Cbd oil gabapentin interactions for nerve pain

CBD and Gabapentin

CBD and Gabapentin explained. Many suffering from neurological disorders, like epilepsy or fibromyalgia, are prescribed gabapentin to help manage their symptoms. These conditions can be uncomfortable, outright painful and debilitating. Gabapentin helps calm the nervous system and can reduce pain, all without narcotic side effects. However, some may be looking to augment their gabapentin with a natural supplement like CBD. But is it safe to combine the two?

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Is it Safe to Mix CBD and Gabapentin?

There is no known interaction between gabapentin and CBD. CBD can change how your body metabolizes certain drugs, but gabapentin hasn’t show conclusive evidence that it is one of them.

What is Gabapentin?

Gabapentin (sold under the brand names Neurontin and Horizant) is an anticonvulsant drug that is used to help people with epilepsy control seizures. It is also approved by the FDA to alleviate neuropathic pain in people suffering from shingles. Shingles are an extremely painful rash that can crop up in people who were infected with the herpes zoster virus, commonly known as chickenpox.

Shingles can develop years or even decades after someone has recovered from herpes zoster and is characterized by shooting nerve pain. Horizant, the brand name extended release version, has also been approved by the FDA to treat restless leg syndrome, a neurological disorder that causes discomfort and an irresistible urge to move the legs.

Gabapentin is also frequently prescribed off label, meaning it’s used to treat conditions other than those approved by the FDA. Off-label gabapentin prescriptions are used to treat conditions like peripheral neuropathic pain, attention deficit disorder, migraine headaches, fibromyalgia, sleep disorders, anxiety and bipolar disorder.

How Does Gabapentin Work?

Interestingly, how gabapentin works is not really understood. Gabapentin is molecularly similar to the neurotransmitter gamma-aminobutyric acid (GABA) found in the brain. A neurotransmitter is a chemical inside the body that transmits messages within and between nerve cells. GABA is known to be an inhibitory neurotransmitter, meaning that it calms the brain neurons down so they don’t fire so rapidly. Note the similarities between the names GABA and gabapentin.

Gabapentin has been proven to have a similar effect to natural GABA; it inhibits neuron activity and thus stops pain, not at the source, but at the brain level. It can’t stop the nerves in your feet from being painful, but it can block your brain from registering it.

Where the mystery comes in with this medication is that even though gabapentin molecules are similar to GABA, and have similar effects, it does not bind to GABA receptors, boost production of the neurotransmitter or stop it from being destroyed by the body.

How is Gabapentin Metabolized?

Gabapentin is a somewhat strange substance because of how it is metabolized by the human body. Most drugs undergo significant chemical changes as they move through the gut, liver and eventually into the bloodstream. However, gabapentin is different. It really isn’t metabolized at all by the human body. It is excreted almost completely unchanged through the kidneys in urine.

CBD can affect the metabolism of drugs that are processed primarily by the liver because it binds to enzymes, chemicals in the body that speed up chemical reactions. Since gabapentin isn’t metabolized in this way, or at all really, no adverse interaction between the two has yet been noted. Even so, you should still discuss adding CBD with your healthcare team and follow their recommendations.

CBD for Epilepsy

Evidence continues to mount that CBD is a viable treatment for intractable epilepsy, meaning epilepsy that does not respond well to conventional anti-seizure treatments. In 2016, an Israeli study examined the effects of CBD on the number of seizures experienced by children with intractable epilepsy treated in five different clinics. 89% of patients had fewer seizures. More than half of the patients who saw improvement, reported their seizures were reduced by 50% or more. The researchers also noted that the patients were more alert and had an improved quality of life.

Dravet Syndrome

In 2017, researchers in the US conducted a double-blind, placebo controlled study to evaluate the effectiveness of CBD as a treatment for the symptoms of Dravet syndrome, an intractable developmental epilepsy. The researchers concluded that almost half of the patients saw a 50% decrease in seizure activity. Since patients with Dravet syndrome can have hundreds of seizures a month, this is a significant improvement.

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Lennox-Gastaut Syndrome

In 2018, another group of US researchers conducted a double-blind, placebo controlled study to investigate CBD as a possible treatment for patients with Lennox-Gastaut syndrome. Lennox-Gastaut is a form of intractable epilepsy that arises in childhood and is a lifelong affliction. The researchers found that 41% of patients given CBD saw improvement in the number of seizures they experienced over a 14 week period.


These US studies prompted the FDA to approve the first CBD-derived medication available by prescription, Epidiolex. Currently, it is only approved to treat Lennox-Gastaut and Dravet syndromes. Despite this, cannabis is still a Schedule I drug, classified as having no medicinal properties.

CBD for Nerve Pain

Both human and animal studies have shown that CBD has the potential to act as an anti-inflammatory for the nervous system. It’s also thought that CBD has neuroprotective properties, meaning that it may help protect nerve cells from ongoing damage.

A 2018 study found that CBD binds to GABA receptors in the brain. If CBD mimics the effects of GABA, it could help calm the rapid firing of neurons, the same idea behind medications like gabapentin.

CBD has also been shown to slow the breakdown of anandamide, another important neurotransmitter that has a calming effect on the central nervous system. CBD inhibits the actions of the enzyme that destroys anandamide, fatty acid amide hydrolase (FAAH). Higher levels of anandamide have been shown in numerous animal studies to lessen pain response and seizure activity.

Anecdotal Accounts

Anecdotal accounts tout CBD for chronic conditions, like fibromyalgia, that cause chronic nerve pain. Some users state that they have better pain control, were able to reduce their medications and had improved sleep. Others use CBD and gabapentin together and feel that adding CBD gives them better control over their symptoms. Don’t add CBD or change your medications without consulting your healthcare team.


There is no known interaction between CBD and gabapentin. CBD can change the way your body metabolizes certain drugs, but since gabapentin really isn’t metabolized by the body, it may be safe to mix the two. CBD also has the potential to alleviate symptoms of neurological disorders in its own right. Be sure to talk to your healthcare team before adding CBD or changing your medications, and always follow their recommendations.

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Medical Cannabis for Nerve Pain (Neuropathy)

According to the National Institute of Neurological Disorders and Stroke, more than 20 million Americans have been estimated to have some form of nerve pain. Many experts, however, think that number is even higher. Nerve pain is also often called “neuropathy” or “peripheral neuropathy“, which refers to damage or dysfunction of one or more nerves, typically resulting in numbness, tingling, muscle weakness and pain in the affected area. Due to neuropathy coming in many different shapes and forms, on top of nerve pain itself often being misdiagnosed due to its complex array of symptoms, those suffering from it often can’t find consistent relief. Medical cannabis could perhaps provide this consistent relief.

Unfortunately for many, the lack of reliable relief and lack of legal access to medical marijuana leads to the traditional medical establishment prescribing them addictive pharmaceuticals, sometimes including opioids, further exacerbating and adding to the millions of Americans who misuse opioids. The most common drugs prescribed for nerve pain are pregabalin (Lyrica) & gabapentin (Neurontin), amitriptyline (a tricyclic antidepressant) and duloxetine (an antidepressant that affects serotonin and norepinephrine). Although these drugs aren’t necessarily as narcotic as opioids, they can still have negative side-effects like addiction, headaches, dizziness, nausea/vomiting and weight/appetite loss. Cannabis can help replace or reduce the need for such medications.

So naturally, many suffering from neuropathy are looking for a more natural way of treating their pain without the many downsides that come with pharmaceutical painkillers. That’s why so many have turned to medical cannabis to deal with their nerve pain – it manages to help beat several other types of pain at once without the need to take several different pills, and there are few pain medications available that are useful for neuropathic pain.

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Medical Cannabis for Treating Chronic Pain

So what exactly makes cannabis so effective as an option for treating neuropathy? To put it as simply as possible, it’s about the way the cannabis you’re using interacts with the endocannabinoid system (ECS) and the impact it can have on damaged nerves and pain generally.

So what does the science say about the impact of cannabinoids like tetrahydrocannabinol (THC) on chronic pain? Unfortunately, due to the ongoing and outdated Reefer Madness-era prohibition of cannabis in the U.S., we don’t have a huge body of research into understanding exactly how and why THC is so effective at treating and soothing nerve pain. The research we do have, however, shows that the links between THC and relief from neuropathy are real and significant. We also know that cannabinoids can be used to treat conditions and symptoms that often accompany neuropathic pain, like headaches/migraines, spasms, stiffness and diabetes.

One study from 2013 that was published in The Journal of Pain showed that even a low dose, vaporized cannabis significantly reduced neuropathic pain. Another follow-up study showed that patients suffering from nerve pain associated with HIV found at least a 30 percent reduction in pain compared to those taking a placebo. More recent studies back up these earlier findings as well.

Another study found that neuropathy patients treated with a THC/CBD nasal spray reported significantly improved levels of pain, sleep quality, and an improved Subject Global Impression of Change (SGIC) regarding the severity of their conditions – a result that is likely due to the entourage effect. For those suffering from chronic pain or neuropathy, a 30 percent reduction in the suffering they’re dealing with can make a world of difference.

On top of that direct research into the ways THC can impact neuropathy directly, some research has been done into the impact of THC on pain in general and found promising results.

So How Exactly Does Medical Cannabis Help Treat Nerve Pain?

So now that we know that research suggests that medical cannabis can help those dealing with neuropathy, let’s talk about how exactly it does so scientifically. Like we mentioned earlier in this article, the answer lies in the interactions between the compounds in the medical cannabis you’re using and the endocannabinoid system itself.

Since neuropathy is most often a result of some type of direct or indirect injury or damage to the nerve itself, neurons tend to become more reactive and responsive to stimulations. That’s what causes the tell-tale tingling, stabbing, shooting, and burning sensations often associated with neuropathy.

The compounds in medical cannabis, most notably cannabidiol (CBD) and THC, have been shown to reduce those reactions and help regulate neurotransmitters and the central nervous system via the endocannabinoid system, which helps soothe and reduce pain. THC and CBD also activate the CB1 and CB2 receptors and help regulate neurotransmitters and the central nervous system, helping to reduce pain. Research has also shown medical cannabis plays a role in the endorphin system and can reduce a patient’s perception of pain, making symptoms feel less intense and easier to deal with. THC, which mimics the natural endocannabinoid anandamide, reduces levels of the enzyme fatty acid amide hydrolase (FAAH), increasing anandamide levels in the body, also decreasing (or distracting from) pain perception.

Which Cannabinoids Can Help Treat Neuropathic Pain?

We’ve mentioned THC and CBD briefly above, but to give a little more detail:

  • THC can act as an analgesic painkiller, helping numb or distract from nerve pain. THC interacts with both CB1 and CB2 receptors, helping reduce inflammation.
  • CBD works on several different receptors at once, but not necessarily directly with the cannabinoid receptors CB1 and CB2. CBD acts on serotonin to improve the mood, as a negative allosteric modulator of CB1 receptors and opioid receptors, helping turn down pain signals’ volume (on top of reducing THC’s psychoactivity), and vanilloid receptors, also helping reduce pain and inflammation. could be very helpful in the treatment of nerve pain associated with diabetes and Alzheimer’s. could help treat chronic nerve pain, and could help rebuild or regenerate old or dead nerve and brain cells!
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Medical Marijuana for Nerve Pain: the Bottom Line

While there needs to be more comprehensive, long-term research done to say so beyond a doubt, early research clearly shows that medical cannabis can play a significant role in treating and reducing the pain associated with neuropathy. On top of that, research shows that medical cannabis as a form of pain treatment is just as effective and far less addictive than the standard doctor-prescribed opioids, sedatives and gabapentinoids, and can be an excellent way to reduce the need for other drugs like antidepressants and gabapentin as well.

As more and more states modernize their views on cannabis and create medical programs of their own, more patients will be able to have consistent and reliable access to natural medicine that can help ease their suffering without the risk of addiction and overdose associated with other forms of pain treatment.

For patients dealing with nerve pain, medical cannabis might be the best – and possibly safest – way to go!

THC and gabapentin interactions in a mouse neuropathic pain model

Clinical studies have shown that the major psychoactive ingredient of Cannabis sativa Δ9-tetrahydrocannabinol (THC) has some analgesic efficacy in neuropathic pain states. However, THC has a significant side effect profile. We examined whether the profile of THC could be improved by co-administering it with the first-line neuropathic pain medication gabapentin. This was done using the chronic constriction injury (CCI) model of neuropathic pain in C57BL6 mice. At 8 days post-CCI nerve injury, acute systemic administration of gabapentin produced a dose-dependent decrease in CCI-induced mechanical and cold allodynia, and increased motor incoordination. Coadministration of THC and gabapentin in a fixed-ratio dose-dependently reduced mechanical and cold allodynia, and produced all the side-effects observed for THC, including motor incoordination, catalepsy and sedation. Isobolographic analysis indicated that the ED50 for the THC:gabapentin induced reduction in allodynia was 1.7 times less than that predicted for an additive interaction. The therapeutic window of combination THC:gabapentin was greater than that for THC alone. These findings indicate that gabapentin synergistically enhances the anti-allodynic actions of THC and improves its therapeutic window. Thus, THC may represent a potential adjuvant for neuropathic pain medications such as gabapentin.

Keywords: Cannabinoid; Gabapentin; Isobolograph; Neuropathic pain; Synergy; Tetrahydrocannabinol.

Copyright © 2018 Elsevier Ltd. All rights reserved.

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