Interactive Case Study: Treatment of Neuropathic Pain in a Patient with Neurodegenerative Disease

Medical History

64-year-old female patient with limited mobility diagnosed with multiple sclerosis.

From patient history: type 2 diabetes (DM2) managed with oral medication, polytopic vertebrogenic pain syndrome.

Medications: pregabalin 150 mg 1-0-1 (could not tolerate dose increase), baclofen 50 mg 3 times/day, metformin 850 mg once/day, methylprednisolone IV at regular intervals, daily doses of NSAIDs (diclofenac, ibuprofen).

Subjectively, the patient suffered from severe spastic muscle pain in the limbs, polyarthralgia, moderate pain (VAS 6/10), sleep disturbances, anorexia, and polypharmacy.

Treatment Course

Initiated treatment with cannabis, initially administering capsules containing balanced THC/CBD levels.

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Conclusion

The patient was successfully treated with a cannabis extract containing THC/CBD 100 mg/20 mg/ml in a 30ml package. The initial dose was 1× 0.5ml, with a gradual titration to 0.4-0.4-0.6 ml, showing good effectiveness for spastic pain and sleep quality. The treatment proved sufficient, allowing the patient to reduce co-analgesics and muscle relaxants (baclofen 50 mg once/day; pregabalin 150 mg twice/day) and significantly limit NSAID pain relievers. Now, NSAIDs are used only sparingly for heightened pain.

The cannabis extract has a rapid onset and is better tolerated by our patient. The treatment led to an improved quality of life and reduced spastic limb pain without undesirable gastrointestinal effects.

MUDr. Katarína Střelcová
pain treatment clinic, THERÁPON 98, Kopřivnice