Three times on the topic of therapeutic cannabis usage possibilities – case studies from Czech practice
The following case studies from real Czech practice describe three cases of patients with various diagnoses, indicated for cannabis extract administration. In the first case, there was significant pain relief in an elderly patient with vertebrogenic pain syndrome. The second case study outlines the possibilities of using cannabis extract in the treatment of neuropathic pain in a polymorbid elderly patient. The final contribution describes the effect of this preparation in palliative therapy of an oncological patient.
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Benefits of cannabis extract therapy in a patient with vertebrogenic pain syndrome
Medical history
A 69-year-old woman suffers from rheumatoid arthritis and has undergone total hip replacement surgery on her left hip joint. She reports back pain in the lumbar spine area.
Risk factors
Rheumatoid arthritis.
Diagnosis
Lumbar and other intervertebral disc disorders with radiculopathy (M51.1).
Objective examination
The patient was found to have scoliosis during the examination. The lumbar spine does not develop, there are noticeable paravertebral spasms and decreased sensitivity in the calf of the left lower extremity. An EMG examination confirmed chronic radiculopathy of L5, S1; according to MRI of the spine, there are protrusions of intervertebral discs L2–L5 up to 5 mm.
Course of therapy (pain management)
Before starting therapy with Naxiva Panaxol THC 50 mg/ml, CBD 10 mg/ml, the patient reported pain at a level of 4 on a 10-point scale (0 = worst pain, 10 = no pain). She rated the quality of sleep at level 2 (0 = worst sleep quality, 10 = sleep without limitation). The dosage of the preparation was set at 0.1 ml once daily. The patient also used Skudexa as needed.
After the first month of treatment, during which drowsiness and dizziness appeared, the woman rated her pain at level 4 and the quality of sleep at level 9. The therapy continued with Naxiva Panaxol at a dose of 0.1 ml twice daily. Upon follow-up after 3 months, the patient confirmed that the side effects of the treatment had subsided, and no additional concurrent pain therapy was needed. The dosage for the next period was increased to 0.2 ml twice daily.
Conclusion
The overall evaluation of efficacy from the perspective of the attending physician was 9 points out of 10, and safety and adherence to treatment were rated similarly. The therapy had a very good effect, and the patient's condition improved.
MUDr. Bc. Eva Kynclová
Pain Management Center, Brno
Treatment of neuropathic pain in a patient with restless legs syndrome
Medical history
An 83-year-old woman is being treated for lumboischial syndrome and neuropathic pain in the lower extremities. In the past, she underwent stomach surgery, cholecystectomy, appendectomy, and two cardiological procedures with stent placement. She is under nephrology (left kidney atrophy) and orthopedics (osteoarthritis) supervision. Rheumatoid arthritis has been ruled out. The woman is asthmatic and allergic (pollinosis). Hypercholesterolemia and hypothyroidism are compensated, and intermittently higher glycemia is observed.
Risk factors
Renal insufficiency, left kidney atrophy, hyperuricemia, peptic ulcer disease.
Diagnosis
Lumboischial syndrome, neuropathic pain in lower limbs.
Objective examination
The asthenic patient shows increased tension, pain in the trapezius muscles, pronounced thoracic kyphosis, and bilateral tenderness of the sacroiliac joints. A detailed spine examination in 2019 showed a flattened cervical lordosis, diffuse skeletal porosis, and vertebral bodies without obvious deformities. Mild discopathy was noted in the C5–7 regions with a noticeable reduction of the intervertebral space at C6/7. Spondylotic changes were moderately pronounced. The thoracic spine is deformed by left-sided scoliosis with an apex at Th9, an arched hyperkyphosis, and normal vertebral body configuration. The spondylotic changes were assessed as advanced.
Course of therapy (pain management)
Previously, the patient tried various pain medications – Targin, Paralen, Algifen, Biofenac, Indomethacin, topical NSAID creams and patches, combined with dietary supplements containing magnesium and B vitamins. Before starting cannabis extract therapy, she described the pain level as 6 (0 = worst pain, 10 = no pain), and rated sleep quality at 2 (0 = worst sleep quality, 10 = sleep without limitation). Treatment with Naxiva Panaxol THC 100 mg/ml, CBD 20 mg/ml began in January 2023 at a dose of 0.1 ml once daily. She also used Targin 10/5 (1–0–1). After one month of therapy, which was free of side effects, her pain improved to level 8, and sleep quality reached a maximum of 10. After an additional 2 months of the same therapy, the patient rated her condition similarly (pain 8, sleep 10).
Conclusion
Cannabis extract treatment proved to be highly effective and safe in this case. It led to significant pain reduction and sleep improvement. The drug form was also favorably evaluated, contributing to excellent treatment adherence.
MUDr. Katarína Střelcová
Pain Management Clinic THERÁPON 98, Kopřivnice
Pain management in palliative care for a patient with brain glioma
Medical history
A 58-year-old woman with brain glioma underwent radiotherapy (1–2/2021) and chemotherapy (1–8/2021). This was followed by corticosteroid therapy with a significant Cushingoid effect and the development of steroid-induced diabetes. Her pharmacological history includes Fortecortin, Keppra, Lamotrigine, Nolpaza, Furosemide, and Gliclazide.
Risk factors
Diabetes mellitus, oncological disease.
Diagnosis
Brain glioma (grade III), clinically progressive psycho-organic syndrome, severe balance and gait disorder, urinary incontinence, partial epilepsy.
Objective examination
The patient, who had a progressive brain glioma detected on MRI in October 2022, has balance problems, stutters in speech, and cannot complete thoughts. Her cognitive state fluctuates. Due to uncertain gait, she is prone to falls and moves outside the home only with family assistance.
Course of therapy (pain management)
Treatment with Naxiva Panaxol THC 100 mg/ml, CBD 20 mg/ml began in January 2023 at a dose of 0.1 ml once daily. No additional pain treatment was being administered at that time. The initial pain level was rated at 5 (0 = worst pain, 10 = no pain), and sleep quality was also rated at 5 (0 = worst sleep quality, 10 = sleep without limitation).
After the first month of therapy, the pain completely subsided, and the quality of sleep was fully restored. The treatment proceeded without side effects. Adherence to therapy was rated at 5. After 3 months of cannabis extract use, adherence to therapy improved (rated at 8), and both pain and sleep quality were rated similarly (both at level 9).
Conclusion
The patient was very satisfied with the cannabis extract treatment and wished to continue this therapy. The attending physician evaluated its efficacy and safety as excellent.
MUDr. Juraj Serafin
Neurology Clinic, Jablunkov
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