Every time a promising new treatment for chronic pain appears, patients experience a fresh burst of optimism, because maybe this is the treatment that will finally offer relief. Perhaps this will be the magic missing piece to solve their puzzle of pain. Is CBD for pain that magic piece?
In this guide to CBD for pain, we’ll look at:
- What CBD is and how it works
- Where CBD comes from
- Potential side effects
- The research behind CBD for pain and other related conditions
- How to use CBD oil for pain
Of course, we can’t cover everything there is to know about CBD here. Your best option is to talk to a trusted doctor to learn more about how it could help you.
What Is CBD?
There is a lot of confusion about CBD oil. Not only is some of the jargon swirling around CBD confusing and often misused, but some marketing techniques have been misleading.
Cannabidiol, shortened to CBD, is one of over 100 cannabinoids found in hemp plants. Hemp plants can be divided into two basic categories: those developed for extracting CBD oil and those used for producing cannabis.
CBD comes from the Cannabis sativa L plant. The Cannabis sativa L plant has low levels of tetrahydrocannabinol (THC), the cannabinoid that produces intoxicating or euphoric effects. It is physically impossible to get high from the trace amounts of THC in the Cannabis sativa L plant.
On the other hand, Cannabis sativa, Cannabis indica, and Cannabis ruderalis are three species of plants in the family Cannabaceae that are most famous for producing different strains of cannabis flowers. These flowers have higher levels of THC and are sold as cannabis. THC can cause the stereotypical feeling of being “high,” but it can also come with a host of side effects.
Still confused? Think of it this way: although all cannabis plants have CBD as one of their cannabinoids, some cannabis plants are cultivated for lower levels of THC. Those plants are used to produce CBD oil. And some types of CBD are produced outside of the hemp plant completely, for example, grown on orange peels.
Because CBD oil has different effects on the body, many people are using it to treat their pain, sleep, and anxiety issues as we’ll discuss in this post. It’s also being used for other conditions, like seizure disorders.
How does CBD affect pain?
Think of CBD oil as the power switch for a system that already exists in your body.
The endocannabinoid system (ECS) is present in every person. This system is complex and not yet well understood, but its primary function is regulating homeostasis in a number of areas, including:
The ECS utilizes cannabinoids as neurotransmitters that bind to receptors in the ECS to help regulate the functions above.
In many cases, the ECS functions in the body just fine, producing its own cannabinoids and working to achieve stability and balance. Our bodies naturally produce endogenous cannabinoids that help the ECS function. However, sometimes the production of endogenous cannabinoids slows, stops, or is otherwise disrupted.
CBD is an exogenous cannabinoid — it occurs outside of the body and inside the cannabis plant, along with its relatives, including:
- Tetrahydrocannabinol (THC)
- Cannabichromene (CBC)
- Cannabigerol (CBG)
These are also known as phytocannabinoids. They can supplement and support the ECS when the body is unable to produce its own endocannabinoids.
So, what’s the connection between the ECS and pain?
Your ECS has two main cannabinoid receptors: CB1 and CB2. CB1 receptors are related to the central and peripheral nervous system. CB2 receptors are primarily in charge of the immune system. That’s a simplistic breakdown of a very complex system that is interwoven with other neurotransmitters and brain chemicals like dopamine and serotonin.
The cannabinoid receptors are found at nearly every level of pain pathway, from the spinal cord through the brain. CBD does not necessarily bind well to the endocannabinoid receptors, but it may inhibit the release of pain signals from neurotransmitters.
CBD may also simply trigger the body’s own regulation to help it achieve greater pain-free balance. Research is still being conducted on exactly how this works, but it appears that CBD has a modulating and regulatory effect on pain transmitters in the body.
Where does CBD oil come from?
CBD oil is available in four ways. Some pharmaceutical CBD oils are approved by the U.S Food and Drug Administration (FDA) for specific conditions. For example, Sativex treats spasticity related to multiple sclerosis that has not responded to other treatments, and Epidolex treats seizures. CBD in this form is available by prescription for those conditions only.
CBD oil is also a natural part of cannabis. The legality of cannabis varies across the U.S. Cannabis is legal is some states either medicinally, recreationally, or both, but it remains illegal in other states.
The 2018 Farm Bill made hemp with less than 0.3% of THC legal across the U.S. Hemp grown in compliance with this bill is the most common way to access CBD oil in its various forms. Hemp is still highly regulated by the FDA, moreso since a 2017 study revealed that as many as 70% of CBD products misrepresent the amount of CBD they contain. This over- or underrepresentation can make accurate, safe dosing difficult.
Finally, some manufacturers have found that CBD is also available from orange peel. Terpenes are volatile compounds found in essential plant oils, including cannabis. The terpene limonene is also found in orange peels and can be used to reconstruct CBD in the lab using a process called cyclic terpene assembly (CTA).
This process is proprietary, and to date, few manufacturers have the ability to use it. CBD oil reconstructed from orange peels has no THC, but is still currently regulated by the FDA.
Does CBD have any side effects or risks?
CBD oil for pain has been marketed as being without side effects and risk. While it’s true that CBD is remarkably safe, even in large doses, as with any medication there is the potential for side effects.
Some of the more common side effects include dry mouth, reduced appetite, drowsiness or fatigue, and diarrhea.
Two potentially serious but rare risks include the following:
- Drug interactions: CBD has the potential to change the potency of blood thinners, heart medications, and immunosuppressants
- Effects on male reproductive system: A study on male mice found that large doses of CBD reduced testes size, lowered fertility, and decreased sexual behavior
There was an earlier study that indicated liver toxicity when CBD was taken in large doses, but that study has since been debunked.
To prevent the risk of side events, it’s important to purchase high-quality CBD oil from a reputable source to ensure its purity and level of actual CBD. If you are on blood thinners, heart medications, immunosuppressants, or any other medications, talk to your doctor before taking CBD oil for pain (or other health conditions).
It is important to note that even with the risk of minor side effects, CBD oil remains remarkably safe and is well-tolerated by the vast majority of people who use it. Its limited side effects and the impossibility of addiction make it safer than most pharmaceutical treatments for chronic pain.
CBD And Pain: What We Know
One of the most promising areas of research is on CBD oil for pain. Not only does CBD oil appear to directly affect pain levels, but it’s also able to change a patient’s perception of that pain. In other words, even if pain levels were the same or just slightly less, the patients taking CBD were less bothered by the pain in general.
Here’s more current research on CBD oil for pain.
Neuropathic pain that results from damage to either individual nerves or to the central nervous system can be incredibly challenging to treat. Shingles, peripheral neuropathy, and post-herpetic neuralgia are all examples of neuropathic pain.
A study in 2020 found that applying topical CBD for neuropathic pain yielded significant relief of both pain and other symptoms of peripheral neuropathy. Just a year earlier, a study in the journal Pain found that CBD oil relieved neuropathic pain in mice. The study authors concluded that CBD’s interactions with serotonin receptors helped to modulate and ease pain. They also noted the need for more research on this type of pain.
One study found that an estimated 70% of people with fibromyalgia began supplementing or replacing their opioid pain killers with CBD oil during the COVID-19 lockdowns.
Of those who used CBD, 70 to 94% of them reduced or stopped taking opioids altogether. This suggests that not only did CBD oil relieve their pain, but it may also have helped ease opioid withdrawal symptoms. Always work with your doctor, though, before discontinuing use of any medications.
Arthritis is essentially inflammation in the joints of the body. There are over 100 types of arthritis, some that are a result of age and wear, and others that might arise due to immune response, injury, or disease.
Regardless of the cause or kind of arthritis, there is good research emerging for the use of CBD oil to treat arthritis.
Rheumatoid arthritis is an overactive immune response that attacks the joints of the body. A 2020 study found that using CBD for arthritis specifically targets the synovial fibroblasts that increase joint destruction in rheumatoid arthritis. The study found that CBD reduced synovial fibroblasts while increasing cellular calcium.
For painful joint inflammation, transdermal CBD for arthritis provided relief from swelling and increased the thickness of synovial lining in the joints of animal subjects in a 2016 study. Although this study was animal-based, there are encouraging parallels between this 2016 study and a 2018 study that found similar results for knee osteoarthritis in humans.
A study in 2021 found that 86% of people who suffer from migraine were able to experience almost four fewer headache days per month by using CBD. This study was scientifically validated and provides hope for people who did not want to use THC as a migraine treatment option.
The Research On CBD And Sleep
For all of the uncertainty that CBD research might present, there is at least one clear connection. Chronic pain and sleep are intimately intertwined, with pain increasing sleeplessness and chronic pain intensifying with lack of sleep. In fact, a 2020 review of 16 studies reiterated how important sleep is in treating chronic pain.
Because the endocannabinoid system plays a role in regulating sleep and the circadian rhythm, it makes sense that CBD could help people struggling with sleep disorders and the related pain.
Do note, though, that the research on CBD and its effectiveness in treating sleep is still emerging.
CBD may treat a variety of sleep conditions
An earlier 2017 review of studies found that CBD showed promise in treating a variety of sleep disorders or conditions, including:
- Obstructive sleep apnea
- Chronic insomnia
- REM sleep behavior disorder and excessive daytime sleepiness
- Nightmares associated with PTSD
- Poor sleep in people with chronic pain
People with insomnia frequently turn to CBD
In a study that ranked the reasons why people used CBD, insomnia was ranked second, but only just missed the top spot. Anxiety ranked first, with 42.6% of people using CBD saying that was their primary reason, with 42.5% looking for help with sleep.
CBD can offer a respite from sleep issues
Despite the fact that a small trial of CBD in Parkinson’s patients did not relieve REM sleep behavior disorder in patients, researchers found an improvement in sleep outcomes between weeks four and eight of their eight-week study. While relief was brief, it was an outcome worthy of further exploration.
Does CBD Help Anxiety?
In 2015, four researchers gathered the available evidence regarding CBD and anxiety disorders. After analyzing the results, they concluded that CBD has incredible potential in treating a variety of anxiety disorders.
This is likely due to the way that CBD interacts with the central nervous system. CB1 receptors are key in how the body perceives and reacts to fear and have long been a target of anti-anxiety medications. Researchers have been studying the anti-anxiety effects of CBD since the early 1980s, but there has been limited large-scale studies on the effectiveness of CBD in treating anxiety disorders.
CBD worked to decrease anxiety that interfered with sleep
In 2019, researchers found in a small study that CBD was helpful for patients with anxiety and poor sleep. The study found that nearly 80% of patients reported a decrease of anxiety in the first month, and almost 67% reported better sleep (those results fluctuated over time).
CBD reduces PTSD-related anxiety
Another small-scale but significant study in 2019 found that 91% of people in the study reported reduced anxiety symptoms. Another outcome of this study was that PTSD-related nightmares were also reduced.
CBD For Other Health Challenges
Although good quality research on CBD remains relatively sparse, there is a growing interest in using this compound to treat two serious conditions: COVID respiratory illness and the rising epidemic of heroin and opioid addiction.
Does CBD treat respiratory COVID-19 symptoms?
COVID-19 remains an ongoing threat. Research from Augusta University in Georgia suggests that CBD oil might help treat one of the primary symptoms that occurs in severe COVID-19 cases.
Acute respiratory distress syndrome (ARDS) is inflammation in the lungs that occurs when the immune system overacts with what is referred to as a cytokine storm. CBD reduces specific cytokines that cause inflammation — which may help ease ARDS in severe COVID-19 patients.
Does CBD reduce cravings in heroin use disorder?
A 2019 study published in The American Journal of Psychiatry found that 400 to 800 mg of CBD administered three days in a row significantly decreased cravings and anxiety in people attempting to quit heroin.
This study was small and short term, but researchers found in their double-blind, placebo-controlled design that participants who took CBD had decreased heart rates and salivary cortisol — two key components associated with cravings and drug relapse.
CBD And Research: What Do We Know?
Does CBD offer a placebo, or is it a panacea? At this point, CBD is woefully understudied but holds serious promise. Current relevant research seems to indicate that CBD could potentially supplement or even replace treatments, like opioid medications, for a variety of chronic pain conditions.
But, with so many people turning to CBD oil for pain, CBD for anxiety, and CBD for sleep, why are there so few large-scale, scientifically-valid studies of this treatment? After all, the risk of side effects is low, and there is an ample supply of CBD in a variety of forms and dosages.
There are several reasons.
CBD is still relatively new
CBD as a compound has only been isolated since 1940. When taken in context with all of the other research and medical advances since then, CBD has simply taken a backseat.
Further, although it has been legalized by the FDA, it is still considered a drug and can therefore not be legally included in food or as a dietary supplement.
High-quality, pure CBD is difficult to come by
Unless researchers develop their own seed, grow their own hemp, and extract their own CBD, large amounts of high-quality, uncontaminated CBD are not widely available. Growers have focused on THC so intensely that traditionally there hasn’t been enough CBD to ensure a regular supply.
This uncertainty of quality is also what makes it challenging for consumers to evaluate whether or not it works. Anecdotal evidence is unreliable because it’s impossible to know exactly how much CBD was actually consumed.
CBD is still an enigma
Cannabidiol is just one of many compounds found in hemp plants. Terpenes, cannabinoids, and flavonoids round out a full-spectrum CBD oil. With so many potentially beneficial compounds, it’s hard to know which one is actually causing the positive (or negative) outcomes in a study.
Although researchers are no strangers to challenging study designs, CBD has so many variable factors within the plant itself that simply designing a proper study that can be replicated is a hurdle.
The U.S. Food and Drug Administration estimates that the cost of a CBD study per study participant is approximately $3,000. This is prohibitive for large-scale studies.
The interest in CBD research is growing, as are waving fields of CBD as growers begin to cultivate this complex plant. While these are key challenges, the potential benefits for building more robust data about CBD benefits is well worth the effort. We’ll continue monitoring this space to provide more information as it becomes available.
How To Use CBD Oil For Pain
Using CBD oil for pain starts with a conversation. Talk to your doctor first to discuss if CBD oil for pain is something that will work with your current medications and treatments. You should not begin taking CBD oil for pain without discussing the appropriate form, dosage, and formulation.
Once you have this conversation, there are a couple of guidelines to follow when using CBD for pain.
Find the right approach for you
Key to successfully treating conditions with CBD is making sure you are taking the right approach for you.
CBD can be ingested in a variety of ways. Some of them are better for slow release, while others are best for acute issues of pain and anxiety. Each has pros and cons, including a varying rate of CBD’s bioavailability. Bioavailability is how much of the CBD actually makes it into the bloodstream for your body to use.
The CBD form that you select will depend on your:
- Personal preference
- Doctor’s recommendation
- Ability to be consistent with the dose
Here are four basic ways to ingest CBD oil for pain.
1. Topical CBD
Topical CBD comes in a variety of forms that can include:
- Bath salts
These topical forms of CBD allow you to target the exact area where relief is needed. CBD bath salts might cut a wider swath through the whole body, but the effects are meant to be acute and transitory.
Another topical form of CBD that differs slightly from the forms above is transdermal patches. These patches typically contain higher amounts of CBD and are meant to be worn for a period of time when the skin absorbs CBD. This allows for a whole-body effect (rather than the localized effects of the above topical applications).
As mentioned, one of the benefits of topical forms of CBD is that treatment can be localized and easily absorbed through the skin. Salves, creams, and lotions also provide moisturizing wherever they are applied. On the other hand, because they cover a wider area, these delivery methods require a higher level of CBD, which could raise the price substantially.
2. Oral CBD
Oral CBD is the most commonly-used form of CBD. You might take your oral CBD for pain in the form of capsules, gummies, edibles, drinks, or plain CBD oil.
There are a few reasons why this is the most common way to take CBD.
First, there are many different product options. If you want to take CBD orally but don’t like the earthy taste of the CBD oil, you can easily blend it into a smoothie, munch on a gummy, or take a CBD capsule.
Oral CBD also takes a while to release. This means that if you are taking a daily dose of CBD for chronic pain, an oral dose will take longer to move to the bloodstream. This provides extended relief.
Finally, oral CBD is very easy to travel with, especially in capsule, pill, or gummy form.
The major downside to this form of CBD is that it acts slower than other forms because it has to move through the digestive process to get into your bloodstream. This means that there is also not a consistent amount of CBD that gets to the bloodstream, and many factors can impact how much or how little CBD actually makes it.
3. Inhaled CBD
Inhaled CBD is another popular way to ingest CBD. Users can vape or smoke a dried CBD flower in a pipe or rolled cigarette.
Inhaling CBD in this way gets it immediately into the bloodstream for quick relief of symptoms. This form of CBD also offers the highest bioavailability of CBD, with up to 60% of beneficial compounds available. Most people who choose this method report relief in a few minutes, with effects that can last several hours.
But this form is not without its drawbacks. If you choose to smoke dried flower, there is the smoke that is released that smells much like cigarette smoke. Vaping only releases mist as you exhale, but vaping oil can have harmful chemicals. The health risks of vaping also not yet well understood (especially as compared to traditional smoking).
Finally, it’s very difficult to get a consistent dose of CBD in this method. Some people hold the smoke in their lungs longer. Some take a deeper breath. Some take many fast puffs, while others smoke less. It’s just not a well-regulated form of CBD oil.
Lingual CBD (also referred to as sublingual CBD) is a form of oral CBD that is administered under the tongue by either a dropper or a spray. A spray makes it easy to take a dose of CBD by spraying the inside of your cheek, too.
This form of CBD is great in an acute crisis (i.e., if you are having a panic attack). The CBD is absorbed quickly through the mouth’s mucous membranes and has a higher bioavailability because nothing has to break it down or interferes with absorption.
What’s The Best CBD Dosage For Pain?
One of the most challenging aspects of treating any condition with CBD oil is figuring out what dose is best. It’s important to note that in the research above, participants were taking extremely high doses of CBD oil. Not only is this amount of CBD cost prohibitive for most people, but it also increases the risk of side effects. You should never take CBD oil for pain or other conditions without first talking to your doctor, and you should definitely not start out with such a high dose!
In general, the key to figuring out the dose that works for you is to start low and go slow.
Once you’ve gotten the okay from your doctor, start with the lowest dose of CBD oil available. Many people start with a 5mg or 10mg dose and move from there. It’s important to pay close attention to your response to that dose. You might note any changes in your symptoms but also some of the following:
- What time of day did you take the dose?
- What form of CBD did you use?
- Did you eat before you took your CBD?
In the case of chronic pain conditions with triggers (e.g., migraine and fibromyalgia), you might also note any triggers (i.e., weather, medications, etc.).
At this point, CBD dosing is not an exact science. It will most likely take a while to figure out which dose works best for you, so be patient.
It is also possible to have a positive reaction to CBD, and then suddenly find no relief. This is similar to what happens with other substances that you might consume daily. Consider caffeine. That first cup of coffee in the morning hits different than the second one. You begin to develop a tolerance to the effects of the caffeine.
Developing this tolerance can occur in one of three ways:
- Behavioral tolerance: The effects become more psychological than physical (like mentally needing caffeine in the morning as part of a routine)
- Metabolic tolerance: Less of the CBD is absorbed over time due to changes in body chemistry
- Cellular tolerance: This occurs when cells are less responsive to the substance (why you need more caffeine over time to get the same response)
But it’s also worth noting that, unlike THC with the strong potential for tolerance, CBD actually has a better potential for what’s known as reverse tolerance. Over time and with regular use, researchers hypothesize that your cannabinoid receptors and neurotransmitters get better at their job and just need less CBD to produce the same effect.
Some researchers have noted also that CBD is less effective over time for sleep and anxiety, but they have not determined why or if increasing (or decreasing) the dose would help.
So, the best answer to the question of how to find the perfect dose is to start with a low-dose, high-quality CBD oil, pay attention to your body’s response, and make adjustments with your doctor to see if it’s going to work for you.
What Is The Best CBD Oil For Pain?
While it’s true that there are many options for CBD oil in the world, it’s also true that not all of them are created equal. The best CBD oil for pain has a few characteristics to pay attention to.
What type of CBD is it?
CBD oil is generally available in three types: isolate, broad spectrum, and full spectrum.
CBD isolate is pure CBD only. This compound is extracted from the cannabis plant and dried into crystal form. This crystal is tasteless and can be ground into powder for use in various ways. Some manufacturers might add additional, non-cannabis ingredients to tailor their CBD products to a specific treatment protocol or condition.
CBD isolate has the benefit of being 100% free from THC. Even in the small quantities allowed in legal CBD oil, THC can show up on a drug screen. For people concerned about ingesting any THC, this is a great option.
Broad spectrum CBD is the next step up from CBD isolate. Broad spectrum CBD preserves more of the cannabis compounds but still removes the THC. In cases where CBD isolate is not helpful, but THC of any amount is a concern, broad spectrum CBD might be a good substitution.
The final type of CBD is full spectrum CBD. Full spectrum CBD oil maintains all of the terpenes, flavonoids, and cannabinoids — including THC. These all work together with the CBD to produce what is known as the “entourage effect.” Each of these compounds enhances the effectiveness of the others.
Remember that CBD oil can have less than 0.3% of THC in it, and some researchers believe that it is best to include all of the beneficial compounds when selecting CBD oil. Where THC is not a concern, full spectrum CBD oil might be the best choice.
How is the CBD extracted from the plant?
There are a variety of different CBD extraction methods. The most basic is extraction by solvents (i.e., food grade ethanol, butane, or propane). This method is efficient and effective but can leave behind chemicals or extract bitter-tasting compounds.
CBD can also be extracted more gently by heating olive oil, but the result is more of an infused oil (rather than a concentrated CBD extraction).
Steam distillation requires a lot of plant matter to get a small amount of CBD, but the benefit of this method is profound. Steam distillation frees the majority of beneficial volatile compounds naturally, with no chemicals or additives. It is becoming popular, but the amount of plant needed means that CBD oil that uses this method is among the most expensive.
The final method, one that brings together sophisticated science and all-natural methods, is extraction by CO2. In a nutshell, CO2 is utilized at various stages to essentially manipulate the beneficial compounds out of the plant matter without any solvents or harmful chemicals. It is an environmentally-friendly process that requires expensive machinery and scientific know-how. Because of that, it is the cleanest, but most expensive type of extraction (and that expense is sometimes passed to the consumer).
What’s added in?
One of the ways that manufacturers can bring the cost of your CBD down is by adding other things into your CBD oil.
Some of these additions help to enhance the effects of the oil, while others function more as filler and actually dilute the effectiveness. This isn’t necessarily bad, just know what’s in the oil you’re purchasing.
Does the manufacturer offer certified lab results?
With all of the potential for additions to extractions, how do you know what’s actually in your oil?
Look for a manufacturer that offers third-party lab test results. These results should be readily available and include batch numbers to identify what’s in your CBD oil. They should specify:
- The amount of CBD
- The percentage of THC
- The percentage of other volatile compounds
- Any additions, and how much
- Type of carrier oil
The label of your CBD oil may carry an abbreviated version of this information, but if you want to dig deeply into your CBD oil ask the manufacturer for their data.
How To Get Started With CBD Oil For Pain
Chronic pain is a complex condition, with many layers. Complementary medical treatments are meant to work within a larger and more comprehensive plan for pain management.
Getting started with CBD oil for pain always starts with a conversation with your primary care physician or pain specialist. While many people do experiment on their own, talking to your doctor before you take CBD oil can help you better understand how it can help with your pain!
Suffering from pain in Arizona? We can help at Arizona Pain. Contact one of our pain management specialists today for help!