Mayo Clinic Connect
Has anyone used CBD oil or anything similar for use in relieving Neuropathy?
Liked by elained
@stulerner As many people are coming here for advice, I feel it necessary to clarify one thing you said in your post: "It's a low-grade narcotic." My major was doctor of pharmacy and I tend to get pedantic when it comes to stuff like this so please don't take offense; with the current opioid epidemic, I feel it's necessary to make sure correct information and proper education are made available.
Buprenorphine is a partial opiate agonist (why some people think it's safer, less strong than other opioids). To give an example of the difference of partial agonists and full agonists, consider marijuana and synthetic cannabinoids known on the street as 'Spice' : THC in marijuana is a partial agonist at cannabinoid receptors and once concentrations reach a certain level, no more drug binds to receptors (no one has ever died from just marijuana). 'Spice', or synthetic cannabinoids are often full agonists, and the more one takes, the more hits receptors and it causes fever, psychosis (anecdotes from nurses and ER staff describe extreme aggression, dissociation, and cannibalistic actions [those stories you hear about high people taking bites out of their significant others are not urban legends, they're real and a major reason why the product that was once available at gas stations is now illegal). This is NOT a perfect example… the fact that buprenorphine is only a partial and not a full agonist DOES NOT mean that it is safer and unable to kill you. Any number of factors can cause it to be fatal such as respiratory depression from mixing it with other CNS depressants, being abused/being taken by an opiate naive patient, and the list goes on. I'm sure your doctor and or pharmacist counseled you on this, but be sure to dispose of the used patches appropriately by folding them (adhesive and drug side in the center) and disposing of them in a manner that prevents them from accidental exposure to anyone or from trying to abuse them. You'd be amazed what desperate people who are addicted to opiates will do to avoid withdrawal.
Even though buprenorphine is only a partial-agonist, its affinity for opiate receptors (how strongly the drug binds to the receptor) is so strong that a patient taking buprenorphine who finds themselves in severe pain from an accident or needing surgery, commonly used opiates like morphine cannot knock buprenorphine out of the opiate receptor and will have no effect. For this reason, ERs and hospitals have been known to keep an opioid called sufentanil on hand. Sufentanil is 500-1,000 times stronger relative to oral morphine (fentanyl is 50-100) with a stronger receptor affinity so that it can knock buprenorphine out of the receptor and provide analgesia to the patient. This is a very complex issue for anesthesiologists as it's not an every day issue they run into, nor does every hospital carry sufentanil. They need to take into account a patient's weight, the dose, route of administration, and length of time a patient has been on buprenorphine (possibly even obtaining drug/drug metabolite concentrations from blood/urine if time allows and the situation calls for it).
Sublingual buprenorphine is 40 times stronger relative to oral morphine; not a 'low-grade narcotic' by any means (and the term 'low-grade narcotic' is misleading; it's not medically descriptive nor is it a term that medical professionals use. It's vague and can lead one into, wrongly, thinking it's describing strength, binding affinity, risk, side effects, abuse potential, addiction potential, etc. It does not attempt to describe any one characteristic of any opioid and is dangerous). It carries the same risks, addiction/abuse potential as other opioids. To compare, oral oxycodone is 1.5 times stronger than morphine.
(Sublingual absorption of medications, very generally speaking, is similar to transdermal in that it bypasses the gastrointestinal system and is absorbed into the blood stream.)
Buprenorphine is expensive and often needs a prior authorization as it is not usually covered by insurances (I started off on sublingual buprenorphine until I had to switch insurances). Double check with your insurance company if a doctor says they submitted a prior authorization and it was denied… mine is an isolated case (I've worked in pharmacies since I was 16 [I'm 32]), but the doctor who prescribed it for me was understaffed and I found out from my insurance company that he/his office did not submit a prior authorization despite telling me he did and it was denied.
Many people think sublingual buprenorphine is Suboxone (Suboxone is buprenorphine AND naloxone and used for opioid dependence; solo sublingual buprenorphine (Subutex) does not have the opioid antagonist naloxone in it).
It's awesome that transdermal buprenorphine (Butrans) has provided you the level of pain relief that it has! I hope you don't take offense to my post or think I was singling you out to pick on. I just joined this group, and have made similar posts as I worry about misinformation being spread; most especially when it's referring to opioids.
For more information on transdermal buprenorphine (Butrans), talk to you doctor, pharmacist, and/or navigate to butrans dot com.
(I have never worked for a pharmaceutical company in case anyone had concern I may have a conflict of interest; I neither promote, nor discourage opioid use in patients who are deemed medically and psychologically appropriate for them and without a personal or family history of addiction of any kind. Before taking or discontinuing any medication, talk to your doctor/doctors and pharmacist about their risks versus benefits, any contraindications you may have, adverse reactions you may experience, and potential interactions with other drugs, food, or supplements you may be taking).
Jump to this post
I’m sorry I don’t quite understand your 2nd paragraph on medical marijuana .
I am currently in the process of trying to get on medical marijuana , for chronic pain is this ok or am I going to get in trouble
I'm honestly not sure which post you're referring to; I apologize. Are you referring to the post that focused on buprenorphine and in the 2nd paragraph used marijuana and synthetic cannabinoids as a rough example of partial/full agonist medications?
If you're asking if marijuana is medically ok for you to take, that is something I cannot legally tell you; I'm not an MD, nor have I met you as a pharmacy patient.
If your question is concerning the law, on the other hand, it depends on which state you live in (keep in mind that even though many states have legalized medical and even recreational marijuana use and others have decriminalized possession of marijuana, it still remains illegal at a federal level which means, technically if the DEA were so inclined, you could have a medical marijuana card from your state and still be charged federally with a crime, but this, to my knowledge, does not happen. Marijuana usage by medical patients with valid state licenses/cards is not a concern of the DEA at the moment, they do not have the man power to enforce it, nor have they shown any interest in doing so [there are strict regulations on who qualifies for medical marijuana, what forms are legal, how and where to obtain it, how and where to use it, and this all varies state to state]. I have not heard of any instance of a medical marijuana patient being charged federally. If anything, the DEA medical marijuana focus is on state sanctioned dispensaries or growing operations that aren't following protocols such as not carding, providing more than is allowed, or distributing across state lines… not the patients.
The product I said was made illegal was a synthetic cannabinoid that went by the street name 'spice' and went under the radar as it was marketed as incense and not for human consumption, but was being smoked. The original synthetic cannabinoids that were being marketed as products like spice were made illegal, and the DEA constantly monitors any attempts by illicit chemists (think Walter White) to create similar chemically similar entities. These synthetic cannabinoids were not found in marijuana and were extremely unsafe. THC (the psychoactive chemical in marijuana) and CBD (the popular new cannabinoid product being sold [not FDA approved or monitored meaning exact strengths aren't definitive, nor are the claims verified. Labels of CBD products are not regulated by the FDA. It is important to do your research on CBD as to which products are reputable, have had independent labs evaluate them, and have a user base that has at least anecdotal accounts of working]) are both natural cannabinoids found in marijuana plants. CBD is currently legal because, unlike THC, it is not psychoactive, and it is derived from industrial hemp plants, not marijuana plants.
If you are in a state that has legalized medical marijuana, you go through the proper steps to register as a patient and obtain all necessary paperwork/licensure, and follow your state's rules regarding obtaining, transporting, and using medical marijuana products, you aren't going to be arrested. Each state that has legalized medical marijuana has clear guidelines on what is necessary to become a legal patient and how to go about each of those steps. Your state government should have this information posted on it's .gov page (NY's, for example, is on it's health dot gov site). I don't know what state your in, but I live in NY which does things a bit different (we're a liberal state except for medication and drugs, which they seem to do things differently. Benzodiazepines are classed as a DEA schedule II narcotic despite them federally being classed less strictly. As far as medical marijuana goes, no plant materials or edibles are allowed. Smoking (combustion) is also not allowed. Currently, the marijuana that is being cultivated undergoes an industrial extraction process to produce oils for either vaporizing or for use in compounded capsules (how they can rationalize this as different from edibles is a little ridiculous to me, although I assume it is to prevent marketing, appeal to, or accidental ingestion by children).
If this hasn't answered your question, or if you need help in finding your state's regulations, please message me back!
Yes, I was referring to normal marijuana for medical use I live in the state of Pennsylvania where it is legal I just recently registered and now I’m looking for a physician to sanction my registration wanted to make sure that normal Medical marijuana was safe to use , your reference to spice had me confused
So I looked up PA's medical marijuana program (appears more inclusive for potential patients), and it looks like they have quite the range of dosage forms that NY doesn't have, especially actual dried plant. I have no idea how familiar you are with marijuana so I apologize if the detail I'm going into is unnecessary (dried plant is what one would normally think of when you hear marijuana, but with the advent of different extraction processes that produce different oil, waxy, buttery, and harder [think malleable jolly rancher] 'shatter' substances that can be smoked or vaporized, the actual 'buds' of the plant that Cheech and Chong smoked are now commonly referred to as flower. After a cursory review of PA's site, I didn't see anything that specifically outlawed smoking it (actually combusting the plant material), but instead said 'for administration by vaporization or nebulization,' (oil would be used in a nebulizer similar to those used by patients with different respiratory disorders, whereas vaporization uses a 'vaporizer' which heats the plant or oil [depending on the vaporizer some can only accommodate one, while others have special chambers to vaporize both] to a point where THC, CBD, and other cannabinoids and beneficial terpenes are literally turned into vapor [think boiling], but without being so hot as to ignite the plant itself and produce noxious smoke). Inhalation is generally considered the fastest and most concentrated way to consume marijuana (edibles are a different story that I admittedly don't fully understand; 'pot brownies' are known to get people uncomfortably high with bad paranoia if taking to much or if you aren't used to marijuana), although smoking is the worst for your lungs as you can imagine, and vaporization is still not fully researched… since it doesn't contain the combustion products it's considered safer, but the heated vapor can irritate your throat and lungs after prolonged use (it is possible to combine a vaporizer with a water pipe [bong] or other apparatuses so as to cool the vapor and help remove any oily/tar like residue from the vapor). From what I understand, in NY, the oil is pre-filled into single use cartridges built into vaporizers that is unique to each dispensary so there isn't the ability to utilize additional paraphenrnalia or specialized high end vaporizers. Tinctures (in the pharmaceutical compounding sense) use ethanol to extract the active components into a concentrated liquid. Tinctures, pills, 'liquid' (it doesn't specify anything about it, so it's too vague for me to know what the exact dosage form is) and oil should all be able to be taken orally. And of course the topicals you would just apply to the affected areas (this could be difficult if you have a restricted range of motion or areas of pain in your back where you can't reach. Theoretically you could have someone apply it for you with gloves on (I'm not sure if caregivers are allowed to 'administer' any of the products to you [example: pharmacists are not legally allowed to take a pill out of a patient's bottle and put it in their mouth if they have physical difficulty, but nurses and doctors can]). Bottom line, if you want the healthiest option, avoid inhaling. This stance is controversial as many people believe vaporizing is healthy, however, inhaling trace amounts of oil can theoretically cause a specific type of pneumonia and/or cause damage to the anatomy of the lungs depending on how long you've used it. There is not enough research out there yet to give a very good picture of the long term effects of vaporizing. It is one of the most popular methods of delivery out there right now, so it is up to you. Again, since it doesn't actually combust the plant, it's not like smoking it or a cigarette with the additional noxious fumes from the burning plant material, and there are ways to filter/cool down the vapor.
Your best bet is to discuss the options available to you with your doctor, along with the specific reasons/symptoms you're using medical marijuana along with your goals for treatment with it. He or she should be much more knowledgeable on the topic than I, although as I said before, this is relatively new, and long term studies on health impact and adverse effects simply don't exist as federal funding is a gray area since it's still considered a DEA schedule I narcotic (street drug with no medicinal value and high abuse potential).
The other major important factor to consider is the strain of medical marijuana you get, along with the percentages of THC and CBD. THC is the psychoactive component, but also is attributed as being a pain killer and relieving spasticity. In NY, three oil preparations must be available at each dispensary (though the exact concentrations are not regulated and vary from one to another), 1. High THC, Low CBD; 2. High CBD, Low THC; and 3. 50% THC, 50% CBD. Since plant material is available in PA, many different strains with different concentrations of each could possibly be available; you'd have to ask your doctor and the dispensaries. High THC can cause anxiety and paranoia in some people, whereas CBD is good for anxiety. Marijuana comes from Cannabis indica, Cannabis sativa, and varieties of hybrids of the two. Indicas are generally known for a relaxed 'high', with sedation and strong appetite stimulation. Sativas are known for a more 'heady high' while being mood elevating and giving the user energy (marijuana users who use during the day typically are using sativas or sativa dominant hybrids). Once you figure out your goals of treatment and symptoms you want to relieve, you can work with your doctor, dispenser, and even research different strains (and learn about marijuana) on websites like leafly dot com.
Any THC containing product will still have the same rules as recreational marijuana including that you cannot and should not operate a motor vehicle, or heavy machinery while under the influence or while you suspect you may still have some affect from it. Common sense things.
Medical marijuana has provided many patients with amazing results and relief and resulted in a much greater quality of life. The pain-killing, anti-anxiety, anti-depressant, stress-relieving, anti-inflammatory, sedating and sleep inducing, and appetite stimulating effects can be quite drastic (in an obviously very positive way) in patients with serious health conditions where other treatments have failed.
I hope this provided some initial information for you to at least know what to research and talk to your doctor about! Good luck with your treatment and I hope it works well for you! If you would, please let me know what you end up trying… I have yet to get my card here in NY as the actual product is too expensive for me. I am very interested in how it works out for SFN!
Liked by teetee7, elained
Thanks for the detailed reply wolf , much appreciated!
I’m not really sure what my diagnosis is only I have numbing and tingling in both feet .
About 10 years ago I injured my back in the gym . To make a long story short 4 days in the hospital then release with pain meds … was told I had L5 and S1 , I don’t remember a definitive diagnosis or maybe it was because I was just so doped up .
I was released from the hospital in four days back pain subsided almost immediately but I developed knee pain and nerve pain going down through my inner Psi my growing into my knee where I felt like there was a balloon in my knee. Went to an orthopedic doctor had an MRI done of the knee he said there was a slight tear in the meniscus it might get better and make it worse it may stay the same. Started PT to help strengthening the back even though the back pain subsided you could see the nerve jumping on my knee where it actually was moving my shorts, the PT looked at me immediately and said it was nerve damage ,He then told me there was nothing that he could do or could be done. Over the last 11 years it really didn’t bother me and on some days it was better than others .
Started to get back pain early last spring and then I had a pain management doctor give me nine Cortizone shots in six months. After the last shots I didn’t go back anymore and then five months after started to develop severe pain in my hips where I could even climb a flight of steps. I went to see a back surgeon that said I had spinal stenosis and had a lumbar laminectomy which didn’t solve anything . Now the pain radiates down through my lower back into my left leg like it feels like severe sciatica. Went back to see the neurologist shortly before Christmas and he did another EMG and said that I need to PRP in my back which I knew was a laughable diagnosis .
I’ve been to the ER room numerous times and now they’ve got me labeled. There have been times that I haven’t even asked for pain medicine when I brought to the ER only to find out what was wrong with me of course they don’t do any testing in the ER and that was my mistake thinking they would.
The pain has gotten really bad over the last month or two so I figured my only option was to get on the medical marijuana program and hopefully the pain will subside and I can find a doctor that can diagnosed me correctly because as of now I’ve been to three neurologist three pain management doctors and no one seems to be able to know what to do or help me or give me the right diagnosis which is quite frustrating .
I plan on get on The medical marijuana program and going with the high CBD low THC Indica .
Hoping to get off the gabapentin and getting some rest and getting back to work and finding a doctor that can figure out this nerve problem .
Thank you for your advice quite detailed and I appreciate it you seem to be very knowledgeable in your field if you knew how to read an EMG i would email it yo you .
You and John seem to give out great advice I’m sure everyone appreciates it
Thank you once again !!
Wolf wanted to get your advice on something . I’m 61 when I was 38 I developed symptoms of Frequent urination without emptying my bladder and just constant peeing and feeling if my bladder was full all the time. My eurologist just at that time diagnosed me with an large prostate and wanted to remove my prostate at the age of 38. I have course got a second opinion and that doctor started me on proscar and all my symptoms were relieved including low back pain which was excruciating.
As I mentioned I had back surgery in October had no relief in sight actually things have gotten worse. I went back to my urologist because I was thinking that possibly enlarge prostate might be contributing to my symptoms a back pain. He examined me and said that my prostate was huge that I was actually in the top 5 percentile. He prescribed an antibiotic for UTI infection and medicine to increase my urine flow but nothing to decrease the size of my prostate he wanted to wait 30 days I am 100% sure that my low back pain has something to do with my prostate.
Does marijuana make the neuropathy go away temporarily or does it control the pain also when you first go to The dispensary how do you know how much you need to take at a time
Liked by Chris Trout
Hello @mandyschneider0, welcome to Mayo Clinic Connect. Marijuana will not cure or make neuropathy go away but it may help with the pain symptoms. I'm tagging @artscaping to see if she has any suggestions.
Are you able to share a little more about your diagnosis and symptoms?
I bought a full spectrum cbd oil few hours ago all it did was make me sick i Don’t think I can deal with this another day
I have peripheral neuropathy in my hands and feet and now my head. Thanks for the suggestions.
Liked by John, Volunteer Mentor
I peripheral neuropathy and my feet and hands but I've been going to a neuropathy clinic but now I have it on my head so they can't really treat it because seizures. So I been trying CBD oil and it helps when I take it .
@mandyschneider0 – that is unfortunate your treatment options for peripheral neuropathy in your head region are more limited due to seizures. Do you have epilepsy or a seizure disorder, or are they concerned about the possibility of seizures due to treatment?
Did you ingest the oil and how much of it?
Did you take under supervision?
CBD if taken correctly can not make you sick.
Be sure your source was a registered supplier as lots of inferior product on the market
Hi, @carryme – just wanted to suggest that this thread, "Unusual frequent urination," might be a good place to get some input on the bladder issues you mentioned https://connect.mayoclinic.org/discussion/unusual-frequent-urination.
@mandyschneider0, @johnbishop Good morning. John has asked me to share some of my experience with you. I have used only medical cannabis for pain control of my SFN for several years now. To keep it simple in response to your questions about the dosage and the relief time, the relief is determined by the type of cannabis you use. Concentrate in a vape can bring relief immediately especially when the pain level begins to ramp up and create anxiety which leads to more pain, then more anxiety, etc. However, it doesn't last more than an hour or so depending on the dosage strength and the number of draws from the vape battery itself.
Tinctures take longer to begin working because they go through the digestive system. Holding the dropper amount under your tongue initially does work best. Depending on the dosage combination of CBD to THC, you can expect to feel emotionally calmer and happier as well as pain-free for several hours. So, my personal routine is after meals and before bedtime. The folks at the dispensaries will help. In some states, they have special pharmaceutical counselors to help get you started on the right track. I have posted frequently about cannabis use for pain management including links to helpful sites online. You may find more info there. My experience leads me to believe that the research for medical cannabis is progressing and the result looks promising. Be safe, be well. Chris
PS……..if you have the tingling needles in your hands or feet, a 3:1 CBD/THC has been more helpful than lidocaine compounds or essential oils. I use P&B Releaf Balm.
version 184.108.40.206.2Page loaded in 0.505 seconds