Author: Jean Talleyrand, M.D.

Abstract

A woman in her early forties with pain, anxiety, poor sleep, diabetes, and peripheral vascular disease received a promotional nano-emulsified, broad-spectrum oral liquid, PhytoRx, reported to contain 50 mg cannabidiol (CBD) and 25 mg cannabigerol (CBG) per full dropper. She consented to pre- and post-use surveys and reported mixing one dropper into a morning beverage five days weekly for four weeks. She currently uses inhaled (Type I) THC-dominant cannabis for symptom relief in the evening. Between July 30 and September 3, 2026, the US EQ-5D-5L utility increased from 0.597 to 0.836; BPI-derived mean pain severity decreased from 3.25 to 2.00, and mean interference from 4.29 to 0.86. Revised abbreviated POMS raw total mood disturbance changed from -10 to -25; the provisional adapted PSQI total changed from 12 to 9. This uncontrolled observation describes temporal changes.  Future studies are warranted to establish efficacy, causation, or safety.

Introduction

A standardized clinical approach to medical cannabis use is important for documenting treatment exposure, monitoring safety, and determining whether perceived benefits translate into improvements in symptoms and daily functioning. Rather than a single disease-specific indication, often patients with multiple diagnoses use cannabis to address overlapping problems such as pain, stress, anxiety, and poor sleep. Medical cannabis assessment should account for the range of symptoms and conditions that motivate use, rather than focus exclusively on a single disease-specific indication. In an analysis of 1,655 applicants presenting to medical cannabis evaluation clinics in California, Nunberg et al. (2011) documented varied clinical presentations, with chronic pain, mental-health problems, and sleep disorders predominating. These findings support a clinical assessment framework that evaluates pain, mood, and sleep across diagnostic categories, alongside underlying diagnoses, concurrent treatments, functional outcomes, and adverse effects.[1]  Assessment should therefore extend beyond the qualifying diagnosis to include disease-general, or transdiagnostic, symptom outcomes, while retaining evaluation and treatment of the underlying conditions. Standardized baseline and follow-up measures of pain severity and interference, mood, sleep, and health-related quality of life can help characterize these outcomes. Recording cannabinoid composition, dose, route, frequency, concurrent medications, and adverse effects is also essential to interpreting changes and supporting individualized care.[2]

The endocannabinoid system provides a biological rationale for evaluating these interconnected symptom domains. Its receptors, endogenous signaling molecules, and associated enzymes are widely distributed throughout the central nervous system and peripheral tissues and participate in processes relevant to pain, stress responses, mood, and sleep.[3]  Modulation of endocannabinoid signaling may influence symptoms shared across multiple diagnoses.  As well, CBD, CBG, and other cannabinoids or terpenoids may act through mechanisms beyond classical cannabinoid receptors. This case study illustrates the importance of evaluating multiple disease-general symptoms in an adult woman with several medical conditions who continued an established evening cannabis regimen while adding a daytime CBD/CBG formulation. By comparing standardized patient-reported outcomes before and after four weeks of use, the report describes both improvement and persistent symptom burden. Without assuming that changes were caused by the product, the report provides an opportunity to develop clinical hypotheses for future research.

Adults who have used cannabis for much of their lives may prefer THC-dominant (Type I) products and associate the noticeable psychoactive effects with medicinal benefit. However, the intensity of intoxication is not a reliable indicator of therapeutic response. Balanced THC/CBD (Type II) and CBD-dominant (Type III) preparations may provide symptom relief with less intoxication, depending on cannabinoid content, dose, and individual sensitivity. Evidence supporting these effects varies by condition and formulation, and the clinical evidence for cannabigerol (CBG), particularly in combination with cannabidiol (CBD), remains limited.

This case report describes an adult woman in her early forties with pain, anxiety, and poor sleep in the context of multiple medical diagnoses and concurrent treatments. She reported smoking THC-dominant cannabis flower at night to alleviate her symptoms. She subsequently received PhytoRx, an ingestible, nano-emulsified, broad-spectrum oral liquid containing 50 mg CBD and 25 mg CBG per full dropper, through a promotional distribution and consented to complete surveys before and after a four-week period of use. She reported adding one full dropper to a morning beverage five days per week.

Objective and design

The objective of this case study was to describe changes in patient-reported pain, mood, sleep, and health-related quality of life during the reported four weeks of PhytoRx use, and to explore the potential role of a CBD/CBG formulation in symptom management for a patient accustomed to nighttime THC-dominant cannabis. The assessment focused on symptom and functional outcomes rather than perceived intoxication as a marker of benefit. As an uncontrolled, single-patient observation, this report cannot establish treatment efficacy, determine whether PhytoRx reduced reliance on THC, or separate its effects from concurrent treatments, expectancy effects, and natural symptom variation.

Patient history and existing treatments

The patient has used cannabis with a medical cannabis recommendation from a licensed California physician for over eight years.  Her principal concerns were general pain, anxiety, and poor sleep. Documented diagnoses were dorsalgia (M54.9), insomnia (G47.00), anxiety disorder (F41.9), and type 2 diabetes mellitus without complications (E11.9). The patient experienced perimenopausal hot flashes (N95.1) and was diagnosed with right leg peripheral vascular disease (I73.9) treated with balloon angioplasty in 2024. She experiences lower to mid back, and neck pain daily or every other day lasting for a few hours to half a day.

The patient reported a height of 5 feet 5 inches and an approximate weight of 210 pounds.  A prior trial of tirzepatide (Mounjaro) reportedly failed to produce desired weight loss; no specific adverse reaction was described.  She currently prefers diet and exercise for diabetes management, following a low-carbohydrate diet, and planning hemoglobin A1c testing to monitor the effectiveness of her life-style changes.  Listed medications were atorvastatin, ibuprofen, metformin, rivaroxaban (Xarelto), and aspirin. Supplements included zinc, magnesium, vitamin D3, vitamin K, liposomal B complex, liquid berberine, and a combination product containing milk thistle, N-acetylcysteine, choline, and L-glutathione. She reported continued use of these treatments during the observation period.

Prior cannabis use and clinical examination

The patient reported smoking approximately ½ gram of Type I (THC-dominant) cannabis flower in evening sessions as needed for pain, mood, and sleep. She reported near-complete symptom relief and no bothersome effects. She continued to smoke cannabis during the PhytoRx observation period without dose changes, total cannabinoid exposure was not determined.

The telemedicine examination documented no acute distress, intact alertness and orientation, no current anxiety, panic, anger, or depression, no suicidal or homicidal ideation, and denial of paranoia. Her condition was assessed as stable. These findings are established as a 2026 baseline examination.

Intervention and timeline

PhytoRx is a nano-emulsified, broad-spectrum oral liquid containing 50 mg CBD and 25 mg CBG per full supplied dropper. The product was produced by combining a CBD broad spectrum nanoemulsion with a CBG isolate nanoemulsion at target ratios. The patient received the product through a promotion and reported adding one full dropper to her morning beverage five days per week, approximately two hours after rivaroxaban.

Data review and scoring methods

Responses were ordered chronologically, with July 30, 2026 as pretreatment and September 3, 2026 as follow-up. Changes are follow-up minus baseline. Questionnaire items are correlated responses from one person, not independent participants.

Health-related quality of life: EQ-5D-5L

Levels range from 1 (no problems) to 5 (extreme problems/unable, depending on dimension). The US preferred valuation model of Pickard et al. gives baseline utility = 1 − (0.096 + 0.089 + 0.101 + 0.060 + 0.057) = 0.597, and follow-up = 1 − (0.096 + 0.068) = 0.836. These coefficients were checked against the published model. The utility increase of 0.239 is descriptive. The 0–100 item is labeled self-rated health.

Pain severity and interference: BPI-derived measures

The exported recall period is seven days except for current pain. Using conventional 0–10 anchors, pain severity is the four-item mean and pain interference the seven-item mean. Severity declined 38.5% and interference declined 80.0% relative to baseline. Average pain declined 4 to 3 (25.0%). Walking and relationships each improved by five points; pain-related sleep interference improved by four.

Mood: revised abbreviated POMS framework

Scoring for all 40 items reported with conventional 0–4 anchors. Ashamed and Embarrassed are reverse-scored as 4 minus the response. Under the revised abbreviated framework, total mood disturbance is tension + depression + anger + fatigue + confusion − vigor − esteem. Negative totals are valid. Raw results indicate less tension, anger, fatigue, and confusion and greater vigor and esteem. Depression–Dejection rises by one point because Discouraged changes from 0 to 1. This does not establish depression.

Sleep: adapted PSQI

Frequency coding is 0 = not during the past month, 1 = less than once weekly, 2 = once or twice weekly, and 3 = three or more times weekly. Time to sleep is 10 to 5 minutes (both scored 0); the corresponding frequency item changes 2 to 0, yielding latency components 1 to 0. Six hours of sleep scores 1 at both assessments. Time in bed is seven hours at baseline (11:30 p.m.–6:30 a.m.) and seven hours forty minutes at follow-up (midnight–7:40 a.m.), yielding efficiencies of 85.7% and 78.3%, respectively. “Somewhat of a problem” is coded 2 for enthusiasm, and “No problem at all” is coded 0, producing daytime components 3 to 1.

Lower scores indicate better sleep. Both global totals exceed the conventional >5 poor-sleep screening threshold, which is not a diagnosis. Subjective quality, latency, and daytime functioning improved, while duration remained six hours and efficiency worsened. The sleep-aid item explicitly includes supplements and the enthusiasm label is adapted. A three-point reduction cannot by itself establish clinically important change for this patient or attribution to PhytoRx.

Safety and tolerability

Upon clinician review, concurrent rivaroxaban, aspirin, ibuprofen, cannabinoids, and supplements reconciliation indicates no adverse events. This report does not recommend altering prescribed antithrombotic therapy.

Discussion and conclusion

This case study demonstrates improved perceived health, pain intensity and interference, selected mood domains, and perceived sleep quality after reported four-week use. The effects are not uniformly favorable: mobility and sleep duration did not change, sleep efficiency declined, and discouragement increased slightly. The findings support a descriptive temporal association. 

Further observation would benefit from exact initiation dates, documentation of concomitant treatments, and systematic adverse-event monitoring.  Limitations include a single participant, two time points, self-report, different recall periods, expectation effects, and no comparator or blinding. Natural symptom fluctuation, regression to the mean, and other treatment or life changes may explain some or all observed changes. Statistical significance cannot be estimated from this single paired observation. The data cannot isolate effects of CBD, CBG, their combination, or nano-emulsification, and do not establish product safety or efficacy.

This case generates several hypotheses for future controlled studies of a standardized oral CBD/CBG formulation in adults who use cannabis for overlapping pain, mood, and sleep symptoms. The principal hypothesis is that adding 50 mg CBD and 25 mg CBG to a stable background treatment regimen improves pain-related interference with daily activities more than placebo. Pain interference is a useful primary outcome because it captures functional consequences across multiple diagnoses. Secondary hypotheses could examine whether treatment improves fatigue, vigor, sleep quality, and health-related quality of life. The mixed findings in this case support measuring each domain separately rather than assuming a uniform therapeutic effect.

A related hypothesis is that symptom improvement can occur without increased intoxication. This would directly address the possibility that some experienced cannabis users associate THC’s noticeable psychoactive effects with medicinal benefit. A controlled study should measure perceived intoxication, treatment expectations, and participant guesses about treatment allocation alongside symptom outcomes. For participants who continue THC-containing cannabis, the initial study should maintain and document a stable background regimen, including dose, potency, and route. 

Future controlled studies will use validated patient-reported outcome measures to assess whether cannabinoid treatment produces consistent, meaningful changes across symptoms and daily functioning. The Brief Pain Inventory (BPI) distinguishes pain intensity from pain-related interference; the Pittsburgh Sleep Quality Index (PSQI) assesses sleep quality and disturbances; the Profile of Mood States (POMS) characterizes mood dimensions, including fatigue and vigor; and the EQ-5D-5L measures health-related quality of life and supports calculation of country-specific utility values. Together, these instruments provide a structured assessment of symptoms shared across multiple diagnoses, extending evaluation beyond a general statement that cannabis “helps.” They also permit detection of mixed responses—for example, improved pain interference despite persistent sleep difficulties.

Consent and Disclosure

This de-identified report uses supplied history and original survey exports obtained by the author.  The patient provided written consent for publication. The author is founder and Chief Medical Officer of the Consortium, a cannabis research organization and does not have a financial relationship with PhytoRx. 

References

1. Nunberg H, Kilmer B, Pacula RL, Burgdorf JR. An analysis of applicants presenting to a medical marijuana specialty practice in California. Journal of Drug Policy Analysis. 2011;4(1):Article 1. doi: 10.2202/1941-2851.1017.

2. Bell AD, MacCallum C, Margolese S, et al. Clinical practice guidelines for cannabis and cannabinoid-based medicines in the management of chronic pain and co-occurring conditions. Cannabis and Cannabinoid Research. 2024;9(2):669–687. doi:10.1089/can.2021.0156.

3. Lu HC, Mackie K. An introduction to the endogenous cannabinoid system. Biological Psychiatry. 2016;79(7):516–525. doi:10.1016/j.biopsych.2015.07.028.

Source materials

Pickard AS et al. United States Valuation of EQ-5D-5L Health States Using an International Protocol. Value in Health. 2019;22(8):931–941. doi:10.1016/j.jval.2019.02.009. Preferred US Tobit model.

MD Anderson Cancer Center. Brief Pain Inventory User Guide and scoring guidance. https://www.mdanderson.org/content/dam/mdanderson/documents/Departments-and-Divisions/Symptom-Research/BPI_UserGuide.pdf

Grove JR, Prapavessis H. Preliminary evidence for the reliability and validity of an abbreviated Profile of Mood States. International Journal of Sport Psychology. 1992;23:93–109.

Buysse DJ et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research. 1989;28:193–213.

University of Pittsburgh. PSQI Form Administration Instructions, References, and Scoring, including May 20, 2005 clarification for other-reason scoring. https://www.psychiatry.pitt.edu/sites/default/files/inline-files/PSQI%20Scoring.doc