CBD Oil Dose For Neuropathic Pain

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Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed. Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain. There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5–5 mg of each cannabinoid once or twice daily and titrates by 2.5–5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day. In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain. Does CBD oil work for neuropathy? Find out why some people are using CBD oil to help with neuropathic pain. We’ve also list of the best CBD oils for neuropathy and nerve pain. The combination of CBD and THC is a powerful treatment for nerve damage and neuropathic pain. Here is what you need to know about CBD:THC ratios for neuropathy.

Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process

Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed.

Methods

Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain.

Results

There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5–5 mg of each cannabinoid once or twice daily and titrates by 2.5–5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day.

Conclusions

In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.

Background

Cannabis is being legalized and/or decriminalized across the globe and hundreds of thousands of patients are currently being treated with medical cannabis (Abuhasira et al. 2018; Lintzeris et al. 2020). Patient-reported data indicate that chronic pain management is one of the most common reasons for medical cannabis use (Reiman et al. 2017; Boehnke et al. 2019; Kosiba et al. 2019; Azcarate et al. 2020). Chronic pain affects close to 2 billion people worldwide and is associated with impairment in physical and emotional function, reduced participation in social and vocational activities, and lower perceived quality of life (Dueñas et al. 2016; Hylands-White et al. 2017; Vos et al. 2017). In patients with chronic pain, medical cannabis treatment has been associated with an improvement in pain-related outcomes, increased quality of life, improved function, and a reduced requirement for opioid analgesia (Abrams et al. 2011; Haroutounian et al. 2016; National Academies of Sciences 2017; Cooper et al. 2018; Rod 2019; Sagy et al. 2019; Johal et al. 2020; Safakish et al. 2020; Okusanya et al. 2020).

Despite the increased global use of medical cannabis to manage pain, systematic reviews and meta-analyses report low to substantial levels of evidence to support the use of cannabis and cannabinoids for the treatment of chronic pain (Russo 2007; Whiting et al. 2015; Allan et al. 2018; National Academies of Sciences 2017; Stockings et al. 2018; Mücke et al. 2018; Häuser et al. 2018; Johal et al. 2020; Safakish et al. 2020; Okusanya et al. 2020). Explanations as to why some describe the level of evidence is low may include limited availability of investigational products due to legal status, lack of standardization of cannabis products, lack of standardization of product administration, and overemphasis on pain scores to define efficacy. However, despite the low to moderate level of evidence, patients are being treated with medical cannabis across the world.

Therefore, the lack of randomized control trial evidence combined with the practical reality that patients are receiving a pharmaceutically active drug creates an atypical clinical scenario that necessitates expert guidance from experienced clinicians on how to safely and, perhaps, effectively dose and administer medical cannabis.

The recommendations presented herein were developed as practical guidance for clinicians who may have limited experience with prescribing or recommending (if patient is in USA) medical cannabis. It is important to note that every patient is different and medical cannabis treatment, like most other therapies, should be individualized to the patient. Shared treatment decision-making with the patient is important and establishing treatment goals during the initial medical consultation may enhance patient outcomes and adherence to medical cannabis treatment. The intent is to provide clinicians with safe and effective medical cannabis prescribing protocols, which may be considered when a clinician decides to include medical cannabis in a patient’s treatment regimen.

Methods

To address the unmet need for clinical guidance on the safe and effective use of medical cannabis for chronic pain, and to build on previous recommendations from MacCallum and Russo (2018) and Boehnke and Clauw (2019), we developed a modified Delphi process (Dalkey and Helmer 1963; Dalkey 1969; Saad et al. 2019; Oude Voshaar et al. 2019) to establish expert consensus-based recommendations on the dosage and administration of medical cannabis (Fig. 1). The modified Delphi process has been used extensively in health care settings to provide consensus-based recommendations on important clinical questions where randomized control trial data is lacking (Hasson et al. 2000).

Timeline and Flow of modified Delphi process

A global task force of twenty individuals was recruited based on extensive clinical experience and/or high academic interest in prescribing and managing patients on medical cannabis for the treatment of chronic pain (Table 1). The panel was selected based on clinical experience prescribing medical cannabis, research with medical cannabis, and a focus on inclusion of representatives from different countries. Upon recruitment, the task force participants completed a practice patterns survey (Additional file 1) to gain insights into how clinicians around the world were treating patients with medical cannabis. After the practice profile was completed, nine recent articles were provided to the task force (Habib and Artul 2018; Banerjee and McCormack 2019; Crawley et al. 2019; Maher et al. 2019; Boyaji et al. 2020; Johal et al. 2020; Montero-Oleas et al. 2020; Wong et al. 2020; Gulbransen et al. 2020). An initial draft of 37 consensus questions was developed based on the practice patterns survey and reviewed for rationale and applicability to clinical practice by a nine-member scientific committee. After review and scientific committee approval, an updated version was distributed to the other task force participants for their review of its rationale and applicability.

Table 1 Global task force on medical cannabis dosing and administration for treatment of chronic pain

Once the full task force had reviewed all questions and proposed answers, and all comments had been incorporated; the first round of voting took place on 63 questions using an online survey (Qualtrics, Provo, Utah; (Additional file 2) with the following rules in place:

For multiple choice questions, consensus is found if ≥ 75% of the responses support one answer. For ranking questions, consensus is found if ≥ 75% of the responses are agree/strongly agree or disagree/strongly disagree. This consensus threshold is similar to previous studies using a modified Delphi method (Diamond et al. 2014; Gillessen et al. 2018).

There was an “abstain” option for all questions.

For the purposes of this document, medical cannabis refers to CBD and THC extracted from a cannabis plant.

The dosing and administration protocol was focused on oral preparations (oils and gel capsules) to support harm reduction from smoking and/or e-vaping (Tashkin 2013; Sangmo et al. 2020), and to nullify the risk of e-cigarette or vaping product use-associated lung injury (EVALI) (Layden et al. 2019).

It was stressed that clinicians would need to customize the recommendations based on availability and regulations in their region of practice.

The first round of voting established consensus on several topics including the rationale for using medical cannabis, the type of pain medical cannabis could be used to treat, age limitations for CBD, when medical cannabis should be avoided, and what the patient goals of using medical cannabis could be. This first round of voting indicated that the task force members were using medical cannabis for similar patient profiles, but dosing and administration protocols were different. The consensus questions were then revised to focus on key remaining elements, and 55 questions were considered for the second round of voting using online surveys (Additional file 3).

Following analysis of the first two rounds of voting, intended live meeting discussion topics were narrowed down. However, due to the COVID-19 pandemic, the live meeting was converted to a virtual format. Over two virtual meetings, 31 questions were voted on through Zoom Meeting polling software (Zoom Video Communications, San Jose, California, Additional files 4 and 5). The key topics for discussion surrounded the dosing and administration procedures across the different medical cannabis treatment protocols. The other two sections for discussion were breakthrough pain and follow-up recommendations. The task force was encouraged to discuss the question before voting to find common ground if possible.

Phrasing of questions was refined over the rounds of review and voting based on task force feedback. At least 16 members of the task force voted at each of the steps. The reader is directed to Additional file 2, 3, 4 and 5 for all voting results.

Role of funding source

This work was funded by Spectrum Therapeutics. Spectrum Therapeutics is the medical division of Canopy Growth Corporation, which sells both medical and recreational cannabis. The funder influenced the selection of the task force, and all authors declare they have received funding from Spectrum (Additional file 6). However, the funder had no influence on the design and conduct of the voting and discussions; collection, management, analysis, and interpretation of the data; preparation, review, approval of the manuscript; or decision to submit the manuscript for publication. The sponsor was provided the opportunity to review the manuscript for medical and scientific accuracy and did not suggest any changes to the manuscript.

Results

Dosing and administration of medical cannabis to treat patients with chronic pain

During the Delphi voting, three streams of oral dosing and administration recommendations based on patient need evolved: Routine, Conservative, and Rapid (Figs. 2, 3, and 4). The protocols were developed with a focus on safety and what experienced prescribers observe in their practice to be effective. For each protocol, a starting cannabinoid type was voted on, followed by a titration protocol up to a maximum daily dose recommendation. If necessary, the clinician may consider moving a patient between protocols to individualize the patient’s treatment plan. There was a consensus that medical cannabis may be considered for the treatment of neuropathic pain, inflammatory pain, nociplastic pain, and mixed pain (Sihota et al. 2020). Clinicians should titrate and manage the dosing regimen to reach patient treatment goals, which may be varied and therefore individualized (Table 2).

Routine protocol for medical cannabis dosing and administration

Conservative protocol for medical cannabis dosing and administration

Rapid protocol for medical cannabis dosing and administration

Routine protocol for medical cannabis dosing and administration

The routine protocol is recommended for most patients (Fig. 2). The Delphi process led to agreement that a patient may initiate with 5 mg twice daily (bid) of a CBD-predominant strain and up-titrate by 10 mg/day (5 mg CBD bid) every 2–3 days up to 40 mg CBD per day. A key reason for choosing to initiate with a CBD-predominant variety was to prioritize safety as CBD is highly tolerable, does not induce euphoria, and has a low risk for adverse effects (Taylor et al. 2018; Larsen and Shahinas 2020). In addition, many CBD-predominant preparations contain a small percentage of THC (Bonn-Miller et al. 2017; Lachenmeier et al. 2020). It was decided that the maximum amount of THC allowed in a CBD-predominant product to be considered for these protocols would be 1:10 THC to CBD. Many global CBD-predominate products contain 0.–2% THC (Bonn-Miller et al. 2017; Corroon et al. 2020; Lachenmeier et al. 2020).

If 40 mg/day CBD-predominant dose does not reach treatment goals, clinicians may consider initiating 2.5 mg of THC per day and titrate by 2.5 mg THC every 2–7 days up to 40 mg/day while maintaining the same CBD-predominant dose. It is recommended to seek expert consultation if considering going above 40 mg/day THC. The THC titration frequency of 2–7 days is a large range to promote tailoring to the patient’s needs.

Clinicians are encouraged to titrate medical cannabis to the effects desired by each patient, as opposed to a specific CBD or THC dose. During the titration phase, the total daily dose of CBD and/or THC can be divided between two to four administrations.

Conservative protocol for dosing and administration of medical cannabis

The conservative protocol is recommended for patients who may be more sensitive to drug effects (Fig. 3). Clinically frail patients, those with complex comorbidities, polypharmacy, and/or mental health disorders may also be appropriate for the conservative approach. It was agreed a patient may start on a 5 mg once daily dose of a CBD-predominant strain and up-titrate by 5–10 mg every 2–3 days up to 40 mg CBD per day, leveraging twice daily administration when needed. If treatment goals have not been met by 40 mg/day CBD-predominant dose, consider initiating 1 mg of THC and titrating by 1 mg once per week up to 40 mg/day of THC while keeping the same CBD dose. The patient may need a higher THC dose and moving them into the routine stream may be necessary. It is recommended to seek expert consultation if the clinician and patient are considering exceeding 40 mg of THC.

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Rapid protocol for dosing and administration of medical cannabis

The rapid treatment protocol may be considered for patients requiring urgent management of severe pain, palliation, and for those with significant prior use of cannabis (Fig. 4). For patients in palliative care, caution is advised when choosing the medical cannabis protocol as these patients may have higher frailty and a higher risk of terminal delirium, which would make them suitable for the conservative approach as well.

It was agreed that a patient should start on a balanced THC:CBD product of 2.5–5 mg of each cannabinoid once or twice daily and up-titrate every 2–3 days by 2.5–5 mg/day of each cannabinoid until patient goals are met, or to 40 mg THC. If choosing to initiate twice daily with a balanced product, the lower doses would be more appropriate to consider at the beginning. The recommendation to seek expert consultation at 40 mg of THC is also present in the rapid protocol. When considering patients with neuropathic pain, products that contain THC may be more suitable (Andreae et al. 2015; Longo et al. 2020).

Medical cannabis treatment for breakthrough pain

In patient scenarios where breakthrough pain is common, inhaled medical cannabis can be considered due to the more rapid onset of action and limited duration of action (Huestis 2007). Dried flower vaporization is the preferred mode of administration as opposed to smoking or vaporization of cannabis extracts in an electronic cigarette device (e-vaping), as smoking and e-vaping carry significant health risks. Smoking cannabis is associated with inflammation of the airways and chronic cannabis smokers may experience a heightened risk for bronchitis, respiratory infections, and pneumonia (Tashkin 2013; Volkow et al. 2014; Owen et al. 2014). E-vaping of THC containing products has been associated with a relatively novel but grave lung disease known as e-cigarette or vaping product use-associated lung injury (EVALI) (Layden et al. 2019; King et al. 2020).

When using medical cannabis to manage breakthrough pain, a balanced THC:CBD or THC-predominant product may be used as needed (prn). Clinicians could also consider that breakthrough pain may be suppressed by increasing the dose or frequency of the scheduled oral medical cannabis treatment.

Follow-up and discontinuation considerations

At the initiation of medical cannabis treatment, clinicians may consider following the patient every 2–4 weeks (Table 3). In individual patients, more frequent follow-up may be needed, particularly at the beginning of the medical cannabis treatment. Once the patient is at a stable dose or sufficiently knowledgeable with medical cannabis dosing and titration, follow-up may occur once every 3 months or even longer thereafter. However, adherence to local jurisdictional guidance may dictate follow-up frequency. The follow-up and discontinuation recommendations were consistent across the three protocols. Discontinuation of medical cannabis treatment should occur if the patient experiences intolerable, moderate, or severe cannabis-related adverse effects, the maximum agreed upon dose is reached and does not benefit the patient, and/or the patient has misuse or diversion associated with cannabis. Reporting of adverse events should be congruent with regional regulatory requirements.

Additional safety considerations for medical cannabis use

Patients who should avoid medical cannabis

There was consensus that individuals with psychotic disorders, unstable cardiovascular disorders, who are pregnant, who are planning to become pregnant, and/or who are breastfeeding, should avoid medical cannabis, similar to previous guidance documents ([CSL STYLE ERROR: reference with no printed form.]; National Academies of Sciences 2017; Canadian Medical Association 2020). The contraindications associated with medical cannabis are more closely linked to THC, but as discussed, CBD-predominant products may contain THC.

Age ranges

There was consensus for no minimum or maximum age limitation for CBD. Although it was agreed no upper age limit for THC use was necessary, there was debate regarding the minimum age recommendation for THC use, but no consensus was found. It has been reported that the human nervous system is not fully developed until 25 years of age, but different jurisdictions around the world have put varying age limits in place (Arain et al. 2013; Casey et al. 2013). In addition, it is unknown whether treatment with medical cannabis supervised by a physician influences brain development in minors. The recommendation for age limits therefore is to follow the local government regulations and consider the clinical risk-benefit ratio to each individual patient.

Drug-drug interactions

Drug-drug interactions should be considered (Balachandran et al. 2021). THC is a substrate of CYP3A4 and CYP2C9 while CBD is a substrate of CYP3A4 and CYP2C19 (Antoniou et al. 2020) CBD and THC may also inhibit or stimulate drug transporter P-glycoprotein (Zhu et al. 2006). Direct-acting oral anticoagulants all contain warnings to avoid use with drugs that inhibit CYP3A4 and P-glycoprotein. Caution is strongly encouraged when coadministering medical cannabis with direct-acting anticoagulants ( XARELTO® (rivaroxaban), 2020; https://www.pfizer.ca/sites/default/files/201910/ELIQUIS_PM_229267_07Oct2019_Marketed_E.pdf, 2020; https://www.boehringer-ingelheim.ca/sites/ca/files/documents/pradaxapmen.pdf, 2020), warfarin (Yamreudeewong et al. 2009; Yamaori et al. 2012), drugs metabolized by CYP2C19 (e.g., clopidogrel (Kazui et al. 2010) and clobazam (Geffrey et al. 2015; Cox et al. 2019), checkpoint inhibitors (e.g., PD-1 (Taha et al. 2019), and immunotherapy agents (e.g., tacrolimus (Leino et al. 2019). In addition, awareness around the potential reduced efficacy of theophylline and clozapine is important (Cox et al. 2019).

Discussion

The modified Delphi process led to the development of three treatment protocols to support dosing and administration of medical cannabis in patients with chronic pain. The clinician may consider moving patients across the streams as a means to tailor the approach. Patient participation in the treatment decisions may enhance adherence and the likelihood of improved patient outcomes. The clinical success of medical cannabis should not be limited to pain scores and should consider improvements in function and quality of life.

Routine CBD dosing and administration

There was considerable debate around the starting cannabinoid type for routine dosing. It was not until the last round of voting that the group reached consensus to start with a CBD-predominant strain. A deciding factor was ultimately the safety profile of CBD. Purified CBD has been shown to be safe and well tolerated up to 6000 mg (Taylor et al. 2018). CBD at doses ranging from 10 to 20 mg/kg/day is effective as an add-on therapy to reduce refractory seizures in two pediatric populations, Lennox-Gastaut syndrome, and Dravet syndrome (Lattanzi et al. 2018). CBD has also been studied in social anxiety where CBD doses ranging from 25 to 600 mg per day has been shown to be effective, as reviewed in Skelley et al. (2020). Our recommendations are much lower than those used in reducing seizures and are at the lowest end of dosing for social anxiety.

There are some data to suggest that CBD may support pain relief and quality of life. In a recent patient-reported outcomes audit study from New Zealand (n = 400), CBD was well-tolerated and improved pain outcomes and quality of life (Gulbransen et al. 2020). The CBD doses used in this study ranged from 40 to 300 mg/day, but there was no statistical association between CBD dose and patient-reported benefit. In a single-arm prospective cohort study investigating the effect of CBD from hemp on opioid use over 8 weeks, CBD reduced opioid use and improved quality of life (Capano et al. 2019). In this study, over 90% of the participants used a dose of 30 mg/day CBD. In a commissioned review by the Australian government, CBD below 60 mg/day was deemed tolerable and safe (Goods Administration 2020). In line with these publications, our Delphi process with global experts in medical cannabis led to the recommendation that in the absence of achieving treatment goals by 40 mg/day of CBD, THC should be considered.

Another deciding factor in choosing CBD-predominant as the initiating product was the fact that many CBD-predominant preparations contain a small percentage of THC (Bonn-Miller et al. 2017; Lachenmeier et al. 2020). If the ratio of THC to CBD is 1:20, a patient taking 40 mg of a CBD-predominant product is also receiving 2 mg of THC. Two milligrams of THC is close to the recommended initiating dose of 2.5 mg. Unexpectedly, experiencing the psychotropic effects of THC may be undesirable for the patient, and treating clinicians should always be aware of the THC concentration within any given product.

Unlike THC, the mechanism of action of CBD is not believed to be primarily through its binding to the cannabinoid receptor. CBD is thought to exert its action on G-coupled protein receptors, transient receptor potential (TRP) channels, reducing intracellular transporters of endocannabinoids, and decreasing metabolism of endocannabinoids through its interaction with the enzyme FAAH and the P450 isoenzyme system (Mlost et al. 2020). CBD has a wide spectrum of biological activity, including antioxidant and anti-inflammatory activity (Atalay et al. 2020). Through these mechanisms of action, CBD is thought to improve symptoms in a variety of chronic pain conditions (Mlost et al. 2020). Preclinical trials have demonstrated a potential anti-nociceptive effect of CBD and when combined with other compounds in several pain-related diseases (Atalay et al. 2020; Mlost et al. 2020).

The 40 mg/day dose of a CBD-predominant strain before adding THC is lower than the CBD doses recommended by Boehske and Clauw (2019). However, the cost of CBD may restrict the use of CBD at high doses (Gulbransen et al. 2020). Moving forward, purified isolates of CBD will likely become more available such that the concern around THC inclusion with CBD-predominant product will be unnecessary.

Sihota et al. recently examined how to use medical cannabis to support opioid tapering (Sihota et al. 2020). The modified Delphi process was also applied in this report to pragmatically align on how to titrate medical cannabis while reducing the opioid dose. This report differs from the present report as we did not specifically consider opioid sparing but considered all patients living with chronic pain. However, similar recommendations on how to dose and administer medical cannabis were observed across the two studies, i.e., start with CBD and titrate THC for most patients. The main difference between the two studies is that the medical cannabis recommendations for opioid tapering are larger in range, while we have provided three titration protocols that may be used depending on the patient. It is encouraging that two Delphi processes resulted in similar recommendations.

Routine THC dosing and administration

In line with two previous clinical dosing and administration recommendation documents (MacCallum and Russo 2018; Boehnke and Clauw 2019), it was agreed that an initiating THC dose of 2.5 mg was appropriate. A large number of studies in various indications, including chronic pain, have observed that in most patients, the analgesic effects of THC start between 2 and 2.5 mg THC (Beal et al. 1995). It is important to note that analgesic effects of THC in chronic neuropathic pain in humans have been shown to occur at plasma levels well below those associated with euphoria (Ware et al. 2010; Wallace et al. 2020). Therefore, the patient may not need to experience the psychotropic effects of THC to achieve pain relief. However, before considering THC, clinicians should review local jurisdictional regulations on THC, as local guidance on THC may differ from CBD and require additional attention.

There was consensus that the daily dose of THC should not exceed 40 mg unless coupled with expert consultation. As the initiating dose is 2.5 mg, the clinician should titrate slowly with THC and ensure the patient is comfortable with each increasing dose. If considering THC above 40 mg, a consult with a cannabinoid specialist or an experienced medical cannabis clinician is highly recommended as tolerance to cannabis may be developing (Nguyen et al. 2018; Wilkerson et al. 2019).

When considering the pharmacodynamics of orally ingested THC, a recent crossover study examining 17 healthy adults who had not consumed recreational or medical cannabis for at least 60 days, completed four experimental sessions where they ingested 0, 10, 25, or 50 mg of THC (Schlienz et al. 2020). Subjective effects, vital signs, cognitive/psychomotor performance, and blood THC concentrations were assessed before, and then every 30 min for 8 h post ingestion. The 10 mg THC dose produced subjective drug effects and elevated heart rate but did not impact cognitive/psychomotor performance. The 25 and 50 mg doses of THC elicited pronounced subjective effects and impaired cognitive and psychomotor functioning compared to placebo. Subject-reported “good drug effect” was similar between the three doses, but the risk of “bad drug effect” increased with the 25 and 50 mg of THC doses. Although there is wide variation, when considering the majority of patients, 10 mg of THC per day is a typical therapeutic dose. If necessary, the tentative maximum daily dose of 40 mg is still safe but is unlikely to be needed often.

When orally administering THC, the pharmacodynamic effects may begin as early as 30 min and continue to rise between 1 and 3 h post ingestion (Grotenhermen 2003; Schlienz et al. 2020). This coincides with whole blood THC concentrations peaking at 1 h (Schlienz et al. 2020). The delay of drug effect when orally ingesting THC and duration of effect are important considerations for patients being treated with medical cannabis. Oral cannabis products (e.g., edibles) are responsible for the majority of emergency room visits related to cannabis intoxication, and understanding when and how long to expect a drug effect may help prevent accidental intoxication (Hudak et al. 2015; Barrus et al. 2016; Monte et al. 2019).

Conservative THC dosing and titration

The conservative protocol was developed to be lower and slower than routine with a focus on prevention of side effects and creating comfort with medical cannabis. The initiating and titrating doses of THC are different between the conservative and routine dosing and administration protocols as there may be concern with the psychotropic effects of THC. Our Delphi process led to agreement that 1 mg THC should be considered as the initiating dose, which is consistent with the lowest range set out in the Boehnke and Clauw guidance document (Boehnke and Clauw 2019). The tentative maximum dose of 40 mg THC for conservative regimen is the same as routine. There was discussion on the importance of exercising caution regarding the rate at which THC is titrated, but not the maximum THC dose.

Medical cannabis safety considerations

The predicted median lethal dose (LD50) for THC is > 1000-fold higher than the effective dose (Thompson et al. 1973; World Health Organization 2012). Unlike opioids, there are limited cannabinoid receptors in the brain stem areas that control vital functions such as respiration (Herkenham et al. 1990). Following oral administration, the LD50 of THC is 800 mg/kg in rats, 3000 mg/kg in dogs, and up to 9000 mg/kg in monkeys. A lethal THC dose for a 70-kg human is therefore estimated at approximately 4000 mg/kg of THC, which is a dose of 280,000 mg THC and likely unachievable with oral consumption, smoking, or vaporization (World Health Organization 2012). Clinicians may feel comfortable with tailoring the medical cannabis treatment regimen knowing that patients are not at a significant overdose death risk. However, cannabis-associated health risks including Cannabis Use Disorder and complications resulting from the psychoactive effects of THC need to be considered, even at low doses (Adam et al. 2020). This concept is important for the operation of motor vehicles, as well as occupational and recreational hazardous activity. When adding THC, the clinician may consider starting the first dose in the evening to limit potential issues with workplace functioning and driving. In addition, THC at night may support sleep quality and many patients with chronic pain suffer from sleep disturbances. Patients often experience an improvement in function as a result of improved sleep quality when treated with medical cannabis (Sanford et al. 2008; Bachhuber et al. 2019). However, the role of medical cannabis and sleep is currently being tested in a placebo-controlled randomized control trial (Suraev et al. 2020).

Conclusions

In summary, this modified Delphi process, led by global experts in the field of medical cannabis/cannabinoid medicine, resulted in the development of three protocols for the dosing and administration of medical cannabis to treat chronic pain. We hope that these recommendations will support clinicians and patients in achieving safe and effective dosing and administration of medical cannabis. Future randomized control trials examining the safety and efficacy of medical cannabis compared against current standards of care will be required to elucidate whether the developed protocols result in improved patient outcomes. The recommendations provided will be updated as new clinical trial evidence becomes available to inform on the type of dosing and mode of administration of medical cannabis for the treatment of chronic pain.

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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)

Product Details

Potency 1200 mg – 2400 mg
Available Flavors Natural, Kiwi, Lychee
CBD per serving 10 mg – 40 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 — is 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)

Product Details

Potency 100 – 1000 mg
Available Flavors None
CBD per serving 3.3 mg – 33.3 mg

About CBDPure

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)

Product Details

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 a more versatile thankful-spectrum extract.

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
  • THC-free
  • 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)

Product Details

Potency 250 mg – 5000 mg
Available Flavors None
Potency 8.33 – 166 mg/mL

About CBDistillery

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 for 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, and 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.

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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
  • Non-addictive
  • Non-intoxicating
  • 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 use CBD creams 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 above.

Let us know in the comments if you use CBD oil for neuropathy — and how it works for you!

Nina Julia

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.

Best CBD:THC Ratio For Neuropathy

Learn how to use CBD & THC together for neuropathy and which ratio is best.

Article By

The main active compounds in cannabis, cannabidiol (CBD) and delta 9 tetrahydrocannabinol (THC), offer pain relief and comfort to those suffering from nerve pain.

Nerve pain or neuropathy is often treated with medications made for other disorders like seizures and depression. CBD and THC make great alternatives with less side effects, less risk for tolerance and addiction, and better efficacy.

While each cannabinoid has its own benefits as an anti-inflammatory, analgesic, and muscle relaxant, research suggests that they offer more potent effects towards supporting neuropathic conditions when combined.

The best CBD:THC ratio for neuropathy is 1:1 — where there is an equal amount of these cannabinoids in each dose.

Here’s everything you need to know about the best CBD: THC ratio for nerve pain based on recent studies.

Table of Contents

What is Neuropathy? What Causes It?

Neuropathy refers to nerve pinching, compression, and damage resulting in pain.

There are many different causes of neuropathy, ranging from traumatic injuries to degenerative disorders like multiple sclerosis or cerebral palsy.

The condition leaves patients with significant pain, numbness, and, in severe cases, a reduction in autonomy and paralysis.

Neuropathic pain is especially difficult to treat. Conventional painkillers like acetaminophen don’t normally work that well for this type of pain because they target inflammation. Because the pain originates from the neurons themselves, reducing inflammation has little impact on pain.

Benefits of CBD & THC For Neuropathy

CBD has been widely studied for addressing neuropathy or nerve pain.

CBD on its own may be helpful for peripheral neuropathy, with patients reporting less pain after taking CBD.

CBD has been observed to reduce inflammation in neuropathy patients by interacting with the α3-glycine receptors, which are responsible for our sense of pain [1].

The Benefits of THC and CBD For Neuropathy Include:

  • Reducing inflammation
  • Managing chronic pain
  • Relieving symptoms of depression
  • Supporting healthy sleep quality
  • Promoting nerve regeneration

Will CBD & THC Interact With My Neuropathy Medications?

Neuropathy is often treated with prescription medications — many of which may interact negatively with CBD.

Make sure to always ask your doctor about interactions with any other medications you take to treat your neuropathy, especially antidepressants.

Common neuropathy medications and their potential interaction with CBD:

1. Opiate Painkillers

Opiates are commonly used to treat nerve pain. They’re considered to be one of the strongest classes of prescription painkillers available. They work by targeting the opiate receptors in the central nervous system. This effect blocks the transmission of pain heading from the body to the brain.

CBD may interact with opioid pain medications. This supplement has a similar effect as opiates on inhibiting neurological function and may compete for metabolism in the liver. Both of these effects could lead to an increased risk of side effects and overdose.

Always speak to your doctor about using CBD if you’ve been prescribed an opioid medication.

Common opiates used for neuropathic pain include:

  • Buprenorphine (Cizdol & Brixadi)
  • Codeine
  • Pethidine (Meperidine & Demerol)
  • Fentanyl (Abstral & Actiq)
  • Hydrocodone (Hysingla ER, Zohydro ER & Hycodan)
  • Hydromorphone (Dilaudid)
  • Methadone (Methadose & Dolophine)
  • Morphine (Kadian & Roxanol)
  • Oxycodone (Percodan, Endodan, Roxiprin, Percocet, Endocet, Roxicet & OxyContin)
  • Tramadol (Ultram, Ryzolt & ConZip)

2. Antidepressants

Long-term neuropathic pain often leads to depression. Lowered quality of life, poor sleep, and job loss all contribute further to this effect.

If you’ve been prescribed antidepressants, it’s important to speak with your prescribing doctor about CBD and THC first. Both compounds can interfere with the metabolism of drugs like SSRIs and SNRIs and lead to negative side effects.

THC is especially likely to interact with these substances in a negative way.

Common prescription antidepressants include:

  • Citalopram (Cipramil & Celexa)
  • Dapoxetine (Priligy)
  • Escitalopram (Cipralex & Lexapro)
  • Fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra & Oxactin)
  • Fluvoxamine (Faverin)
  • Paroxetine (Seroxat)
  • Sertraline (Lustral)
  • Vortioxetine (Brintellix)
  • Atomoxetine (Strattera)
  • Desvenlafaxine (Pristiq, Khedezla)
  • Duloxetine (Cymbalta, Irenka)
  • Levomilnacipran (Fetzima)
  • Milnacipran (Savella)
  • Venlafaxine (Effexor XR)

CBD & THC Ratios: What Dose Should I Take?

The best CBD:THC ratio for neuropathy is 1:1+, meaning equal parts CBD and THC or less CBD than THC.

Keep in mind that dosing and ratio are two very different things.

The dose refers to how much of the compounds you’re taking, and it’s typically measured in milligrams. There is no one-size-fits-all approach to dosing for neuropathic pain, but higher doses (50 mg +) have been shown to provide the most relief towards pain and inflammation.

To determine your doses, you can try our dosage calculator. This will give you a rough estimate of how much CBD you should consume depending on your weight and desired strength, but you can expect to experiment with your doses as cannabinoids affect individuals differently.

CBD and THC gummies and oils are easy to dose using ratios because you can cut the gummies or measure oil in mL. However, you can also buy CBD:THC ratio products that are already mixed for you.

Other CBD:THC Ratios

The best ratio of CBD to THC is a hot topic lately. While we already have a lot of data available for the benefits of both these cannabinoids for certain conditions — there’s very little information about what the optimal ratio of each one is when used in conjunction.

As more research comes to light on the intricate synergy between these two compounds, scientists are uncovering insight into ways we can get even more effectiveness out of cannabis.

Here are some of the other optimal CBD to THC ratios based on the current evidence so far:

Final Thoughts: Best CBD:THC Ratio For Neuropathy

The best CBD:THC ratio for neuropathy is 1:1 with equal parts THC to CBD.

Both THC and CBD are useful in managing pain from this condition. Taken together, the effects become even stronger.

There are several pharmaceutical medications using CBD and THC for treating pain — the majority of which use this same 1:1 ratio.

You can achieve this ratio by taking equal doses of CBD oil and THC oil or by mixing roughly equivalent doses of CBD or THC vape pens, capsules, gummies, or other products. You don’t have to use a premade CBD:THC product to get the benefits of this combination.

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