Eight years ago, at 38, Stephanie Johnson was diagnosed with advanced, triple-negative breast cancer. “I was given a 23 percent chance of living to see five years, and now I’m at eight years,” says Johnson. “I got to see my boys become men.” Her sons, teens when she was diagnosed, are now 22 and 25. But post-treatment she battled unrelenting pain that interfered with her daily life until she found something—CBD oil—that could ease her torment.
After her diagnosis, Johnson endured a year of treatment that included four months of chemotherapy and three surgeries. But while the chemo drug, taxol, helped eliminate her cancer, it left Johnson with painful nerve damage in her hands and feet that she continues to struggle with today. Johnson likens the sensation to being stabbed with a multitude of tiny icepicks. “It’s prickly and almost an electrical shock feeling—but a lot of little [shocks]. The feet will swell and they get sore, too.”
Her condition, peripheral neuropathy, develops in about 30 percent to 40 percent of people who undergo chemotherapy, according to the National Institute of Neurological Disorders and Stroke. Taxol and related drugs, as well as cisplatin-based chemo, can cause this type of nerve damage, says Antonio Vigano, MD, the director of Cancer Rehabilitation and Medical Cannabis Programs at McGill University Health Center in Montreal, Quebec, Canada.
“It’s a particular type of pain that relates to disruption of the normal nerve function, primarily in the nerve endings,” Dr. Vigano explains. Patients may feel numbness, a sense of burning, and “pins and needles” all at once. Peripheral neuropathy first appears when patients begin chemo, and while it often improves with time and may even get better completely, many patients like Johnson have persistent symptoms.
Peripheral neuropathy can also result from poorly controlled diabetes, autoimmune disease, nutritional deficiency, viral infections, injuries, and a host of other factors.
Temporary relief with standard meds
For about 18 months, Johnson tried treating her painful, tingling hands and feet with over-the-counter pain relievers and topicals, which are recommended options from the American Academy of Pain Medicine: The group’s guidelines steer patients toward nonopioid medications including certain antidepressants, drugs for treating seizures and nerve pain known as gabapentinoids, and topical therapies such as creams containing capsaicin.
Unfortunately for Johnson, she couldn’t find relief—plus, she worried about potential side effects, like organ damage. “I finally was like, you know what, I’ll try this CBD [cannabidiol] stuff,” she says. Johnson had become familiar with CBD through her job at a marketing, branding, and advertising agency in Dallas, where she researched and wrote content for clients including CBD product makers, hemp farmers, and medical marijuana firms.
“I did a lot of due diligence, and working with brands in the space allows me an opportunity to know more about the process than those who may be looking up CBD on Google for the first time,” Johnson says. “Therefore, I was certainly confident in the safety of CBD. Of course, I’ve endured chemotherapy and almost everything pales in comparison in my opinion.”
What is CBD, really?
CBD isn’t like the other main active ingredient of cannabis, THC (delta-9-tetrahydrocannabinol): It won’t get you high, although it may help calm the brain. In 2018, the U.S. Food and Drug Administration approved the first-ever CBD medication, Epidiolex, for treating rare syndrome-related seizures in children. Ingested CBD has also shown promise in anxiety and insomnia, ulcerative colitis, Parkinson’s disease, chronic pain, and post-traumatic stress disorder (PTSD), among other mental and physical conditions. Applied to the skin, CBD creams and oils may also help relieve pain. In a 2019 study of 29 patients with peripheral neuropathy, published in the journal Current Pharmaceutical Biotechnology, researchers found CBD oil containing 250 milligrams of CBD per three ounces significantly reduced intense and sharp pain and cold and itchy sensations compared to a placebo.
The human body can make its own cannabinoids, known as endocannabinoids, which act on cells throughout the central nervous system and are believed to help maintain an individual’s internal equilibrium in multiple ways. When CBD and other cannabinoids are taken systemically, meaning eaten or inhaled so the entire body is exposed to their effects, they also interact with these cells, according to a 2016 study published in the journal Biological Psychiatry. CBD is also readily absorbed through the skin.
Does it work?
While scientists are still teasing out the specifics of how these external cannabinoids may act in and on our bodies, topical CBD likely reduces pain by quelling inflammation and reducing hypersensitivity to heat, pain and other unpleasant sensations.
“Our approach has been primarily using CBD as a systemic treatment,” notes Dr. Vigano, who is also the research director of Sante Cannabis, which runs medical and research cannabis clinics in the province of Quebec. While studies in animals have shown that CBD can treat and might even help prevent neuropathic pain, Dr. Vigano notes, there is virtually no clinical data in humans.
Clinicians at Sante Cannabis may recommend topical CBD for patients with peripheral neuropathy that is very localized, or if systemic CBD is contraindicated for a patient due to heart or liver disease, Laurence Cousineau, a research nurse at Sante Cannabis in Montreal, says.
A backup option
But neither systemic or topical CBD should be the first-line treatment for peripheral neuropathy, says Dr. Vigano. Like Johnson, patients should seek more established treatments, he says: “Pregabalin, duloxetine, those are medicines that definitely could have a role and potentially should be tried first.”
He also recommends that anyone considering a trial of topical CBD for peripheral neuropathy do so under medical guidance, ideally with a provider experienced in recommending cannabis-based medicine. “What works for one patient may not necessarily work for others,” he warns. “Cannabis is not a miracle, and it takes time to be adjusted and has to be part of a coordinated approach. It’s not a magic bullet.”
Johnson was one of the lucky patients: “I remember the first time I tried a topical on my feet, and I rubbed it in and I said, ‘ok here we go,” she adds. “I could start feeling the pain calming down and everything subsiding, and I looked at my husband and said, ‘Oh my God, I feel good! This is great!” She has tried an array of CBD products; right now uses a cream for her neuropathy symptoms containing 750 milligrams of CBD, and a lower-potency CBD oil to ease achy legs at bedtime.
The pain in her hands and feet has lessened over the years, she says, but it can still sometimes reach excruciating levels so she still uses a CBD topical at least once a day. “I think it’s going to be something that I’m just going to always have hanging on in some form or fashion,” she says. “What’s nice is I have a solution.”