The Medicinal cannabis in the rehabilitation of thalamic syndrome: case report

Abstract

Abstract: The thalamic syndrome or thalamic pain syndrome is a term used to characterize the central neuropathic pain that most commonly occurs after a stroke in the spinothalamic tract. After a thalamic stroke, pain usually occurs throughout the contralateral half of the patient's body and is aggravated by touch or palpation. Management of thalamic syndrome is complex and requires a multidisciplinary health team. Traditional treatment for chronic pain and centralized pain often includes antidepressants, anticonvulsants, and opioid analgesics. In this case, the evidence is limited and varies in effectiveness. The use of medicinal Cannabis, more specifically Cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), are a therapeutic possibility for refractory cases. There are several physiological mechanisms that justify the therapeutic potential of cannabis to control chronic pain. The endocannabinoid system has multiple functions that lead the body to balance, helping the rehabilitation process of patients with this condition. Despite the main challenge being pain control, and that many of the other symptoms are a consequence of uncontrolled chronic pain, it is important to highlight the improvement in functionality and cognition globally, resulting in a gain in functional independence, with repercussions in improving quality of the patient's life. In this report, the evolution of a patient's rehabilitation was evaluated, comparing functionality parameters through the Functional Independence Measure (FIM) and the Visual Analog Scale (VAS) of pain at the beginning of treatment and after 6 months of follow-up.