Seems like everybody’s talking about CBD for pain relief these days. Heck, even Harvard published an article about it, saying:
CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.
On that last point both we and the good doctors at Harvard agree: there is definitely more research needed to understand how, exactly, CBD affects pain.
But in this article, we’ll talk about what we do know so far. And while it’s admittedly not as much as we’d like, there are some intriguing things to consider if you’re among the 20% of folks who suffers from chronic pain.
We will look at:
How Chronic Pain Works
- The different types of pain.
How CBD Works
- The ECS, and its role in pain.
CBD and Pain Relief
- How/if CBD works for arthritis pain.
CBD vs THC
- Do you really need both for effective pain management?
CBD Dosage for Pain
- How much should you take?
CBD Health Risks
- The potential risks of using CBD.
- How much do you need for pain relief?
Let’s get started …
PainScience.com says there are three types of pain:
- Nociceptive Pain (pain arising from musculoskeletal tissue damage).
- Neuropathic Pain (pain arising from your central nervous system, or CNS).
- Other Pain (pain arising from neurological dysfunction, not damage, like fibromyalgia).
So exactly how pain works is a complex answer, that depends largely on the type of pain you’re suffering.
One of the things we know for certain is that pain can modify the way your CNS works, so that you actually experience more pain with less provocation over time.
This is called pain sensitization and it’s an important concept to understand.
Let’s look at arthritis as an example …
In a 2009 study of rheumatoid arthritis patients, researchers found that people often suffer more pain than expected—and sensitization is most likely the explanation for the “spread” of pain beyond their joints.
Certain factors like poor sleep quality can increase sensitization to pain, and are therefore more of a “cause” of pain than anything going on in the tissues.
Researcher Lorimer Moseley said in his research paper Teaching people about pain: why do we keep beating around the bush?:
It’s actually quite astonishing how little pain is caused by some seemingly dramatic issues in your tissues! The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain, neck pain, and knee osteoarthritis).
Ok, now let’s switch gears for a moment and discuss how CBD works …
CBD’s mechanism of action has important implications on understanding if/how CBD works for pain management.
It all starts with the Endocannabinoid System, or ECS.
Long story short, the ECS is a signaling network made up of cannabinoid receptors (CB1 and CB2) and endogenous ligands called cannabinoids. The system is responsible for helping balance and regulate many processes in your body, including controlling the stimulation of nerve cells to increase or decrease pain.
With that in mind, let’s look at the current body of evidence around CBD for pain relief and management.
Here’s what we know about how CBD affects different types of pain …
CBD Oil for Arthritis Pain
Jennifer Freeman, M.D., writes on the Rheumatoid Arthritis Foundation website:
One of the primary CBD oil benefits for arthritis sufferers is its positive effect on pain, and research confirms it. A study published in the journal Pain in December 2017 analyzed whether CBD could prevent osteoarthritis pain and joint neuropathy. Based on their findings, researchers affirmed that it did both because it decreased joint inflammation and served as a protectant to the nerves.
A research review called The endocannabinoid system in pain and inflammation: Its relevance to rheumatic disease published in the European Journal of Rheumatology stated:
The primary components of the endocannabinoid signaling system (CB1, CB2, and FAAH) are characteristically expressed in the synovium of both osteoarthritic (OA) and rheumatoid arthritic (RA) patients, with compelling evidence to demonstrate an active participation in the pathophysiology of joint pain. Preclinical and clinical studies support the therapeutic application of cannabinoids in the treatment of chronic pain, and to date, patients suffering from chronic arthritic and musculoskeletal pain
A 2018 research review called Cannabinoids and Pain: New Insights From Old Molecules said:
The evidence from current research supports the use of medical cannabis in the treatment of chronic pain in adults.
Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated in quality studies in humans. Anecdotally, some people with arthritis who have tried CBD, but not all, report noticeable pain relief, sleep improvement and/or anxiety reduction.
“Quality studies” is quite subjective but as we stated earlier, we do agree that more controlled trials are needed.
Kevin Boehnke, Ph.D., research investigator in the department of anesthesiology at the University of Michigan’s Chronic Pain and Fatigue Research Center notes that ongoing preclinical studies in animals have demonstrated that CBD reduces pain and inflammation, and studies of CBD in humans show that it is well-tolerated and has few negative side effects. He states:
There are observational studies that ask why people use CBD and if it’s effective, and results tend to be quite positive. People report using CBD for anxiety, pain, sleep — all things that go hand-in-hand with chronic pain.
And in a commentary published in Annals of Internal Medicine, Boehnke and Daniel Clauw, M.D., director of the Chronic Pain and Fatigue Research Center, provided advice for clinicians on how to guide their patients about CBD and cannabis use.
They also provided guidance for the Arthritis Foundation, who recently surveyed 2,600 people with arthritis and found that 29% currently use CBD to treat arthritis symptoms.
CBD Oil May Offer Chronic Pain Relief for Other Conditions
CBD oil may provide at least some relief for other types of chronic pains. A 2008 research study published in the journal Therapeutics and Clinical Risk Management showed that cannabinoids like CBD may help ease pain for those diagnosed with conditions such as multiple sclerosis.
Perhaps you’ve heard of the “Entourage Effect.”
Dr. Clauw from the University of Michigan says:
CBD widens THC’s therapeutic window when administered concomitantly, increasing the maximum tolerated dose and decreasing the risk for adverse events.
Long story short, you should consider a full spectrum CBD product with at least a small amount of THC if you’re looking for the best pain management results.
And don’t worry: full spectrum CBD derived from hemp plants will not get you high (but will likely enhance your CBD’s pain-reducing effects).
There are certain safety considerations if you’re considering CBD. Make sure you understand the potential benefits and risks.
The aforementioned Dr.’s Boehnke and Clauw recommend that if you have chronic pain, you should talk to your doctor about adding CBD to your treatment regimen. They offer up these helpful tips to make sure you’re playing it safe:
- Refrain from smoking and vaping. Your lungs will thank you. Vaping may increase your odds of getting lung disease, says the Centers for Disease Control & Prevention.
- Only buy from reputable sources. CBD products are not approved by any regulatory agency so it’s up to you as a consumer to ensure you’re choosing a product that has been third party lab tested. Otherwise, you may be getting a product with excess THC, mold, or heavy metals!
- Different routes of administration have different onset times. For example, CBD gel capsules may take 30-60 minutes to begin working. Tinctures applied under your tongue can start working in minutes. And balms applied directly on trouble spots can also work within minutes.
While there’s no proven dosage of CBD to treat pain, it’s generally recommended to start low and slow. Start with a small amount (5-10 mg) and slowly increase your dosage until you begin to get relief over the course of several weeks. Increase the dosage until you find a dose that works for you (and if you don’t, stop taking it!).
Dr. Clauw recommends the following two-step process if you’re using CBD for pain management:
- Begin with 5 – 10 mg of CBD and try using it only at night at first.
- Slowly increase the dose (by 5 mg/day or so) until you reach a range that works for your pain. 25-50 mg twice daily seems to be the range most people land on. If that doesn’t help, try a CBD product with a low dose of THC.
One more thing to keep in mind … CBD is most effective for pain when you use it consistently for several weeks. If you take it once or twice, don’t expect to get much relief.
Gabriella Gobbi, MD, says, “The most effective neuropathic pain relief occurs after 1 week of daily CBD treatment.”
Wrap Up: CBD and Chronic Pain
CBD isn’t a magic potion for pain. And it comes with side effects and risks for some people.
So why use CBD for pain when there are easier/cheaper/more effective options available?
The reasons why most folks choose pay a little more for CBD are:
- Most painkillers come with unwanted side effects.
- CBD is not addictive and you won’t build a tolerance to it, unlike many pain meds.
- CBD is viewed as a more “natural” way of treating pain compared to prescription drugs and other lab-derived compounds.
In a 2015 paper published in the medical journal Transactions of the American Clinical and Climatological Association, Leslie J. Crofford, MD writes:
Unfortunately, treatments for chronic pain are woefully inadequate and often worsen clinical outcomes. Developing new treatment strategies for patients with chronic pain is of utmost urgency. This essay provides a framework for thinking about chronic pain and developing new treatment approaches.
This Pain Science article sums it up well:
The last 20 years of pain science strongly suggest that neurology is by far the most important factor in most chronic pain.
That’s what makes CBD so intriguing … it appears that these phytocannabinoids have neuroprotective properties that could play a role in pain management.
We need more clinical studies to help us better understand how, exactly, CBD affects pain and whether or not it’s a safe and effective long-term option. Fortunately, we’re starting to see some progress in that regard …
Project CBD reports a new controlled trial seeks to study CBD and THC’s impact on arthritic pain. Here’s what they have to say:
Cannabinoids seem promising for treating the symptoms or progression of rheumatoid arthritis. But in the name of caution, many doctors prefer no treatment rather than trusting anecdotal reports about cannabis for arthritic pain. There’s hope that this attitude may change with upcoming research from a group of Danish scientists who recently pre-registered a double-blind randomized controlled trial of cannabinoids’ effects on arthritic pain and ankylosing spondylitis. The primary question is whether cannabinoids will decrease self-reported pain, measured as a reduction of at least 2 points on a 10-point pain scale. The study is designed with the expectation that at least half of the participants taking CBD will report improvement, while only 20% of those in the placebo group will improve. If the effect of CBD is smaller than this 50% threshold, the study won’t be powered to detect what is called a statistically significant result. Pre-registration – an integral part of the growing statistical reform movement – dramatically decreases the likelihood of false positive results. It also forces scientists to report negative results, which may be otherwise ignored as a failed experiment.
Here’s the link to that clinical study. We’ll update this article as we find out the results!