- Research on cannabidiol (CBD) and pain management has been promising. A study found that cannabinoids, like CBD and tetrahydrocannabinol (THC), might reduce pain(1).
- Ongoing preclinical studies in animals have demonstrated that CBD reduced pain and inflammation(2).
- A 2012 study in The Journal of Experimental Medicine demonstrated the mechanism by which CBD alleviates inflammatory and neuropathic pain in a rodent model(3).
- Results from a 2017 study showed that CBD and THC could potentially lead to less acute pain and less intense pain for people with migraines(4).
- A 2018 review in Frontiers in Pharmacology examined the studies on various types of pain, including neuropathic pain, cancer pain, and fibromyalgia. Researchers suggested that CBD might be effective based on the data that currently exist(5).
Potential Benefits of CBD Oil for Pain
Ongoing preclinical animal studies have demonstrated that CBD reduced pain and inflammation, according to Kevin Boehnke, Ph.D., a research investigator in the Michigan Medicine Chronic Pain and Fatigue Research Center(6).
The research on CBD and pain management has been promising. One example is the study published in the journal Therapeutics and Clinical Risk Management that explored the efficacy of cannabinoids in pain management(7).
The study showed that cannabinoids could reduce the pain of individuals with conditions that are hard to manage.
The participants in the study had cancer or multiple sclerosis, conditions that are associated with challenging-to-treat pain.
CBD for Chronic Pain
CBD may be feasible as an option for treating some types of chronic pain(8).
When the body is injured in some way, pain is a signal to the brain that something has been damaged(9). One of the major categories of pain is chronic pain.
Chronic pain management continues to challenge some patients and their doctors. The investigation into potential therapies, such as CBD and hempseed oils, continues for the future of clinical pain management(10).
As for CBD and hemp oils’ potential use in treating chronic pain, a 2018 study noted that an overwhelming body of scientific evidence indicated that cannabinoids might produce pain-relieving effects in inflammatory and neuropathic rodent pain models(11).
Also, studies showed that CBD might be able to treat addiction by reducing the activity of the amygdala and modulating dopamine and serotonin(12).
The amygdala is a set of neurons known for its role in fear processing, sending signals to areas of the brain to trigger a “fight-or-flight” response(13).
Thus, CBD may represent an attractive future option in chronic pain treatment, particularly in the context of opioid abuse.
CBD is useful because of its potential efficacy and its limited misuse and abuse safety profile(14).
However, more research is needed as the pilot human studies were conducted with small sample sizes.
Nevertheless, the studies represent potential cannabinoid use in the clinical treatment of pain relief and opioid abuse.
A 2018 review examined how well CBD works to help relieve chronic pain. The review analyzed the studies conducted between 1975 and March 2018(15).
Researchers examined the studies on various types of pain, including chronic back pain, cancer pain, neuropathic pain, and fibromyalgia.
The researchers concluded that CBD was effective overall. However, the available data are not yet strong enough for CBD to become a mainstay treatment modality.
CBD for Arthritis Pain
According to a 2016 animal study from the European Journal of Pain, CBD applied on the skin might help lower pain and inflammation due to arthritis(16).
Researchers used topical CBD on the rats for four consecutive days, with the animals receiving different doses per day.
The researchers noted a reduction in inflammation and overall pain in the animals’ affected joints without noticeable side effects.
The rats that received low doses of CBD did not show improvement in their pain scores. Results found that 6.2 mg/day was a high-enough dose to reduce the rats’ pain and swelling symptoms.
Also, rats who received 62.3 mg/day had similar outcomes to the rats that received 6.2 mg/day. Receiving a substantially larger dosage did not result in them having reduced pain.
The pain-relieving and anti-inflammatory characteristics of CBD gel could potentially help individuals with arthritis. However, more human studies are needed(17).
A 2017 study from the journal Pain looked at the ability of CBD to prevent joint neuropathy and joint pain associated with osteoarthritis(18).
Neuropathy is the damage or dysfunction of nerves that results in numbness, tingling, muscle weakness, and pain in the affected area(19).
Osteoarthritis, a common form of arthritis, occurs when the protective cartilage that cushions the ends of the bones wears down over time. With osteoarthritis, the joints can get painful, swollen, and hard to move(20).
The researchers found scientific evidence to support both the neuropathic and osteoarthritic functions of CBD.
They concluded that CBD’s potential benefits were due to its nerve-protective properties and anti-inflammatory properties on the joints.
CBD for Neuropathic Pain
A 2012 study published in The Journal of Experimental Medicine showed the mechanism by which CBD alleviates neuropathic and inflammatory pain, which are challenging types of chronic pain to treat(21).
However, more studies with human subjects are needed to substantiate CBD proponents’ claims about pain control.
Muscle spasms are typical symptoms of neuropathic damage, which often leads to painful, uncontrolled muscle twitches(22).
A study has demonstrated that Sativex, a medicine constituted by CBD and THC in a 1:1 ratio, might help with pain management.
Sativex may help those with chronic neuropathic pain, pain due to nerve damage, peripheral neuropathy, advanced cancer pain, rheumatoid arthritis, and spasticity due to multiple sclerosis (MS)(23).
Similar results were obtained from another review published in The Cochrane Database of Systematic Reviews in 2018(24).
The said review of hundreds of studies examined marijuana-based pharmaceuticals on neuropathic pain in adults.
While not all results were positive, there was evidence that cannabinoids could reduce the symptoms of neuropathy or nerve pain.
CBD for Migraine Pain
Studies on CBD and migraine are limited. Most of the studies, so far, have examined CBD’s effects when combined with THC, not when CBD is used alone(25).
Migraine pain usually impacts both sides of the head and is often accompanied by light sensitivity and nausea.
Results from a 2017 study reported at the 3rd Congress of the European Academy of Neurology showed that CBD and THC might potentially lead to less acute pain and less intense pain for people with migraine(26).
The study, conducted in Italy, first set out to discover the most effective dosage of these cannabinoids for headaches.
A starting dose of 10 mg was given orally to 48 chronic migraine patients in a combination of two compounds.
The first dose contained 19% THC, and the second contained 9% CBD without THC.
The researchers found that doses <100 mg were ineffective and that a 200 mg dose elicited a 55% drop in acute pain.
Results showed that those who took the THC-CBD drug reported fewer stomach aches and less muscle pain than those who took pain medications.
The downside was that those taking the THC-CBD combination reported having some drowsiness and trouble with concentration.
CBD for Cancer Pain
Cancer and its treatment can lead to pain, and most people with cancer go through severe pain chronically.
About 70 to 90 percent of patients with advanced cancer experience significant pain(27). Cancer often causes pain due to pressure or damage to internal organs, inflammation, or nerve injury.
In cancer patients, cannabinoids have primarily been used as a part of palliative care to alleviate pain, relieve nausea, and stimulate appetite(28).
While there are prescription medications to ease the discomfort, they come with severe side effects, such as vomiting, extreme sleepiness, constipation, and addiction.
When the pain is severe, it can become resistant to opioids, which are also excellent pain relievers. Some patients may not respond well to opioids.
A study published in The Journal of Pain and Symptom Management showed that THC: CBD extract is efficacious for pain relief in individuals with advanced cancer pain not adequately relieved by potent opioids(29).
The study found that the extract, when used in addition to the opioids, provided improved relief from pain compared to using opioids alone.
While both CBD and opioids help with pain management, CBD has not been linked to death by lethal dosage. However, the Centers for Disease Control and Prevention (CDC) reported two out of three drug overdose deaths due to opioids(30).
What is CBD Oil?
CBD oil contains cannabidiol, one of the most prominent compounds found in the Cannabis Sativa plant. Unlike marijuana, CBD does not produce the usual psychoactive effects of cannabis.
Multiple studies have suggested that CBD has anti-inflammatory, analgesic, and neuroprotective properties(31). These purported benefits are realized by CBD’s interaction with the body’s endocannabinoid system (ECS) and its cannabinoid receptors.
The ECS is mainly responsible for regulating various body functions to maintain a state of balance and promote overall wellness.
CB1 and CB2 are the two main types of receptors found in specific parts of the human body.
CB1 receptors are mostly situated in the brain and central nervous system. CB1 is also found in the gastrointestinal and urinary tracts, reproductive organs, liver, lungs, and retina(32).
CB2 receptors are predominantly located in the immune system and affect pain and inflammation.
Various studies of the cannabinoid receptors have shown that endocannabinoids attenuate and suppress the perception of pain(33).
Types of CBD Oil
The three types of CBD oil are full-spectrum, broad-spectrum, and CBD isolates.
Full-spectrum CBD oil contains all the naturally occurring cannabinoids in the cannabis plant, including THC, terpenes, flavonoids, and fatty acids.
According to a 2005 study, full-spectrum hemp extract had greater medicinal properties than pure CBD(34). The high concentrations of cannabinoids and terpenes produce an “entourage effect” to maximize the potential health benefits of CBD.
Broad-spectrum CBD contains multiple cannabinoids and other chemical compounds in the hemp plants, except for THC.
CBD isolates only contain cannabidiol and do not have any other cannabinoids, terpenes, or fatty acids from the hemp plant.
CBD products are usually diluted with a carrier oil, such as hempseed or coconut oil. Although the typical CBD formulation is oil, it may also be taken through tinctures, gummies, vape products, and topicals.
These CBD products vary in bioavailability or the body’s absorption of CBD from the application area into the bloodstream.
CBD tincture may be consumed under the tongue (sublingual method) for faster absorption. Using a dropper provides convenient and accurate dosing.
CBD may be ingested through edibles, gummies, edibles, and capsules. The ingestion method takes much longer to get CBD into the bloodstream.
Topical products include CBD-infused salve, creams, or lotions. They are ideal for dealing with inflammation or pain in a specific area of the body.
After applying the product directly onto the affected area, the relief may be felt in about 15 minutes(35).
Vaping delivers fast-acting effects as CBD is sent directly to the lungs and absorbed by the body. However, vape use may lead to lung injuries and diseases, like collapsed lung and lipoid pneumonia(36).
CBD Risks and Side Effects
Most people tolerate CBD oil well(37). However, there are some possible side effects.
According to a 2017 review in Cannabis and Cannabinoid Research, the most common side effects include diarrhea, tiredness, dry mouth, reduced appetite, and changes in body weight(38).
Moreover, the use of CBD oil with certain medications can make those medications more or less effective. This interaction is brought about by some medications that are metabolized or broken down in the body after ingestion.
The CYP450 liver enzymes are primarily responsible for breaking down toxic compounds, including over 60% of any over-the-counter or prescription drugs consumed.
Certain substances can affect processing times within this system, making drugs metabolize faster or slower than they would on their own.
Cannabidiol can inhibit the cytochrome P450 system’s ability to metabolize certain drugs, leading to an overall increase in processing times(39).
In theory, using CBD with medications broken down by the liver may increase the effects and side effects of certain medications.
CBD might also affect the liver’s ability to break down toxins, increasing the risk of liver toxicity.
Meanwhile, the patient information leaflet for Epidiolex cautions that there is a danger of liver damage, lethargy, depression, and suicidal thoughts(40). However, these are also true of other treatments for epilepsy.
CBD and other cannabinoids may also put the user at risk for lung problems. A 2016 study in Frontiers in Pharmacology suggested cannabinoids’ anti-inflammatory effect may reduce inflammation too much(41).
A significant reduction in inflammation could diminish the lungs’ defense system, increasing the risk of infection.
Scientists still have to study some aspects of CBD, such as its long-term effects on hormones. Further studies are needed to understand and determine any side effects CBD has on the body over time.
Those who are considering using CBD oil should be well-informed of all the side effects induced by CBD and discuss their concerns with their doctors.
The Food and Drug Administration (FDA) also warns against CBD products being marketed and sold as dietary supplements(42).
Consumers are advised to purchase CBD oils from reliable sources and ensure that products are tested by an accredited third-party lab.
Legality of CBD
CBD is readily obtainable in many parts of the United States, although its exact legal status continually changes.
In December 2015, the FDA eased the regulatory stipulations that allowed researchers to conduct CBD investigations and clinical trials(43).
In 2018, Congress removed industrial hemp as a Schedule I drug under the Federal Controlled Substances Act(44). This law allowed the sale of hemp products across state borders.
The Farm Bill of 2018 legalized the growth, production, and manufacturing of hemp on the federal level(45). This law allowed hemp-derived products, such as CBD oil, to become more readily available in the market.
Many people are now able to get CBD online without a medical cannabis license(46). On the other hand, state laws may have varying degrees of restriction.
For instance, marijuana used for a medical condition may require a prescription from a licensed physician in some states. Meanwhile, other states have legalized medical marijuana with high levels of THC(47).
Individuals who possess cannabis products in a state where these are illegal or do not have a medical prescription in states where these are legal for medical treatment could be penalized.
Studies conducted with human and animal models have shown that CBD might help with pain conditions and symptoms associated with chronic pain, arthritis pain, neuropathic pain, migraine pain, and cancer pain.
While there is no conclusive data to support CBD or CBD oil as the preferred method of pain management, researchers agree that these types of products have much potential and future research is prudent.
CBD is non-addictive and non-psychoactive, making it beneficial for individuals with pain without causing drug intoxication and dependence.
Still, further research needs to be conducted to study the long-term side effects of CBD use.
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