CBD for post-stroke pain -- recommendations?

Post date: 2022-12-04 12:33:45

A relative of mine suffered a stroke several years ago, and still suffers from chronic pain, probably nerve pain. I'm interested in whether CBD or CBD+THC might help.

My relative -- 70s, male -- had a left-side ischemic stroke a little less than three years ago. Aside from the expected paralysis and aphasia, he has also had chronic problems with seizures and pain, and the last couple of years have been a constant struggle to find a mix of medications that will address these problems without intolerable side effects. Today I'm asking primarily about the pain.

It's somewhat difficult to get a clear description of the pain, because he suffers from pretty severe aphasia. Although he's made progress in speech therapy, it's still difficult for him to answer open-ended questions. What is clear is the location of the pain: primarily on the stroke-affected side. I also believe that it is at least in part nerve pain/neuralgia, in part because he has indicated that the pain includes tingling, and in part because he is sometimes very sensitive to light touch specifically.

For the most part, conventional medications have not been successful here. Gabapentin (which he was prescribed in the aftermath of the stroke) seems to work on the pain, but also leaves him extremely sleepy and lethargic. This has also been a common problem for him with muscle relaxers and antiepileptics as well -- even low doses will leave him sleeping for the majority of the day, and only somewhat awake the rest of the time. We seem to have reached a dose and combination of antiepileptics that keep his seizures under control without completely knocking him out, but the pain is still a problem.

I have done some googling on the use of CBD/THC to address post-stroke pain, and the scientific literature seems fairly thin on the subject. But there is enough to make me think there may be some promise, including a single case report in the BMJ of CBD+THC successfully treating otherwise treatment-resistant post-stroke pain. So, I'm interested in exploring this, and was wondering if MeFites have any useful information, anecdotal/experiential or otherwise.

Specifically:

Any recommendations for route of administration -- capsules? tinctures? topical creams or oils? I'm inclined to believe that topical is not the way to go for a systemic, possibly CNS-related issue, but my initial search of Ask did show some people recommending topical CBD for localized nerve pain, so I'm open to correction here.
Any reputable brands? CBD-only products are available in grocery stores here, but I don't know which ones are reputable. If I should avoid the products in grocery stores entirely and just go to a dispensary, that's useful to know too.
I know you are not my (or his) doctor, and we'll ask that doctor as well, but if you are aware of a well-known drug interaction or similar issue that means we should not try this at all, I'd like to know that as well.
Local recommendations are welcome! My relative is in Prescott, AZ, but I'm in Tucson and would be easily able to pick up products here or in the Phoenix area. Arizona has legalized both medical and recreational marijuana, so although getting a medical endorsement for this would be ideal in the long run, I can pick things up without any paperwork while we're still trying things out.

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