How CBD Helps With Pain
According to research investigator Dr. Kevin Boehnke, current preclinical animal studies suggest that CBD may reduce inflammation and pain. Boehnke is a research investigator for the Michigan Medicine Chronic Pain and Fatigue Research Center(1).
Another research, published in the Therapeutics and Clinical Risk Management journal, studied the efficacy of cannabinoids, such as CBD, in managing pain(2).
The study indicated that cannabinoids may reduce individuals’ pain from challenging-to-treat pain conditions, including pain linked with cancer and multiple sclerosis.
CBD vs. Arthritis Pain
In a 2016 animal study, researchers stated the topical application of CBD may reduce pain and inflammation from arthritis(3).
Researchers used topical CBD on rats for four days, with the rats receiving different CBD doses per day. After administering CBD, the researchers noticed a reduction in inflammation and pain in the rats’ affected joints without any side effects(4).
The study’s authors noted that 6.2mg CBD a day for four consecutive days may reduce pain and swelling symptoms. The rats who received the lowest doses of the cannabinoid did not experience any pain improvement(5).
Rats that received 62.3mg CBD daily had the same outcomes as those that received 6.2mg per day. Results indicated that taking a higher CBD dose does not guarantee better results(6).
According to the authors, the cannabinoid’s analgesic (pain-relieving) and anti-inflammatory properties may help treat arthritis patients. However, the researchers noted that more human studies are needed(7).
A 2012 study showed CBD’s potential in preventing the onset of joint neuropathy and joint pain linked with osteoarthritis(8).
Neuropathy pertains to nerve dysfunction, resulting in muscle weakness, numbness, and discomfort in the affected area(9).
Osteoarthritis is a common type of arthritis that occurs when the joints’ protective cartilage wears down. Patients who are suffering from osteoarthritis experience painful and swollen joints(10).
The study, published in the journal Pain, suggested CBD’s ability to help with neuropathic and osteoarthritic functions. The researchers attributed CBD’s potential benefits to its neuroprotective and anti-inflammatory properties(11).
CBD vs. Migraine Pain
According to a 2018 review published by the Cochrane Library, there are limited studies on CBD’s potential as an alternative treatment for migraines. The review also noted that most of the existing studies examined CBD’s analgesic effects when used with tetrahydrocannabinol (THC)(12).
In a 2017 study, researchers indicated that CBD and THC may reduce acute and intense pain for migraine patients. The study aimed to discover the most effective CBD and THC dosage for headaches(13).
The authors administered a starting dose of 10mg to 48 subjects with chronic migraine.
The subjects received the doses containing a combination of two compounds. The first dose had 19% THC and the second dose contained no THC and 9% CBD.
After dosing, the researchers noted that amounts of less than 100mg were ineffective in reducing pain. However, they recorded a 55% drop in pain in patients who received 200mg doses(14).
The researchers also noted that patients who took the drug with a combination of THC and CBD had fewer stomach aches and less muscle pain than the patients who took pain medications.
One recorded drawback was that the patients taking the THC-CBD drug also experienced side effects, including drowsiness and trouble with concentration(15).
CBD vs. Neuropathic Pain
In a 2012 study, medical researchers stated that CBD may help relieve neuropathic and inflammatory pain, categorized as types of challenging-to-treat chronic pain(16). However, more human studies are needed to solidify the claims about CBD’s potential in pain management.
Muscle spasms are known symptoms of neuropathic damage, leading to painful muscle cramps(17).
In a 2006 study, the authors indicated that Sativex, a medicine composed of CBD and THC, may help patients manage pain(18).
According to the study, the medication may help patients with nerve damage pain, chronic neuropathic pain, peripheral neuropathy, rheumatoid arthritis, cancer pain, and multiple sclerosis (MS).
A 2018 review backed the Sativex study, saying that cannabinoids may reduce nerve pain(19). The review evaluated hundreds of studies that discussed the effect of marijuana-based pharmaceuticals on neuropathic pain.
CBD vs. Cancer Pain
According to a 2009 study published by Oxford University Press, 70% to 90% of advanced cancer patients experience significant pain(20). Cancer pain may be due to damage or pressure to internal organs.
In a 2019 study, the researchers stated that cannabinoids had been used as a part of palliative care to relieve pain, reduce nausea, and increase appetite(21).
Another study noted that THC and CBD may provide pain relief to patients with advanced cancer pain resistant to opioids(22).
The study, published in the Journal of Pain and Symptom Management, indicated that CBD and THC, when used in addition to opioids, may be more effective in relieving pain than using opioids alone.
CBD vs. Chronic Pain
According to a 2018 article published in the Harvard Health Publishing, CBD may serve as an alternative treatment to certain chronic pain types(23).
Meanwhile, research conducted in the same year cited scientific evidence indicating that cannabinoids may possess inflammatory and neuropathic pain-relieving effects in rats(24).
In a 2018 review, medical researchers examined the effectiveness of CBD in relieving chronic pain. The review evaluated animal and human studies between 1975 and 2018(25).
The review showed that CBD may help treat various types of pain, including cancer pain, chronic back pain, and neuropathic pain. The authors noted that CBD was effective in relieving pain overall(26).
Benefits of Using CBD for Pain
According to a 2017 review, CBD may be well-tolerated at doses of up to 1,500mg per day(27). The World Health Organization (WHO) also stated that CBD has a good safety profile(28).
National Institute on Drug Abuse (NIDA) Director Nora Volkow also indicated that CBD is non-psychoactive and non-addictive. These characteristics make the cannabinoid a safe option for patients in pain who do not want to be drug dependent(29).
According to a recent article published by Creighton University’s School of Pharmacy and Health Professions, clinical trials suggest that CBD doses of up to 300mg every day for six weeks are well-tolerated by seniors or elderly patients(30).
Other Health Benefits of CBD
According to a study, CBD has anxiolytic (anti-anxiety), neuroprotective (nerve cell function protection), hypoxia-ischemia (proper blood flow to organs), analgesic (pain- relieving), anti-inflammatory, anti-asthmatic, antitumor, and antipsychotic effects(31).
However, existing research says CBD may not reduce chronic pain symptoms in kidney transplant patients, ulcerative colitis, and experimentally-induced anxiety(32).
Meanwhile, several studies looked at the potential benefits of the non-psychoactive cannabinoid. Some researchers also studied the effects of CBD in drug addiction treatments.
According to a recent review, preclinical studies note that CBD may help people suffering from cocaine, opioid, and psychostimulant addiction(33).
Based on preliminary data, CBD may help treat tobacco and cannabis addiction in humans(34). Still, researchers believe that more study is required to evaluate CBD’s potential as a cure for drug addiction.
Moreover, in a study published in 2019, researchers stated that 88.3% of the chronic migraine patients who participated in the study reported fewer headaches and improved anxiety symptoms, sleep, and mood, after taking medicinal cannabis(35).
The study’s authors also noted that the patients who received the 20:1 THC to CBD ratio experienced fewer headaches than the patients taking the 1:1 THC to CBD ratio(36).
A comprehensive literature review conducted in 2018 supported the results of the study above. According to the literature review, cannabis-derived products possess therapeutic benefits, especially in improving migraines(37).
A survey also noted that some oncologists consider the use of cannabis products to help cancer patients. In a 2018 survey, 67% of oncology doctors who responded to the survey stated that medical marijuana may be helpful in providing pain relief(38).
In the survey, eight in 10 oncologists reported having discussed marijuana with cancer patients. In the eight cases, patients brought up the subject of medical marijuana use.
Forty-six percent of the oncologists also recommended marijuana to their patients for pain management and other cancer-related symptoms(39).
In a 2014 study, medical researchers noted that cannabinoids may help block spinal, peripheral, and gastrointestinal mechanisms which may trigger muscle spasms, headache, irritable bowel syndrome, and fibromyalgia(40).
According to a 2017 CBD report from the WHO, CBD may reduce restlessness, muscular tension, fatigue, social anxiety, and concentration problems in animal models. The report also noted that CBD may also reduce the symptoms of social anxiety in patients(41).
In a 2017 study, the authors noted that medical cannabis may have the potential to treat insomnia(42). Meanwhile, another 2017 study suggested that CBD may also help individuals suffering from rapid eye movement (REM) sleep behavior disorders(43).
According to Colorado-based research, CBD oil administration to patients with PTSD may reduce the patients’ symptoms, including anxiety and insomnia. The five-month study suggested that CBD use may consistently lessen the patients’ scores on the sleep scale and the anxiety scale(44).
Medical researchers also studied the effects of Sativex, a cannabis-derived medicine with 15 mg of CBD and THC. According to the study, Satives may help improve sleep in patients suffering various pain conditions, including peripheral neuropathic pain, intractable cancer pain, rheumatoid arthritis, and multiple sclerosis(45).
Meanwhile, in a 2017 animal study, the authors observed that CBD may effectively treat traumatic brain injury (TBI) in animal models(46). Another research published in 2012 noted that using CBD may trigger long-term neuroprotection in newborn rats with hypoxia-ischemia (HI) brain injury(47).
The medical researchers observed that CBD helped reduce the volume of brain damage, the extent and rate of brain damage, and inflammation in the brain. The authors also noted that CBD may help improve neurological behavior impairment.
According to WHO, human studies on CBD’s effects suggest that the cannabinoid may have neuroprotective properties that may help patients with inflammatory diseases and Alzheimer’s disease(48).
According to a recent study, CBD may also help prevent the onset of several movement disorders, including Parkinson’s disease. According to the study, CBD may help improve primary and secondary dystonic movements(49).
Medical researchers also stated that CBD possessed antidepressant effects. According to a recent study, cannabinoids may play a crucial role in the development of new therapeutic strategies in mental illnesses, including anxiety and schizophrenia(50).
Although CBD is a cannabinoid that humans have been using for centuries, medical researchers still lack information about its potential uses and indications in medicine. The limited study about the medical benefits of the cannabinoid highlights the need for further research.
Another reason to look for more clinical trials is that existing information about CBD is for older patients who have suffered chronic medical conditions for many years. The medical industry needs new details on CBD and how it may treat current health conditions.
Recent medical studies about CBD also suggest that CBD may be useful for a wide range of medical conditions. With more research, medical researchers may understand how CBD affects the human body’s perception of pain.
Additional research may also help physicians with the practical and safe dosing of CBD for their patients.
Risks of Using CBD for Pain
Although deemed safe by many, CBD still comes with possible side effects(51).
In a 2017 review, researchers noted that CBD use’s most common side effects include tiredness, diarrhea, dry mouth, changes in appetite, and changes in body weight(52).
CBD may also affect the effectiveness of other medications in the body. The cannabinoid interacts with the body’s cytochrome P450 (CYP450) liver enzymes, which break down toxic compounds, including over 60% of drugs(53).
Meanwhile, Epidiolex, a CBD-based drug approved by the United States Food and Drug Administration (FDA), also comes with side effects. According to its patient information leaflet, Epidiolex may cause liver damage, depression, lethargy, and suicidal thoughts(54).
In elderly patients, taking CBD may cause lightheadedness, sedation, slowing of psychomotor functions, and orthostatic hypotension (sudden blood pressure drop when standing up)(55).
Other particularly bothersome side effects of CBD in elderly patients include gastrointestinal discomfort, lack of appetite, dry mouth, and weight loss.
Moreover, studies have shown that CBD and other cannabinoids may be harmful to the lungs. According to a 2016 study, the cannabinoids may hinder proper lung function and affect respiratory pathogen clearance(56).
According to the study, a significant reduction in inflammation may diminish the lungs’ defense system, increasing lung infection risk(57).
Patients considering CBD to treat pain should be well-informed of all the possible side effects and consult their doctors about the use of the cannabinoid.
The FDA has also warned buyers of CBD products marketed as dietary supplements(58). Buyers must only purchase CBD products from reliable brands and dispensaries to ensure their safety and quality.
Precautions When Considering Pain Treatment
The National Center for Complementary and Integrative Health (NCCIH) provided a list of precautions to take when considering treatment for pain(59):
- Conduct thorough research about the product or practice before trying them.
- Visit a medical professional knowledgeable about chronic pain. Ask your doctor about the alternative treatments you want to try.
- Ask your doctor to recommend a practitioner before trying spinal manipulation, acupuncture, or massage.
- Remember that some supplements may cause health issues if not used correctly. Some supplements may also interact with prescription medications or over-the-counter medications.
In a 2017 study published in the Annals of Internal Medicine, medical researchers provided three recommendations that may help doctors and their patients in their search for treatments to reduce acute, subacute, and chronic low back pains(60):
Clinicians and patients should opt for a non-pharmacologic treatment, such as massage, spinal manipulation, or acupuncture. According to the 2017 study, a non-pharmacologic approach is the smart first option since most patients with low back pain tend to improve over time regardless of treatment.
Non-Pharmacologic Treatment With Therapy
In addition to massages, spinal manipulation, or acupuncture, patients may also try to reduce their pain by adding to non-pharmacologic interventions any of the following:
- Multidisciplinary rehabilitation
- Mindfulness-based stress reduction
- Tai chi
- Progressive relaxation
- Motor control exercise
- Low-level laser therapy
- Cognitive-behavioral therapy
- Operant therapy
If non-pharmacologic interventions fail to relieve pain, patients with chronic lower back pain should consider pharmacologic treatments.
Nonsteroidal anti-inflammatory drugs may be first-line treatment.
Second-line therapy may be tramadol or duloxetine, an antidepressant with analgesic effects(61).
According to the NCCIH, patients who experience no changes even after following the aforementioned recommendations should only consider opioids as an option.
CBD Dosage and Methods of Consumption
Since the FDA still does not regulate the CBD market, guidelines for proper CBD dosage for pain conditions remain unclear.
CBD users must also note several factors to consider when determining the correct CBD dose for pain. These factors include the user’s weight, desired results, and the CBD amount the product contains.
However, most CBD brands provide a recommended dosage to every CBD product they offer. It is recommended that users follow the recommended dosage, then adjust the dosage accordingly.
According to the Minnesota Department of Health, a daily dose of 27mg THC and 25mg CBD per day may help alleviate cancer pain(62).
Still, it is recommended to consult a medical professional before taking CBD. Consulting a medical professional is crucial, especially when individuals taking CBD for the first time are also taking other medications.
Routes of Administration
CBD products vary in bioavailability, depending on the method of consumption.
Patients may administer CBD oil tincture sublingually or drop the oil directly under the tongue for faster absorption. Using a measured dropper provides convenient and accurate dosing for CBD users.
Some users may opt for orally ingestible CBD products, such as edibles, gummies, and capsules.
Some CBD companies offer CBD topical products, including CBD salves, CBD creams, or CBD lotions. These products are recommended for dealing with inflammation or pain in specific areas of the body.
Topical and Transdermal Route
Transdermal or topical administration delivers drugs through the skin via patches, salves, creams, or lotions.
Transdermal administration of cannabinoids avoids the first-pass metabolism, improving drug bioavailability. This route allows a consistent infusion of a drug to be delivered over a prolonged period of time while minimizing the adverse effects of higher drug peak concentrations(63).
Most CBD users opt for topical administration to deal with localized symptoms, such as dermatological medical conditions, arthritis, and peripheral neuropathic pain.
According to a 2019 study, when applying a cannabinoid-derived product directly onto the skin, the relief may be felt after 15 minutes(64).
The oral administration of CBD allows for standardized concentrations and doses. This route is also convenient and straightforward(65).
According to a 2018 study, CBD in oil and capsule formats provides more accurate and convenient dosing than CBD juices or teas(66).
However, the study also noted that absorption for oral cannabinoid ingestion is slow, erratic, and variable. With oral consumption, the highest plasma concentrations are recorded one hour to two hours after dosing and may even be delayed for up to six hours(67).
The authors noted that the effect duration from oral ingestion varies from eight hours to 20 hours(68).
Topical, nasal, inhaled-pulmonary, and oral transmucosal (surface of the mouth) delivery allows for drug uptake directly into the bloodstream, eliminating the first-pass metabolism(69).
The first-pass metabolism is the early metabolization of a drug, reducing drug concentration before reaching its intended action site(70).
According to a study, the non-invasive method of sublingual administration is superior to oral dosage in terms of providing pain relief(71).
A 2018 study noted that the intrapulmonary administration of cannabinoids is effective, as it results in the fast-action and high-systemic bioavailability(72).
The effects of the pulmonary administration of cannabinoids may be experienced within a few minutes of the first inhalation, with the effects increasing over time. Peak plasma concentration is reached 10 minutes after consumption and is maintained for three to five hours(73).
However, one major drawback of inhaling cannabinoids is the variability of efficiency caused by differences in inhalation techniques and respiratory tract irritation during inhalation(74).
Although smoking cannabinoids delivers fast-acting effects directly to the lungs, it may also be harmful to the lungs. According to an article published in Johns Hopkins Medicine, vape use may cause lung injuries and diseases, such as collapsed lung and lipoid pneumonia(75).
Cannabidiol is one of the most prominent compounds present in the Cannabis sativa plant. CBD is not psychoactive unlike THC, the main psychoactive component of cannabis.
Hemp is typically harvested for its useful flowers, seeds, and stalks. Hemp flowers are rich in cannabinoids and are the source of CBD for most CBD brands.
Many people are confused when it comes to differentiating hemp and marijuana, mainly since there are similarities between the two. Both plants are cannabis species, and most cannabinoids from both marijuana and hemp plants are from cannabis flowers.
However, marijuana is a cannabis plant harvested for its psychoactive properties. The plant may contain up to 30% THC per dry weight(76).
Unlike hemp, marijuana seeds and stalks are not usually harvested. Marijuana plants are typically harvested only for their highly resinous flowers, which contain various cannabinoids.
You may find THC throughout all of the aerial parts of the plant. However, the psychoactive cannabinoid is most abundant in the flowers of marijuana plants.
Marijuana and hemp flowers and leaves possess different concentrations of CBD and THC. Hemp leaves, flowers, and stems contain CBD, while marijuana flowers possess high THC concentrations.
How CBD Works
Medical researchers have noted that CBD possesses analgesic, anti-inflammatory, and neuroprotective effects(77).
The benefits of CBD are realized by the cannabinoid’s interaction with the body’s endocannabinoid system (ECS) and its cannabinoid receptors.
ECS’s main role is to regulate various body functions to promote overall wellness and maintain a state of balance. The ECS has CB1 and CB2 receptors, which are present in specific parts of the human body.
CB1 receptors are mostly present in the brain and central nervous system. They may also be found in the body’s reproductive organs, gastrointestinal and urinary tracts, liver, retina, and lungs(78).
Meanwhile, CB2 receptors are mostly located in the body’s immune system. They affect pain and inflammation.
According to a study of the cannabinoid receptors, endocannabinoids may suppress the body’s perception of pain(79).
Types of CBD
Most CBD brands sell three CBD types: full-spectrum CBD or whole-plant CBD, broad-spectrum CBD, and CBD isolates.
Full-spectrum CBD oil has all the naturally occurring phytocannabinoids in the cannabis plant, including terpenes, flavonoids, fatty acids, and THC.
In a 2005 study, medical researchers observed that full-spectrum hemp extract had greater medicinal properties than pure CBD(80).
This advantage may be attributed to the “entourage effect” present in full-spectrum products, which pertains to the maximized health benefits of cannabinoids when used with other cannabis compounds.
Meanwhile, broad-spectrum CBD contains multiple cannabinoids and other chemical compounds in the hemp plants, except THC.
Finally, a product with a CBD isolate only contains CBD and no other cannabinoids, terpenes, or fatty acids. If you want to experience the benefits of CBD while keeping your body THC-free, a product containing only CBD isolates or a broad-spectrum CBD may be the choice for you.
Most CBD brands dilute CBD extracts with a carrier oil, such as olive oil, hempseed oil sourced from hemp seeds, or medium-chain triglyceride oil (MCT oil) sourced from coconut oil.
Although the usual CBD formulation is oil, the cannabinoid may also be taken through gummies, hemp extracts, vape products, topicals, and CBD tinctures. Some brands even offer unflavored and flavored options to attract more consumers.
To ensure their products’ efficacy, some CBD companies also infuse their CBD topicals with beneficial compounds that possess anti-inflammatory properties, like peppermint(81).
Legality of CBD
In 2015, the FDA implemented more lenient laws that allowed researchers to perform CBD investigations and clinical trials(82).
Former President Donald Trump signed the Farm Bill into law in 2018. Under this law, Congress removed industrial hemp as a Schedule I drug under the Federal Controlled Substances Act(83).
The 2018 Farm Bill authorized the marketing of hemp products across state borders. It also legalized the cultivation, production, and manufacturing of industrial hemp on the federal level(84).
The law allowed CBD brands to offer more accessible hemp-derived products, such as CBD oil, in the market.
Nowadays, you may buy CBD products online without a medical cannabis license(85). However, you may still need to research state laws since they have varying degrees of restriction regarding medical marijuana and CBD(86).
Currently, CBD alone is not approved for the treatment of pain in the USA(87). The FDA has only approved the use of Epidiolex to treat seizures associated with Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS), two severe forms of epilepsy(88).
In some US states like Alabama, a prescription is needed to possess or use CBD products(89).
Choose the Best CBD Oil for Pain
Regardless of the kind of CBD products you are looking for, remember the tips below to ensure the safety and quality of the product you want to buy.
- Look for CBD brands with accreditation from certification authorities.
One of the most popular certification authorities in the CBD industry is the US Hemp Authority. The organization provides certification to companies with the best CBD products.
Meanwhile, the Better Business Bureau (BBB) collates consumer reports and accredits brands with the best business practices.
Certification authorities like the BBB and US Hemp Authority recognize certain products only after performing a series of thorough screening tests.
- Compare the information on the product label to data from third-party testing.
You may also read the product’s third-party lab test results to know if a company’s claim about its products match the information indicated on the product label.
A third-party lab result includes information about a product’s THC content, CBD potency and concentration, and the presence of harmful compounds.
- Seek medical advice from health professionals.
Before you buy a CBD product for pain, visit a medical professional experienced in CBD. A doctor may help you with safe dosing and provide more precautionary measures to follow when taking CBD.
A visit to the doctor is important, especially if you are also taking prescription drugs for a serious medical condition.
- Choose the best CBD oils from reliable and legitimate CBD companies.
Most brands ensure their products are safe by using non-genetically modified organism (non-GMO) ingredients. Some brands also offer vegan and gluten-free products.
Also, determine whether a store or a dispensary has been authorized by the government to sell CBD.
Most reliable CBD companies that produce high-quality products cultivate industrial hemp from their farms. Some brands opt to buy hemp grown by licensed and reputable hemp producers.
In the US, most brands cultivate their hemp from farms in Colorado, which is at the forefront of hemp oil production.
The medical and recreational use of CBD and other cannabis-derived products have been legal in the state since 2012(90). Some of the popular CBD brands, including NuLeaf Naturals, CBDPure, and CBDistillery, have farms in the state.
Many CBD brands offer a money-back guarantee option for customer satisfaction.
- Read product reviews.
Research product reviews from past customers when buying CBD online. Also, find out whether a store or a dispensary has been authorized by the government to sell CBD.
- Determine the extraction method used.
According to the FDA, the supercritical-CO2 extraction procedure is safe to use in pharmaceutical manufacturing(91).
Also dubbed as the supercritical fluid extraction (SFE) procedure, the supercritical-CO2 extraction method relies on carbon dioxide (CO2) to extract CBD from the raw hemp material.
During the CO2 extraction process, CBD manufacturers use an extraction machine to squeeze and freeze carbon dioxide until it achieves a supercritical cold liquid state. Hemp oil then passes through the plant compound, taking CBD and other phytocannabinoids with it.
Other CBD brands use solvent-based extraction methods. During a solvent-based extraction process, CBD manufacturers use solvents, such as propane, butane, and ethanol, to remove cannabinoids from hemp plants.
Check the product labels and read the information provided. Most reliable CBD companies include the following information on the product labels:
- Supplement fact panel
- Complete list of ingredients
- Amount of CBD or CBD concentration and potency
- Net weight
- Name of the product manufacturer and distributor
- Recommended dosage
- Batch or date code
- Type of CBD the product contains: full-spectrum CBD, broad-spectrum CBD, or BD isolate