CBD For Pain

If you’ve watched a loved one struggle with chronic pain, you know how devastating it can be. Unfortunately, what begins as a need for potent and effective pain relief can sometimes lead to medication abuse. Research shows that 21-29% of patients prescribed opiates for chronic pain misuse them, with 8-10% developing an opioid use disorder. The misuse of prescription opiates has fueled the opioid epidemic. In 2019, roughly 9.7 million people reported misusing prescription pain relievers in the past year. More than 130 people die every day after overdosing on opioids in the United States.

Given these startling statistics, it’s no surprise that many are searching for safer ways to manage their pain. Whether they want to avoid the risks associated with conventional medications or feel they’ve exhausted other options, more and more people are turning to cannabidiol (CBD) for pain.

So, what exactly is CBD? Does it really relieve pain? What does science say? Let’s look at some CBD facts and examine the evidence around using CBD for pain.

What is CBD?

CBD is a compound (known as a phytocannabinoid) derived from cannabis or hemp plants. Unlike the more widely known euphoric phytocannabinoid THC, CBD on its own does not have psychoactive effects, meaning it doesn’t get you high. It does, however, appear to offer several health benefits, including pain relief.

How does CBD work to relieve pain?

Scientists still haven’t fully identified how CBD relieves pain, but they know it interacts with our endocannabinoid, inflammatory, and nociceptive (pain-sensing) systems. You see, our bodies produce endocannabinoids—molecules similar to cannabinoids—that interact with receptors in our endocannabinoid system. The receptors bind to our body’s endocannabinoids and the phytocannabinoids in the CBD from cannabis/hemp to regulate various bodily functions such as pain, perception, and mood.

What does science say about CBD oil to treat pain?

There is abundant anecdotal evidence from people who’ve managed their pain by using CBD. And the scientific research on cannabis extracts and CBD for pain relief is also promising. Studies suggest CBD can safely and effectively relieve varying kinds of pain, including:

Neuropathic pain

Neuropathic pain can be difficult to treat and can significantly impair one’s quality of life. A four-week, randomized clinical trial found topically delivered CBD (250 mg/3 ounces cream) resulted in a statistically significant reduction in intense pain, sharp pain, and cold and itchy sensations in the CBD group compared to placebo.

Back pain

Topical CBD can also relieve both acute and chronic back pain. A literature review found that applying a cream containing hemp-derived CBD provided notable pain relief for the patients described in the case series.

Temporomandibular disorder (TMD)

TMD is the second most common form of musculoskeletal pain, right after lower back pain. Roughly 1/3rd of the US population has at least one TMD symptom. A randomized trial of 60 patients with TMD found that a topical CBD ointment (7.3% concentration) applied twice per day to the masseter muscles for 14 days resulted in a significant reduction in pain and measurable relaxation in the masseters, compared to a placebo ointment.

Arthritis pain

In a randomized, placebo-controlled, parallel-group trial, 58 patients with rheumatoid arthritis self-administered a combination of CBD and THC for five weeks. This combination significantly reduced pain during movement and at rest compared to placebo. The cannabis-based medicine group did not report any withdrawals or adverse events.

Cancer-related pain

A 2010 multicenter, double-blind, randomized, placebo-controlled, parallel-group study with 177 subjects investigated one extract containing equal parts CBD and THC, one with THC-only, and placebo, for efficacy, safety, and tolerability in patients with cancer-related pain. The results showed that the extract containing CBD and THC improved pain scores by 30% in more than half of that group, whereas the THC-only group had no significant improvements over the placebo group.

Should CBD be used for pain?

Overall, CBD appears to be very safe and well-tolerated. But with so many CBD products on the market, it may be difficult to judge the purity of a product or know what dosage is appropriate for you.

If using a topical CBD product for pain, look for one that provides at least 250 mg CBD per 3 ounces of cream/gel/lotion. Apply at least twice daily for several weeks to determine if it is helping. Talk to your healthcare partner before taking high doses of oral CBD (more than 100 mg per day), especially if you take medications such as clobazam and eslicarbazepine.

The cannabis plant is a bio-remediator. Anything in the soil it grows in gets absorbed into the plant (including pesticides to heavy metals). For this reason, I suggest seeking out companies that produce CBD using organic practices to avoid potential exposure to toxins.

Natural alternatives for pain relief

I am encouraged by the ever-growing interest in researching natural alternatives, like CBD, to address the complex and challenging problem of pain relief. Whether you suffer from a chronic condition and have exhausted conventional treatment options or simply want a natural remedy for occasional aches and pains, topical CBD in particular shows promise as a safe, effective, and natural pain reliever.

References:

Xu DH, Cullen BD, Tang M, et al. The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Curr Pharm Biotechnol 2020;21(5):390-402.

Eskander JP, Spall J, Spall A, Shah RV, Kaye AD. Cannabidiol (CBD) as a treatment of acute and chronic back pain: A case series and literature review. J Opioid Manag. 2020;16(3):215-218. doi:10.5055/jom.2020.0570

Nitecka-Buchta A, Nowak-Wachol A, Wachol K, et al. Myorelaxant Effect of Transdermal Cannabidiol Application in Patients with TMD: A Randomized, Double-Blind Trial. J Clin Med. 2019 Nov; 8(11): 1886.

Blake DR, Robson P, Ho M, Jubb RW, McCabe CS. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology (Oxford). 2006;45(1):50-52. doi:10.1093/rheumatology/kei183

Johnson JR, Burnell-Nugent M, Lossignol D, DoinaGanae-Motan E, Potts R. Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. J Pain & Symptom Mgmt. 2010;39(2):167-179.