CBD for post-stroke pain -- recommendations?
December 3, 2022 3:33 PM Subscribe
A relative of mine suffered a stroke several years ago, and still suffers from chronic pain, probably nerve pain. I'm interested in whether CBD or CBD+THC might help.
My relative -- 70s, male -- had a left-side ischemic stroke a little less than three years ago. Aside from the expected paralysis and aphasia, he has also had chronic problems with seizures and pain, and the last couple of years have been a constant struggle to find a mix of medications that will address these problems without intolerable side effects. Today I'm asking primarily about the pain.
It's somewhat difficult to get a clear description of the pain, because he suffers from pretty severe aphasia. Although he's made progress in speech therapy, it's still difficult for him to answer open-ended questions. What is clear is the location of the pain: primarily on the stroke-affected side. I also believe that it is at least in part nerve pain/neuralgia, in part because he has indicated that the pain includes tingling, and in part because he is sometimes very sensitive to light touch specifically.
For the most part, conventional medications have not been successful here. Gabapentin (which he was prescribed in the aftermath of the stroke) seems to work on the pain, but also leaves him extremely sleepy and lethargic. This has also been a common problem for him with muscle relaxers and antiepileptics as well -- even low doses will leave him sleeping for the majority of the day, and only somewhat awake the rest of the time. We seem to have reached a dose and combination of antiepileptics that keep his seizures under control without completely knocking him out, but the pain is still a problem.
I have done some googling on the use of CBD/THC to address post-stroke pain, and the scientific literature seems fairly thin on the subject. But there is enough to make me think there may be some promise, including a single case report in the BMJ of CBD+THC successfully treating otherwise treatment-resistant post-stroke pain. So, I'm interested in exploring this, and was wondering if MeFites have any useful information, anecdotal/experiential or otherwise.
Specifically:
My relative -- 70s, male -- had a left-side ischemic stroke a little less than three years ago. Aside from the expected paralysis and aphasia, he has also had chronic problems with seizures and pain, and the last couple of years have been a constant struggle to find a mix of medications that will address these problems without intolerable side effects. Today I'm asking primarily about the pain.
It's somewhat difficult to get a clear description of the pain, because he suffers from pretty severe aphasia. Although he's made progress in speech therapy, it's still difficult for him to answer open-ended questions. What is clear is the location of the pain: primarily on the stroke-affected side. I also believe that it is at least in part nerve pain/neuralgia, in part because he has indicated that the pain includes tingling, and in part because he is sometimes very sensitive to light touch specifically.
For the most part, conventional medications have not been successful here. Gabapentin (which he was prescribed in the aftermath of the stroke) seems to work on the pain, but also leaves him extremely sleepy and lethargic. This has also been a common problem for him with muscle relaxers and antiepileptics as well -- even low doses will leave him sleeping for the majority of the day, and only somewhat awake the rest of the time. We seem to have reached a dose and combination of antiepileptics that keep his seizures under control without completely knocking him out, but the pain is still a problem.
I have done some googling on the use of CBD/THC to address post-stroke pain, and the scientific literature seems fairly thin on the subject. But there is enough to make me think there may be some promise, including a single case report in the BMJ of CBD+THC successfully treating otherwise treatment-resistant post-stroke pain. So, I'm interested in exploring this, and was wondering if MeFites have any useful information, anecdotal/experiential or otherwise.
Specifically:
- Any recommendations for route of administration -- capsules? tinctures? topical creams or oils? I'm inclined to believe that topical is not the way to go for a systemic, possibly CNS-related issue, but my initial search of Ask did show some people recommending topical CBD for localized nerve pain, so I'm open to correction here.
- Any reputable brands? CBD-only products are available in grocery stores here, but I don't know which ones are reputable. If I should avoid the products in grocery stores entirely and just go to a dispensary, that's useful to know too.
- I know you are not my (or his) doctor, and we'll ask that doctor as well, but if you are aware of a well-known drug interaction or similar issue that means we should not try this at all, I'd like to know that as well.
- Local recommendations are welcome! My relative is in Prescott, AZ, but I'm in Tucson and would be easily able to pick up products here or in the Phoenix area. Arizona has legalized both medical and recreational marijuana, so although getting a medical endorsement for this would be ideal in the long run, I can pick things up without any paperwork while we're still trying things out.
A friend received a lot of relief for nerve pain through straight up pot (she makes her own pot brownies), after being on gabapentin and not finding it helpful for the pain and with yucky side effects. This is probably the route I would take first since, according to her, it provided pain relief immediately.
When I had nerve pain from shingles, I took a low-dose tricyclic (Amitriptyline) which is used off label for a variety of nerve pain, and either I got better on my own or it worked. I had no side effects other than a dry mouth. It takes days or weeks to start working. That was after trying a potent CBD/CBG (both topically and orally) and finding it had only slight relief for the pain. But if you want to try that out, Lazarus Naturals seems to be a good brand for CBD.
posted by nanook at 4:02 PM on December 3, 2022 [1 favorite]
When I had nerve pain from shingles, I took a low-dose tricyclic (Amitriptyline) which is used off label for a variety of nerve pain, and either I got better on my own or it worked. I had no side effects other than a dry mouth. It takes days or weeks to start working. That was after trying a potent CBD/CBG (both topically and orally) and finding it had only slight relief for the pain. But if you want to try that out, Lazarus Naturals seems to be a good brand for CBD.
posted by nanook at 4:02 PM on December 3, 2022 [1 favorite]
I can’t speak about how they work for pain, but if you want to try CBD and THC, the cheapest brand with (seemingly-legit) lab results I’ve found is Alliant Hemp. They make a tincture in 25:1 and 100:1 CBD:THC ratios.
I’ve read that CBD is poorly absorbed when eaten, but sublingual tinctures are more reliable. I find Alliant’s 25:1 tincture extremely calming without making me high, but I only take about 0.75ml at a time. At the doses needed for pain, I would think the THC would start to be noticeable.
Alliant also has a trial pack of their tinctures that has various ratios, including high potency CBD isolate that contains zero THC, if that’s of interest.
posted by uncleozzy at 4:18 PM on December 3, 2022
I’ve read that CBD is poorly absorbed when eaten, but sublingual tinctures are more reliable. I find Alliant’s 25:1 tincture extremely calming without making me high, but I only take about 0.75ml at a time. At the doses needed for pain, I would think the THC would start to be noticeable.
Alliant also has a trial pack of their tinctures that has various ratios, including high potency CBD isolate that contains zero THC, if that’s of interest.
posted by uncleozzy at 4:18 PM on December 3, 2022
I would recommend starting with a well-reviewed CBD-only lotion or oil roller, topically. When my father was ill enough that he was no longer mobile, the vascular and muscle-spasm pain in his legs really only responded to topicals. I take a high-CBD/low THC edible for sleep, and I think it's generically helpful with inflammation but I have been dealing with a series of sprains that were still painful enough to keep me awake despite the edibles until I used my preferred CBD-only salve on them.
I would just be very, very averse to giving THC to someone who can't provide feedback. I am personally a super-lightweight and it does not take very much for me to hit Oh God I'm Going To Die. We're talking one julienned piece of a sample brownie from a dispensary will leave me content but nonverbal and the same amount makes my partner so paranoid and anxious it takes days to recover. My sleep gummies are 1mg THC (to 20mg CBD, it's the highest ratio I can find on the West Coast) for a whole one and I only take half and that is still "a little bit high" territory for me, so if you're going to try THC you need to use something that is highly titratable and start with literal microdoses.
posted by Lyn Never at 5:24 PM on December 3, 2022 [2 favorites]
I would just be very, very averse to giving THC to someone who can't provide feedback. I am personally a super-lightweight and it does not take very much for me to hit Oh God I'm Going To Die. We're talking one julienned piece of a sample brownie from a dispensary will leave me content but nonverbal and the same amount makes my partner so paranoid and anxious it takes days to recover. My sleep gummies are 1mg THC (to 20mg CBD, it's the highest ratio I can find on the West Coast) for a whole one and I only take half and that is still "a little bit high" territory for me, so if you're going to try THC you need to use something that is highly titratable and start with literal microdoses.
posted by Lyn Never at 5:24 PM on December 3, 2022 [2 favorites]
When I had shingles there was pain from light touch. It was so bad I couldn't sleep. The solution for me was topical capsaciacin. Walgreen brand 1% capsaicin cream was too strong (it burned) but I thinned it with lubriderm and it worked like a miracle. Actually, hot sauce also worked but didn't last very long :)
Substance P may be involved.
posted by H21 at 6:28 PM on December 3, 2022 [1 favorite]
Substance P may be involved.
posted by H21 at 6:28 PM on December 3, 2022 [1 favorite]
This meta-study says cannabis and derivatives are no better than placebo for pain relief.
This
This
posted by H21 at 1:07 PM on December 4, 2022
This
This
posted by H21 at 1:07 PM on December 4, 2022
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Not a doctor, but the only obvious thing I can think of for someone in their 70s is that THC does raise your heart rate, so if he has any heart problems, I'd advise him to talk to his doctor first.
Charlotte's Webb is reputable for CBD.
Since you're in a legal state, I'd look for edibles that are either 1:1 CBD : THC or even CBD dominate (like 5:1). Start him on a low dose and see what happens. Microdosing THC is a thing now, and so your local shop should have options for that - if not, you can always cut up a low-dose gummy into quarters.
posted by coffeecat at 4:02 PM on December 3, 2022