Medical Cannabis for the Treatment of Peripheral Neuropathy

Peripheral neuropathy, the most prevalent chronic complication of diabetes, often results in pain, tingling, and numbness in the extremities.1 Traditional treatment medications, in many cases, can yield suboptimal therapeutic results or significant adverse effects.Medical cannabis, through its effect on the endocannabinoid system, may offer additional treatment options in the future.2 The purpose of this article is to discuss an overview of medical cannabis, the categories of current products, overall chronic pain research, and the current research for peripheral neuropathy in patients with diabetes.The benefits and challenges for incorporating medical cannabis into an ongoing treatment regimen for a case study will also be explored. Traditional Treatment OptionsCurrent medication options aim to manage pain and improve function.3 Only 3 are approved by the Food and Drug Administration (FDA) for this indication: duloxetine, pregabalin, and tapentadol.Anticonvulsants like gabapentin and pregabalin modulate abnormal electric activity in the nerves but can cause side effects, such as weight gain and dizziness.Antidepressants including serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic amines (TCA) are also prescribed.The norepinephrine components of duloxetine and venlafaxine, both SNRIs, help with pain relief.Of these aforementioned medications, duloxetine, pregabalin, and gabapentin are often considered first line.Other medications include a TCA, amitriptyline, which is limited by side effects such as dry mouth, constipation, and blurry vision-especially in older patients.3 Although opioids and opioid-like medications, such as tapentadol, could be used, long-term use is associated with dependency, tolerance, and a range of other side effects.Topical treatments, such as 8% capsaicin patches and 5% lidocaine patches, can provide localized relief but may not address pain effectively in all cases.Despite these options, many with neuropathy continue to experience significant pain and discomfort.This has led researchers to