CBD, a non-psychoactive component in cannabis, is emerging as a promising pharmaceutical agent to treat pain and other conditions. Unfortunately, few studies in humans have examined its effectiveness, and the cannabis industry’s profit motive is driving a wave of dubious claims about what CBD can do. Scientists have tested CBD’s efficacy as an analgesic—and with promising results. Here’s what we know so far about how we can use CBD oil for pain relief.
CBD for chronic pain: The science doesn’t match the marketing
If you ask health care providers about the most challenging condition to treat, chronic pain is mentioned frequently. By its nature, chronic pain is a complex and multidimensional experience. Pain perception is affected by our unique biology, our mood, our social environment, and past experiences. If you or a loved one is suffering from chronic pain, you already know the heavy burden.
People are looking for novel, nonaddictive ways to treat pain
Given the ongoing challenges of chronic pain management coupled with the consequences of the opioid epidemic, pain management practitioners and their patients are searching for effective and safer alternatives to opioids to alleviate pain. With the legalization of marijuana in many states and resulting cultural acceptance of this drug for recreational and medical use, there has been an increased interest in using cannabis for a myriad of medical problems, including pain.
Cannabis (most commonly obtained from the Cannabis indica and Cannabis sativa plants) has three major components: cannabinoids, terpenoids, and flavonoids. While there are over a hundred different cannabinoids, the two major components are tetrahydrocannabional (THC) and cannabidiol (CBD). Historically more attention has been paid to the psychoactive (euphoric “getting high”) component of the cannabis plant, THC; there have been fewer scientific studies on the medical use of CBD, a non-psychoactive component of the plant.
What’s the thinking behind using cannabis for chronic pain?
CBD is emerging as a promising pharmaceutical agent to treat pain, inflammation, seizures, and anxiety without the psychoactive effects of THC. Our understanding of the role of CBD in pain management continues to evolve, and evidence from animal studies has shown that CBD exerts its pain-relieving effects through its various interactions and modulation of the endocannabinoid, inflammatory, and nociceptive (pain sensing) systems. The endocannabinoid system consists of cannabinoid receptors that interact with our own naturally occurring cannabinoids. This system is involved in regulating many functions in the body, including metabolism and appetite, mood and anxiety, and pain perception.
What’s the research that CBD works in humans?
Given its promising results in animal models, along with its relative safety, non-psychoactive properties, and low potential for abuse, CBD is an attractive candidate to relieve pain. Unfortunately, there is a lack of human studies about the effectiveness of CBD. However, there is an abundance of commercial advertisements about the magical effects of CBD, and it is frequently presented as a cure-it-all potion that will treat everything including diabetes, depression, cancer, chronic pain, and even your dog’s anxiety!
So far, pharmaceutical CBD is only approved by the FDA as adjunct therapy for the treatment of a special and rare form of epilepsy. Currently, CBD alone is not approved for treatment of pain in the United States. But a combination medication (that contains both THC and CBD in a 1:1 ratio) was approved by Health Canada for prescription for certain types of pain, specifically central neuropathic pain in multiple sclerosis, and the treatment of cancer pain unresponsive to optimized opioid therapy. There is currently no high-quality research study that supports the use of CBD alone for the treatment of pain.
Why is CBD presented to the public this way, when it is not without risks?
Given the rapid change in the legality of cannabis coupled with the increased appetite for something new, and driven by unprecedented profit margins, the advertising for cannabinoids in general and CBD in particular has gone wild. The FDA is very clear that it is illegal to market CBD by adding it to a food or labeling it as a dietary supplement. And it warns the public about its potential side effects, as it’s often advertised in a way that may lead people to mistakenly believe using CBD “can’t hurt.” CBD can cause liver injury, and can affect the male reproductive system (as demonstrated in laboratory animal studies).
Most importantly, CBD can interact with other important medications like blood thinners, heart medications, and immunosuppressants (medications given after organ transplantation), potentially changing the levels of these important medications in the blood and leading to catastrophic results, including death. Also, more information needs to be gathered about its safety in special populations such as the elderly, children, those who are immunocompromised, and pregnant and breastfeeding women.
Many of the CBD products on the market are unregulated
In fact, the FDA has issued several warning letters to companies and individuals that market unapproved new drugs that allegedly contain CBD. The FDA has tested the chemical content of cannabinoid compounds in some of the products, and many were found to not contain the levels of CBD the manufacturers had claimed they contain.
Beware of powerful testimonials
Finally, there is anecdotal wisdom, when experiences by patients and health professionals have positive results. While the experience or medication could be beneficial, that doesn’t mean it is going to work for everyone. That’s because each and every person is unique, and what works perfectly for one patient could have no effect on another patient. This is especially true for pain, where many other factors (our mood and stress level, our environment and other medical conditions, and our previous experiences) can affect the perception of pain. Please be careful, and keep in mind that some of these incredible-sounding testimonials are merely marketing materials meant to lure consumers to buy more products, as the CBD market is expected to hit $20 billion by 2024.
The bottom line: Don’t make CBD your first or only choice for pain relief
If you or someone close to you is considering trying CBD, I would recommend Dr. Robert Shmerling’s advice about the dos and don’ts in choosing an appropriate product. Until there is high-quality scientific evidence in humans, it is difficult to make a recommendation for the regular use of CBD in chronic pain management.
About the Author
Shafik Boyaji, MD , Contributor
Dr. Boyaji earned his medical degree from University of Aleppo, Syria. He completed an Internal Medicine residency at Michigan State University and an Anesthesiology residency at the Brigham and Women’s Hospital. Currently he is in fellowship … See Full Bio
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How To Use CBD To Help Manage Pain
Dr. Bindiya Gandhi is an integrative medicine physician with expertise in functional and holistic medicine based in Atlanta, Georgia.
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Table of Contents
- CBD for Pain Relief
- CBD for Chronic Pain
- CBD for Arthritis and Joint Pain
- CBD for Neuropathic Pain
Without the intoxicating properties of its cousin delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) can provide the human body with a handful of health benefits. Cannabinoids like CBD interact with receptors in the endocannabinoid system, which plays a role in signaling bodily functions, from emotional responses to motor control to energy balance  Mouslech Z, Valla V. Endocannabinoid system: An overview of its potential in current medical practice. Neuro Endocrinol Lett. 2009;30(2):153-179. .
Over the last two decades, scientists have tested CBD’s efficacy as an analgesic, or painkiller, specifically—and with promising results. While research is ongoing, here’s what we know so far about how we can use CBD oil for pain relief.
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CBD for Pain Relief
For now, no CBD-based medications are approved as painkillers in the U.S. Epidiolex, which is used for rare forms of epilepsy, is the only CBD treatment approved by the Food and Drug Administration (FDA).
Meanwhile, several countries have approved CBD to treat certain conditions. For instance, the U.K. approved it for multiple sclerosis, and Canada approved it for cancer pain. Ongoing research suggests CBD oil for pain can aid medical conditions, including arthritis and fibromyalgia, at varying doses. Some pain may not be treatable by CBD alone, but it can help when paired with THC or Western medication applications.
Interestingly, 60% of U.S. adults who use CBD products do so for its potential pain-relieving effects, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll.
What’s more, 60% of U.S. adults have tried CBD and believe it has medicinal benefits.
CBD for Chronic Pain
Chronic pain is defined as any pain lasting longer than several months. Studies have found CBD, often alongside THC, to be an effective pain reliever for various chronic conditions.
In clinical trials, Sativex, a spray with equal parts CBD and THC, proved significantly successful as an analgesic for cancer-related pain  Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008;4(1):245-259. . The spray, also used for multiple sclerosis-related pain, is approved in Canada to treat cancer pain and is currently undergoing trials for approval and use in the U.S.
A 2019 study found Sativex to be an “effective and well-tolerated add-on treatment” for patients with severe chronic pain stemming from various ailments. The study identified three types of pain: nociceptive (affecting body tissue), neuropathic (affecting nerves) and mixed pain. Sativex helped treat all three kinds but proved especially effective against neuropathic pain.
An earlier study also found CBD to be effective in chronic pain relief for conditions like multiple sclerosis and spinal cord injury, although across a much smaller sample size  Wade DT, Robson P, House H, Makela P, Aram J. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil. 2003;17(1):21-29. .
CBD for Arthritis and Joint Pain
Arthritis is a broad term that encompasses hundreds of joint-related conditions and pains. Common symptoms include swelling, pain and stiffness in the joints and may progress over time.
Already a proven analgesic for other conditions, CBD shows promise as an anti-inflammatory substance in both animal and preclinical trials, which bodes well for arthritis treatment  Nichols JM, Kaplan BLF. Immune Responses Regulated by Cannabidiol. Cannabis Cannabinoid Res. 2020;5(1):12-31.  Mlost J, Bryk M, Starowicz K. Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action. Int J Mol Sci. 2020;21(22):8870.  Kosgodage US, Mould R, Henley AB, et al. Cannabidiol (CBD) Is a Novel Inhibitor for Exosome and Microvesicle (EMV) Release in Cancer. Front Pharmacol. 2018;9:889.  Lowin T, Tingting R, Zurmahr J, Classen T, Schneider M, Pongratz G. Cannabidiol (CBD): a killer for inflammatory rheumatoid arthritis synovial fibroblasts. Cell Death Dis. 2020;11(8):714. . However, clinical research dedicated to CBD administration for arthritis is less robust and ongoing.
The first controlled trial conducted in 2006 focused on patients with rheumatoid arthritis, an autoimmune disease that causes inflammation in the joints and other affected areas  Blake DR, Robson P, Ho M, Jubb RW, McCabe CS. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology (Oxford). 2006;45(1):50-52. . Researchers found that, compared to a placebo, Sativex significantly improved participants’ pain during movement, pain at rest and quality of sleep. Any adverse reactions to the treatment were mild or moderate, and there were no complications with withdrawal.
In 2018 researchers tested the efficacy of topical CBD gel on participants with osteoarthritis-related knee pain over the course of 12 weeks  Hunter D, Oldfield G, Tich N, Messenheimer J, Sebree T. Synthetic transdermal cannabidiol for the treatment of knee pain due to osteoarthritis. Osteoarthritis and Cartilage. 2018;26:S26. . Participants used either 250 milligrams or 500 milligrams, split into two applications, daily. Overall, participants’ weekly pain levels didn’t improve much with CBD compared to placebo. However, when researchers evaluated the average weekly worst pain scores and Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical function scores, participants who applied 250 milligrams of CBD daily experienced significant improvement over placebo participants.
Meanwhile, a small 2019 trial suggests a mix of CBD and THC may prove beneficial for people with fibromyalgia, a type of arthritis that results in whole-body pain and fatigue  van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain. 2019;160(4):860-869. . The study found that, via a single inhalation, a CBD-THC solution performed better than a placebo and either substance on its own.
CBD for Neuropathic Pain
Various conditions and injuries that damage nerves or the nervous system can result in neuropathic pain. This kind of pain manifests as tingling, numbness, muscle weakness and a sharp, shooting, burning or stabbing pain.
Multiple sclerosis (MS) is a common cause of neuropathic pain. The disease wears down myelin, a mixture of proteins and phospholipids that coats nerve cells. Sativex is already approved as an MS treatment around the world due to its success in clinical trials. As a spray, Sativex is absorbed in the mouth. Studies support a median dose of eight sprays a day for patients with MS, which provides about 20 milligrams of CBD and 21.6 milligrams of THC  Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC). Datapharm. Accessed 7/9/2021. . However, doses vary between patients, and each person needs to find their optimal dose.
A 2020 study also tested topically administered CBD oil as a treatment for patients with peripheral neuropathy, or damage to the peripheral nervous system, which sends information throughout your body from the central nervous system  Xu DH, Cullen BD, Tang M, Fang Y. The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Curr Pharm Biotechnol. 2020;21(5):390-402. . When compared to placebo, the topical CBD significantly reduced patients’ intense pain and sharp pain, as well as cold and itchy sensations.
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