CBD for Pain | Science | CBDnerds 2021

Gleb Oleinik

Authored: Feb 17, 2021

Updated: May 1, 2021

Scientific Confidence Grade

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Editorial Note

CBD may help relieve various types of pain. Still, much of the evidence comes from animal studies so more human research is needed.

Multiple human studies have demonstrated CBD’s pain-relieving effects.

CBD may significantly reduce pain.

CBD for Pain: Can It Help? (May 2021)

Although more evidence is needed, CBD seems to be a promising, safe alternative to standard pain medications and may work for many types of pain.

Chronic pain is the most common reason people turn to cannabidiol (CBD) products.^{^[1]}

Although more human research is needed, a growing number of studies provide proof of CBD’s pain-relieving effects, particularly when combined with THC and other cannabis compounds.

The wide breadth of research suggests that CBD can help with neuropathic, inflammatory, and many other types of pain.

CBD is also seen as a safer, natural alternative to prescription painkillers, which can cause addiction and significant side effects that have contributed to the opioid epidemic.

Read on to learn more about the potential benefits of CBD for pain relief.

Pain Overview

Pain is an uncomfortable sensation caused by injury or illness. Generally speaking, it’s your body’s way of telling you that something isn’t right.

A fairly complex phenomenon, pain involves nerve fibers sending signals to your brain via the spinal cord, which then interprets them and elicits the feeling of pain.

The perception of pain and an individual’s tolerance to it differs greatly from one person to another. It is influenced by many factors including your mood, past experiences, and genetics.

Pain is the most common symptom for which people seek relief. In the United States alone, chronic pain affects an estimated 50 million to 116 million adults.^{^[2]}

Types of Pain

It can be helpful to classify pain to better understand what causes it and find the best way to treat it.

Keep in mind that many categories of pain overlap with each other. For example, all types of pain are either acute or chronic, and nociceptive pain can be either somatic or visceral: ^{^[3]}

Acute: Pain that lasts anywhere from a few minutes to several months. Acute pain is typically caused by an injury, like cutting your finger or spraining your ankle, or temporary illness, such as the body aches you might experience during the flu.
Chronic: Ongoing pain that’s typically caused by a persistent or intermittent condition, such as arthritis, migraines, fibromyalgia, cancer, or diabetes. Chronic pain is the main reason people turn to alternative treatments such as cannabis and CBD.
Nociceptive: Pain caused by damage to your tissues, such as touching a hot stove or stubbing your toe.
Neuropathic: Persistent pain caused by damage to the nerves and other parts of the nervous system. This type of pain is often difficult to relieve.
Inflammatory: Pain caused by the immune system’s inflammatory response, which can be passing (e.g. when you hurt your knee) or long-lasting in case of inflammatory diseases.
Somatic: Pain in your bones, joints, skin, muscles, and other soft tissues.
Visceral: Pain in your internal organs that’s felt in the pelvis, abdomen, or chest. Visceral pain can be difficult to pinpoint.

Pain Symptoms & Pathology

Pain can be described in many ways including sharp, aching, burning, freezing, shooting, cramping, throbbing, and stabbing pain. It can also be accompanied by numbness, tingling, itching, and sensitivity to touch.

More importantly, pain can vary in intensity from mild to severe.

The precise sensations depend on the cause and type of pain you’re experiencing, as well as your tolerance to it.

Can CBD Help With Pain?

Most of our understanding of CBD’s analgesic (pain-relieving) effects comes from animal studies.

These investigations suggest that CBD can relieve various types of pain including arthritis pain, inflammatory, neuropathic, and myofascial (muscle) pain as well as regular nociceptive pain.^{^[4]}

CBD has also been shown to work in synergy with morphine, enhancing its pain-relieving effects.^{^[5]}

Having said that, it’s important to note that THC from medical marijuana seems to have stronger analgesic effects than taking CBD. CBD also enhances THC’s effects, which means that using both cannabinoids together is ideal for optimal pain relief.

For example, one animal study found that combining THC with CBD led to a 200-fold increase in their effectiveness at low doses.^{^[6]}

CBD seems to work by interacting with our endocannabinoid, inflammation, and pain-regulating systems.

How CBD Works

CBD is best known for interacting with your body’s endocannabinoid system (ECS).

This system is composed of cannabinoid receptors, endocannabinoids made in the body, and specific enzymes. While not yet fully understood, it plays an important role in maintaining homeostasis: a healthy state of balance.^{^[7]}

To achieve this, the ECS is involved in regulating vital functions and processes such as pain. In fact, the ECS influences every part of the pain processing pathways, with endocannabinoids acting much like a “brake” that reduces the feeling of pain.^{^[8]}

Additionally, there’s growing evidence that suppressing the enzymes that break down the two major endocannabinoids — anandamide and 2-AG — can be an effective strategy to relieve pain.

For example, a highly cited 2008 study found that suppressing MAGL, the enzyme that breaks down 2-AG, increased its levels and produced analgesia (lessening or absence of pain) in mice.^{^[9]}

A similar study that looked at the effects of blocking FAAH, the enzyme that breaks down anandamide, reported increased anandamide levels and reduction of inflammatory pain.^{^[10]}

Interestingly, CBD works through the same mechanism.^{^[11]} By suppressing FAAH, CBD seems to increase the levels of anandamide, helping support its pain and inflammation-relieving effects.^{^[12]} ^{^[13]}

Other Ways CBD Can Help With Pain

CBD also affects many other receptors and molecules that regulate inflammation and pain.

For example, multiple studies have shown that CBD acts on TRP channels^{^[14]} which play a major role in sensing various types of pain.^{^[15]}

CBD is also known to interact with PPARγ,^{^[16]} GPR,^{^[17]} glycine receptors,^{^[18]} as well as mu and delta-opioid receptors,^{^[19]} all of which are involved in regulating pain and the related process of inflammation.

Studies also report that CBD seems to suppress (NF)-κB, a pro-inflammatory pathway involved in pain, and influence other inflammation-related pathways.^{^[20]}

What Does the Research Say?

Much of the evidence for CBD’s pain-relieving effects is limited to animal studies. However, there are more human studies every year.

One 2020 study looked at the effects of CBD in peripheral neuropathy, a type of neuropathic pain that typically affects the hands and feet.

Twenty-nine people topically applied placebo or CBD oil to their lower extremities. Only the CBD group reported improvement of pain, cold, and itching sensations.^{^[21]}

Another 2019 study tested the effects of full-spectrum CBD softgels for chronic pain patients that use opioids. A total of 97 people took CBD alongside their standard opioid medication for 8 weeks.^{^[22]}

Over half (53%) of the participants reduced or completely stopped taking opioids within 8 weeks and 94% reported improved quality of life, including less pain and better sleep.

Meanwhile, a 2018 study compared a synthetic transdermal CBD gel to a placebo in 320 patients with knee osteoarthritis. While not everyone showed improvements, patients that were considered “responders” saw a significant reduction in pain.^{^[23]}

Additionally, multiple high-quality studies have shown that a combination of similar amounts of CBD and THC can relieve pain stemming from cancer, multiple sclerosis, arthritis, and neuropathic sources.^{^[24]} ^{^[25]} ^{^[26]}

177 patients with advanced cancer pain showed that while THC alone did not outperform placebo for pain relief, the combination of THC and CBD resulted in statistically significant improvement.^{^[27]}

Lastly, several systematic reviews, where researchers pool the data from many studies, have concluded that cannabinoids as a whole can help with chronic pain.^{^[28]} ^{^[29]}

All in all, although much of the current evidence is limited to animal studies, there’s a growing volume of human research showing that CBD can relieve various types of pain.

Studies also indicate that CBD provides the greatest effects when combined with THC and other cannabis compounds, which supports the idea that cannabis works best as a whole-plant preparation.

Using CBD for Pain

There are several helpful tips to keep in mind to maximize the benefits of CBD for pain.

First, you should consider which method of CBD administration is best for your symptoms. Generally speaking, there are four main ways to use CBD:

Orally as capsules (American Shaman offers a high-quality version), gummies, or other edibles and drinks
Sublingually as CBD oil (tinctures)
Topically as creams, oils, or a similar products (Sol CBD has a hemp-infused balm)
Inhalation by smoking or vaping (Direct Vapor provides starter kits for first-time vape users)

For most cases, sublingual (applied under the tongue) CBD oil is the best approach because of the increased efficiency in absorption and relatively long-lasting, whole-body effects. However, the other methods have their uses as well.

For example, you might want to vape CBD when you’re looking for immediate pain relief since it starts to work right away.

Meanwhile, topical CBD products are ideal for localized pain because they only work where you apply them.

Finally, oral products are best used for their convenience, since they have relatively low absorption.^{^[30]}

We also recommend using a full-spectrum CBD product whenever possible. Full-spectrum hemp extract provides not only CBD but also small amounts of THC (<0.3%) and many other beneficial phytocannabinoids, terpenes, flavonoids, and various active plant compounds.

As we discussed earlier, CBD’s analgesic effects work best when combined with THC and other cannabis compounds.

This is all thanks to the “entourage effect” — the research-backed idea that all of the compounds in hemp and cannabis work in synergy, providing greater relief than CBD or THC alone.^{^[31]}

How Much CBD Should I Take for Pain?

There isn’t enough research to recommend a dosage of CBD for pain.

The optimal dosage varies from person to person, based on the type of pain and its severity, as well as your body weight, genetics, and the type of CBD product you’re using.

That’s why the best approach to dosing CBD is to “start low and go slow.”^{^[32]}

You can start with a 10-15 mg dose of CBD, wait two hours to see the effects, and gradually increase the dosage over time until you find the amount that gives you the desired pain relief.

Keep in mind that different products and methods of administering CBD will provide varying effects, so you may not be able to use the same dose across all CBD products.

Are There Any Side Effects?

According to numerous clinical studies, CBD is a safe, well-tolerated compound with mostly minor side effects.^{^[33]}

The most common potential side effects of CBD are: ^{^[34]}

Tiredness and drowsiness
Dry mouth
Diarrhea and nausea
Low blood pressure
Lightheadedness
Changes in appetite or weight

In most cases, these effects are minor and have only been reported by studies using high oral doses of pure CBD.

In contrast, most people take much smaller doses of CBD in the form of oil drops under the tongue and often opt for full-spectrum products. Comparatively, with this method, your chances of experiencing CBD’s side effects are relatively small.

Conclusion

Research suggests that CBD is a great option for natural pain relief.

While more clinical studies are needed to substantiate CBD’s benefits, particularly for specific types of pain like migraines, the existing evidence is strong enough to support its use for everything from arthritis to neuropathic pain.

Another great thing about CBD is that it’s a relatively safe, natural substance. In contrast, opioid painkillers are notorious for their significant side effects and a high risk of addiction and withdrawal symptoms.

Better yet, early research suggests that CBD could help with addiction to opioids and other substances, meaning it could also help address the opioid epidemic.

If you’re interested in trying CBD for pain, full-spectrum CBD oil is typically the best option. However, be sure to look for the product that works best for your unique needs and take some time to find your ideal dosage.