“CBD oil sold here.” Columnist Ezekiel Lim says there is key information needed for patients and caregivers considering CBD for peripheral neuropathy.
CBD oil has some ‘tingling’ with excitement
Cole Smith, a pharmacist at and cannabidiol ambassador for Eastridge-Phelps Pharmacy, stands next to the store’s collection of CBD oil products.
These signs — or some variation of them — are seemingly popping up in front of every store, ranging from pharmacies to gas stations and everything in between.
But according to Cole Smith, who earned her pharmacy doctorate from Lipscomb University, works at Eastridge-Phelps Pharmacy and has recently become an ambassador of sorts to local doctors on behalf of the new cannabidiol (CBD) products they sell over the counter, not all CBD oil is the same.
“The first thing I want them to know is that all CBD oil is not created equal,” Smith said, “so those who are interested need to make sure they’re getting it at a reputable place.”
Smith said prices vary depending on where someone purchases CBD, but lower cost often translates to an inferior product. It might be less effective, manufactured under questionable conditions or even show up as marijuana on drug tests.
Because they’re sold over the counter, CBD products do not have to go through Food and Drug Administration testing as a prescription drug would.
Cannabidiol is extracted from either marijuana plants or hemp plants, but despite being the second most active ingredient in marijuana, it does not get you high. Only tetrahydrocannabinol (THC) does that, and only THC should register on a drug test.
So, why do some CBD products cause users to test positive for marijuana usage?
“The product we carry [at Eastridge-Phelps] has less than .3% of THC in it,” Smith explained. “It comes from Colorado, which has much stricter regulations on CBD produced there. If you’re not buying from a reputable source, it’s very likely that THC is going to show up.”
In her experience, no one who has bought their product has seen THC show up on a drug test. Even so, everybody processes drugs at a different rate.
That means THC could stick around longer in your body than it does in someone else’s.
“Some employers will say, ‘If you bring in the CBD oil when you test positive, it’s fine,’” she said. “But for law enforcement and truck drivers and other jobs with zero-tolerance policies, it may not be a good fit for them.”
Another big factor in whether CBD oil is a good fit for someone, according to Smith, is what they’re planning to use it for.
“The top thing we’re seeing it used for is pain, including arthritic pain or ‘generalized pain,’ as well as localized pain.”
Smith said there are two different ways of using CBD oil, and she suggests different ones for each pain type.
For generalized pain and body aches, she suggests liquid or capsules. For localized pain, like a hurt knee or aching back, she recommends ointment patients rub on.
Each method has its benefits.
“Topical ointments won’t get into your system as much, which makes it great for people worried about taking it orally,” Smith said. “The liquid drops have a taste that some people can’t stand, but it gets to work faster than the capsules. Capsules don’t have that bad taste, though, so some people prefer those.”
Smith said the bad taste of the drops is the “side effect” most patients complain about, though drowsiness and a tingling sensation where the topical ointment is applied may occur.
Aside from pain and inflammation, Smith also sees CBD oil used by people dealing with insomnia, anxiety and “mood” issues.
Deciding what CBD should or should not be used to treat is tricky, though.
Even for the most common issues it’s recommended for, very few studies have been conducted.
The Dravet and Lennox-Gastaut syndromes cause childhood seizures resistant to most treatments, but CBD seemed to help, according to a study titled “Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome” published by The New England Journal of Medicine in May 2017.
After that trial came others and the FDA approved Epidiolex, the first prescription drug derived from CBD, in June 2018.
The FDA has not approved CBD oil as a treatment for anything else, but some studies do show it could be helpful with the pain, insomnia and sleep issues Smith recommends it for.
Many patients are willing to try it for an array of other problems, though.
“A lot of people will come and ask questions about what CBD oil can treat,” she said. “When someone comes in and wants to use it to treat, say, their upset stomach, if I’ve not read any literature on it, from a scientific standpoint, I don’t want to recommend it for treating that thing.”
Some people prefer to take the research into their own hands, but hoaxes and misinformation abound online. Medical professionals and other scientists are better trained to tell when a study is legitimate.
There is no evidence CBD is the “miracle drug” some say it is in Facebook posts or alternative medicine blogs.
“Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer, which it is not,” wrote Peter Grinspoon. He’s a primary care physician at Massachusetts General Hospital, an instructor at Harvard Medical School and contributing editor for the Harvard Health Blog.
He updated his article “Cannabidiol — what we know and what we don’t,” on June 5, 2019, to talk about Epidiolex and the need for further research on CBD.
Grinspoon says that while some studies show CBD is effective at treating chronic pain, insomnia and anxiety, more evidence is necessary.
The European Journal of Pain published a study about CBD’s ability to treat arthritis in rats. Scientists often use animal models to test new drugs, but most trusted medicines have had clinical trials, too.
“Without enough high-quality evidence in human studies we can’t pinpoint effective doses,” Grinspoon wrote. “Because CBD is currently mostly available as an unregulated supplement, it’s difficult to know exactly what you are getting.”
Smith noted that the biggest factor in whether someone should try CBD oil is the advice a trusted medical professional gives you.
“CBD oil, from what studies have found, generally does not have many drug interactions,” Smith explained. “But the main thing you worry about when someone goes out on their own looking for something is that it could interact with the drug regimen they’re already on.
“If it’s working, be sure to speak with your pharmacist or healthcare provider about coming off your medication. I would never recommend going rogue.”
What Patients Should Know About CBD for Peripheral Neuropathy
The pain associated with peripheral neuropathy symptoms makes everyday life difficult for patients. And the medication needed to treat the underlying physical symptoms of familial amyloid polyneuropathy can prove too costly for those on a limited budget.
Alternative methods for managing neuropathic pain are available. CBD is an emerging alternative treatment that allegedly has significant pain-reducing qualities.
What is CBD?
Cannabidiol (CBD) is one of the most abundant compounds in the marijuana plant. CBD products come primarily in the form of oils, topical ointments, and infused food items. However, with the exception of one prescription product to treat rare forms of epilepsy, the U.S. Food and Drug Administration has not approved any other CBD products.
Recent clinical research, including a study by researchers at Scotland’s University of Glasgow , looks at CBD’s effects on anxiety, movement, and pain. The study found that a “meaningful proportion” of patients exhibited improvements in sleep quality and pain when administered CBD.
Is CBD for real?
CBD’s impact could be a placebo effect, though the results of the study at the University of Glasgow appear to show otherwise. The emergence of clinical studies corroborating CBD’s pain-relieving qualities and a surge in CBD-based retail stores may offer peripheral neuropathy patients a solution for foot pain.
The plausibility of CBD being a reliable treatment may be subjective. Many peripheral neuropathy patients, including my mother-in-law, find THC products are a suitable method for alleviating neuropathic pain. THC’s alleged calming effects may benefit patients with chronic tingling and burning sensations of the feet, but these effects may not necessarily be true for everyone with peripheral neuropathy symptoms.
Not every patient with polyneuropathy will be quick to adapt to CBD as a solution for pain. My mother-in-law struggles with the side effects of gabapentin: drowsiness, dizziness, and fatigue. This has led her to use prescribed marijuana. Her medical marijuana use has helped alleviate the pain, burning, and tingling in her limbs.
Ultimately, CBD may provide temporary relief from pain with potentially fewer side effects than medicines such as gabapentin.
Note: FAP News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of FAP News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to familial amyloid polyneuropathy.
About the Author
Ezekiel Lim Ezekiel is caregiver to his mother-in-law, who has familial amyloid polyneuropathy. He holds a bachelor’s degree in strategic and organizational communications from Temple University and currently lives in Philadelphia, Pennsylvania. When not writing, he’s skateboarding or hanging out with his wife, Maryann.
I have severe pain in both feet and trouble sleeping and Bella Rose CBD oil really helps in both cases. My pain is caused by Neuropathy. It gets so bad that it’s hard to do anything. This is the best product that I have found yet.
Im trying to find something for pain in my foot neuropathy. Its terrible. I cant sleep at night. All through the day all i can think about is my foot pain . The main pain is actually in my big to and toes. Please help
I hope more clinical trials are conducted to validate the pain alleviating properties of CBD products to treat peripheral neuropathy.
My wife bought me a “Sports gel”, main active ingredient is CBD. plus a touch of capsaicin and arnica. I’ve had ideopathic pedal neuropathy for several years and learned to live with it on my daily exercise walks. Nothing my primary care GP could find to help it.
A natural-born sceptic, science-rooted, I’ve been trying this out in disciplined fashion. Light application once a day for the first 5 days brought pretty amazing results. While general numbness didn’t vanish. Nothing like that. A great of sensitivity to ground impact, terrain, added experience returning to my walks.
Cut it back to every other day. Worked just as well. Now, a few more weeks have passed and I’ve gone as long as 4-day intervals with no application. and no diminishing of the positive effect.
I’m returning to every other day, starting tonight. wondering if the effect will become greater.
For the record, lost a bunch of weight a few years back. Now, weigh ~180#, 5’10”, decent physical shape for my age after a lifetime of one or another sport, outdoors physical activity, a lifetime walker [using top quality hiking or sports shoes the last 50 years. decent work shoes before that]. I’m 83.