Rebound Pain in a Patient Taking Medical Marijuana for Phantom Limb Syndrome (P3.9-054)

July 28, 2020

Background: Phantom limb pain (PLP) is a debilitating condition experienced by up to 85% of amputees. A complex mixture of central and peripheral pain, PLP is often resistant to conventional analgesics. Despite the success of marijuana in treating neuropathic pain and a strong mechanistic rationale, there are limited studies addressing its effectiveness in the management of PLP.

Design/Methods: A 70-year-old male presented to the neurology clinic with a 32-year history of PLP following transfemoral amputation of his left leg. His pain was refractory to multiple therapies, including opioids, and significantly impaired quality of life and independence. The patient was prescribed medical marijuana pills starting at a 20:1 CBD:THC ratio under mixed guidance with a pharmacist. He was interviewed at two and four month intervals after beginning treatment.

Results: During his first two months of treatment, the patient experienced a 40% reduction in pain, better sleep quality, and marked improvement in quality of life. During the third month, however, the patient’s PLP worsened and ingestion of marijuana during episodes became associated with a paradoxical increase in pain. After progressive alteration of the CBD:THC ratio to 1:1 produced progressive exacerbations of pain, the patient stopped taking marijuana and his pain during episodes returned to baseline.

Conclusions: This case is, to our knowledge, the first to demonstrate initial success and subsequent rebound pain in a patient taking medical marijuana for PLP. While the source of the patient’s rebound pain is unclear, a mechanism for marijuana-induced hyperalgesia involving dorsal horn sensitization has been demonstrated, suggesting that dorsal horn changes occurring after amputation may have played a role. Further trials of marijuana in PLP are necessary to explore its therapeutic effects and potential complications. Given the high prevalence of amputation among veterans, the federal injunction against medical marijuana in Veterans Administration hospitals poses significant challenges to further research.

Disclosure: Dr. Hirsch has nothing to disclose. Dr. Gierlich has nothing to disclose. Dr. Glants has nothing to disclose. Dr. Sheikh has nothing to disclose. Dr. Duran has nothing to disclose. Dr. Krishna has nothing to disclose.

8 comments on “Rebound Pain in a Patient Taking Medical Marijuana for Phantom Limb Syndrome (P3.9-054)”

  1. In collaboration with public partners, Business connects local businesses and job-seeking residents with government-funded resources. Ramonda Ham Bertasi

  2. Dolor sit amet, consectetur adipiscing elit. Phasellus feugiat elit vitae enim lacinia semper. Cras nulla lectus, porttitor vitae urna iaculis, Melisandre tincidunt lectus. Brienne nec tellus sit amet massa auctor imperdiet imp vitae diam. Albertina Kellby Delwin

  3. Thanks for the sensible critique. Me and my neighbor were just preparing to do a little research on this. We got a grab a book from our local library but I think I learned more from this post. I am very glad to see such fantastic info being shared freely out there. Delly Gaby Johnson

Leave a Reply

Your email address will not be published. Required fields are marked *

Canna Databank

Check Our Socials:
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram