Can Medical Cannabis Help With Diabetic Neuropathy?

Medical marijuana helps improve the quality of life for millions of patients across the United States. Individuals who experience chronic pain may be eligible to use doctor-supervised medical cannabis, as it is a common qualifying health condition accepted by most states.

Painful diabetic neuropathy is a common complication of diabetes, and according to the Centers for Disease Control and Prevention (CDC), over 34 million Americans have been diagnosed with diabetes. Approximately 1 in 3 patients with diabetes will develop diabetic neuropathy.

Diabetic neuropathy pain is categorized as a chronic pain condition. Medicinal cannabis is now a legal alternative for patients to explore and can help with neuropathic pain. Let’s take a closer look at diabetic neuropathy to learn how it impacts the lives of patients. In this article, you’ll also hear from a patient who has had diabetes for seventeen years and how she is using THC to help moderate her symptoms.

Understanding Diabetic Neuropathy: Causes and Symptoms

One of the most common complications that arise from diabetes is peripheral neuropathy. While most people associate diabetic neuropathy with foot or toe pain, it can also happen in other areas of the body, including hands, fingers, arms, and legs.

The cause of diabetic neuropathy is nerve damage caused by long-term exposure to high blood sugar levels. The small blood vessels that supply oxygen and nutrients to the nerves become damaged, and their ability to transmit signals effectively is impaired. Diabetic polyneuropathy can also disrupt spinal cord messaging and may cause cold burning deep pain, electric stabbing, or randomized sharp pain in the back.

The result can cause tingling, numbness, burning sensations, and weakness in the areas affected. It can impact muscle strength in the hands, arms, legs, and feet. Other problems from diabetic neuropathy can impact digestion and the nerves and muscles around the heart.

Chronic inflammation is another struggle patients with diabetes face, and it is related to peripheral neuropathy. Elevated blood sugar levels over a long period of time also strip the protective covering of nerves, called the myelin sheath. That makes nerves more susceptible to damage and impairs nerve functioning.

It is important for patients with diabetes to follow the care advice of their practitioners. About fifty percent of Americans diagnosed with diabetes have nerve damage. Autonomic neuropathy becomes more severe during the later stages of diabetes, and the nerve damage is irreparable.

Diabetic neuropathy pain and other effects are a leading cause of serious health risks, disability, and loss of quality of life for people with the condition. Managing blood sugar and engaging in diabetic neuropathy treatment can help patients moderate pain intensity, improve mobility, and reduce insomnia for diabetic patients.

How is Diabetic Peripheral Neuropathy Diagnosed?

There are several tests your primary care provider will do to determine if you have developed diabetic peripheral neuropathy. The goal of the tests is to determine if nerve damage has occurred and how the body’s nerve fibers may be impaired by exposure to high blood sugar over extended periods of time.

The five most common diabetic peripheral neuropathy pain tests for diagnosis are:

1. Filament Testing

Also known as a 10g monofilament test, the non-invasive diagnostic is used to assess the severity of diabetic neuropathy. A thin filament is applied to specific areas of the body, and the patient is asked to indicate when they feel pressure.

This important test helps determine the level of decreased sensitivity, particularly in the feet. This can help educate the patient on foot injuries that can happen when the ability to perceive pressure or touch is compromised. Prevention can help reduce the risk of diabetic foot ulcers and infections, as nerve damage impedes wound healing.

2. Sensory Testing

This diagnostic test applies touch, vibration, discomfort, and temperature challenges, to different areas of the body. Most commonly, sensory testing is conducted on the toes and feet. A sensory score is determined, which helps the physician guide the patient regarding the prevention of injuries.

3. Nerve Conduction Testing

One of the most common and important tests for diabetes-related neuropathic pain is nerve conduction testing (NCS). It is sometimes called nerve conduction velocity (NCV). The test involves placing small electrodes in the affected areas and applying an electrical pulse to measure how reactive nerves are and how well they are functioning.

This test helps to diagnose neuropathy at the earliest stages. And it also helps determine if neuropathic pain is being caused by other symptoms, such as impinged nerves, injuries, and other causes. It also provides a baseline record of nerve performance to allow practitioners to monitor the condition on an ongoing basis.

In some cases, nerve injury can occur elsewhere in the body, such as spinal cord injuries, impinged disks, and other sources of spontaneous pain.

4. Electromyography

An electromyography or EMG test involves the insertion of small needles into muscle groups. Electronic signals are recorded while the patient is active (moving) and inactive (seated or at rest). When a patient has diabetic neuropathy, the nerve damage is reported as abnormal electrical activity in the EMG readings; this helps determine the severity of the neuropathy and helps the physician develop a treatment plan.

By the time a patient develops diabetic neuropathy symptoms, there may be significant nerve damage. An EMG test can help detect it early, and the physician may recommend different types of insulin treatments to help lower glucose levels and slow the progression of nerve damage.

5. Autonomic Testing

This diagnostic procedure tests the autonomic nervous system. That is the network of nerve signals that controls involuntary functions (or things that happen automatically) in the body, including your blood pressure regulation, digestion, sweating, and heart rate.

Diabetic neuropathy can disrupt those signals and cause problems with autonomic reflex functions. The autonomic testing can help detect the problem and create a treatment plan to help avoid long-term complications.

Is Medical Cannabis Better Than Opioids for Neuropathy?

Patients who develop diabetic neuropathy are often prescribed pain medications, including opioids or NSAIDs. But in the past ten years, what we know about the long-term use of opioid medications for pain management has grown significantly. And many patients are looking for an alternative to opioid use.

There are four main reasons why prescription opioids can be ineffective to treat diabetic neuropathy:

Neuroplasticity

The long-term use of opioids may hurt the central nervous system. It can cause neuroplastic changes, which alter how pain signals are communicated through the spinal cord and throughout the network of nerves throughout the body.

The neuroplastic changes can cause an upregulation of “pain-sensitive pathways,” which can increase the severity of pain experienced by patients with neuropathy. This is why some studies suggest long-term use of opioids can increase (not decrease) chronic pain sensations over time.

N-Methyl-D-Aspartate (NMDA) Receptor Activity

The NMDA receptors are responsible for pain modulation, or how severe your perception of chronic pain becomes. Some studies have suggested that opioids burn out NMDA, and the receptors develop a tolerance that can then increase pain sensitivity.

Increased Inflammation Caused by Opioids

Inflammation causes pain, and pain also causes chronic inflammation. When it comes to diabetic neuropathy, inflammation makes things worse. Some studies have stated that long-term use of prescription opioid medications can increase the production of cytokines and chemokines, which cause an increase in inflammation. It can also cause something called opioid-induced hyperalgesia susceptibility, which is a heightened perception of pain.

Potential for Opioid Addiction and Abuse

In the United States, the opioid crisis continues, even if it is not talked about often. In 2022, there were 79,770 opioid-related deaths in the United States. That was a slight decrease from 80,007 opioid-related fatalities in 2021.

Opioid addiction remains a significant health risk, whether prescribed or obtained illegally (fentanyl). Long-term use of opioids increases the risk of addiction and other health complications, including infectious diseases, mental health disorders, and respiratory depression.

There has not been a report of one single fatality due to cannabis use, where cannabis was the single drug consumed. It is not surprising, given the inherent risks of long-term opioid use, that many people are exploring doctor-supervised medical marijuana as an alternative pain management option.

What Types of Medical Cannabis Do Patients With Diabetes Use?

There are many different ways to use medical marijuana to help with chronic neuropathic pain. Some patients use different strains of cannabis for daytime use versus nighttime use. Sativa medical marijuana can offer some mild pain relief while reducing symptoms of stress and anxiety. Whereas Indica dominant cannabis therapy can offer a sedative effect and help improve the quality of sleep.

Because neuropathic pain is usually localized, some patients use THC-infused medical cannabis topicals. They can be applied directly to the affected area and help soothe muscle and pain caused by nerve damage. Topicals are available in a variety of different formulations, and many doctors recommend finding a topical that also has cannabidiol (CBD) content, which can help reduce inflammation.

Best Cannabis Strains Diabetic Neuropathy Relief

There are more than 700 different strains of cannabis, but availability varies. You may not be able to find specific strains in your area. However, if you talk to a medical dispensary, you can request that they carry a specific strain. If demand is great enough from multiple patients, they may cultivate specific strains to meet the needs of local patients.

Some of the most popular strains of cannabis that are used to help with diabetic neuropathy pain include:

• Afghan Kush.
• White Widow.
• Jack Flash.
• Harlequin.
• Cannatonic.
• ACDC.
• Charlotte’s Web.
• Critical Mass.
• Amnesia Haze.
• Sour Diesel.
• Pineapple Express.
• Granddaddy Purple.

If none of these strains are currently available in your area, the best advice is to talk to your local dispensary. They can suggest strains that are very similar to what you are looking for. As chronic inflammation is a concern for patients with diabetic neuropathy, aim for strains that have a high ratio of cannabidiol (CBD) which can help reduce inflammation.

A Success Story of Diabetic Neuropathy Patients Using Cannabis

Lori R. is a patient who was diagnosed with Type 2 diabetes at the age of thirty-three. About fifteen years later, she began to develop symptoms of diabetic neuropathy pain and agreed to share some of her experiences with MedWell Health & Wellness Centers.

1. What was the first sign of diabetic peripheral neuropathy for you?

I first began to notice that the skin around my toes was darkening. I thought it was freckles or hyperpigmentation, so I didn’t do anything about it. About a year later, I started to experience sensations of pins and needles, particularly after sitting for long periods of time. Sometimes, my feet were also very cold, even if the surrounding temperature was warm.

I didn’t know much about diabetic neuropathy, but as the frequency of the “pins and needles” increased, I started doing some online research. Then I spoke to my doctor, and he did a variety of different tests; some were nerve conduction, and others were sensory tests to see how sensitive my toes and upper feet were to touch. The tests confirmed I had diabetic peripheral neuropathy.

2. How often do you experience symptoms of diabetic neuropathy?

When I was first diagnosed, I would have the sensations maybe two or three times per week. And the pins and needles didn’t hurt much; it was more of a strange feeling and annoying. However, after two years, I began to experience symptoms on a daily basis.

I have spoken to many other patients who have diabetic peripheral neuropathy, and they experience pain symptoms that are far worse. When I do experience the sensations, it is not too painful (yet), but I feel numbness in my toes. It’s really a spontaneous pain that occurs any time of the day, and the pain intensity varies. It is manageable for me now, and I don’t have any real debilitating symptoms.

3. Does diabetic neuropathy pain affect your sleep?

Yes. It’s been about three years since I was diagnosed with neuropathy. Sometimes I get a sharp pain in my toes that wakes me up. It can be hard to get back to sleep when I experience the pins and needles in my toes, and my fitness tracker shows that I wake up several times throughout the night.

If I do not take something before bed, I wake up feeling very tired the next morning. The amount of REM and deep sleep I get has dropped significantly. My energy level and mood are definitely impacted by the disrupted sleep.

4. How do you cope with your symptoms?

Usually, I massage my feet on a daily basis and do leg stretches that help improve circulation, and the discomfort goes away temporarily. Every once in a while, I will have a stabbing pain in a toe or several toes at once, but it goes away quickly.

I have noticed that I can wear high heel shoes with minimal discomfort now. I guess that is a plus side to the condition. But I am more attentive to my feet now than ever before. I use cream to keep them well moisturized, and that helps prevent cracked skin. I know it’s really important to prevent infections in my feet since reduced circulation means my body will not be able to fight off infections as well in that area.

I do wear compression socks when the pain flares up during the day. I also use air compression boots for thirty minutes every day. They squeeze my feet, toes, and calves tightly and then release. I read that compression therapy can help improve insulin sensitivity. I also use the boots when the pain is particularly bad, and it seems to help.

5. Have you tried THC for pain relief?

Yes, I use THC gummies to help with pain. I prefer a low dose that is enough to “take the edge off” the neuropathic pain. I have tried other things, such as Advil and Tylenol extra strength, but they also did not work.

I was offered prescription opioid medications by my physician, but I am concerned about side effects and have opted not to use NSAIDs or opioids for the time being. I may have to in the future; for now, THC helps a lot. I usually take one half to a full edible about one hour before bed and sleep much better when I do.

With the edibles, I have noticed my REM and deep sleep phases are longer, and I feel well-rested in the morning. However, I only use the edibles in the evenings and use warming or cooling diabetic foot creams and compression socks during the day, which works well for now.

6. What advice do you have for other patients with diabetic neuropathy?

Know the early signs that you are developing peripheral neuropathy. Talk to your doctor, but also educate yourself about alternative therapeutic methods. While I briefly relied on prescription pain medications, they radically impacted my energy level and overall mood. I am glad I found what works for me now.

Diabetes can be overwhelming. Keeping your blood sugar under control is a daily battle. And even when you take all your medication properly and eat well, stress, caffeine, and lack of exercise can make many symptoms worse.

I have lost 130 pounds since I was diagnosed, and I continue to read about things I need to do to try to avoid some worst outcomes that can happen if you don’t make time to take care of yourself. I now work out four days per week at the gym, and I feel that has helped my symptoms of neuropathy as well. On the weeks I can’t make the gym, the symptoms are worse, so I think physical activity is a very important part of managing neuropathic pain.

I think medical cannabis can help in so many ways when you are struggling with symptoms of Type 2 diabetes. Living with diabetes is stressful, and cortisol (stress hormone) can make managing blood sugar very difficult. If you have anxiety, insomnia, and pain, medical cannabis can provide relief.

Consulting Your Doctor about Cannabis for Diabetic Neuropathy

If you have been diagnosed with diabetic neuropathy pain, you may be qualified to use medical cannabis. A formal diagnosis is required to apply for your medical cannabis card, and you can submit your health records from your primary care physician as a qualifying health condition.

If you are suffering from debilitating symptoms of diabetic neuropathy, your appointment with a MedWell Health & Wellness physician is an opportunity to get expert advice. Our cannabis healthcare specialists can suggest medical cannabis products that may help you better manage diabetic neuropathy and help you explore alternative health options for pain relief.

If you suffer from Diabetic Neuropathy, you have chronic pain. Looking for relief? Book a consult with Medwell Health and Wellness Centers for your Medical Card.