Can CBD be used for pain relief? Find out what science has to say about the potential of CBD for chronic pain.
Over 20% of people in the United States struggle with chronic pain. This type of pain is hard to treat and can have a dramatic influence on one’s quality of life.
As CBD (cannabidiol) has rapidly gained popularity and legality across the United States, more people are turning to it for a variety of health goals. This begs the question, can CBD help relieve pain?
In this article, we will explore what human studies have found when investigating the relationship between CBD and pain.
Pain is not an illness, but rather an unpleasant sensation that’s felt when a signal travels to the brain to tell you something is wrong. Pain is either acute or chronic. Acute pain is caused by an injury or illness and fades with time as your body heals from the damage.
Chronic pain is long-lasting and more complicated than acute pain. There are two types of chronic pain: inflammatory pain and neuropathic pain. Inflammatory pain is caused by localized inflammation as experienced in irritable bowel disease (IBD) and arthritis. Neuropathic pain is caused by damage to nerves, resulting in sharp pains, numbness, or tingling.
There are many causes of chronic pain, including:
- Irritable bowel disease
- Multiple sclerosis
- Back problems
Treating acute inflammatory pain is relatively simple. You can opt for over-the-counter painkillers like aspirin or ibuprofen. For more extreme pain, your doctor may prescribe temporary use of opioid drugs such as morphine or codeine.
Unfortunately, treating chronic pain is more challenging. The common analgesic medications are best for short-term use. Extended use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen is dangerous for your liver, while opioid use can cause addiction.
To create a successful pain management strategy, it’s essential that you and your doctor first understand what’s causing your pain receptors to send signals to your brain. From there, your doctor can help create a plan that targets the cause of your pain.
Unfortunately, even with the help of a doctor, many people with chronic pain experience ongoing symptoms that interfere with their quality of life. Chronic pain often hinders sleep and can exacerbate depression and anxiety. Concurrently, poor sleep, depression, and anxiety can increase pain.
With the severe impact that chronic pain can have on one’s overall happiness and wellbeing, many people with pain conditions are turning to natural remedies in the hope of relief.
The History of Cannabis and Pain
Cannabidiol (CBD) is a chemical that’s extracted from Cannabis sativa plants, mainly the non-intoxicating hemp variety. CBD and other cannabinoids are the chemical compounds responsible for many of the health effects of cannabis.
Humans have been consuming Cannabis sativa for many thousands of years, with evidence of its medicinal use going back to 400 AD. It may surprise you to know that cannabis was widely used as medicine in the United States back in the 1800s and early 1900s, and has been used for pain relief for thousands of years. After decades of being illegal in the USA, California legalized medical marijuana in 1996 for the pain associated with late-stage HIV/AIDs.
Today, 35 states and the District of Columbia have legalized medical marijuana. One of the most common reasons for patients to qualify for a medical cannabis card is chronic pain, such as that caused by cancer, multiple sclerosis, or other medical conditions.
However, many people don’t want to experience the cannabis “high.” Then there are others who don’t live in a state with legal medical marijuana or who have jobs that drug test. These people are unable to utilize therapies with THC, the primary psychoactive compound in cannabis. This is why so many people are turning to CBD products like CBD cream for pain. But the question is, can CBD on its own help with pain?
Can CBD Help With Pain?
Cannabidiol (CBD) is not approved by the FDA for pain relief. At present, the only FDA approved CBD-only product is Epidiolex, a prescription drug for epilepsy. The reason is simple: there aren’t enough large-scale human clinical trials to determine the safety and efficacy of CBD for pain and other ailments.
There is another FDA-approved drug, Nabiximols, that’s a 1:1 THC:CBD oromucosal spray that’s used to treat multiple sclerosis spasticity. In Canada, Nabiximols is an approved analgesic for multiple sclerosis and cancer patients. Keep in mind that this is not proof that this treatment is effective against pain but does demonstrate Canada’s confidence in the potential benefit and safety profile of Nabiximols.
So, what do we know about CBD-only therapy? Fortunately, there are preclinical studies and small clinical studies that provide insight into the potential health benefits of CBD. While it’s important to understand that none of these studies prove efficacy, they can still be used to help you determine if you want to try CBD oil.
The Science of CBD for Pain
In this section, we’ll review many of the peer-reviewed studies that have been published examining CBD and pain in humans. These include both small studies that investigate CBD-only therapy and those that look at cannabis-based therapies that include CBD along with other cannabinoids, like THC.
1. CBD for Chronic Pain in Kidney Transplant Patients
Aim: This study assessed the “effect, safety, and possible drug interactions in kidney patients treated with CBD for chronic pain.”
Design: Seven kidney transplant patients who asked to receive CBD for pain were given CBD twice daily for three weeks. CBD dosage increased during the treatment period from 50 mg to 150 mg twice daily, although some patients did reduce their dosage due to adverse effects. Various measurements were taken to assess pain-relieving potential, safety, and drug interactions.
Findings: Of the seven patients, two experienced full pain improvement, four had partial pain relief during the first fifteen days, and one had no change in pain levels. There were no severe adverse events, although there were mild to moderate side effects, including nausea, dizziness, drowsiness, and dry mouth.
2. CBD, Chronic Pain, and Opioid Use
Aim: The researchers of this study aimed to evaluate the impact of full spectrum hemp extract rich in CBD on the quality of life and opioid use of patients with chronic pain.
Design: One hundred and thirty-one chronic pain patients between the ages of 30 and 65 who had been using opioid drugs for one-year or more were recruited. These patients took CBD-rich hemp extract daily for eight weeks. Medication use and quality of life were assessed at the start of the study, at four weeks, and at eight weeks.
Findings: Of the 97 patients who completed the entire study, 53% reduce or eliminate their opioid use after using CBD-rich hemp extract for 8 weeks. 94% experienced quality of life improvements, including significant improvements in the Pittsburgh Sleep Quality Index and the Pain Intensity and Interference index. There were no significant improvements in the Pain Disability Index or the Patient Health Questionnaire.
3. CBD for Non-Cancer Pain
Aim: This study investigated self-reported quality of life and CBD safety in patients prescribed CBD in New Zealand.
Design: An audit was conducted on all patients who sought CBD prescriptions at Cannabis Care in New Zealand over a one year period. The following data was collected: quality of life at baseline and after 4 weeks of CBD treatment, side effects, CBD dosage, and patient-reported satisfaction.
Findings: Of the 397 patients who received a prescription, 253 completed the follow-up assessment at 3 weeks. Those with non-cancer pain reported improvements in pain with no major adverse effects. Other benefits found in patients included an increase in quality of health, appetite, and a decrease in anxiety and depression symptoms.
4. CBD:THC Extract vs THC Extract for Cancer-Related Pain
Aim: In this study, scientists sought to compare the efficacy of a THC:CBD extract and a THC-only extract with placebo in treating pain in cancer patients.
Design: Advanced cancer patients who had experienced poor pain relief with opioid use were split into one of three groups: THC:CBD extract, THC extract, or placebo. There were 177 patients included in the study, and the treatment period lasted for two weeks. The patients’ pain was measured before and during the treatment to evaluate the change from baseline pain levels.
Findings: The THC:CBD extract resulted in a significantly larger favorable change from baseline pain when compared to the placebo. The THC-only extract did not lead to a significant difference when compared to the placebo.
5. Cannabinoids and Chronic Neuropathic Pain
Aim: This study reviewed the existing research examining cannabinoid therapy for chronic neuropathic pain to determine the safety and pain-relieving efficacy of selective cannabinoids in comparison to placebo or conventional medications.
Design: The researchers conducted a review and meta-analysis of peer-reviewed randomized controlled trials comparing the effect of particular cannabinoids with placebo or active conventional treatments against neuropathic pain. The cannabinoid treatments included in the review were Nabilone (a synthetic cannabinoid similar to THC), Dronabinol (THC), and Nabiximols (THC and CBD). Eleven trials were included with a total of 1,219 patients.
Findings: Patients who received a selective cannabinoid treatment experienced a significant reduction in pain scores when compared to the conventional treatment and placebo groups. These patients also experienced improved sleep and quality of life, and no major adverse effects were found.
6. Medical Cannabis and Chronic Pain in Fibromyalgia Patients
Aim: The goal of this study was to explore the pain-relieving effects of cannabis in fibromyalgia patients. The researchers further compared the efficacy of four different cannabis strains with different CBD:THC ratios.
Design: Twenty patients with chronic fibromyalgia pain were assigned to one of four medical cannabis groups: a high THC/low CBD strain, a high THC/high CBD strain, a low THC/high CBD strain, and a placebo cannabis strain without any CBD or THC. These patients were given a single medical marijuana vapor inhalation, after which pain scores, pain thresholds, THC and CBD levels, and drug high were measured over three hours.
Findings: None of the THC or CBD-rich strains resulted in a significant difference in the pain responses. Only the strain high in both CBD and THC experienced a 30% decrease in pain scores relative to the placebo strain. Both high THC varieties resulted in an increase in pressure pain threshold compared to the placebo, although the existence of CBD reduced the THC’s pain-minimizing effects.
7. Cannabis-Based Medicines and Chronic Neuropathic Pain
Aim: The aim of this study was to “ assess the efficacy, tolerability, and safety of cannabis-based medicines (herbal, plant-derived, synthetic) compared to placebo or conventional drugs for conditions with chronic neuropathic pain in adults.”
Design: The researchers searched multiple research databases to find randomized, double-blind trials comparing medical cannabis or cannabinoid medicines against conventional treatments or placebo for neuropathic pain in adults. They then evaluated and reviewed the existing research to draw conclusions about the efficacy and safety of cannabis-based medicine for neuropathic pain.
Findings: The researchers concluded that cannabis-based medicines may help patients with neuropathic pain find some level of relief. However, they also found that patients who took cannabis-based therapies experienced more adverse events when compared with placebo. Additionally, there was no information on the long-term risks of these therapies.
The Future of CBD Research
Scientists and medical professionals around the globe are interested in the potential of CBD and other cannabinoids for patients with hard-to-treat chronic pain. While the studies thus far have provided reason for further research, larger and longer-lasting studies are needed before any conclusions can be drawn regarding CBD and pain.
Chronic pain can have far-reaching negative effects on one’s overall quality of life. It’s important to work with your doctor to come up with a comprehensive treatment plan. If you’re interested in trying CBD for pain, be sure to mention this to your doctor. And if you’d like to speak with someone with extensive cannabis-based experience, find a doctor near you using the search feature on the Society of Cannabis Clinicians website.