Best CBD Ratio for Pain - April 2024

What Are CBD to THC Ratios?

Most CBD products, such as CBD oils, tinctures, edibles like gummies, topicals, and vapes, often contain THC and CBD in varying amounts. 

The CBD to THC ratio is the proportion of the amount of CBD and the levels of THC a particular product has⁽⁵⁾. 

Understanding CBD to THC Ratios 

A 1:1 CBD to THC ratio means equal parts of CBD and THC. If a consumer is looking for a ratio of CBD higher than 1:1, standard options include 4:1, 8:1, 20:1, and 24:1⁽⁶⁾. 

Although every person reacts differently, THC’s effects in a 1:1 ratio may be highly noticeable to a first-time user. In contrast, a more experienced cannabis user may not find the effects overpowering. 

In addition, a ratio of 8:1 CBD to THC or higher does not cause impairment. Usually, THC’s effects will diminish for ratios higher than 8:1. Hence, the effects of THC in a 24:1 ratio may not be noticeable at all⁽⁷⁾.  

Individuals who have qualifying conditions and live in a state where they can access medical cannabis may find THC helpful⁽⁸⁾. 

However, high THC products or THC in high doses may not be ideal for people who need to work during the day. Thus, a low THC cannabis-derived product may be more applicable⁽⁹⁾. 

Still, consulting a physician experienced in cannabis use is recommended for more accurate dosing.  

What Is the Best CBD to THC Ratio for Pain?

Full-spectrum CBD oil contains all the extracts of the cannabis plant, including essential oils, flavonoids, terpenes, and other cannabinoids. It also has a THC concentration of less than 0.3%⁽¹⁰⁾. 

While using the whole plant or full-spectrum products brings the most efficacious results, the CBD to THC ratio is another aspect to consider⁽¹¹⁾.  

CBD and THC work better together. Thus, finding the right strength, percentage, or ideal ratio of CBD to THC for a specific medical condition, such as pain, is a vital part of the full-spectrum approach to cannabinoid therapy. 

A mini-review article published in the Frontiers in Cellular Neuroscience mentioned that CBD and THC in 1:1 ratio may help multiple sclerosis patients improve pain relief, muscle spasms, spasticity, and bladder control⁽¹²⁾. 

Sativex is a cannabis-based pharmaceutical product containing a 1:1 mixture of THC and CBD (27mg of THC and 25 mg of CBD)⁽¹³⁾. 

In addition, Sativex contains less than 10% of other cannabis compounds, flavonoids, and terpenes present in the cannabis plant and may influence the actions of the primary cannabinoids. 

Meanwhile, a randomized experimental study from the journal Pain examined the analgesic effects of pharmaceutical-grade cannabis in 20 chronic pain patients with fibromyalgia⁽¹⁴⁾.  

Although none of the treatments had an effect better than placebo on electrical pain responses, more subjects who received Bediol displayed a 30% decrease in pain scores than a placebo⁽¹⁵⁾.

 Bediol contains 13.4mg of THC and 17.8 mg of CBD⁽¹⁶⁾. 

 A 2018 study from the Biochemical Pharmacology journal suggested that a combined therapy of cannabinoids (THC and CBD at a 1:1 ratio) and TMZ (temozolomide) may help target glioma initiating cells⁽¹⁷⁾.

Glioma is a type of brain tumor⁽¹⁸⁾. Meanwhile, temozolomide is often utilized to treat brain tumors by stopping or slowing down the growth of cancer cells in the body⁽¹⁹⁾. 

Common CBD to THC Ratios

The most commonly suggested CBD to THC ratio is 1:1 due to the clinical trials done for Sativex, with a balanced ratio of CBD to THC⁽²⁰⁾. 

Nevertheless, if a patient has difficulty tolerating medication with higher amounts of THC, ratios higher in CBD may be used during the day, with more THC added at night.  

For skin applications, the typical ratio of 1:1 is often ideal. Topical products with THC affect cells near the site of application. Nonetheless, they do not cross the blood-brain barrier and thus are not psychoactive⁽²¹⁾. 

Topical products may be available in oils, sprays, ointments, or other variations with different ratios of CBD and THC. 

If a person does not want products that contain CBD and THC in equal amounts, there are CBD ratios higher than 1:1, such as 4:1, 8:1, 20:1, and 24:1⁽²²⁾.  

How Different CBD to THC Ratios and Types of Products May Help With Pain

Available cannabis products can be categorized as CBD dominant, THC dominant, or a combination of CBD and THC⁽²³⁾. 

A 2021 study from the journal Frontiers in Oncology hypothesized that the ratio of CBD to THC in medical cannabis may help improve brain cancer patients’ physical and functional well-being⁽²⁴⁾. 

Based on the study, a CBD to THC ratio of 1:1 led to more improvements in physical and functional capacities and better sleep quality in adult patients diagnosed with high-grade glioma, compared to adults with the same condition who used a CBD to THC ratio of 1:4. 

Glioma is a common type of brain tumor. 

Meanwhile, a study mentioned that Nabiximols (Sativex) with a 1:1 ratio of CBD and THC may be used as a possible treatment for the symptomatic relief of multiple sclerosis-based spasticities in adults⁽²⁵⁾. 

Multiple sclerosis is a disabling disease of the spinal cord and brain. 

Sativex may also be used as an analgesic treatment for adult patients with multiple sclerosis experiencing neuropathic pain⁽²⁶⁾. 

Neuropathic pain happens when the nervous system is not working correctly.   

Benefits of Taking CBD and THC Together

Cannabinoids are chemical substances that join the cannabinoid receptors of the brain and body. These substances have similar effects to those compounds found in Cannabis sativa⁽²⁷⁾. 

Cannabis has over 400 chemical entities. More than 60 of these entities are cannabinoid compounds, some of which have opposing effects⁽²⁸⁾. 

The two main cannabinoids are THC and CBD⁽²⁹⁾. 

Below are some research studies that examine the purported therapeutic effects of cannabinoids, particularly CBD and THC, and their possible benefits when taken together:

Pain Management  

There are two frequent types of pain: acute and chronic⁽³⁰⁾. 

Acute pain occurs immediately and goes away even if there is no cause. Meanwhile, chronic pain usually lasts longer than six months and may continue even when the illness or injury has been treated⁽³¹⁾. 

A study from the Australian Journal of General Practice examined how CBD and THC may help with chronic pain. The study also summarized the evidence related to the efficacy of these cannabinoids, the optimal prescribing practices, and side effects⁽³²⁾. 

The study also assessed nabiximols, an oromucosal spray with a 1:1 ratio of THC and CBD. Nabiximols has demonstrated efficacy in multiple sclerosis (MS)⁽³³⁾. 

MS is a disabling disease of the spinal cord and the brain⁽³⁴⁾. However, clinical trials of nabiximols for pain linked to diabetes, spinal cord injury, and chemotherapy have reached negative results⁽³⁵⁾. 

Meanwhile, a study from the Journal of Pain Research examined the tolerability and effectiveness of THC to CBD oromucosal spray as an additional measure in patients with severe chronic pain⁽³⁶⁾. 

The study involved 800 patients who utilized THC to CBD oromucosal spray. The results indicated that 70% of those patients reported more than 50% improvement in pain after 12 weeks. Overall, relief and improvement scores favored neuropathic pain over nociceptive pain⁽³⁷⁾.   

Neuropathic pain is usually triggered by neural or irrational tissue compression or inflammation, whereas nociceptive pain does not cause nerve damage. Generally, nociceptive pain is the body’s response to painful stimuli⁽³⁸⁾.   

On the other hand, a review of 28 randomized trials of cannabinoids in which chronic pain was examined reported that there had been improvements in pain measures among individuals taking cannabinoids⁽³⁹⁾.  

Twenty-two of these studies evaluated plant-based cannabinoids⁽⁴⁰⁾:

• Nabiximols – 13 trials
• Plant flower that was either smoked or vaporized – five trials
• THC oromucosal spray – three trials
• Oral THC – one trial

Cannabinoids, particularly CBD, have been assessed to potentially treat seizures associated with rare and severe forms of epilepsy that are difficult to control using other medicines⁽⁴¹⁾. 

The FDA (Food and Drug Administration) has approved Epidiolex, an oral CBD, to treat seizures in individuals with Dravet syndrome⁽⁴²⁾. 

Dravet syndrome is a rare and drug-resistant type of epilepsy that starts in infancy or early childhood⁽⁴³⁾. 

CBD and THC work better together due to THC’s ability to boost and complement the efficacy of CBD⁽⁴⁴⁾. 

THC may also be a therapeutic agent for the management of issues like fibromyalgia-related pain relief and sleep problems⁽⁴⁵⁾. 

Fibromyalgia refers to a condition that brings about widespread pain all over the body⁽⁴⁶⁾.

The Entourage Effect

CBD and THC work better together⁽⁴⁷⁾. THC may increase the general efficacy of CBD for many people⁽⁴⁸⁾. Meanwhile, several studies have shown that CBD may counteract the negative effects of THC⁽⁴⁹⁾. 

The entourage effect involves the synergy of pharmacological effects that occur through the integration of all the cannabis compounds, including CBD and THC⁽⁵⁰⁾.   

The Frontiers in Plant Science study suggested that the entourage effect in full-spectrum hemp extracts may produce better therapeutic benefits than pure CBD⁽⁵¹⁾.  

Timing One’s Dose: How Different Cannabis Products Reduce Pain

It is recommended that individuals work with a physician experienced in cannabis use to determine the accurate dosage and appropriate delivery method of CBD or medicinal cannabis.

CBD products with higher doses, such as a ratio of 20:1, may be administered as drops, capsules, or edibles⁽⁵²⁾. 

High CBD cannabinoids may effectively alleviate chronic anxiety, manage temporary stress, and protect the body from the physiological effects of chronic anxiety and stress⁽⁵³⁾. 

Meanwhile, CBD-dominant products with a 4:1 ratio of CBD to THC, taken sublingually (under the tongue) or as drops, capsules, or edibles, may reduce chronic pain from arthritis⁽⁵⁴⁾. 

For acute pain, however, vaporizing or smoking may work well. The effect is immediate and may last 1 to 3 hours. Vaporizers that utilize a cartridge filled with carbon dioxide concentrate may be highly effective and come in different ratios of CBD to THC⁽⁵⁵⁾. 

On the other hand, herbal vaporizers that use the whole plant may also be an effective delivery method. 

Drugs That Do Not Mix With THC and CBD

Despite their benefits when taken together, THC and CBD consumed with other prescription drugs may affect the metabolism of various substances⁽⁵⁶⁾. 

The following are drugs that do not mix with THC and CBD⁽⁵⁷⁾: 

• Warfarin (blood thinners)
• Alcohol
• Theophylline (a substance used for COPD or chronic obstructive pulmonary disease and asthma)
• Clobazam (used with other medications to control seizures) 

CBD and Its Uses 

CBD (cannabidiol) is a principal active component of marijuana (sometimes referred to as cannabis). Although the compound is a vital ingredient in medical marijuana, it comes from the hemp plant, a derivative of cannabis⁽⁵⁸⁾. 

CBD does not cause a euphoric high⁽⁵⁹⁾. It was isolated from cannabis during the 1940s due to its ability to reduce the psychotropic effects of THC (tetrahydrocannabinol)⁽⁶⁰⁾. 

THC is the mind-altering chemical compound found in marijuana⁽⁶¹⁾. 

Subsequently, it has been demonstrated that cannabidiol may have a broad spectrum of actions, including anti-inflammatory, analgesic, neuroprotective, anxiolytic (anti-anxiety), anti-epileptic, and antipsychotic effects⁽⁶²⁾.  

CBD interacts with the ECS or endocannabinoid system. The ECS is present in most parts of the body and functions by maintaining homeostasis⁽⁶³⁾.

Homeostasis is the process where living things keep a specific state of equilibrium while adapting to changing external environments⁽⁶⁴⁾.  

The endocannabinoid system comprises cannabinoid receptors, namely CB1 and CB2, found in cells throughout the body⁽⁶⁵⁾. 

CB1 receptors are involved in pain sensation. Meanwhile, CB2 works by hindering inflammatory hypersensitivity resulting in anti-inflammation⁽⁶⁶⁾.

Cannabidiol has a low binding affinity for CB1 and CB2 receptors. However, the non-psychoactive compound may antagonize these cannabinoid receptors in the presence of THC. CBD may also regulate the perception of pain⁽⁶⁷⁾.  

THC and Its Uses 

Delta9-tetrahydrocannabinol, commonly known as THC, is a cannabinoid with psychoactive effects⁽⁶⁸⁾. It is sourced primarily in the flowers and leaves of the cannabis plant⁽⁶⁹⁾. 

The THC content varies depending on the cannabis plant part. In leaves, for instance, the THC content is 1 to 2%⁽⁷⁰⁾. THC is also responsible for the pharmacological actions of cannabis, such as the following effects⁽⁷¹⁾:

• Analgesic
• Antioxidant
• Anti-inflammatory
• Antipruritic (anti-itch)
• Bronchodilatory (ability to open small airways in the lungs)
• Antispasmodic (ability to relieve spasm)
• Muscle relaxant
• Psychoactive 

Tetrahydrocannabinol acts as a partial agonist at cannabinoid receptors. THC has a high binding affinity with the CB1 receptors, thereby appearing to mediate the compound’s psychoactive properties and the body’s memory processing and motor control⁽⁷²⁾. 

It has been reported that other constituents of the cannabis plant may reverse numerous side effects of THC, including immunosuppression, impaired memory, and anxiety⁽⁷³⁾.

CBD, for instance, may reduce the potency and efficacy of THC⁽⁷⁴⁾.

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1. Healing With CBD, page 186.
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
2. Perspectives on Cannabis-Based Therapy of Multiple Sclerosis: A Mini-Review
   https://www.frontiersin.org/articles/10.3389/fncel.2020.00034/full#B71
3. Healing With CBD, page 218.
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
4. The Case for the Entourage Effect and Conventional Breeding of Clinical Cannabis: No “Strain,” No Gain
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334252/
5. Healing With CBD, page 218.
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
6. Ibid.
7. Healing With CBD, page 219.
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
8. Healing With CBD, page 186.
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/vie
9. Ibid.
10. Cannabidiol Primer for Healthcare Professionals
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340472/
11. CBD: A Patient’s Guide to Medicinal Cannabis, page 91.
    https://drive.google.com/file/d/1MILU_6ZjYkII-XMUPHLFPiPQbrz__5Sh/view
12. Perspectives on Cannabis-Based Therapy of Multiple Sclerosis: A Mini-Review
    https://www.frontiersin.org/articles/10.3389/fncel.2020.00034/full#B71
13. Perspectives on Cannabis-Based Therapy of Multiple Sclerosis: A Mini-Review
    https://www.frontiersin.org/articles/10.3389/fncel.2020.00034/full#B71
14. An Experimental Randomized Study on the Analgesic Effects of Pharmaceutical-Grade Cannabis In Chronic Pain Patients With Fibromyalgia
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430597/
15. Ibid.
16. Ibid.
17. Targeting Glioma Initiating Cells With a combined therapy of cannabinoids and temozolomide
    https://pubmed.ncbi.nlm.nih.gov/30195736/
18. What Is a Glioma?
    https://www.hopkinsmedicine.org/health/conditions-and-diseases/gliomas
19. Temozolomide
    https://medlineplus.gov/druginfo/meds/a601250.html
20. CBD: A Patient’s Guide to Medicinal Cannabis, page 178.
    https://drive.google.com/file/d/1MILU_6ZjYkII-XMUPHLFPiPQbrz__5Sh/view
21. CBD: A Patient’s Guide to Medicinal Cannabis, page 186.
    https://drive.google.com/file/d/1MILU_6ZjYkII-XMUPHLFPiPQbrz__5Sh/view
22. Healing With CBD, page 218
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
23. Medicinal Cannabis in the Treatment of Chronic Pain
    https://www1.racgp.org.au/ajgp/2021/october/medicinal-cannabis
24. A Phase 2 Randomised Clinical Trial Assessing the Tolerability of Two Different Ratios of Medicinal Cannabis in Patients With High-Grade Gliomas
    https://www.frontiersin.org/articles/10.3389/fonc.2021.649555/full
25. Cannabinoid Delivery Systems for Pain and Inflammation Treatment
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222489/
26. Ibid.
27. Cannabis, a Complex Plant: Different Compounds and Different Effects on Individuals
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/
28. Cannabis (Marijuana) and Cannabinoids: What You Need To Know
    https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know
29. Cannabis (Marijuana) and Cannabinoids: What You Need To Know
    https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know
30. Acute vs. Chronic Pain
    https://my.clevelandclinic.org/health/articles/12051-acute-vs-chronic-pain
31. Ibid.
32. Medicinal Cannabis in the Treatment of Chronic Pain
    https://www1.racgp.org.au/ajgp/2021/october/medicinal-cannabis
33. Ibid.
34. Multiple Sclerosis
    https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
35. Medicinal Cannabis in the Treatment of Chronic Pain
    https://www1.racgp.org.au/ajgp/2021/october/medicinal-cannabis
36. Effectiveness and Tolerability of THC: CBD Oromucosal Spray As Add-On Measure in Patients With Severe Chronic Pain: Analysis of 12-Week Open-Label Real-World Data Provided by the German Pain E-registry
    https://pubmed.ncbi.nlm.nih.gov/31190969/
37. Ibid.
38. Difference Between Neuropathic and Nociceptive Pain
    https://www.neurosurg.org/articles/difference-between-neuropathic-and-nociceptive-pain
39. Therapeutic Effects of Cannabis and Cannabinoids
    https://www.ncbi.nlm.nih.gov/books/NBK425767/
40. Ibid.
41. Cannabis (Marijuana) and Cannabinoids: What You Need To Know
    https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know
42. FDA Approves First Drug Comprised of an Active Ingredient Derived from Marijuana to Treat Rare, Severe Forms of Epilepsy
    https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms
43. Dravet Syndrome Information Page
    https://www.ninds.nih.gov/Disorders/All-Disorders/Dravet-Syndrome-Information-Page
44. Healing With CBD, page 186.
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
45. Ibid.
46. Fibromyalgia
    https://www.cdc.gov/arthritis/basics/fibromyalgia.htm#:~:text=Fibromyalgia%20(fi%C2%B7bro%C2%B7my,pain%20than%20people%20without%20fibromyalgia.
47. Healing With CBD, page 186.
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
48. Healing With CBD, page 93.
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
49. Does Cannabidiol Protect Against Adverse Psychological Effects of THC?
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797438/
50. CBD: A Patient’s Guide to Medicinal Cannabis, page 78.
    https://drive.google.com/file/d/1MILU_6ZjYkII-XMUPHLFPiPQbrz__5Sh/view
51. The Case for the Entourage Effect and Conventional Breeding of Clinical Cannabis: No “Strain,” No Gain
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334252/
52. CBD: A Patient’s Guide to Medicinal Cannabis, page 188.
    https://drive.google.com/file/d/1MILU_6ZjYkII-XMUPHLFPiPQbrz__5Sh/view
53. CBD: A Patient’s Guide to Medicinal Cannabis, page 189.
    https://drive.google.com/file/d/1MILU_6ZjYkII-XMUPHLFPiPQbrz__5Sh/view
54. CBD: A Patient’s Guide to Medicinal Cannabis, page 192.
    https://drive.google.com/file/d/1MILU_6ZjYkII-XMUPHLFPiPQbrz__5Sh/view
55. Ibid.
56. Medicinal Cannabis—Potential Drug Interactions
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473892/
57. Medical Cannabis Adverse Effects & Drug Interactions
    https://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Medical%20Cannabis%20Adverse%20Effects%20and%20Drug%20Interactions_0.pdf
58. Cannabidiol (CBD)-What We Know and What We Don’t
    https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476
59. Ibid.
60. Cannabidiol and Other Non-Psychoactive Cannabinoids for Prevention and Treatment of Gastrointestinal Disorders: Useful Nutraceuticals?
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246936/
61. What Is Marijuana?
    https://www.drugabuse.gov/publications/research-reports/marijuana/what-marijuana
62. Cannabidiol and Other Non-Psychoactive Cannabinoids for Prevention and Treatment of Gastrointestinal Disorders: Useful Nutraceuticals?
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246936/
63. The Endocannabinoid System, Our Universal Regulator
    https://www.jyi.org/2018-june/2018/6/1/the-endocannabinoid-system-our-universal-regulator
64. Homeostasis: The Underappreciated and Far Too Often Ignored Central Organizing Principle of Physiology
    https://www.frontiersin.org/articles/10.3389/fphys.2020.00200/full
65. The Endocannabinoid System, Our Universal Regulator
    https://www.jyi.org/2018-june/2018/6/1/the-endocannabinoid-system-our-universal-regulator
66. Cannabinoids and Pain: New Insights From Old Molecules https://www.frontiersin.org/articles/10.3389/fphar.2018.01259/full
67. Ibid.
68. The Effects of Cannabinoids on the Brain
    https://pubmed.ncbi.nlm.nih.gov/10368032/
69. Cannabinoids and Pain: New Insights From Old Molecules
    https://www.frontiersin.org/articles/10.3389/fphar.2018.01259/full
70. Recommended Methods for the Identification and Analysis of Cannabis and Cannabis Products, page 14.
    https://www.unodc.org/documents/scientific/ST-NAR-40-Ebook_1.pdf
71. Cannabinoids and Pain: New Insights From Old Molecules
    https://www.frontiersin.org/articles/10.3389/fphar.2018.01259/full
72. Ibid.
73. Ibid.
74. Ibid.

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