Introduction to Using CBD for Pain
Cannabis is a genus of plant species which encompasses a variety of marijuana and hemp plants. These plants contain two key chemical components, which are called cannabidiol (or CBD) and delta-9-tetrahydrocannabinol (or THC). The CBD component of these plants is the piece that is used for therapeutic potential. CBD does not cause any euphoric effects, but rather, the THC component of the plant is what causes the feeling of a “high”. Research on CBD so far has been promising and has been associated with an improvement in pain management.
Pain can either be categorized as nociceptive or neuropathic. Nociceptive pain is commonly a reaction by the nervous system. This type of pain is the body’s reaction to painful stimuli such as a stubbed toe, a sprained ankle or a pulled muscle. Nociceptive pain will likely result in acute pain, which occurs suddenly and resolves within days to weeks. Neuropathic pain on the other hand is commonly a result of nerve weakening, nerve damage or inflammation. This can result in chronic pain which is ongoing and can last for months to years. Unfortunately, chronic pain does not always resolve with medications or natural remedies. Therefore, exploring options such as CBD can be beneficial for individuals that are not finding the comfort or resolution they need from their current pain management.
Currently, it is not entirely understood how CBD reduces pain symptoms. However, it is thought that CBD works with the endocannabinoid system (ECS) of one’s body. This system is primarily located in the brain and immune system. It is hypothesized that CBD can interact with this system and thereby cause anti-inflammatory responses and pain-relieving effects.
Although there are studies that suggest an improvement in pain relief for individuals who are taking CBD, there are no Food and Drug Administration (FDA)-approved CBD products for pain management at this time. CBD is not regulated for purity and appropriate dosage like FDA-approved drugs are. Therefore, it is important to use caution and discuss the option of starting CBD with your doctor to ensure it is a safe option for you.
CBD for Pain
Over the years, many studies have indicated that there is a correlation between CBD and pain management. One of the most common uses for CBD is cancer pain. A 2009 study showed that the addition of CBD to opioid pain regimens in cancer patients provided a significant increase in pain relief.1 Another study which was completed in 2013 showed similar findings as well.2 This 2013 study determined that with the long term use of CBD spray, patients with cancer-related pain did not seek an increase in their pain-relieving medication.2 In fact, the National Cancer Institute (NCI) has suggested CBD as a possible option for reducing side effects related to chemotherapy including pain, vomiting and lack of appetite.3
Additionally, CBD has also been used to help with chronic pain relief as well. Studies have found that chronic pain was very often relieved with the use of CBD.4,5 A 2018 review of various studies assessed how well CBD worked to relieve chronic pain.6 This review determined that CBD was, in fact, effective in overall pain management.6 Regardless, although many studies have shown promising results, the use of CBD for pain relief still requires additional data and evidence to support these potential benefits.
Aside from the potential therapeutic benefits, there are additional advantages to using CBD for pain. CBD can be an alternative for individuals who have chronic pain and rely on opioid medications for pain management. Taking opioids over a long term can lead to chronic side effects such as constipation and opioid dependence. As of now, current data suggests that overall, CBD is well-tolerated, with the most common side effects of CBD being fatigue, changes in appetite and diarrhea.7 Therefore, referring CBD as an alternative to opioids for pain management can be beneficial. Additionally, CBD comes in a variety of formulations including topical creams, ointments and oils, which is advantageous if an individual prefers to avoid taking an oral tablet or capsule by mouth.
How to Use CBD Oil for Pain
It is important to fully understand how to use CBD oil for pain. The two kinds of oils are broad-spectrum and full-spectrum oils. Broad spectrum oils do not contain THC, while full-spectrum oils contain both CBD and THC. To determine how to use CBD oil for pain, it is important to consult the directions that are given with the bottle. Always make sure that the CBD product you are purchasing is lab-tested by a third party. Although the FDA does not regulate these products at this time, selecting lab-tested products will allow you to understand exactly what ingredients are in the product.
When looking at CBD oils, there are general use instructions to follow. CBD oil can either be taken orally, or it can be added to moisturizers and applied topically. Always shake the bottle prior to use. Using the dropper that comes along with the CBD oil, you will place the oil under the tongue and hold it under the tongue for about 30 seconds prior to swallowing the oil. Make sure to follow the label instructions by the manufacturer to determine exactly how many drops to take. Most often, individuals start with a small dose and gradually increase the dose until they have achieved desired results. Doses are typically taken anywhere from 4 to 6 hours apart, however, you may consult with your doctor to ensure that this is appropriate for your needs. Immediate effects can be seen within 30 to 90 minutes, while long-term effects may take several weeks to attain.
CBD products are overall well-tolerated. However, there are some drugs that can negatively interact with CBD. Consult with your doctor before starting a CBD product to ensure this is a safe option for you.
With data from current studies, most researchers agree that CBD has considerable potential. In fact, much research correlates improvement in pain management when CBD has been used by the patients. CBD has been used to manage a variety of symptoms including pain, chemotherapy-induced side effects such and nausea or vomiting, and much more. To date, the use of CBD has not been associated with any indicators of abuse or dependence potential per the World Health Organization (WHO). Therefore, CBD can be an impactful method of pain management without the fear of intolerable side effects or dependence. As always, it is important to use caution and consult with your doctor if you decide to use CBD.
- Iffland K, Grotenhermen F. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis Cannabinoid Res. 2017;2(1):139-154. Published 2017 Jun 1. doi:10.1089/can.2016.0034
- Johnson JR, Burnell-Nugent M, Lossignol D, Ganae-Motan ED, Potts R, Fallon MT. 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 Manage. 2010 Feb;39(2):167-79. doi: 10.1016/j.jpainsymman.2009.06.008. Epub 2009 Nov 5. PMID: 19896326.
- Johnson JR, Lossignol D, Burnell-Nugent M, Fallon MT. An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. J Pain Symptom Manage. 2013 Aug;46(2):207-18. doi: 10.1016/j.jpainsymman.2012.07.014. Epub 2012 Nov 8. PMID: 23141881.
- Costa B, Trovato AE, Comelli F, Giagnoni G, Colleoni M. The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. Eur J Pharmacol. 2007 Feb 5;556(1-3):75-83. doi: 10.1016/j.ejphar.2006.11.006. Epub 2006 Nov 10. PMID: 17157290.
- Serpell M, Ratcliffe S, Hovorka J, Schofield M, Taylor L, Lauder H, Ehler E. A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment. Eur J Pain. 2014 Aug;18(7):999-1012. doi: 10.1002/j.1532-2149.2013.00445.x. Epub 2014 Jan 13. PMID: 24420962.
- Van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain. 2019 Apr;160(4):860-869. doi: 10.1097/j.pain.0000000000001464. PMID: 30585986; PMCID: PMC6430597.
- Hoggart B, Ratcliffe S, Ehler E, Simpson KH, Hovorka J, Lejčko J, Taylor L, Lauder H, Serpell M. A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain. J Neurol. 2015 Jan;262(1):27-40. doi: 10.1007/s00415-014-7502-9. Epub 2014 Sep 30. PMID: 25270679.