CBD Dosage for Pain - April 2024

What Is the Normal Dose of CBD for Pain?

To date, there is no standard cannabidiol (CBD) dosage guide endorsed by the U.S. Food and Drug Administration (FDA) to help with pain.

One recommendation for CBD dosing is to start with a low dose. For products with CBD-dominant content, individuals may consider starting at 10 milligrams (mg) per day⁽³⁾.

On the other hand, individuals contemplating taking CBD products with tetrahydrocannabinol (THC) content may start with a low THC dose of 1 to 2.5mg⁽⁴⁾.

Important CBD Dosing Considerations for Pain

Since there is currently no standard dosage chart for CBD use in pain, individuals may have to perform self-titration to find the dosage⁽⁵⁾.

Self-titration involves adjusting the dosage of one’s medication as needed.

In general, individuals should start with the lowest possible dose that may produce the desired results. Lower doses may be more cost-effective, while high doses do not necessarily provide better outcomes⁽⁶⁾.

Research on Dosage of CBD for Pain

A 2019 review evaluated CBD dosing in various clinical settings⁽⁷⁾.

One study reviewed the effects of cannabidiol sublingual spray on individuals with chronic pain. The researchers administered nine sprays per day, equal to 22.5 milligrams (mg) of CBD per day.

Results showed that CBD spray may improve sleep quality among persons experiencing chronic pain. However, sleep duration and symptom control did not improve.

A clinical study conducted in 2018 examined the effects of CBD on kidney transplant patients experiencing chronic pain⁽⁸⁾.

The study suggested that CBD doses of 50 to 150mg administered twice daily for three weeks may be well tolerated among kidney transplant patients. However, the researchers mentioned that longer follow-up research may be required.

In a 2020 study conducted in New Zealand, 400 patients who were given CBD prescriptions were evaluated regarding the effects of CBD⁽⁹⁾.

The researchers used CBD oil products containing 100mg of CBD in 25ml bottles and orally administered using a dropper. They observed that CBD may help improve mobility and help with anxiety, depression, and pain management. They also noted how the participants were able to complete their usual activities.

Factors That May Influence CBD Dosage for Pain

Without a standard as set by the Food and Drug Administration, cannabis dosage may vary from person to person. Some of the factors that may influence CBD dosage include the user’s⁽¹⁰⁾:

• Overall health
• Exercise regimen
• Diet
• Sleep patterns
• Daily stress levels
• Family history or genetics

Other factors to consider that may also affect CBD dosing are the following⁽¹¹⁾:

• The specific time of day to take CBD – Some CBD products may be more optimized to be taken during certain hours of the day.

For example, formulations containing more CBD may be taken during the daytime, while those with higher THC content may be administered at night.

• Experience using cannabis: New users may get the best results with low doses, while experienced individuals may need a higher dose.

However, chronic CBD users may have to take a break to reset their cannabis sensitivity.

• Preventive dosing: Taking CBD at low doses for prolonged periods may help manage chronic symptoms or prevent some diseases from recurring.

Preclinical studies suggest that the neuroprotective and cardioprotective properties of cannabinoids may help limit damage due to brain injury or heart attack.

• Cannabinoid acids: Raw CBD and THC in acid form (CBDA and THCA, respectively) may be effective when orally administered in low doses over several months.

Individuals may also consider the types of CBD or route of administration when determining the dosage. These administration routes and product types include the following:

• Oral administration: CBD oil is taken orally and passes through the digestive tract before getting absorbed into the bloodstream.

Examples of CBD products administered orally include CBD capsules and edibles like CBD gummies, candies, and cookies.

• Sublingual administration: CBD is applied sublingually using a dropper or spray. CBD is then absorbed by the blood vessels under the tongue, bypassing the digestive tract and going directly into the bloodstream.

Some CBD products applied sublingually include tinctures and oromucosal sprays.

• Topical application: CBD products like creams, lotions, and balms are applied to the skin to help provide localized pain-relieving effects. Topical CBD has zero bioavailability and is not absorbed into the bloodstream⁽¹²⁾.

Bioavailability is the rate or fraction of an administered drug entering the body’s systemic circulation.

• Inhalation: CBD oil products such as vapes are administered by inhalation and absorbed through the lungs before spreading throughout the body.

Individuals are advised to use vapes with caution as vaping may cause potential health risks related to lung disease⁽¹³⁾.

Calculating the Best CBD Dosage for Pain

Many edibles, such as gummies or chews, and single-serve products like tablets and capsules usually have dosage information specifying the CBD content per serving size. This information makes it easy to determine the CBD dosage of these products⁽¹⁴⁾.

However, for products like tinctures, consumers may have to calculate or estimate the optimal dose for their needs.

For example, a one-ounce (30ml) bottle containing 500 mg of CBD means there is approximately 17mg per milliliter (mg/ml) of CBD (500mg ÷ 30ml = 17mg/ml)⁽¹⁵⁾.

What CBD Strength to Use for Pain

Because there is currently no FDA-approved CBD dosage guide, determining the optimal CBD strength to help manage pain may vary among individuals.

Following the recommendation to start with a low dose, individuals may start with 10mg of CBD per day⁽¹⁶⁾. One should observe the results after taking such a dosage.

When the dosage strength seems to have positive effects, one may maintain that dose for several days before considering increasing the amount of CBD.

How Much CBD Oil to Take

Deciding the right amount of CBD to take may depend on the following variables⁽¹⁷⁾:

• Endocannabinoid tone: An individual’s endocannabinoid system (ECS) regulates many body functions, such as learning, memory, sleep, temperature, pain control, and immune and inflammatory responses⁽¹⁸⁾.

The endocannabinoid tone is the overall state or health of a person’s ECS⁽¹⁹⁾. It determines the endocannabinoid levels and abundance of cannabinoid receptors.

• Reason for taking CBD: Individuals must first ask themselves why they are considering the use of CBD. Some questions they may ask include the following:
  • Is it for health benefits and general wellness?
  • Is it to relieve neuropathic pain, chronic pain, or arthritis pain?
  • Is it for helping with anxiety disorders?
  • Is it to help manage epilepsy?

How to Measure CBD Oil Dosage

The following methods may help individuals establish some benchmarks for measuring CBD oil dosage⁽²⁰⁾:

• CBD oil tinctures usually come in 1oz bottles. Some CBD brands also sell them in 2oz volumes or more.
• 1oz is approximately 30ml.
• Tinctures usually have a dropper with a standard size of 1ml.
• Thus, a 1oz (30ml) bottle is about 30 droppers.
• Each 1ml dropper contains approximately 20 drops.

Suppose a 2oz tincture contains 350mg of CBD. Since two ounces is about 60ml, each dropper may contain close to 6mg of CBD (350mg ÷ 60ml = 5.8mg)⁽²¹⁾.

If 6mg of CBD provides the desired effect, individuals may maintain this dosage for their needs. Those who need a higher and more effective dose may consider increasing the dosage from 6 to 12mg by taking two full droppers.

Possible Side Effects of CBD Oil for Pain

There is insufficient clinical data to date to determine what side effects may manifest from specific CBD doses.

However, in general, some known side effects of cannabidiol include loss of appetite, drowsiness, dry mouth, fatigue, and diarrhea⁽²²⁾.

A 2018 study mentioned that kidney transplant patients taking CBD to help with chronic pain may experience dry mouth, nausea, dizziness, or intermittent heat episodes⁽²³⁾.

In a 2020 study on the effects of CBD on patients prescribed with CBD oil, the researchers noted that some of the patients experienced adverse effects such as vivid dreams and sedation⁽²⁴⁾.

Another study showed that the side effects of CBD most commonly reported include changes to appetite or body weight, tiredness, and diarrhea⁽²⁵⁾.

Additional human studies and clinical trials must be performed to conclusively determine the specific CBD oil doses that may cause adverse effects on humans.

While CBD is considered a safe substance, it may interfere with the cytochrome P450 enzymes at certain doses⁽²⁶⁾.

This interference may adversely affect how the body metabolizes various pharmaceutical medications. Some of these medications may include⁽²⁷⁾:

• Antihistamines
• Antibiotics
• Antidepressants
• Anesthetics
• HIV antivirals
• Beta blockers
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Individuals uncertain if their current medication will interact with CBD may initiate a conversation with a doctor or clinician regarding their prescription.

The FDA warns that CBD products with false, misleading, or unproven claims may cause consumers to skip or decline proper treatment, medical diagnosis, and appropriate healthcare⁽²⁸⁾.

Individuals need to consult a doctor for medical advice regarding the treatment of diseases or medical conditions before taking CBD.

Benefits of Taking CBD Oil for Pain

One of the primary reasons why people take CBD is for pain relief. CBD’s purported anti-inflammatory benefits make the drug a potential candidate for helping with various types of pain⁽²⁹⁾.

The benefits of CBD include helping manage pain associated with the following health conditions⁽³⁰⁾:

• Arthritis
• Inflammation
• Diabetes
• Multiple sclerosis
• Fibromyalgia
• Migraines
• Parkinson’s disease
• Cancer

Safety of CBD Used for Pain

The World Health Organization (WHO) mentioned in a report that CBD is generally a well tolerated substance with a good safety profile. The WHO also acknowledges that CBD does not exhibit effects indicative of abuse or dependence⁽³¹⁾.

Preclinical studies also suggested that CBD may have therapeutic benefits that may help with addiction to opioids, cocaine, and other psychostimulants⁽³²⁾.

To date, the FDA has approved Epidiolex as the only CBD product that may be used as a prescription medication for treating epilepsy⁽³³⁾.

Aside from studies on Epidiolex, more research, clinical trials, and human and animal studies are needed to conclusively determine CBD’s safety and other benefits.

Tips on Choosing High-Quality CBD Oil for Pain

Before purchasing a CBD product, individuals should look into its extraction method, product classification, and CBD content and evaluate whether the item matches their personal preferences.

CBD oil is derived from hemp plants. Manufacturers use different methods like carbon dioxide (CO2), hydrocarbon, or ethanol extraction to generate CBD from the plant.

Once extracted, CBD oil is classified as full-spectrum, broad-spectrum, or isolates.

Full-spectrum CBD oil contains most cannabinoids and other compounds present in the cannabis plant, such as THC, flavonoids, and terpenes.

Terpenes are plant compounds that give plants their distinct aroma. Meanwhile, flavonoids are components that have antioxidative properties.

When combined, these compounds produce an “entourage effect.” This effect is when the benefits of cannabinoids and other compounds are greater than the sum of the benefits each part contributes⁽³⁴⁾.

Broad-spectrum CBD oils usually contain similar compounds as full-spectrum products except for THC.

CBD isolates are composed of pure CBD only. They do not contain the other compounds or cannabinoids found in full- or broad-spectrum products.

Individuals who prefer high-quality cannabis products without the psychoactive effects of THC may consider trying isolates or broad-spectrum CBD oil.

CBD products from reputable brands have a certificate of analysis (COA). COAs are provided by third-party labs and contain the test results of the product’s actual CBD content.

Additionally, third-party lab tests determine if the product contains harmful contaminants like pesticides or heavy metals that may cause toxicity and health risks to consumers.

Individuals may review the COA to ensure the information on the product’s label matches the COA results. CBD brands selling quality products must be transparent by posting the COAs on their website.

The FDA cautions consumers that CBD products marketed as food additives or dietary supplements are illegal.

Individuals interested in purchasing and using CBD must check their state’s laws to know if CBD or medical cannabis is legal in their area or not.

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1. CBD dosing
   https://www.projectcbd.org/guidance/cbd-dosing
2. page 223 of Healing With CBD
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
3. page 218 of Healing With CBD
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
4. Ibid.
5. page 223 of Healing With CBD
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
6. page 224 of Healing With CBD
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
7. A systematic review of cannabidiol dosing in clinical populations
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710502/
8. Chronic Pain Treatment With Cannabidiol in Kidney Transplant Patients in Uruguay
   https://pubmed.ncbi.nlm.nih.gov/29579828/
9. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330185/
10. CBD dosing
    https://www.projectcbd.org/guidance/cbd-dosing
11. Ibid.
12. page 210 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
13. Can vaping damage your lungs? What we do (and don’t) know
    https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734
14. page 219-220 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
15. page 221 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
16. page 218 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
17. page 214 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
18. The endocannabinoid system: Essential and mysterious
    https://www.health.harvard.edu/blog/the-endocannabinoid-system-essential-and-mysterious-202108112569
19. Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes
    https://pubmed.ncbi.nlm.nih.gov/28861491/
20. page 220 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
21. page 221 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
22. What are the benefits of CBD — and is it safe to use?
    https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
23. Chronic Pain Treatment With Cannabidiol in Kidney Transplant Patients in Uruguay
    https://pubmed.ncbi.nlm.nih.gov/29579828/
24. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330185/
25. Dosage, Efficacy and Safety of Cannabidiol Administration in Adults: A Systematic Review of Human Trials
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092763/
26. CBD user’s guide
    https://www.projectcbd.org/guidance/cbd-users-guide
27. page 115 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
28. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD
    https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
29. page 167 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
30. page 167-168 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
31. CANNABIDIOL (CBD)Pre-Review ReportAgenda Item 5.2
    https://www.who.int/medicines/access/controlled-substances/5.2_CBD.pdf
32. Ibid.
33. What are the benefits of CBD — and is it safe to use?
    https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
34. The “Entourage Effect”: Terpenes Coupled with Cannabinoids for the Treatment of Mood Disorders and Anxiety Disorders
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324885/

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