Medical Cannabinoids for Neuropathy

Neuropathy qualifies for medical cannabinoids in New York, however the conditions that qualify as neuropathy are less certain. In general, neuropathy means a nerve disorder but the law doesn’t explain what “Neuropathy” means and the medical definition isn’t always clear either. There are different types of neuropathy and different verbiage is used to describe neuropathy. One may refer to a nerve disorder in the wrist as Carpal Tunnel Syndrome or as a “distal median neuropathy.” In a neurology text, Guillain–Barré syndrome may be referred to as a lumbosacral polyradiculoneuropathy, or polyneuropathy.

So, if you ask two doctors “What is neuropathy?” you can expect to get completely different answers. This lack of clarity also extends to what conditions are considered to be neuropathy. Is a disorder of the nerve roots deemed Neuropathy, Radiculopathy or both? While the definitions rarely affect the management of a disease, they are nonetheless important for facilitating access to medical cannabinoids treatment in New York – important for those who need it to alleviate disabling pain and important for the providers who want to comply with the law.

Basic Anatomy of the Nervous System

The nervous system has millions of neurons or nerve cells. The Central Nervous System includes the brain and spinal cord and is made up of central nerves. The peripheral nervous system has nerves that extend outside of the spinal cord to the arms and legs. These peripheral nerves include roots, plexus and branches.

Definition of Neuropathy

Neuropathy is a general term that means a nerve disorder. Merriam-Webster defines “neuropathy” as a “degenerative state of the nervous system or nerves.” That definition includes diseases affecting the central and peripheral nervous system. In other words, neuropathy means a nerve disorder inside or outside the brain and spinal cord. While this is correct, it doesn’t reflect the common usage for the term “neuropathy.”

Neuropathy Usually Means Peripheral Neuropathy

In practice, the term “neuropathy” refers to “peripheral neuropathy.” This difference between the definition and the usage leads to confusion about neuropathy. Another cause for confusion is that there are many different types of neuropathy. According to the NIH (National Institute of Health), there are over 100 neuropathies. Neuropathy can affect one nerve (mononeuropathy) or many nerves (polyneuropathy). It can also affect nerves in different locations. If it affects a nerve as it exits the spine at its root, it’s called a radiculopathy. If it affects the nerve near its furthest point, it’s a distal neuropathy. If it affects a network of nerves or a plexus, it’s a plexopathy. A neuropathy can also affect a nerve anywhere else from its root to its furthest point.

Radiculopathy is Neuropathy

Google the difference between Neuropathy and Radiculopathy and you are likely to find articles that focus on how to tell the two apart. This may lead you to believe that Radiculopathy isn’t a Neuropathy at all, but it is in fact a specific form of neuropathy. It is different to other forms of peripheral neuropathy because it affects the nerve root at the earliest part of the peripheral nerve where it exits the spinal cord. In distal neuropathy, a form of peripheral neurology, the nerve region involved is closer to its end point.

“Radiculopathy is a specific form of neuropathy…a disorder of the nerve root at the earliest part of the peripheral nerve, where it leaves the spinal cord.”

If you have neuropathy, you might not have radiculopathy but if you have radiculopathy, you have neuropathy. In other words, neuropathy includes radiculopathy. Think of it this way – if you say you hurt your hand, it might not mean you hurt your fingers, palm or knuckles, but we all understand that these are all parts of the hand. You may well have hurt your fingers and if so, then you also hurt your hand. Similarly, radiculopathies are also referred to as neuropathy. Guillain–Barré syndrome, for example, affects many nerve roots and is also known as a polyneuropathy.

 

The definition of neuropathy doesn’t usually matter in the context of treatment. If radiculopathy is being treated, what does it matter if it is a neuropathy or something else? For a person with disabling radiculopathy though, the definition means the difference between receiving palliative medical cannabinoids treatment, or not.

Which Neuropathies Qualify for medical cannabinoids?

Neuropathies are a “severe disabling condition” according to the Compassionate Care Act. This law allows medical cannabinoids treatment for Neuropathy and other disabling conditions. New York’s law, however, doesn’t explain what it means by “Neuropathy” and it doesn’t list medical conditions that classify as neuropathies. Did the law intend neuropathy to have a broad definition? As mentioned above, some definitions of neuropathy include any disorder of the nervous system and this would include any disorder affecting the central or peripheral nervous system. These definitions would include, among other disorders, migraine, stroke and multiple sclerosis. Alternatively, the law might use neuropathy to refer to peripheral neuropathy as it is typically used in professional writing or conversation.

What is Neuropathy in Compassionate Care Act

Neuropathy in the Compassionate Care Act was probably intended to refer to peripheral neurology. If this was not the case, the law probably wouldn’t have listed other conditions of the brain and spinal cord, such as spinal cord injury. It wouldn’t have listed Parkinson’s Disease or ALS (Amyotrophic Lateral Sclerosis) either. However, a fundamental rule of legal statutory construction is that “unless otherwise defined, words will be interpreted as taking their ordinary, contemporary, common meaning.” This often leads courts to scrutinize the dictionary definition of a word (as we provided for neuropathy above) to determine what a law means. A more literal interpretation of neuropathy would lead to eligibility for many more disorders. While the argument could be made, it is unlikely that the law intended the definition to be broader than peripheral neurology. Still, a legal scholar could argue that the law did not define neuropathy “otherwise.”

Neuropathy’s definition is important for medical cannabinoids treatment in New York. Based on New York’s Law, Neuropathy probably refers to peripheral neuropathy or conditions affecting nerves outside of the brain and spinal cord. These are the conditions that benefit most from pain relief with medical cannabinoids and include radiculopathy, affecting the nerve root, or disorders affecting the peripheral nerve in any location.

References:

  1. Blumenfeld, H. (2010). Neuroanatomy through clinical cases. Sinauer Associates.
  2. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025454/
  3. https://www.ninds.nih.gov/disorders/all-disorders/peripheral-neuropathy-information-page
Michael Morgenstern, MD

Michael Morgenstern, MD

Founder at NY Medical Marijuana Association
About the author: Dr. Michael Morgenstern is double board certified in Neurology and Sleep Medicine. He works in private practice in Manhattan, Queens and Long Island and has extensive expertise treating patients with Medical Cannabinoids.
Michael Morgenstern, MD

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