Neuropathic itch treated with oral cannabinoids: A case series

Morin, Catherine Besner; Raef, Haya S.; Elmariah, Sarina B.

doi:10.1016/j.jdcr.2021.09.006

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…Those with severe NP may benefit from more invasive treatments such as botulinum toxin A injections, nerve blocks, transcutaneous electrical nerve stimulation, IV ketamine, and IV phenytoin [70][71][72][73][74]. Botulinum toxin A, which is used to prevent cholinergic transmission and reduce substance P along the itch pathways, is injected into several points at 1-2 cm intervals along the affected area.…”

Section: Treatment and Management Of Neuropathic Pruritusmentioning

confidence: 99%

“…IV phenytoin provides rapid relief of neuropathic dysesthesias and is an acute rescue therapy for trigeminal neuralgias [73]. Recently, Morin et al reported three cases of severe localized NP refractory to treatment that was successfully and rapidly treated with dronabinol, an oral synthetic formulation of delta-9-tetrahydrocannabinol [74].…”

Section: Treatment and Management Of Neuropathic Pruritusmentioning

confidence: 99%

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Neuropathic Pruritus: An Underrecognized and Often Misdiagnosed and Difficult to Treat Medical Condition

Akarsu¹

2023

Rare Diseases - Recent Advances

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It is estimated that approximately 8% of chronic pruritic cases are of neuropathic origin. Common neuropathic pruritic syndromes include different clinical presentations such as postherpetic pruritus, trigeminal trophic syndrome, anogenital pruritus, scalp dysesthesia, nerve compression syndromes (e.g., notalgia paresthetica, brachioradial pruritus), small-fiber neuropathy (secondary to various metabolic, infectious, autoimmune, and genetic diseases), and disorders affecting the central nervous system (occupying lesions, iatrogenic, infectious, neurodegenerative, or demyelinating diseases). Although general practitioners are most likely to see the itchy cases first and consider referring them to further medical advice, it would be a better approach for the physicians to cooperate with dermatologists and neurologists and physiotherapists in particular especially in chronic persistent itchy conditions. Neuropathic pruritus must first be differentiated from other possible etiologies of pruritus by medical history and physical examination, laboratory tests, skin biopsy, and radiological and functional evaluations. It often does not respond to classical antipruritic treatments and different treatment options such as neuroleptics, topical capsaicin, epidural steroid injections, botulinum injections, nerve blocks, and neurostimulation techniques have been tried with variable success responses. This chapter provides a comprehensive overview of the characteristics and clinical presentations of neuropathic pruritus and the diagnostic and therapeutic management used in such patients.

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Section: Treatment and Management Of Neuropathic Pruritusmentioning

confidence: 99%

Section: Treatment and Management Of Neuropathic Pruritusmentioning

confidence: 99%

Neuropathic Pruritus: An Underrecognized and Often Misdiagnosed and Difficult to Treat Medical Condition

Akarsu¹

2023

Rare Diseases - Recent Advances

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“…Another compound being explored for chronic itch is oral dronabinol, a synthetic form of tetrahydrocannabinol (THC). In one case, a patient with a chronic itch history resulting in multiple wounds experienced a significant reduction in itch score from 10 to 0-1 on a visual analog scale with the use of 2.5 mg of oral dronabinol (twice daily) after other methods failed [60]. However, it is not known which, if any, of these molecules will be effective for the management of chronic neuropathic ocular surface itch.…”

Section: Neuropathic Itch and Neuropathic Painmentioning

confidence: 99%

Ocular surface itch and pain: key differences and similarities between the two sensations

Raolji

Kumar

2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review To review the pathophysiology and treatment of ocular itch and pain, encompassing nociceptive and neuropathic categories. Recent findings Ocular itch and pain are sensations that arise from activation of ocular surface polymodal nerves. Nociceptive itch, commonly comorbid with ocular pain complaints, is mainly driven by a histamine-mediated type 1 hypersensitivity reaction. Beyond topical therapy, novel drug delivery systems are being explored to improve ocular residence time of nonsteroidal anti-inflammatory drugs (NSAIDs) and antihistamines. Nociceptive ocular pain can be driven by a variety of factors. Treatment focuses on addressing the causative sources of pain. Neuropathic ocular itch and pain are driven by nerve damage and dysfunction and as such, topical and oral neuromodulation have been explored as treatments. Oral neuromodulators include alpha 2 delta ligands, tricyclic antidepressants (TCAs), and low dose naltrexone. Novel therapies are being evaluated for both modalities such as difelikefalin (κ-opioid receptor agonist) for neuropathic itch and libvatrep (transient receptor potential vanilloid 1 antagonist) for neuropathic pain. Summary Both ocular itch and pain can be driven by nociceptive and/or neuropathic mechanisms. Identifying contributors to abnormal ocular sensations is vital for precise medical care. Novel therapeutics for these conditions aim to improve patient outcomes and quality of life.

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“…Several studies have identified naltrexone as an effective agent for different forms of chronic pruritus, which can be administered at 50 mg daily [44,45] . Dronabinol can be started at 2.5 mg 3 times per day and can be titrated up to 7.5 mg 3 times per day [43] . It is appropriate to start with low doses of these medications and titrate as tolerated by the patient.…”

Section: Treatmentsmentioning

confidence: 99%

“…Case reports have identified that stopping gabapentin may be associated with rebound pruritus, which must be considered for patients not otherwise tolerating the medication [40] . Additional options include antidepressants, opioid axis modulators including Kappa opioids, mu antagonists, and cannabinoids [41][42][43] . Several studies have identified naltrexone as an effective agent for different forms of chronic pruritus, which can be administered at 50 mg daily [44,45] .…”

Section: Treatmentsmentioning

confidence: 99%

United States expert panel consensus on uniform nomenclature and diagnosis for neuropathic pruritus

Kwatra,

Elmariah,

Chisolm

et al. 2023

Itch

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Importance: Neuropathic pruritus is a debilitating condition lacking a uniform approach to nomenclature and diagnosis. Objective: A panel of dermatologist experts in pruritus was convened to develop definitions, diagnostic recommendations, and treatment guidelines for neuropathic pruritus. Evidence review: A roundtable discussion of 10 experts was conducted on November 3, 2021, via the Zoom platform. This study follows the Standards for Reporting Qualitative Research reporting guidelines for qualitative studies. A systematic review of prior literature on the definition, scope, diagnostic, and treatment was performed, looking at sources of treatment from 1991 to 2021. Consensus was defined as >70% agreement for acceptance of a definition or recommendation. A draft of evidence was subjected to revision by all participants and was endorsed by all participants. Findings: The roundtable identified definitions for neuropathic pruritus, which included different forms of the condition based on cause and presentation such as brachioradial pruritus, notalgia paresthetica, and scalp pruritus. Diagnostic and treatment guidelines were also established. Limitations of this process included lack of randomized controlled studies. These recommendations are also based on expert consensus and must be further supported by evidence-based outcomes research. Conclusions: Neuropathic pruritus contains numerous subtypes, causes, diagnostic methods, and treatment modalities. The recommendations developed by this panel are meant to serve as shared nomenclature for future clinical studies.

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Neuropathic itch treated with oral cannabinoids: A case series

Cited by 8 publications

References 15 publications

Neuropathic Pruritus: An Underrecognized and Often Misdiagnosed and Difficult to Treat Medical Condition

Neuropathic Pruritus: An Underrecognized and Often Misdiagnosed and Difficult to Treat Medical Condition

Ocular surface itch and pain: key differences and similarities between the two sensations

United States expert panel consensus on uniform nomenclature and diagnosis for neuropathic pruritus

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