Central neuropathic pain (CNP) occurs in many multiple sclerosis (MS) patients. The provision of adequate pain relief to these patients can very difficult. Here we report the first phase III placebo-controlled study of the efficacy of the endocannabinoid system modulator delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray (USAN name, nabiximols; Sativex, GW Pharmaceuticals, Salisbury, Wiltshire, UK), to alleviate CNP. Patients who had failed to gain adequate analgesia from existing medication were treated with THC/CBD spray or placebo as an add-on treatment, in a double-blind manner, for 14 weeks to investigate the efficacy of the medication in MS-induced neuropathic pain. This parallel-group phase of the study was then followed by an 18-week randomized-withdrawal study (14-week open-label treatment period plus a double-blind 4-week randomized-withdrawal phase) to investigate time to treatment failure and show maintenance of efficacy. A total of 339 patients were randomized to phase A (167 received THC/CBD spray and 172 received placebo). Of those who completed phase A, 58 entered the randomized-withdrawal phase. The primary endpoint of responder analysis at the 30 % level at week 14 of phase A of the study was not met, with 50 % of patients on THC/CBD spray classed as responders at the 30 % level compared to 45 % of patients on placebo (p = 0.234). However, an interim analysis at week 10 showed a statistically significant treatment difference in favor of THC/CBD spray at this time point (p = 0.046). During the randomized-withdrawal phase, the primary endpoint of time to treatment failure was statistically significant in favor of THC/CBD spray, with 57 % of patients receiving placebo failing treatment versus 24 % of patients from the THC/CBD spray group (p = 0.04). The mean change from baseline in Pain Numerical Rating Scale (NRS) (p = 0.028) and sleep quality NRS (p = 0.015) scores, both secondary endpoints in phase B, were also statistically significant compared to placebo, with estimated treatment differences of -0.79 and 0.99 points, respectively, in favor of THC/CBD spray treatment. The results of the current investigation were equivocal, with conflicting findings in the two phases of the study. While there were a large proportion of responders to THC/CBD spray treatment during the phase A double-blind period, the primary endpoint was not met due to a similarly large number of placebo responders. In contrast, there was a marked effect in phase B of the study, with an increased time to treatment failure in the THC/CBD spray group compared to placebo. These findings suggest that further studies are required to explore the full potential of THC/CBD spray in these patients.
The effects and dose are based on your DNA, and because our bodies are all ever so slightly different, your personal chemistry will determine how your body processes hemp. Don't try to compare yourself or what you feel to other people you know – or even what you read on the internet, this post included. It's a good frame of reference so you know what to possibly expect, but not a hard and fast set of rules. Got it?
Once you've "graduated" from there, try 10 to 15 milligrams. Sagely Naturals makes a 10 milligram turmeric and CBD capsule that I love, and CW Hemp (my first CBD love) makes 15 milligram capsules. From there, try two pills. Give yourself time to see how long it takes to set in. Take notes, and keep a journal of how you feel. This is a really important part of any new regimen and medication, not just CBD!
Tip 2: Hydrate Extra!
Would you rather have chocolates and gummies, or an oil tincture? Maybe you'd rather pop a vitamin-like capsule! Only need muscle relief? A topical balm or cream might be your best bet.
Since I've been using a variety of different CBD products over the past five months, I think I've graduated from "beginner" to "intermediate" CBD consumer. I've tried topical and ingestible products; creams and salves, sprays and balms, chocolates, capsules, tinctures, and oils. I've taken anything from 2 mg at a time to 90 mg so far and have found my personal sweet-spot dose for different purposes, whether it's daily stress management, intense anxiety, or muscular tension and pain relief after a workout.
Tip 4: Don't Give Up if You Don't Feel Anything at First
While starting with a smaller dose, you might not feel any effects at all! That's normal, so don't stress, and definitely don't give up on it, because a world of anxiety-free living just within your grasp, dear friend. Patience is a virtue, especially with this process.