.
RISKS OF CANNABIS USE
Like any drug therapy, cannabis has effects that may limit its use. Cannabis can affect a person’s psyche, physiology, and lifestyle.
Impaired attention, task speed
Neurocognitive changes associated with cannabis use—especially dizziness, fatigue, and slowed task-switching—could affect driving and other complex tasks. Evidence indicates that such activities should be avoided in the hours after treatment. 26,27,32,33
Concern over brain development
Most worrisome is the effect of long-term cannabis use on brain development in young adults. Regular use of cannabis at an early age is associated with lower IQ, decline in school performance, and lower rates of high school graduation. 35
Avoid in psychiatric patients
It is unlikely that cannabis can be safely used in patients with psychiatric illnesses. Anxiety, depression, and psychotic disorders can be exacerbated by the regular use of cannabis, and the risk of developing these conditions is increased while using cannabis. 36,37
THC potency affects tolerability
High concentrations of THC (the highest concentration used in the above studies was 9.5%) can cause anxiety, paranoia, and psychosis.
Long-term cannabis smoking may cause wheezing, cough, dyspnea, and exacerbations of chronic bronchitis. There is some evidence that symptoms improve after stopping smoking. 33,38
SHOULD WE RECOMMEND CANNABIS?
Where cannabis can be legally used, doctors should be familiar with the literature and its limitations so that they can counsel patients on the best use and potential risks and benefits of cannabis treatment.
A recent conceptualization of pain suggests that a pain score reflects a composite of sensory factors (eg, tissue damage), cognitive factors (eg, beliefs about pain), and affective factors (eg, anxiety, depression). 39 Physicians should keep this in mind when evaluating patients to better assess the risks and benefits of cannabis. While pharmacotherapy may address sensory factors, cognitive behavioral therapy may help alter beliefs about the pain as well as anxiety and depressive symptoms that might influence subjective reports.
Ideally, patients being considered for cannabis treatment would have a type of neuropathic pain proven to respond to cannabis in randomized, controlled studies, as well as evidence of failed first-line treatments.
Relative contraindications include depression, anxiety, substance use, psychotic disorders, and respiratory conditions, and these should also be considered.
Although current research shows an analgesic benefit of cannabis on neuropathic pain comparable to that of gabapentin, 40 further investigation is needed to better evaluate long-term safety, efficacy, and interactions with standard therapies. Until we have a more complete picture, we should use the current literature, along with a thorough knowledge of each patient, to determine if the benefits of cannabis therapy outweigh the risks.
We thank Camillo Ferrari, BS, and Christina McMahon, BA, for their helpful comments.
Best CBD Oil for Nerve Pain Reviewed in 2022
Neuropathy involves not only pain but also other pesky symptoms such as anxiety, nausea, and vomiting, as shown in studies on painful peripheral neuropathies. If nerve pain plagues every day of your life, things like muscle spasms, joint inflammation, and stiffness can become unbearable.
People who used up their conventional treatment options, but to no avail, have recently started switching to natural resources, such as CBD oil, for their nerve pain. According to recent studies, CBD may ease neuropathy and help individuals manage their symptoms in a safe and effective way.
These findings are promising for people with neuropathy, even though it’s too early to make definite statements. In this article, we’ll present the data from the current research on this subject on top of our industry overview, where we give our recommendations on the best CBD oil for neuropathy.
Best CBD Oils for Neuropathy
The quality of CBD oil is paramount for your results with neuropathy. Unfortunately, no two CBD oils are made the same; in fact, there’s a large degree of difference in quality between brands. There are many great companies committed to quality, but there’s an equal number of fly-by-night brands preying on uneducated customers.
Having been in the business for 7 years, we’ve tried a plethora of CBD oils from dozens of different brands. This year was even more demanding in terms of the tested products considering the continuously rising popularity of CBD.
We’ve selected the top 5 CBD oils for neuropathy from over 40 companies that offer CBD oil in three different types: full-spectrum, broad-spectrum, and isolate. Our ranking is based on the quality criteria such as hemp sourcing, extraction methods, third-party testing, and customer service.
1. Royal CBD (Best CBD Oil for Neuropathy)
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|Potency||250 mg –2500 mg|
|Available Flavors||Natural, Berry, Mint, Vanilla|
|CBD per serving||8.3 mg – 83.3 mg|
Why Royal CBD is the Best CBD Oil for Neuropathy
Royal CBD was launched in 2018 in California by a group of cannabis aficionados with a vision to elevate the quality standards and customer service on the market after collecting their own experiences from the customer’s side. This premium brand offers full-spectrum CBD oil sourced from organic hemp and extracted with supercritical CO2. This method of extraction allows even high-potency oils to maintain the plant’s original chemical profile due to lower temperatures.
Royal CBD oil comes in four different strengths, including 250 mg, 500 mg, 1000 mg, and 2500 mg. For potencies between 250 mg and 1000 mg, you can choose between three flavored options, such as Mint, Berry, or Vanilla. The strongest version (2500 mg) is only available in the natural flavor, as adding flavorings would negatively impact the potency of CBD.
Speaking of high-potency oils, the 2500 mg bottle is my favorite product from Royal CBD. The hemp aftertaste is surprisingly mild because the oil has been infused into food-grade coconut-derived MCT oil. This adds another benefit because MCT oil also enhances the absorption of CBD.
If you experience nerve pain — whether regularly or from time to time (like me) — this potency will probably be your go-to choice. It has a deeply relaxing effect and can reduce inflammation for quite a long time after ingestion. I take it under the tongue, wishing the extract around my mouth to increase the surface area for absorption and minimize the amount of oil that passes through the gut.
- Sourced from non-GMO, Colorado-grown hemp
- Extracted with supercritical CO2
- Contains full-spectrum CBD
- Available in 4 strengths and 3 flavored options
- Up to 2500 mg of CBD per bottle
- Lab-tested for potency and purity
- 30-day money-back guarantee
- Slightly more expensive than the competition
- No vape products available
2. Gold Bee (Best Organic)
|Potency||300 mg – 2400 mg|
|Available Flavors||Natural, Honey-Kiwi|
|CBD per serving||8.3 mg – 33.3 mg|
About Gold Bee
Our second-best CBD oil for neuropathy comes from Nevada, but Gold Bee is a true maverick among other brands due to the unique honey flavor of its full-spectrum CBD oil, which the company produces from locally grown, non-GMO hemp.
The quality of ingredients — just as the honey flavor — are award-winning in my opinion. This CBD oil has a very natural flavor, with an actual honey aftertaste, which makes this product particularly enjoyable to use. There’s no tart, earthy taste that you can feel with the majority of CBD oils.
When it comes to easing nerve pain, I noticed similar results to what I got with Royal CBD, but due to the lack of high-potency oils in its lineup, Gold Bee is the runner-up in this compilation.
- Made from US-grown organic hemp
- Contains the full spectrum of cannabinoids and terpenes
- Up to 33 mg CBD/mL
- Good potency range for new users
- Lab-tested for CBD content and purity
- No high-potency oils
- Honey is the only flavored option
3. CBDPure (Top Transparency)
|Potency||100 – 1000 mg|
|CBD per serving||3.3 mg – 33.3 mg|
CBDPure is one of the most reputable US brands that specialize in making low-potency CBD oil, although the company has lately expanded their line up with a 1000 mg strength. This is a nice nod towards users who want to save more money on their CBD oil but their dosage doesn’t exceed 30 mg CBD daily.
CBD pure is also one of the most transparent companies on the market. The guys at CBDPure explain every step of how their oils are made, and surprisingly for low-potency extracts, these products provide decent results when it comes to pain relief. The only reason CBDPure scores third place on this list is because of the higher prices. Some users may find these oils less affordable than other premium brands in the long run.
Want to try if CBDPure products will work for you? The brand has a 90-day money-back policy. You can return the product for a full refund within 90 days if you’re unsatisfied with the results.
- Sourced from Colorado-grown organic hemp
- Extracted with CO2
- 4 strengths to choose from
- Lab-tested for potency and purity
- 90-day return policy
- No high-potency oils
- Only two forms of CBD available
- Priced higher than competitors
4. Hemp Bombs (Best CBD Isolate)
|Potency||125 – 4000 mg|
|Available Flavors||Natural, Acai Berry, Orange Creamsicle, Peppermint, Watermelon|
|CBD per Serving||4 – 133 mg/mL|
About Hemp Bombs
When it comes to the best isolate-based CBD oil for nerve pain, Hemp Bombs offers the widest selection of products. The company has covered the entire potency range for CBD oils, offering up to 4000 mg of total CBD.
This oil is a good alternative for people with neuropathy who, for some reason, want to abstain from taking any THC in their product while getting a decent dose of CBD per serving. Full-spectrum products contain up to 0.3% THC; while this isn’t enough to get the user high, CBD isolate is completely free of THC. This trait is particularly important for CBD users who are regularly tested for drugs at work.
Because CBD isolate is made from 99% pure CBD, it has no aroma and flavor, which makes it more versatile thankful-spectrum extracts.
On the other hand, you won’t get the synergy from other cannabinoids and terpenes with CBD isolate, so this company may not have the best products if you want to benefit from whole-plant extracts in your supplementation.
- Made from organic hemp
- Extracted with CO2
- Third-party tested for potency and purity
- Up to 4000 mg of total CBD
- 5 potency options to choose from
- Flavored with synthetic ingredients
- No synergy from other cannabinoids and terpenes
- Most people don’t need so much CBD oil in their routine.
5. CBDistillery (Most Affordable)
|Potency||250 mg – 5000 mg|
|Potency||8.33 – 166 mg/mL|
CBDistillery is one of the most reputable companies in the American market. The company has been selling premium CBD oils for over 5 years, becoming one of the largest brands in the USA. Started by a group of Colorado natives with a mission to produce high-quality CBD products affordable for everyone, CBDistillery offers two types of hemp extracts: full-spectrum and broad-spectrum (pure oil). Similar to the full-spectrum CBD, broad-spectrum extracts contain CBD along with other non-intoxicating cannabinoids, but without any traces of THC. The THC is removed from the product after initial extraction.
The CBDistillery CBD oil comes in a wide range of concentrations, from 250 mg to a massive 5000 mg of CBD per bottle. The strongest version provides 166 mg of CBD per milliliter, which usually lasts for months.
As for the results, I was satisfied when it came to pain and irritation. I also noticed that my stomach was calmer than before taking this oil. However, there’s a reason why I’ve placed CBDistillery at the very bottom of this compilation. Unlike competitor brands, this one doesn’t use organic hemp plants.
So, CBDistillery may not sell the best CBD oils out there, but considering the price, these are hands down the best CBD oils for neuropathy in their range.
- Available as full-spectrum or broad-spectrum CBD
- 5 strengths to choose from
- Up to 166.6 mg of CBD per mL
- Third-party tested for CBD content and purity
- Very affordable
- Sourced from non-organic hemp
- No flavored oils
What Causes Neuropathic Pain?
Neurons within the body carry signals to the brain, including pain signals. While this sensation is anything but pleasant, it has one important purpose — to prevent injuries. Once you place your foot on a hot surface, the painful sensation will warn your brain against the danger.
That’s how the process is supposed to work in healthy people. But with patients suffering from neuropathic pain, that nervous signaling system falls out of whack. In simple words, your brain receives pain signals, and you feel the pain, but there’s no obvious cause of that feeling. And because of this, it’s difficult to find an immediate remedy.
What’s the matter with those wayward nerves? Most of the time, it’s the result of damage from a disease or physical injury, including:
- Physical injuries: this is a very common cause of neuropathic pain, in which nerves get crushed, compressed, or severed.
- Shingles: this condition is another cause of neuropathy, one that can transform into a painful disease called postherpetic neuralgia. This type of nerve pain can be particularly severe and immediate.
- Cancer and other tumors: As they grow, tumors can constrict the surrounding nerves. Cancer cells can also grow out of the nerves on their own. Sometimes, chemotherapy or radiation can damage nerve cells too, resulting in neuropathic pain.
- HIV: this autoimmune viral condition can lead to painful nerve damage. Nerve pain actually affects around one-third of HIV patients, and nerve within the hands and feed is one of the first symptoms that occur. Antiretroviral treatments can also lead to nerve damage that triggers pain.
- Diabetes: if you have diabetes, you have a higher risk of suffering from nerve injury. At some point, consistently high levels of glucose accompanied by hypertension can damage the nerves.
These are just a few conditions that can cause nerve damage and lead to neuropathic pain. Others include vitamin deficiencies, hormone balances, constant exposure to stress, and more. In some rare cases, nerve pain can just occur without a reasonable explanation.
Experts on Neuropathic Pain and Its Prevalence
Nerve pain derives from the central or peripheral nervous system. These networks are made of the brain and spinal cord. The spinal cord runs down from the brain and through the center of the spine. The nerves stretching from the spinal cord and traveling throughout the limbs and head are the peripheral nervous system. All these structures work together, constantly exchanging signals about your body.
Dr. Suraj Muley, an esteemed neurologist and director of the neuromuscular division at Barrow Neurological Institute in Phoenix, there are several common points for patients with neuropathy. They usually include electric-like, shooting pain with an ice-cold sensation, sensitivity to touch, and feelings of numbness.
The nerves are important players for any kind of pain, as well as other types of sensations. According to Dr. Ryan Jacobs, a neuromuscular neurologist, pain messages are sent by the nerves. This often happens as a result of inflammation or injury that causes damage to body tissues such as skin, bones, or muscles. However, nerve pain refers to damage caused by an injury to the nerves on their own. He also added that in some cases, it can be damage to one significant nerve or a few minor ones that can contribute to a widespread nerve injury.
How Can You Determine the Cause of Neuropathic Pain?
Doctors first conduct an interview with their patients, asking about the symptoms, history of medical conditions, and running a short examination. A physician may check for such things as sensory loss using a pinprick on different parts of the body. If the patient doesn’t feel the impulse from the pinprick or other things, that could indicate neuropathy, as said by Dr. Eva Feldman, a professor of neurology at the University of Michigan.
Aside from the interview and initial examination, your doctor may recommend conducting additional testing, such as bloodwork, to gain a bigger picture of what’s the reason behind the neuropathic pain in your case. You may be asked to run a test called hemoglobin A1C to check your average blood sugar levels and exclude the possibility of diabetes. The doctor may also check if you have sufficient vitamin B12 levels; deficiencies in this vitamin can lead to nerve damage and numbness.
Treatment Options for Nerve Pain
Treating neuropathy is tricky due to its specific nature and the exact cause of the problem. When nerve pain is triggered by a condition such as HIV, diabetes, or cancer, tackling the underlying disease is undoubtedly the priority. However, this treatment won’t necessarily help with your neuropathic pain. Nerve pain may require a dedicated treatment, one that is different from the treatment for the disease that’s causing it.
Doctors typically use prescription painkillers depending on the type and severity of neuropathic pain. However, people can build a tolerance to the active ingredients in these medications, let alone the risk of addiction and several dangerous side effects, including lethal overdose.
Experts believe that 40 million Americans struggle with nerve pain. The impact of neuropathy on modern society is enormous, and for many of us, the potential side effects of pharmaceutical medications outweigh their benefits. It’s totally understandable that people have started to look for natural alternatives such as CBD oil.
Using CBD is an option for treating many types of pain. Studies have already highlighted a few mechanisms responsible for the versatility of CBD in mitigating pain signals. But can it help with neuropathic pain?
Why Some People Are Choosing CBD Oil for Neuropathy
Some forms of neuropathy can be easily treated and sometimes cured. If neuropathy is incurable, the treatment should aim at preventing further damage to the nerve and controlling symptoms.
CBD has been shown to have some therapeutic qualities that might assist patients with neuropathic pain and other symptoms linked to neuropathy such as suppression of the nerves like Carpal Tunnel Syndrome.
CBD vs Anxiety, Chronic Pain, and Vomiting
According to the American Chronic Pain Association, neuropathic pain is the type of chronic pain that occurs in the nerves in the peripheral nervous system due to injury or damage.
Anxiety, nausea, pain, and vomiting are telltale neuropathic symptoms, as noted by a study on painful peripheral neuropathies that was published in Current Neuropharmacology.
Research has shown that CBD may be useful in easing different types of chronic pain. Neuropathic pain falls into this category, but unlike other chronic pain conditions, neuropathy is particularly difficult to treat, according to the author of a paper on neuronal mechanisms of neuropathic pain.
On top of acting as a neuroprotectant, CBD also has some other therapeutic properties, including antiemetic and anxiolytic effects.
CBD vs Inflammation and Muscle Spasms
Neuropathy often results from chronic inflammation, such as in diabetes, which is the number one cause of neuropathic pain in the United States.
Neuropathy can also derive from autoimmune diseases, such as arthritis or lupus. Autoimmune diseases are linked to a higher risk of hypertension and cardiovascular problems.
CBD can inhibit inflammatory and neuropathic pain caused by autoimmune diseases. In a 2016 animal study published in the European Journal of Pain, topical application of CBD helped reduce pain and inflammation triggered by arthritis.
CBD’s remarkable anti-inflammatory effects were also demonstrated in vivo in a 2018 study published in the Journal of pharmacology and Experimental Therapeutics.
Moreover, CBD may help relieve muscle spasms, which is a common feature of nerve damage, often marked by uncontrolled and painful muscle twitches.
Sativex, a combined oral spray consisting of THC and CBD in a 1:1 ratio demonstrated high efficacy in helping with pain management in patients with neuropathic pain caused by nerve damage, peripheral neuropathic pain, rheumatoid arthritis, advanced pain, and spasticity from multiple sclerosis. The results were published in Neuropsychiatric Disease and Treatment.
Similar results were observed in a review of similar studies published in The Cochrane Database of Systematic Reviews in 2018.
The above review examined hundreds of studies on using cannabinoid-based medicines on neuropathic pain in adults. While not all of them turned out positive, there was significant evidence that cannabinoids could reduce nerve pain and other symptoms of this condition.
How Could CBD Oil Help With Neuropathy?
The endocannabinoid system (ECS) is essential for understanding how CBD works to relieve neuropathy. The health benefits of CBD and other cannabinoids result from their interaction with the body’s ECS, which is the major regulatory network in all mammals.
The ECS controls a wide range of biological processes, including immune response, sleep, mood, appetite, metabolism, memory, and pain sensation.
This system consists of two types of cannabinoid receptors — CB1 and CB2 — which are found in specific parts of the body.
CB1 receptors are mostly found in the brain and central nervous system, but there are some concentrations of these receptors in reproductive organs, lungs, liver, retina, and urinary tracts.
CB1 receptors are involved in-memory processing, pain sensation, mood, sleep, and motor regulation. Their activation is linked to neuroprotective responses, suggesting that the cannabinoids acting on CB1 receptors could help in the prevention and treatment of neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis.
When it comes to CB2 receptors, these are primarily located on the surface of the immune system cells and their associated structures. The activation of CB2 receptors is said to produce an anti-inflammatory response, minimizing damage to nerves and reducing pain.
The above qualities have been found to be potentially helpful for treating autoimmune conditions, such as Crohn’s disease, arthritis, inflammatory bowel syndrome, and chronic inflammatory demyelinating polyneuropathy (CIDP).
CBD doesn’t bind to any of the cannabinoid receptors; it does, however, act indirectly on them, causing similar actions as the substances that typically stimulate the receptor.
CBD also has more than 65 molecular targets. It can interact with other receptors in the body, such as the 5-HT1A serotonin receptor. Serotonin is a neurotransmitter that controls feelings of well-being and emotional stability. It can also modulate nausea, anxiety, and pain.
Pros & Cons of Using CBD Oil for Neuropathy
- Can help with symptoms such as inflammation, anxiety, pain, nausea, vomiting, and muscle spasms
- Has been recognized as safe by major health agencies including the WHO
- Can be purchased without a prescription (locally and online)
- Not approved as an official treatment by the FDA
- Can interact with 70-80% of prescribed medications
- Side effects include dry mouth, drowsiness, fatigue, and changes in appetite
- Products sold online and in local stores are mostly unregulated
CBD vs Other Alternative Treatments for Nerve Pain
Alternative treatments for patients with neuropathy include the use of capsaicin, primrose oil, and amino acids.
Capsaicin is an analgesic compound found in hot peppers. A study examining the use of an 8% capsaicin dermal patch found that almost 71% of participants with cancer-related neuropathic pain experienced 90% relief.
Primrose oil may help ease neuropathic pain in people with diabetes, as stated by Mayo Clinic in an article regarding peripheral neuropathy diagnosis and treatment.
According to the same clinic, amino acids, such as acetyl-L-carnitine, may help people after chemotherapy as well as patients with diabetes.
Is there a way to combine the benefits of the above compounds with the analgesic effects of CBD?
Some CBD products come in the form of salves infused with capsaicin. In these CBD products, the capsaicin supports CBD’s natural pain-killing benefits to help with problematic spots on the body.
As for hemp oil, which is often added to CBD topicals, it’s an excellent source of essential fatty acids and amino acids. You can also look for topicals infused with primrose oil for enhanced anti-inflammatory effects.
How to Use CBD Oil for Neuropathy?
Figuring out how to use CBD oil for neuropathy can help you maximize your results. Sometimes, cream or gel maybe is your best option if you want to completely avoid ingesting the oil.
However, if you want to approach the problem from two different angles, we recommend that you use full-spectrum CBD drops as your primary means of CBD oil.
CBD oil should be applied under the tongue for approximately 60 seconds before swallowing. This method of administration ensures that the CBD absorbs into the bloodstream through sublingual capillaries, avoiding the first-pass effect in the liver.
Alternatively, you can take capsules or edibles if you have problems holding the oil in your tongue, but CBD taken orally takes more time to kick in. Capsules and edibles are a great option if you want to ease nerve pain in social settings, or when you need longer-lasting relief at the cost of delayed onset.
If you need something to help with localized pain, then a topical such as warming salve could provide some relief. Usually, people who take CBD for neuropathy combine the oil (or edibles) with topical products.
CBD Dosage for Neuropathic Pain
Everybody will react to CBD differently because we’re not made the same. You need to ask yourself a few questions.
How much pain am I in?
Is it chronic pain or does it just happen randomly throughout the day?
Do you want to take CBD oil to function better or take the nerve pain away entirely?
Other important considerations for CBD dosage include your weight, age, metabolism, overall health, and prior experience with CBD oil.
Customers usually take CBD oil as well as use a topical about 1–3 times a day. In order to find the right dose and strength for yourself, you’ll need to go through some trial and error, starting at the lower end of the recommended serving size, and slowly making your way up to the point where you experience a significant difference in your symptoms.
Safety and Side Effects of CBD Oil
CBD has a well-established safety profile. It can be taken under the tongue in doses of 300 mg – 1500 mg daily for up to several weeks. Dosage recommendations for prescribed cannabidiol (Epidiolex) range from 10 to 20 mg per kg regularly.
Some rumored side effects of CBD oil include dry mouth, dizziness, changes in appetite, and sedation resulting from a temporary drop in blood pressure. Signs of diarrhea have also been reported in some patients, but this is a very rare adverse reaction.
Final Thoughts on Using CBD Oil for Neuropathy
CBD has demonstrated the ability to reduce neuropathic pain in many studies. Not only that, but CBD can also help with other neuropathic symptoms, such as anxiety, nausea and vomiting, spasms, and inflammation.
As more studies are being conducted in this area, CBD may become the go-to treatment option for neuropathy in the future. However, CBD isn’t the only cannabinoid found in cannabis that can help alleviate neuropathy.
Full-spectrum CBD oil contains all phytonutrients naturally found in hemp, including terpenes, flavonoids, and trace cannabinoids. These compounds work together to amplify the health benefits of each cannabinoid, producing the “entourage effect.”
This is the best type of CBD for neuropathy. However, regardless of the product choice, make sure to check all marks on the quality checklist, including the source of hemp, extraction method, and third-party lab testing. If you don’t have the time to do your own research, you can use our recommendations from above.
Let us know in the comments if you use CBD oil for neuropathy — and how it works for you!
Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.
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Medicinal Marijuana and CBD Treatments
I live in a state with medicinal marijuana and CBD are legal however GBS isn’t yet on the list of treatable ailments to obtain the products. Who has tried either and what effects both positive and or negative have you experienced? Thank you.
June 27, 2017 at 5:08 am
Marijuana is not a treatment for GBS. It might make you feel better, but only because it makes everybody feel better.
September 29, 2019 at 9:13 pm
Marijuana helps alleviate pain from GBS. I’ve had it since March of this year and it also helps me sleep very soundly. I have nothing negative to say about it.
I began taking Neurontin a few days ago and it relieves pain, too.
November 6, 2017 at 2:56 pm
Medical Marijuana is not prescribed as a treatment per se as it will not cure GBS or CIDP but rather it will help with pain relief. I was diagnosed with CIDP which is similar to GBS and also live in a state where Medical Marijuana is now legal. My neurologist is licensed to prescribe MM and did to help me with my extreme neuropathy. I am taking high-CBD/low-THC drops and it helps more than any other drug that I have been prescribed (Horizant & Cymbalta) while not having the same side effects. The high-CBD quells my pain for up to 3-4 hours and you do not get high, just pain relief. On Horizant and Cymbalta I felt like hell the next day – foggy brained and lack of focus – and it did not help as much as the MM with my pain.
MM is a God-send for me. The U.S. Government also holds a patent (US 6,630,507) on cannabinoids based on their antioxodent and neuroprotectant properties.
January 25, 2019 at 10:02 am
I’m considering using it. What is the proper balance. I’m not interested in getting high. I’ll use a martini for that if it’s safe to mix……. Do you know? But please tell me the proper mix of CBD and THC. What doses are we talking about? Thank you.
December 12, 2017 at 1:48 am
Absolutely agree. CBD has a good effect on neuropathies and epileptics. While useful for many other things, this seems to be the best documented. No problem at all getting it set up, and the high CBD is definitely the way to go. I can feel my legs ease and pains subside within minutes of vaping. I use a tincture during the day and it’s been very helpful. If all you get is a feel better effect, than you’re likely using something too high in THC.
January 25, 2019 at 9:58 am
I live in New York and it’s legal. You mean that we cannot get it b/c it’s not listed? Why the hell isn’t it? Can you verify that?
January 25, 2019 at 12:23 pm
No it won’t cure CIDP but sure deals with the symptoms. Much of the proven work (as best we can guess anyway…) is it’s effect on epilepsy and neuropathies, so worth a try. I can feel the symptoms start to resolve in minutes. A CDB containing creme also works well on isolated areas of itchiness/psoriasis but if it’s a generalized problem best to treat whole body. I use a high CBD tincture during most of the day. Takes about an hour or so to take effect. Vaping works very quickly. So I vape a bit to get to sleep and let the last dose of tincture kick in while I’m (hopefully) sleeping. There is no general dose per se. What works for you. Start low and add…but give the first dose plenty of time to do it’s work or it’s easy to go too high. I know people who use it to treat severe pain like back pain. Doesn’t do anything for me…but for the problems of CIDP it works very well. Find what works for you. May take awhile, but it’s worth it. And no, it’s not just a ‘feel good’ effect. And remember that the parts of the brain that control vital functions like heart rate, breathing, etc. are fairly devoid of cannabinoid receptors. There is no documented case of death by overdose. Opiods are there….and they can kill. Cannabinoids will cause sleep etc. but not much more. 5 Drunk guys will start a fight. 5 Stoned guys will start a band….
January 25, 2019 at 4:13 pm
This topic was first discussed a few years ago here:
Most marijuana-based products do not have approval from the FDA and more evidence is necessary to confirm their safety and effectiveness. There is limited research available on the use of specific marijuana strains for pain and other symptoms. As a result, strain-specific recommendations are not medically proven.
Nonetheless, “Indica” is a THC-dominate (TetraHydroCannabinol) strain considered by many as the best choice for medical use. These strains are selected by patients treating pain, depression, anxiety, insomnia, and more. A typical Indica flower will have between 12%-28% THC and 1%-5% CBD. This works out to 120mg-280mg of THC and 10mg-40mg of CBD. If you tend to feel anxious with THC-dominant strains, or dislike other side effects associated with THC, try a strain with higher levels of CBD.
But dosage varies by delivery method (smoking, vaping, edibles, etc.). Edibles get metabolized by the endocannabinoid system way differently so don’t start out with apples to apples dosage from flower to edibles. When it comes to edibles, I would suggest starting with a very low dose, perhaps 2 or 5 milligrams and slowly increase after 1-2 hours. You will need to wait for some time to experience the effects as THC is processed through the liver before it enters your bloodstream.
Following are some recent educational materials and studies about using medical marijuana to treat neurologic pain:
June 12, 2019 at 1:28 pm
Try the cannabis strain “Platinum Daddy”. I was at my wits end in nerve pain and saw it advertised as helping with neuropathy. A vendor a few miles away carried it (california) and it absolutely worked. It’s the strongest pot I have ever smoked, and will basically knock you out if not carefull.