Case Report: Nothing was able to treat a man’s severe itching caused by nerve damage. So his doctors tried medical cannabis – and they got results within days

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Imagine having severe itching over your whole body – and not being able to scratch it. That was the case with a 60-year old man diagnosed with something called neuropathic pruritus, which is an itch caused by nervous system damage due, in this case, to the man’s motor neuron disease, ALS.

The ALS left his upper limbs so weak that he essentially had no use of his arms or hands. Thus, according to a case report published this week by palliative care physicians at the University of British Columbia:

. . . he is unable to scratch the affected areas and relies on his caretakers to provide relief. The constant nature of this symptom, especially at night when there is no one to provide scratching has caused significant distress and has interfered with his sleep and mood.

Significant stress, indeed. Of the 5 standard meds he was then on, 4 were meant to treat pain, anxiety, or depression, in addition to his itching. And while some helped for a short time they all ultimately failed and were limited by their significant sedating and other side effects.

Various topical moisturizers were also tried, e.g. menthol and camphor ointment, steroid cream, antihistamine cream, and capsaicin cream, and they failed as well.

Although nothing was working, his doctors were aware of a growing body of evidence that said medical cannabis (MC) can treat similar neuropathic conditions caused, not by ALS, but by such diseases as diabetes, HIV, and multiple sclerosis.

So a case conference was held and the team, with their patient’s permission, decided to try MC. Specifically, he would be given a capsule that contained 2.75 mg CBD/2.43 mg THC, twice daily. A combination was used because it’s thought cannabinoids work together synergistically and because CBD counters the psychoactive effects of THC.

When the therapy began the man’s pruritus score was 7/10 (10 being the worst possible pruritus, 0 is no pruritus), and he was taking the anti-anxiety analgesic medication, pregabalin, twice a day.

The results were staggering: Just a few days into the therapy his pruritus score dropped to 3/10 – “the patient reported that the level of pruritus control is sufficient,” he was able to be weaned off the pregabalin, follow-up visits showed that his improvement continued, and there were no side effects.

Physicians, of course, describe their results using more careful language:

This case report describes a sustained reduction of generalized pruritus of potential neuropathic origin by oral cannabinoids in a patient with ALS. …

The sustained efficacy is further supported by the weaning of pregabalin without worsening of pruritus control. Shared decision-making with the patient allows for additional treatment options when standard therapies are exhausted. With the increased availability and improved regulation of cannabinoid products, it may prove to be a useful tool to manage symptoms in the future.

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