Treating Peripheral Neuropathy With Medical Cannabis

Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist, discusses where medical cannabis can play a role in the treatment of peripheral neuropathy in diabetes.

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Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist, discusses where medical cannabis can play a role in the treatment of peripheral neuropathy in diabetes.
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Video transcript

Featuring Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist

Duration: 4 minutes, 45 seconds

Diabetes can affect nerves in many ways, and one of the most common ways is peripheral neuropathy. And by that I mean the nerves, the long nerves to your feet get damaged, slowly and progressively, starting with symptoms in your toes, then the forefoot, then the whole foot and with time, involving the lower leg.

We try to prevent diabetic nerve damage by keeping blood sugars as low as possible, avoiding other toxins or medications that might hurt the nerves, but we’re not always successful. Some diabetic neuropathy is mostly a numbness in the feet, and not that troublesome and doesn’t require a specific therapy to make someone feel better.

It can have an importance in terms of risk of foot infections and ulcerations. Painful diabetic neuropathy is much more troublesome for the patients. It can take the form of a burning sensation in your feet, or a shooting, lancing sensation, or deep internal pain. And unfortunately, tends to be worse as the day goes on, and many of our patients complain that it bothers them in the evenings, and it will affect their ability to sleep.

How do we treat it? We use medications to try and suppress the pain. Opioids have been used for many, many years, opium derivatives, and there’s many, many of them that have been tried. And they have a role, but a small role in treating neuropathy, as they really don’t tend to be long-term solutions.

Other drugs that have been used are some of the antidepressants. The tricyclic antidepressants, for example, amitriptyline, which has been used for many, many years to treat neuropathy, and is probably even today the most studied medication to decrease the pain, is another class of drugs that can be tried.

Anti-seizure medications are another class of drugs that’s successful, and all of these have a role, but no one drug is perfect in given patients with diabetic neuropathy. And there are some patients, that despite working the way through the established evidence-based medications that we have, do not find sufficient relief from their neuropathy.

Or, the relief that they get comes at a price of complications and side effects from those drugs, and they need something else. And that’s where medicinal marijuana seems to have a role. Medical marijuana can be prescribed in different ways. It can be smoked, which is the historical way marijuana was used.

There’s vapourizers now, ingested or taken orally, or some have attempted to extract components out of the raw marijuana , and either use that orally, or actually in the case of peripheral neuropathy from diabetes, to apply the extract directly to the feet, where the pain is.

Now, which is best? Like most facts, or questions about marijuana, we really don’t know. It’s my bias, and it’s I think a logical position with the data we have right now that it’s probably best not to smoke marijuana, and the reason for that is we know there are some tars and compounds liberated, that are probably in the absence of good studies at least, not good for you lungs. So why expose yourself to them when you have another option, for example taking it orally, which won’t expose you to potential danger.

To summarize the use of medicinal marijuana in the treatment of painful diabetic neuropathy, the first course of action is to try and prevent it. If you can’t prevent it and you’re having pain, work through the available validated therapies that are available to you.

And if they work, super. If they don’t and you’ve run out of options, it’s a serious consideration to try some medicinal marijuana with the direction of your physician, who you should consult to guide you through these various stages and options that you have and discuss what’s best for your particular situation.

Presenter: Dr. Richard Bebb, Endocrinologist, Vancouver, BC

Local Practitioners: Endocrinologist

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.