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Marijuana for Painful Peripheral Neuropathy?

Summary and Comment |
April 30, 2007

Marijuana for Painful Peripheral Neuropathy?

  1. Judith Feinberg, MD

A cleverly designed trial demonstrated the pain-relief benefits of smoked marijuana in patients with HIV-associated sensory neuropathy.

  1. Judith Feinberg, MD

In 1999, an Institute of Medicine report concluded that the natural products contained in marijuana (cannabinoids) might be useful for managing pain and spasticity. Now, investigators have conducted a randomized, double-blind, placebo-controlled trial to determine whether smoked marijuana has therapeutic value specifically in HIV-infected patients with painful peripheral neuropathy.

Using a uniform puff procedure, 50 patients smoked marijuana three times daily for 5 days at an inpatient general clinical research center (GCRC) in California. Those assigned to the treatment group smoked active marijuana (grown by the federal government and not very potent by street standards), whereas those assigned to the placebo group smoked marijuana with the cannabinoids removed. The trial incorporated many clever design elements to control for potential confounding, including eligibility criteria that required a history of prior marijuana exposure but did not allow for current substance abuse, a 2-day lead-in phase in the confines of the GCRC, observation of smoking sessions by study staff, and no visitors permitted during the 7-day GCRC stay. All patients rated their chronic neuropathic pain on a daily basis before, during, and after the smoking phase of the study. In addition, 30 patients underwent experimental tests, both before and after smoking, that involved exposing their forearms to heat for 1 minute; these tests allowed for an assessment of marijuana’s effects on acute pain.

At baseline, the groups had similar median daily pain ratings. By the end of the smoking phase, about half of the marijuana group, compared with one quarter of the placebo group, had a clinically significant reduction in chronic pain (defined a priori as >30%). The median daily reduction in chronic pain was 34% in the marijuana group and 17% in the placebo group. During most of the experimental tests, the marijuana group experienced a significantly smaller area of pain than did the placebo group. Sedation, anxiety, disorientation, confusion, and dizziness were all significantly more common in the marijuana group.

Comment

Despite relatively low concentrations of active cannabinoids, the marijuana cigarettes used in this study reduced chronic pain associated with peripheral neuropathy and also alleviated acute pain. The level of pain relief was comparable to, or better than, that seen with other drugs, such as anticonvulsants and tricyclic antidepressants, that have been evaluated for peripheral neuropathy. Legal issues with the medical use of marijuana abound, but I think that clinicians and patients who are comfortable with the concept of therapeutic cannabis use can explore its usefulness in ameliorating painful peripheral neuropathy, especially in situations in which other approaches have failed.

Citation(s):

Reader Comments (4)

Macharia Other, Other

In my country Kenya, many people who smoke marijuana are aftenly associated with anti social behaviours like violence againist other people. So would such a drug be useful?

gary l west disabled

Isn't it amazing what u see when u realty look and not just listen to a bunch of quacks with and agenda. Congratulations for opening up your eyes now do some good with your knowledge.

Peter A Cain

I have been through every avenue of treatment for peripheral neuropathy which effects mostly my thighs and lower legs. Nothing but "weed" has been effective. I believe part of the pain relief is simply a cognitve shift. The result however, is a drastic reduction of irritation agitation and depression. Antidepressants, especially SSRI's had disastrous effects-a manic episode, seizures, and eventual hospitalization - I warn averyone to avoid unsupervised use of these volatile drugs- marijuana is prediictable. Join NORML and remain sane!

Competing interests: None declared

Jack Futerman

In Canada there are drops available which concentrates the pain killer in cannabis. You put the drops in your nose and from there it travels via the capillaries in your nose directly to your brain. I will be starting this sometime next week for my idiopathic peripheral neuropathy. My pain specialist informs me that he has a patient suffering from MS who has benefited from these drops. I hope to resume my normal recreational activities once I experience the pain reduction this medication promises.

Competing interests: None declared

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