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Trigeminal Neuralgia (TN) and Medical Cannabis

Trigeminal Neuralgia (TN) and Medical Cannabis

Definition

Neuralgia essentially stands for “nerve pain”, and can occur in a nerve in any part of the body. In the case of Trigeminal Neuralgia, it is the trigeminal nerve (the fifth cranial nerve, also known as CN 5), which is the largest cranial nerve, and is responsible for sensation in the face as well as functions such as biting and chewing.

Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Trigeminal Neuralgia

Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help

THC, CBD, CBG, CBC, THCV, CBDA and beta-caryophyllene [1] may be useful for TN.

Medical Cannabis Pros

Fewer side-effects in comparison to many other medications.

Cannabinoids can be used to improve mood, sleep and appetite, which are all affected severely by the pain of TN.

CBD may act as a neuroprotectant [2] and help slow the degradation of the myelin sheath due to multiple sclerosis or any other neurodegenerative disease.

Cannabinoids “may prove useful in pain modulation by inhibiting neuronal transmission in pain pathways. Considering the pronounced antinociceptive effects produced by cannabinoids, they may be a promising therapeutic approach for the clinical management of trigeminal neuralgia.” [3]

Medical Cannabis Cons

Too high a dose of THC may increase anxiety and exacerbate pain. Increasing anxiety can increase sensitivity to pain in any condition.

Those suffering from cluster headaches as well may have to be careful with cannabinoids such as THC, as in some it may trigger an attack.

More About the Condition

Trigeminal neuralgia (TN) is a chronic pain disorder, where the trigeminal nerve (responsible for actions such as biting and chewing, as well as many other facial sensations) is damaged. As is to be expected, those who suffer from conditions such as multiple sclerosis, AIDS/HIV and diabetes are more likely to be affected, as the myelin sheath surrounding the TN nerve is damaged. An estimated 1 in 8,000 people a year develop TN, with onset usually beginning after 50 years old.

The pain of TN is extreme and has the unfortunate moniker of being a “suicide disease”, as 25% of sufferers commit suicide. The only condition with similar suicide rates are cluster headaches, and it is possible that the two conditions are linked in some way. The pain of both TN and cluster headaches are said to be so excruciating that it is often ranked alongside or even exceeds the pain of being bitten by a bullet ant, giving birth or even being shot by an actual gun! Burning and/or a persistent hammering or stabbing pain is often associated with TN, as well as “shock”-like pain.

Opioid and opiate-based medications are not recommended for TN, as they are ineffective at treating nerve pain to any significant degree. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are often used, as are anticonvulsants such as gabapentin. Antipsychotics may also be prescribed, as are antiepileptic and anticonvulsant medications. GABA receptor agonists are also often prescribed, but their side-effects can be extremely deleterious and sedative, making doing anything else difficult. It is not unusual for a TN patient to be prescribed a cocktail of drugs, including a low dose of opioids, even if they don’t help with nerve pain directly.

Quotes from Experts

“Cannabis‐based medicines may increase the number of people achieving 50% or greater pain relief compared with placebo (21% versus 17%; risk difference (RD) 0.05 (95% confidence interval (CI) 0.00 to 0.09); NNTB 20 (95% CI 11 to 100); 1001 participants, eight studies, low‐quality evidence). We rated the evidence for improvement in Patient Global Impression of Change (PGIC) with cannabis to be of very low quality (26% versus 21%;RD 0.09 (95% CI 0.01 to 0.17); NNTB 11 (95% CI 6 to 100); 1092 participants, six studies). More participants withdrew from the studies due to adverse events with cannabis‐based medicines (10% of participants) than with placebo (5% of participants) (RD 0.04 (95% CI 0.02 to 0.07); NNTH 25 (95% CI 16 to 50); 1848 participants, 13 studies, moderate‐quality evidence). We did not have enough evidence to determine if cannabis‐based medicines increase the frequency of serious adverse events compared with placebo (RD 0.01 (95% CI ‐0.01 to 0.03); 1876 participants, 13 studies, low‐quality evidence).

Trigeminal Neuralgia is perhaps one of the worst forms of pain in the world, with few medications that can help overcome it. Can medical marijuana help?

Best CBD Oil for Trigeminal Neuralgia – November 2020

Does CBD Oil Work for Trigeminal Neuralgia ?

  • Trigeminal Neuralgia (TN) is caused by damage or dysfunction in the trigeminal nerve , resulting in severe pain on the face.
  • C annabidiol ( CBD ) may have therapeutic effects in pain management by modulating receptors in the ECS (1) . A study from Pharmacological Reviews showed that CBD might strengthen nerve impulse in the ECS receptors, resulting in analgesic potency (2) .
  • A review shared that CBD might be useful in alleviating neuropathic pain and hyperalgesia (pain sensitivity) (3) .
  • Researchers observed that high blood pressure increases the risk of TN. A 2017 preclinical study showed that CBD reduced the resting blood pressure of human subjects (4) .
  • However, more studies are needed to support CBD’s benefits to people with trigeminal neuralgia.

Best CBD for Trigeminal Neuralgia

Spruce 750mg Lab Grade CBD Oil

Specifically formulated to be more palatable to CBD users
Overall Clinical Score

Each bottle of the 750mg CBD oil tincture contains 25mg of CBD per dropper full. The oil is peppermint flavor to mask any unpleasant tastes related to CBD.

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NuLeaf Naturals 900mg Full Spectrum Hemp CBD Oil

Perfect for anyone who are looking for CBD products that promote a healthy body and mind.
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Natural remedy for various illnesses. NuLeaf Naturals’ CBD oil is a whole-plant extract containing a full spectrum of naturally occurring synergistic cannabinoids and terpenes.

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Sabaidee Super Good Vibes CBD Oil

4x the strength of a regular cbd oil
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Super Good Vibes CBD Oil provides the purest and highest quality Cannabidiol (CBD) on the market as well as other high quality phytocannabinoids, terpenes, vitamins, omega fatty acids, trace minerals, and other beneficial for your health elements, which all work together to provide benefits.

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cbdMD CBD Oil Tincture Natural 1500mg

Uses USA hemp that is grown on non-GMO farms, and is both vegan and gluten-free
Overall Clinical Score

cbdMD’s CBD oil tinctures are made using only CBD sourced from medical hemp and MCT oil as a carrier oil. Tinctures are offered in orange, mint, natural, and berry flavors. Safe for daily use, the oil tinctures are packaged with a built-in rubber dropper to adjust CBD dosage easily. The packaging is made to be easy to transport and discreet to use.

  • &nbsp Various delicious flavors to choose from
  • &nbsp Has vegan, organic, and gluten-free ingredients
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  • &nbsp cbdMD uses MCT as its carrier oil so individuals who are allergic with coconuts should consider other brand options
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Why People Are Turning to CBD Oil for Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a form of neuropathic pain condition caused by dysfunction in the trigeminal nerve . The nerve is responsible for carrying sensation signals from the face to the brain.

TN pain has been reported to be so severe that it has been called the “ suicide disease ” (5) .

Slight stimulations on the face, such as touching, brushing, and washing may cause severe facial pain . TN may also cause muscle spasms, feelings of electric shock , and burning sensation .

TN symptoms include anticonvulsant agents, antispasmodic agents, surgery, and other procedures that involve inserting a stent into the trigeminal nerve .

Antiepileptic medications, such as gabapentin and carbamazepine, have been used to treat TN (6) . However, the lack of intolerability and efficacy has been observed among these medications after prolonged use (7) .

CBD is a proven antiepileptic treatment (8) . A recent study posted in Molecules mentioned evidence of CBD ’s anticonvulsant and neuroprotective properties. These actions might help reduce spasms (9) .

Studies have not investigated CBD ’s efficacy on spasms caused by TN. However, CBD might have therapeutic benefits for treating chronic pain caused by TN (10) .

A review shared that cannabinoids , such as CBD , might help alleviate neuropathic pain and hyperalgesia (pain sensitivity). The review mentioned that there is evidence that cannabinoids might block the pain pathway ’s neural transmission (11) .

The authors added that the nociceptive effects produced by cannabinoids might be a potential therapeutic approach to the management of trigeminal neuralgia (12) .

The analgesic and anti-hyperalgesic effects of CBD were supported by an animal study published in the Journal of Experimental Medicine (13) .

The study mentioned that CBD possesses therapeutic benefits that might reduce pain and inflammation caused by neuropathy (14) .

Neuropathy is dysfunction or damage in the nerves that may cause pain, tingling and burning sensations , numbness, or muscle weakness.

Moreover, the authors added that CBD was able to mitigate hyperalgesia in mice models. The study concluded that CBD reduced persistent inflammation and neuropathic pain (15) .

Another study shared in the European Journal of Pharmacology demonstrated that CBD possesses potent anti-inflammatory and immunomodulatory effects (16) .

In the study, oral CBD was administered on rat models with induced sciatic nerve compression. Researchers found that CBD treatment reduced hyperalgesia and reduced inflammation (17) .

According to experts, trigeminal nerve pain can be caused by a blood vessel pressing on the trigeminal nerve . This compression causes damage to the trigeminal’s protective coating (myelin sheath) (18) .

Moreover, researchers observed that high blood pressure increases the risk for TN (19) .

A preclinical study acknowledged that CBD has cardiovascular benefits (20) . The authors mentioned that healthy volunteers (age 21-29) whose hypertension is triggered by stress displayed a lower resting blood pressure after taking CBD .

Clinical studies without limitations are needed to demonstrate CBD ’s ability to reduce blood pressure in older individuals.

Most of the studies mentioned have shown results using animals as test subjects. More clinical studies are needed to prove CBD ’s efficacy in alleviating nerve pain .

How CBD Oil Works to Help With Trigeminal Neuralgia

The endocannabinoid system (ECS) is essential in maintaining homeostasis in the central nervous system , peripheral nervous system , immune system, and organs.

The ECS is composed of receptors that are spread across the human body. These receptors include the cannabinoid receptors (CB1 and CB2) and glycine receptor (GLyR) (21) .

Studies acknowledged that modulating the receptors in the ECS might influence bodily functions, resulting in several therapeutic benefits (22) .

Modulatory effects can be triggered or stimulated by cannabinoids , such as cannabidiol ( CBD) , tetrahydrocannabinol ( THC ), cannabichromene (CBC), cannabinol (CBN), and cannabigerol (CBG) (23) .

A study posted by the Journal of Experimental Medicine suggested that modulating the ECS might have therapeutic effects in pain management (24) .

Moreover, the authors mentioned that glycine receptors in the central nervous system are an essential target for alleviating neuropathic pain (25) .

The authors added that cannabinoids , such as THC and CBD , might strengthen nerve impulses in the glycine receptors, resulting in analgesic potency (26) .

Glycine receptors are ion channels that are responsible for neurotransmission.

The study found that oral CBD treatment provided a binding glycine activity that reduced hyperalgesia and neuropathic pain in mice models.

The Pros and Cons of CBD Oil for Trigeminal Neuralgia

The Pros
  • Studies demonstrated that CBD might have therapeutic effects in pain management by modulating receptors in the ECS (27) .
  • Researchers acknowledged that CBD might strengthen nerve impulses in the ECS receptors, resulting in analgesic potency (28) .
  • Animal studies have shown that oral CBD treatment might be useful in alleviating neuropathic pain and hyperalgesia (pain sensitivity) (29) .
  • Studies have shown that CBD might reduce blood pressure . High blood pressure might increase the risk for TN (30) .
  • Researchers acknowledge that CBD is well-tolerated and has an excellent safety profile (31) .
The Cons
  • There are not enough clinical studies that support CBD ’s efficacy in treating trigeminal neuralgia .
  • Studies mentioned that CBD might cause adverse effects, such as dry mouth, diarrhea, drowsiness, loss of appetite, and CBD -induced drug interactions (32) .
  • An animal study has shown that CBD might cause hepatotoxicity (liver damage) when taken in extremely high doses. This hypothesis is supported by the US Food and Drug Administration (FDA) (33) .

How CBD Oil Compares to Alternative Treatments for Trigeminal Neuralgia

There are not many alternative treatment options for painful conditions, like TN. The efficacy of alternative anticonvulsants for treating TN is currently not supported by scientific studies.

A popular alternative treatment for TN is acupuncture. A review mentioned that a 66-year woman suffering from TN believed that she was successfully treated by acupuncture (34) .

Acupuncture is a Chinese tradition that uses microneedles to balance the energy in the body.

Researchers mention that acupuncture may help maintain homeostasis in the ECS and must be investigated. So far, no direct studies have been made on how acupuncture might trigger the cannabinoid receptors (35) .

A study published in Frontiers of Molecular Neuroscience has found that electroacupuncture on osteoarthritis rats was able to increase receptor activity, resulting in reduced chronic pain (36) .

Electroacupuncture is conducted by sending electrical signals through acupuncture needles.

CBD has somewhat similar characteristics to electroacupuncture. A study discussed that CBD ’s modulation of adenosine receptors resulted in reduced pain and inflammation in rheumatoid arthritis mice (37) .

Another alternative treatment for TN is vitamin B12. Studies have shown that vitamin B12 has analgesic properties that might be useful for treating neuropathic pain (38) .

A review from Neural Plasticity cited clinical studies that produced positive results from neuropathic patients following treatments of methylcobalamin (MeCbl), a form of B12. These clinical studies included patients with neuropathic health conditions, such as TN and diabetic neuropathy (39) .

Clinical studies have yet to test CBD ’s efficacy on TN and diabetic neuropathy. However, a study acknowledged that CBD might also possess therapeutic benefits for neuropathic conditions.

CBD ’s modulation of glycine receptors resulted in alleviating chronic pain and hyperalgesia in mice models (40) .

How to Choose the Best CBD Oil for Trigeminal Neuralgia

Full-spectrum CBD oil carries all the major cannabinoids found in hemp plants, such as CBD , CBG, CBC, and 0.3% THC .

Full-spectrum CBD is recommended for treating neuropathic pain . A study posted in Therapeutics and Clinical Risk Management acknowledged the analgesic effects of other cannabinoids present in hemp (41) .

Broad-spectrum CBD contains the same cannabinoids in full-spectrum without THC . Broad-spectrum is recommended for individuals who do not want traces of THC in their system.

Full-spectrum and broad-spectrum types provide individuals with the “entourage effect.” The entourage effect means that all the cannabinoids are working in synergy.

Individuals who cannot tolerate other cannabinoids may opt for CBD isolate. This concentration contains 90% CBD .

Additional tips to consider before buying CBD :

  • Customers may check for cannabinoid concentration in the product by referring to the certificate of analysis (COA).
  • Checking testimonials and reviews from other customers is helpful.
  • Consulting with a neurologist before taking CBD is important.

CBD Dosage for Trigeminal Neuralgia

More clinical trials are crucial in determining the correct CBD dose for health conditions.

The British Journal of Pharmacology published a study that recommended a low dose of less than 1 to 50 milligrams kilograms per day ( (42) .

Individuals may increase their dose once their bodies get used to having CBD in their system.

Moreover, a clinical study published by the Brazilian Journal of Psychiatry mentioned that a dose-response curve was observed with CBD (43) .

The authors explained that 300mg pure CBD treatment produced positive results, while 150mg and 600mg did not produce any changes.

Also, a high dosage of CBD is not recommended. A study released by Molecules observed that extremely high doses of CBD caused hepatotoxicity in rat models (44) .

How to Take CBD Oil for Trigeminal Neuralgia

CBD oil may be taken orally in forms of capsules, softgels, and gummies. Individuals may also take CBD capsules , gummies, and other edibles with a glass of water.

A study observed that CBD remained in the system three to four hours after oral intake (45) .

Individuals who want a higher potency of CBD may opt for sublingual administration. CBD tinctures may be taken by using an applicator to drop CBD under the tongue.

More studies are needed to determine absorption speed and plasma concentrations for sublingual delivery.

The half-life of sublingual CBD administration has been observed to be dose-dependent. Nevertheless, researchers observed that plasma concentrations are faster when individuals are in a fasted state (empty stomach) (46) .

CBD tinctures may have an earthy taste due to the presence of terpenes. Terpenes are aromatic compounds found in the plants.

Some individuals may want the fastest method for pain relief . Thus, CBD vape pens and cartridges may be recommended.

Studies have shown that the lungs can be very efficient in delivering CBD into the bloodstream (47) . The authors explained that inhaling CBD through vaporization could deliver plasma concentrations to the body in less than 10 minutes.

However, another study reported that vaping might cause side effects , such as chest pain, shortness of breath, allergic reactions, and chemical irritation (48) .

Are CBD Oil and Medical Marijuana the Same?

Some individuals may mistake CBD for medical marijuana . However, these compounds differ in cultivation and concentration.

Medical marijuana or medical cannabis can come from several cannabis strains. The cannabis plant is harvested for its flowers and leaves, after which they are cured and dried for consumption.

CBD is usually extracted from Cannabis sativa, particularly hemp, using CO2 extraction, solvent extraction, or steam distillation.

The extraction method creates a more concentrated version of hemp. The cannabinoids are manufactured into carrier oils, capsules, edibles, vape juice, and other products.

CBD and medical marijuana also differ in terms of THC content.

CBD contains only 0.3% THC or less, making it legal in all 50 US states and territories (49) . Meanwhile, some dispensaries sell cannabis products that may contain up to 25-28% THC (50) .

Recreational and medical use of marijuana is illegal in the US, except for 11 states. These states may require consumers to procure a medical marijuana card (51) .

Although CBD products are legal, the CBD market remains highly unregulated.

Individuals are advised to always look for the certificate of analysis (COA) before buying the product. The COA is a third-party lab test result from ISO-certified laboratories.

These labs test for cannabinoid concentration and harmful chemicals, such as heavy metals, pesticides, and other contaminants.

The COA allows consumers to know that the product is high-quality and safe for humans or pets.

Conclusion

Studies have shown that CBD might be useful in alleviating neuropathic pain and hyperalgesia . This mechanism is due to CBD’s ability to block neural transmission in the pain receptors (52) .

Researchers also acknowledged that CBD might produce analgesic potency by strengthening nerve impulses in glycine receptors (53) .

Moreover, studies have shown that CBD might indirectly reduce TN pain by lowering blood pressure (54) .

More direct studies are needed to prove CBD ’s efficacy in alleviating neuropathic pain .

However, researchers mention that CBD ’s therapeutic potentials showed promise in improving the quality of life of individuals with TN (55) .

Trigeminal Neuralgia (TN) is caused by damage or dysfunction in the trigeminal nerve, resulting in severe pain on the face.