Ask a Nurse: What cannabis works for complex regional pain syndrome?

Q:

What type of cannabis should be used for complex regional pain syndrome (CRPS)? I receive ketamine infusions every six weeks. There is still pain at times.

A:

The most common question that we receive from Radicle Health patients is “What type of cannabis would help with____________?”

Our response, typically, is “It depends.” Pain is an individual experience and often requires an individualized approach. Fortunately, there are multiple combinations of cannabinoids and several routes of administration that health care professionals can recommend to treat chronic pain.

Which Cannabinoid?

The type of pain you want to treat will determine which cannabinoids you want to use:

  • CBD
    CBD is not psychoactive in the same manner as THC, but it can positively influence mood and it can help manage the dysphoria associated with pain. Additionally, CBD can boost opioid-based analgesic effects, enabling patients to achieve efficacy with lower doses of opioids, reducing the risk of addiction and overdose.

  • THC
    THC is responsible for the psychoactive and euphoric effects of cannabis, but many patients want to use cannabis without these side effects. Small amounts of THC can provide pain relief, reduce inflammation, and relax muscles without producing powerful psychoactive effects. It may not be necessary for patients to experience psychoactivity to achieve relief when using THC.

  • Tetrahydrocannabinolic Acid (THCa)
    THCa is a non-impairing cannabinoid that can help with inflammation and mild pain. Research suggests THCa is more water-soluble than THC, so patients can use lower doses of THCa to achieve relief, which reduces cost and adverse side effects. If THCa is exposed to heat or prolonged UV light, it will convert to THC and produce psychoactivity. Always keep THCa in a cool, dark place to prevent it from converting to THC.

  • Cannabidiolic acid (CBDa)
    CBDa is a non-impairing cannabinoid that has anti-inflammatory properties, which may be helpful for arthritic pain. While CBDa has not been studied as rigorously as CBD or THC, observational reports suggest CBDa helps with mild pain and fatigue. CBD is more water-soluble than CBD, so patients can use lower doses of CBDa to achieve relief, which reduces cost and adverse side effects. Always keep CBDa in a cool, dark place to prevent it from converting to CBD.

  • Cannabigerol (CBG)
    CBG is a non-impairing cannabinoid that can inhibit the uptake of the neurotransmitter GABA, which can decrease anxiety and muscle tension. Also, CBG has anti-inflammatory properties that might help patients suffering from intestinal bowel disease. Finally, CBG might offer therapeutic potential as an antidepressant, for the treatment of psoriasis, and as an analgesic.

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Written by Eloise Theisen

Eloise Theisen, AGPCNP-BC, is a dedicated and patient-focused nurse. For over 17 years, she has specialized in aging, cancer, chronic pain, dementia, Alzheimer’s, Parkinson’s, anxiety, depression, fibromyalgia, and various autoimmune and neurological diseases. The founder of Radicle Health, she started her career at John Muir Medical Center caring for patients suffering from cancer, terminal illnesses, respiratory failure/complaints, drug overdoses, acute alcohol ingestion, gastrointestinal bleeds, traumatic brain injury, and multiple traumas. Through her work with Aunt Zelda’s and the American Cannabis Nurses Association, Elosie has extensive knowledge of the endocannabinoid system and how cannabis and cannabinoids can be used successfully to treat patients.

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