According to a report by Global Industry Analysts, more than 1.5 billion people worldwide suffer from chronic pain. That means around 4.5% of the entire population suffers from neuropathic pain.
In the United States alone, approximately 100 million adults suffer from chronic pain – more than diabetes, heart disease and cancer combined.
Pain management translates to $300 billion in health care costs annually. Chronic pain is a financial burden not only to the patient but to the family too because of long hospital stays, difficult rehabilitation, and lost income and insurance coverage.
Unlike acute pain that you can treat with over-the-counter drugs like Aspirin, chronic pain never goes away. Pain will keep triggering your nervous system for months or even years. Chronic pain can often be traced to a serious injection, injury or ongoing condition such as arthritis or cancer. But some people suffer from chronic pain even without any existing health issue. Chronic pain symptoms include persistent headaches, low back pain, joint paint, and neurogenic pain resulting from nerve damage.
CBD for pain management has become a hot topic in recent years. Plant-based cannabidiol (CDB) is a natural alternative remedy for those who do not like the side effects of non-steroidal anti-inflammatory drugs (NSAIDs), prescription painkillers, nerve blockers, steroids, and opioids.
Whether the chronic pain is in your back, neck, head, hands, or other bones, CBD might be able to help with your treatment regimen.
The CBD craze
Cannabis is all the rage these days, especially its non-psychoactive compound called cannabidiol. Available in oil, capsule and cream form, CBD can be mixed with vaping liquid, nighttime tea, and skin products as people claim to experience relief from chronic pain, anxiety, and even insomnia. Although CBD oil is extracted from the cannabis plant, it does not alter the mind with psychoactive side effects associated with its cannabis sibling – THC.
Last June 25, the U.S. Food and Drug Administration (FDA) announced the approval of a purified form of CBD for the treatment of seizures associated with two rare, severe forms of epilepsy in patients two years of age and older. This is the first cannabis-derived drug approved at the federal level.
What is CBD oil?
Cannabidiol is one of over 80 active compounds – called cannabinoids – found in the cannabis plant. CBD oil can be extracted from the resin glands of cannabis buds and flowers. It can also be extracted from industrial hemp which is a fibrous form of cannabis. Industrial hemp contains less than 0.3% of tetrahydrocannabinol (THC) – the main psychoactive cannabinoid in the cannabis plant.
The human body has its own endocannabinoid system (ECS) that receives and translates signals from endocannabinoids that are produced in the body. The ECS helps regulate pain, sleep, and immune-system responses, among other things.
When THC binds to the CB1 endocannabinoid receptors in the brain, it activates the brain's reward system which in turn produces dopamine and creates euphoria.
CBD, on the other hand, interacts with those same receptors 100 times weaker than THC so you do not get high. According to one study posted to Neurotherapeutics, CBD stops the body from absorbing anandamide – a compound associated with regulating pain. More anandamide levels in the bloodstream can help reduce pain.
How CBD for pain works
From what scientists have discovered, CBD works by desensitizing the pain receptor called TRPV1. The burning sensation you feel from a condition like nerve damage can be traced to the TRPV1 receptor.
What scientific evidence says about CBD for pain
Animal studies and anecdotal evidence suggest that CBD oil may actually have health benefits. Cannabidiol has shown potential in treating a wide range of conditions including chronic pain, anxiety, substance abuse disorders, and central nervous system issues.
In one 2012 study it is said that “systemic and intrathecal administration of cannabidiol (CBD) and its modified derivatives significantly suppress chronic inflammatory and neuropathic pain without causing apparent analgesic tolerance.”
Two years later another study showed that plant-based cannabinoids “have been effective in a range of experimental neuropathic pain models, and there is mounting evidence for therapeutic use in human neuropathic pain conditions.”
That same year one more study demonstrated how the cannabinoid system targets analgesia, leading to “the efficacy of cannabinoid compounds in the treatment of neuropathic pain.”
The use of hemp CBD for pain dates back to thousands of years ago. Only recently have scientists begun to study it again as a potential remedy for modern diseases. Here are some of the potential benefits of CBD for pain management.
CBD for arthritis pain
The European Journal of Pain published a study in 2016 exploring the anti-inflammatory properties of cannabidiol.
Studying a group of rats with arthritis, researchers applied a topical gel containing 0.6mg, 3.1mg, 6.2mg, and 62.3mg CBD for four consecutive days. The results noted a significant reduction in inflammation and signs of pain in the affected joints without any side effects.
People using CBD topical creams and gels for arthritis vouch for their effectiveness in providing pain relief. However, more human studies are needed to confirm these findings.
CBD for multiple sclerosis
Multiple sclerosis (MS) is an autoimmune disease that affects your brain, spinal cord, and optic nerves. Among the common symptoms of MS are very painful muscle spasms.
In 2007 a study looked at the effects of cannabinoids in treating the debilitating pain relate to multiple sclerosis. The double-blind placebo-controlled study concluded that cannabinoids, including the CBD/THC buccal spray, are effective in treating neuropathic pain in MS patients.
Another study that year evaluated the long-term effects of Sativex – a pharmaceutical CBD/THC therapy – in select MS patients. After two years of treatment, researchers concluded that THC/CBD was effective in mitigating symptoms, with no evidence of tolerance.
In one report in 2014, taking oral CBD for a short period showed a potential to reduce spasticity levels in adults with multiple sclerosis.
CBD for chronic pain
In multiple systematic reviews of dozens of trials and studies, researchers concluded that there is substantial evidence showing cannabis as an effective treatment for adults who are suffering from chronic pain.
In a 2008 review, neurologist Ethan Russo (author of Handbook of Cannabis Therapeutics) assessed how CBD works to pain treatment by looking at studies conducted between the late 1980s and 2007. He concluded that CBD was effective in treating pain-related insomnia and overall pain without adverse side effects.
A separate study published in the Journal of Experimental Medicine supports these results, suggesting that CBD can be beneficial in reducing pain and inflammation.
In most clinical trials, subjects did not exhibit tolerance to the effects of CBD so there was no need to continually increase the dosage.
CBD for cancer pain
CBD extracts are also receiving good reviews from cancer patients. In animal studies, mice have exhibited a reduction of cancerous tumors after taking CBD. While human studies are still lacking, research has shown how CBD oil could help manage pain related to cancer treatment.
The National Cancer Institute (NCI) has an entire page on its website dedicated to cannabis and cannabinoids as a possible option for treating chemotherapy-related pain.
The NCI conducted a study on CBD oil used in conjunction with opioids and sprayed into the mouth. Although the results revealed better pain management with the help of CBD oil, more research is still needed.
A 2014 study published in the British Journal of Pharmacology investigated the therapeutic potential of CBD in treating chemotherapy-induced neuropathic pain (CIPN). The research team concluded that adjunct treatment with CBD during paclitaxel (PAC) chemotherapy may be safe and effective in the prevention or attenuation of chemotherapy-induced neuropathic pain.
CBD for other disorders
Hemp CBD oil has also shown promise in treating other issues such as:
- Epileptic seizures
- Alzheimer's symptoms
- Psychosis in schizophrenic patients
- Type 1 diabetes
- Smoking cessation and drug withdrawal
CBD vs. Placebo
Anecdotal evidence on CBD for pain relief is abundant, which is why researchers often try to find out whether that is due to the CBD or just a placebo effect.
The U.S. National Library of Medicine currently has 25 clinical studies listed on CBD for pain. Only a handful of those have been completed, most of the subjects are people with advanced cancer, and treatment usually involved combining CBD with THC. While some of them exhibit positive results, others demonstrate only placebo relief.
Majority of the studies on CBD involve mice rather than humans. And in those human clinical trials, the test group often involves only a small number of subjects. The short trial period also does not provide reliable data on the long-term effects of cannabis-based treatment.
With the CBD market in full swing and expected to be worth $646 million by the year 2020, science has a lot of catching up to do.
CBD full spectrum vs. CBD isolate
In a 2008 study of the anti-hyperalgesic effect of a Cannabis sativa extract, researchers found that a controlled cannabis extract containing a defined ratio of multiple cannabinoids and other non-cannabinoid fractions such as terpenes and flavonoids provided better anti-nociceptive efficacy than a single cannabinoid molecule.
Again in 2011, a study showed that two non-psychoactive cannabinoids – cannabidiol (CBD) and cannabichromene (CBC) – stimulated descending pathways of anti-nociception and caused analgesia by interacting with several target proteins involved in nociceptive control. These compounds when combined might represent useful therapeutic agents for pain management.
While CBD isolates represent the purest form of CBD, full-spectrum CBD is considered more effective in treating pain. CBD plus the terpenes and flavonoids of the entire cannabis plant is more beneficial than a single CBD molecule alone.
How to take CBD for pain
CBD is not regulated as medicine by the FDA. It is considered a food supplement so dosages should be approached with caution.
When creating a CBD for pain regimen, one should aim for maximum relief. Preventive maintenance is more important than managing acute flair ups.
The best way to manage pain is to take full spectrum CBD oil daily in the form of oral capsule or sublingual tincture. Both products contain the same ingredients but differ in dosage and form.
Start with a baseline of 5mg to 10mg per day and increase by 5mg to 10mg until the desired pain relief is achieved. Keep in mind that ingestible CBD products have a delayed onset time. It can take up to 90 minutes for CBD capsules and CBD tinctures to take full effect.
Most CBD gel capsules are sold in 25mg pills. While this is way higher than the prescribed 5mg to 10mg dosage, there is no harm in starting at 25mg daily. No one overdoses on CBD!
CBD products that are taken orally are known to provide sustained relief for several hours – even one whole day!
For muscle and joint pain, we recommend supplementing on a CBD topical salve. Apply this extra strength rub directly to the skin for instant relief of aches in muscles, bones, tendons, ligaments, or myofascial tissue. CBD topical products are able to penetrate deep into the skin to reduce pain and inflammation. One can feel the effects within 15 minutes. Apply again if necessary.
For acute flair ups caused by cold weather, recent injury, or general aggravation, we recommend vaping or dabbing a CBD isolate for immediate relief. Each CBD isolate contains 99% CBD and provides a wave of relief throughout the body.
A sensible CBD dose for treating chronic pain is 2.5mg to 20mg taken no more than 25 days.
Side effects of CBD for pain
“CBD is generally well tolerated,” says Dr. Seth Waldman, anesthesiologist and director of the pain management division at the Hospital for Special Surgery (ranked No. 1 for orthopedics and No. 3 for rheumatology in the US).
Since it is well tolerated by the human body, cannabidiol has a distinct advantage over other pain medications such as steroids, opioids, anticonvulsants, non-steroidal anti-inflammatory drugs (NSAIDs), and antidepressant medications.
The biggest concern when taking CBD is making sure the product does not contain THC. If you consume higher concentrations of THC and you are pre-disposed for mental illness, it could make your condition worse.
There are no severe side effects related to CBD. Even the World Health Organization (WHO) confirmed that no health problems have been associated with the use of pure CBD. It also has not shown any potential for dependence or abuse.
While CBD oil is well tolerated in most people, there are quite a few potential side effects to look out for. According to a review in Cannabis and Cannabinoid Research, the most common side effects include:
- Change in appetite
- Weight gain or weight loss
In a 2014 review on CBD in Epilepsy Currents by Professor Timothy Welty, 10% of patients showed changes in liver function and 3% had to stop taking CBD due to possible liver damage.
Welty is chair of the department of clinical sciences in the College of Pharmacy and Health Sciences at Drake University in Iowa.
CBD and other cannabinoids may also cause lung problems. One study published in Frontiers in Pharmacology suggested that cannabinoids may be reducing inflammation too much that it could alter the defense system of the lungs against possible infection.
Taking CBD with other medications could also result in serious side effects from the other drugs.
Before taking CBD oil, consult with your doctor.
Is CBD for pain legal?
In the United States, some places allow cannabis only for specific medicinal purposes. There are states that require a license from your doctor to be able to buy CBD.
Hemp CBD is legal in all 50 states.
If cannabis is legal in your state, you may be able to purchase CBD for pain from a dispensary or clinic. CBD oil is also available online.
Even if medical marijuana is legal in your jurisdiction, the Drug Enforcement Administration (DEA) still classifies CBD extracts as a Schedule 1 substance — which is the federal agency's most restricted category. Schedule I drugs, substances or chemicals are defined by the DEA as drugs with no currently accepted medical use and a high potential for abuse.
The potential benefits of cannabidiol in treating pain and other medical conditions are enormous. With more and more studies coming to light, cannabis proponents are hoping for a change in the legal classification of CBD.
How to find the best CBD for pain
The potency and purity of CBD supplements vary from brand to brand and even from bottle to bottle.
A study published last year in JAMA found that more than two thirds of CBD products sold online contained either higher or lower concentrations of the substance than their labels indicated. Some of them even had significant levels of THC.
Professor Welty noted that the safety and reliability of CBD products might depend on where they are made. Minnesota and Iowa require testing on CBD products for purity, content, and strength. In states where regulation is non-existent, there is no way to verify if CBD products are free from pesticides, fungus, and other impurities, or if the cannabidiol content on the label is accurate.
While conclusive data to support the efficacy of CBD for pain may be lacking, researchers agree that cannabidiol shows a lot of potential. CBD products might be able to offer relief for people who are suffering from chronic pain – without having to worry about intoxication, paranoia and dependence.