This chapter presents 25 clinical cases demonstrating how cannabinoid-based therapies can integrate with multiple treatment modalities: Physical Therapy/Physics, Interventional procedures, Medical (including Medical Cannabis and dietary interventions) management, Psychiatric support, and—where needed—specialist referrals or surgical consultations. Each case also highlights how specific terpenes and flavonoids can potentiate clinical benefits.

Clinical Insight: The following cases demonstrate primarily oral and sublingual recommended routes of administration, which are of slower onset and longer duration. Inhalation routes can also be added where more immediate relief is needed. Topical routes may provide near immediate relief or take 2-3 days of consistent dosing. Many patients prefer the flexibility to have a combination of routes, something that is often lacking in traditional medical care.

Chronic Pain | Musculoskeletal System

Case 1: Chronic Lower Back Pain Relief in Middle-Aged Adult

Patient Profile: 45-year-old female with obesity, hypertension, and a 3-year history of refractory lower back pain, often 7+/10, worse with activity

Plan: Strengthen core with enhanced physical therapy and aquatic exercises; use low- dose THC:CBD oil (5 mg each, BID gradual increase to 10 mg each TID) with beta- caryophyllene (anti-inflammatory) and myrcene (analgesic); provide lifestyle counseling for weight reduction; consider orthopedic consult if structural issues emerge.

Outcome: ~40% pain reduction in 4 weeks, improved physical therapy engagement.

Case 2: Fibromyalgia with Insomnia

Patient Profile: 52-year-old female with fibromyalgia and depression.

Plan: Use low-impact aerobic therapy (swimming, stationary bike) and TENS for pain relief; start 1:2 (or 1:1) THC:CBD capsules (5 mg THC / 10 mg CBD BID) with myrcene (sedative) and beta-caryophyllene (anti-inflammatory); continue antidepressants and reinforce CBT for insomnia.

Outcome: 35% pain reduction and improved sleep at 8 weeks, increased appetite managed through dietary guidance.

Chronic Pain | Neurologic Conditions

Case 3: Multiple Sclerosis-Related Spasticity

Patient Profile: 60-year-old female with MS, experiencing pain and spasticity.

Plan: Continue targeted physical therapy for stretching and cooling strategies; start nabiximols (Sativex) spray (2 sprays BID) with beta-caryophyllene and humulene (anti- inflammatory, appetite modulation). Add turmeric and red onions to the diet - flavonoids (e.g., quercetin).

Outcome: Marked spasticity reduction after 6 weeks, mild dizziness resolved with dose adjustment.

Case 4: Chronic Migraine Management

Patient Profile: 35-year-old female, migraines ~15 days/month, comorbid depression. New to medical cannabis.

Plan: Use biofeedback and posture training to address tension components; start (3:1 or 4:1) CBD-dominant oil (15 mg CBD / 5 mg THC BID gradual increase to QID over 1 week) with limonene (anti-inflammatory) and eucalyptol (anti-inflammatory); maintain antidepressants; consider occipital nerve and spg blocks PRN.

Outcome: Migraine frequency reduced to 8 days/month over 3 months, mild sedation addressed with evening dosing.

Case 5: Parkinson’s Disease with Tremors

Patient Profile: 65-year-old male with PD, troublesome resting tremors and rigidity.

Plan: Emphasize gait and balance exercises; add 1:2 (or 1:2-5) THC:CBD oil ( gradual increase to 5 mg THC / 10 mg CBD TID) with pinene (alertness) and humulene (anti- inflammatory); collaborate with neurology for dopaminergic treatment adjustments. Another option is RSO tincture sublingual at a similar dose.

Outcome: Reduced tremors, better motor function in 2 months, mild dryness in mouth resolved by adjusting fluid intake.

Case 6: Epilepsy with Refractory Seizures (Dravet Syndrome)

Patient Profile: 12-year-old male, multiple antiepileptics failing to control seizures. New to medical cannabis | Parents prefer a more holistic approach and are informed of the potential developmental risks.

Plan: Add Epidiolex (CBD) at 10 mg/kg/day; collaborate with pediatric neurology; avoid THC-rich terpenes for seizure-prone pediatric patients.

Outcome: 50% seizure frequency reduction within 4 weeks, diarrhea and elevated liver enzymes monitored.

Case 7: Chronic Neuropathic Pain in Diabetic Neuropathy

Patient Profile: 55-year-old male with Type 2 diabetes, burning foot pain and numbness; often 7/10, worse at night

Plan: Optimize glycemic control and gabapentin therapy; add topical CBD cream BID with beta-caryophyllene (localized anti-inflammatory).

Outcome: Reduced neuropathic pain by > 50% over 8 weeks, minor skin irritation alleviated by adjusting application frequency.

Case 8: Spinal Cord Injury with Neuropathic Pain

Patient Profile: 40-year-old male, severe neuropathic pain post-trauma.

Plan: Intensive PT/OT for mobility; introduce balanced THC:CBD (5 mg THC / 10 mg CBD TID) with myrcene (muscle relaxation) and beta-caryophyllene (pain modulation).

Outcome: Marked pain reduction, improved rehab participation; dizziness handled by slower titration.

Case 9: Neuropathic Pain in Chemotherapy-Induced Peripheral Neuropathy

Patient Profile: 60-year-old female, post-chemotherapy breast cancer, severe tingling/ burning in hands and feet.

Plan: Maintain gabapentin and vitamin B12; add 2:1 THC:CBD capsules (5 mg THC / 10 mg CBD TID) with myrcene and eucalyptol (analgesia and inflammation control).

Outcome: 45% pain reduction over 3 months, mild drowsiness managed by evening dosing.

Case 10: Complex Regional Pain Syndrome (CRPS)

Patient Profile: 35-year-old female, severe burning pain and swelling after ankle surgery.

Plan: Pursue physical therapy (desensitization, mirror therapy) and possible sympathetic nerve blocks; use vaporized THC:CBD (2 mg each per puff, up to 6 puffs/day) with beta- caryophyllene and myrcene (analgesic/sedative synergy).

Outcome: 50% pain reduction, better limb function over 3 months, mild lightheadedness addressed with hydration.

Case 11: Migraine with Aura

Patient Profile: 29-year-old female, recurrent migraines with visual aura. New to medical cannabis

Plan: Emphasize trigger identification; use triptans as needed; start CBD tincture (start 25 mg daily and gradually increase to 50 mg BID) with eucalyptol (anti-inflammatory) and limonene (mood-lifting).

Outcome: Migraine frequency halved (12 to 6 per month) over 3 months, no significant adverse effects.

Case 12: Huntington’s Disease (Motor Symptoms) and Cervical and Lumbar Disc degeneration causing severe chronic pain

Patient Profile: 50-year-old male, chorea, rigidity, and impaired coordination. New to medical cannabis.

Plan: Incorporate balance/coordination PT; begin THC:CBD oil (start 2.5/5 mg BID, over 3 weeks increase to 5 mg THC / 10 mg CBD TID) with pinene (alertness) and humulene (anti-inflammatory); adjust dopaminergic treatments as needed.

Outcome: Reduced chorea, improved mobility after 3 months, mild dizziness resolved by incremental dose adjustment. Reduced chronic pain with activity from >7/10 to 3-4/10.

Case 13: Trigeminal Neuralgia

Patient Profile: 60-year-old female, severe “electric shock” facial pain. Experienced with medical cannabis, unknown amount.

Plan: Consider nerve blocks and possible microvascular decompression; add inhaled THC:CBD (3 mg each/puff, up to 8 puffs/day) with beta-caryophyllene and myrcene (analgesic synergy).

Outcome: Fewer intense pain episodes, improved QoL in 4 months, mild cognitive effects handled by dose adjustments.

Case 14: Post-Stroke Rehabilitation with Spasticity

Patient Profile: 68-year-old female, ischemic stroke with lower limb spasticity. New to medical cannabis.

Plan: Focus on intensive physical/occupational therapy; introduce 1:1 (2.5-5mg|2.5-5 mg) sublingual tincture or spray (Start 2x day and gradually increase to 2 doses BID) with beta-caryophyllene and myrcene (spasticity relief).

Outcome: Significant decline in spasticity, enhanced mobility after 4 months, mild dizziness mitigated by shifting dose timing.

Psychiatric Disorders

Case 15: Generalized Anxiety Disorder in Young Adult

Patient Profile: 28-year-old male, no significant medical history, presenting with pervasive anxiety. New to medical cannabis.

Plan: Incorporate regular aerobic exercise to lower sympathetic arousal; begin CBD- dominant tincture (10 mg daily) alongside cognitive-behavioral therapy; favor linalool (calming) and limonene (uplifting) if terpene-rich products are available.

Outcome: 50% anxiety reduction over 6 weeks, mild initial drowsiness resolved with dose adjustment.

Case 16: Post-Traumatic Stress Disorder (PTSD) in Veteran

Patient Profile: 38-year-old male with PTSD, history of alcohol use disorder. New to medical cannabis.

Plan: Incorporate yoga or Tai Chi for relaxation; initiate low-dose CBD (20 mg/day) with linalool-predominant terpene profile to aid sleep; provide trauma-focused psychotherapy and group support; monitor alcohol use.

Outcome: Decreased flashbacks, improved sleep after 12 weeks, minimal side effects.

Case 17: Bipolar Disorder with Mood Stabilization

Patient Profile: 30-year-old female with Bipolar I, mood swings, anxiety, insomnia. New to medical cannabis.

Plan: Continue lithium and psychotherapy; add low-dose CBD (25 mg/day gradually increase to 6x daily - 50 mg TID) with linalool (calming) and limonene (uplifting) terpene profiles to maintain calm while avoiding THC-induced mania.

Outcome: More stable mood over 3 months, no adverse events.

Case 18: Generalized Anxiety with Social Phobia

Patient Profile: 25-year-old female, intense social anxiety impairing work and relationships. New to medical cannabis.

Plan: Combine SSRIs, exposure therapy, and situational CBD dosing (10-25 mg before social events, gradually increase to 30-75 mg before social events); choose linalool and limonene terpene profiles for anxiolysis.

Outcome: Improved ability to engage socially, minimal drowsiness.

Case 19: Obsessive-Compulsive Disorder (OCD)

Patient Profile: 32-year-old female, persistent intrusive thoughts and rituals. New to medical cannabis.

Plan: Maintain SSRI regimen and continue CBT; add oral CBD (20-25 mg/day and gradually increase to 4x daily) with pinene (focus) and linalool (anxiolytic) if using a full- spectrum product.

Outcome: Decreased intensity of compulsions over 3 months, mild GI discomfort resolved spontaneously.

Case 20: Major Depressive Disorder with Treatment Resistance

Patient Profile: 50-year-old female, chronic depression unresponsive to multiple antidepressants. New to medical cannabis.

Plan: Continue psychotherapy; consider augmentation with atypical antidepressants; add CBD (25 mg/day and increase to BID over 3 days) with limonene (mood elevation) if available.

Outcome: Noticeable improvement in mood and energy by 6 weeks, no reported adverse effects.

Case 21: Autism Spectrum Disorder (ASD) with Irritability

Patient Profile: 10-year-old male, severe irritability and aggression. Parents tried CBD/ hemp in the past but unsure of the amount due to poor product labeling and lack of 3rd party testing.

Plan: Continue behavioral and occupational therapies; begin CBD-dominant oil (10 mg/kg/day divided BID) avoiding high-THC products; use beta-caryophyllene (anti- inflammatory). Optimize diet, activity, and sleep patterns for improved mental health.

Outcome: Fewer aggressive episodes, improved social interaction by 4 months, minor fatigue resolved via dose titration.

Case 22: Schizophrenia with Persistent Psychosis

Patient Profile: 40-year-old male, partial response to antipsychotics. New to medical cannabis.

Plan: Continue clozapine and psychotherapy; carefully add low-dose CBD (Start 25 mg daily and increase over 4 weeks to 100 mg/day); avoid THC to prevent exacerbating psychosis; limit terpene selection.

Outcome: Gradual reduction in delusions and hallucinations at 3 months, no major side effects.

Case 23: ADHD in Adolescent with Depression

Patient Profile: 16-year-old male, inattentiveness, hyperactivity, impulsivity. New to medical cannabis and parents would like to try a holistic approach to help wean down stimulant prescription.

Plan: Maintain stimulant medication (methylphenidate) and behavioral therapy; add low-dose CBD (20-25 mg/day divided BID and gradually increase over 3 weeks to 25mg BID-TID) with pinene (cognitive support) and limonene (mood-lifting). Add exercise and music therapy and group sports/activities 3-5x/week.

Outcome: Notable improvement in focus and reduced hyperactivity after 3 months, minimal fatigue managed by timing the dose.

Neurodegenerative Disorders

Case 24: Parkinson’s Disease with Tremors

Patient Profile: 65-year-old male with PD, troublesome resting tremors and rigidity. New to medical cannabis.

Plan: Emphasize gait and balance exercises; add THC:CBD oil (5 mg THC / 10 mg CBD BID) with pinene (alertness) and humulene (anti-inflammatory); collaborate with neurology for dopaminergic treatment adjustments.

Outcome: Reduced tremors, better motor function in 2 months, mild dryness in mouth resolved by adjusting fluid intake.

Case 25: Alzheimer’s Disease with Behavioral Symptoms

Patient Profile: 70-year-old female, agitation, aggression, sleep problems. New to medical cannabis.

Plan: Continue cholinesterase inhibitors and PRN antipsychotics if severe; add (1:2 or 1:2-5) THC:CBD oil (2.5 mg THC / 5 mg CBD BID) with linalool (sedation) and quercetin (potential neuroprotection).

Outcome: Decreased agitation, improved sleep in 4 months, mild sedation mitigated by lowering THC dose.

Conclusion and Key Takeaways

These 25 cases illustrate the broad applicability of cannabinoid therapies across pain, mental health, and neurological conditions. When combined with physical therapy/ physics modalities, selective interventional procedures, and robust psychiatric support, cannabinoids can enhance patient outcomes. Incorporating targeted terpenes (e.g., linalool, limonene, beta-caryophyllene, myrcene) and dietary anti-inflammatory flavonoids (e.g., quercetin) often augments therapeutic benefits. Early referral to specialists or surgical consult is prudent when standard measures fail or the clinical picture is complex. By following a “start low, go slow” principle and customizing interventions to individual patient needs, clinicians can optimize the efficacy and safety of cannabinoid-based treatments.