Let's Talk About CBD & Pain
More and more people are using this buzzy herbal remedy to treat all kinds of pain. But how effective is it?
CBD, short for cannabidiol, is having a major moment right now. While many people are turning to the herbal alternative to help treat a host of different conditions, the majority are using it to ease chronic pain (in no small part because it’s nonaddictive, unlike many traditional treatments). In fact, among the 62% of survey participants who reported using CBD to treat a medical issue, the top condition they used it to treat was, you guessed it, chronic pain, according to a study published in Cannabis and Cannabinoid Research. And those pain-related conditions include everything from arthritis and fibromyalgia to migraine, muscle pain, and even cancer. If you've been wondering if CBD is the pain-reliever you've been looking for all your life, we'll help figure out if it's time to make the first move.
Our Pro Panel
We went to some of the nation’s top experts in CBD to bring you the most up-to-date information possible.
Peter Grinspoon, M.D.
Instructor of Medicine and Board Member
Harvard Medical School and Doctors for Cannabis Regulation
Hollis Karoly, Ph.D.
Institute for Cognitive Science/Department of Psychology and Neuroscience Center for Innovation and Creativity at the University of Colorado
Ryan Vandrey, Ph.D.
Associate Professor Behavioral Pharmacology Research Unit
Johns Hopkins University School of Medicine
Products can be purchased online, over the counter, and at cannabis-specific dispensaries throughout most of the country. The best way to help ensure a quality sample is to look for products that have been tested by a third-party company. This should be marked on the label, and if not, check the company’s website. Keep in mind, because CBD is unregulated, you won’t know the quantity of CBD or the other constituents that may be present. (Research shows as many at 70% of CBD products may be mislabeled.) Additionally, there are no established clinical guidelines regarding forms and dosing, so be sure to talk with your doctor before using CBD.
CBD is a single chemical entity molecule and the second main cannabinoid found in cannabis. Unlike THC, CBD is not psychoactive, i.e. it can’t get you high. Many people find it to be therapeutic for things like anxiety, insomnia, nausea, and pain. THC works by binding to receptors in the brain and central nervous system to produce psychoactive effects.
Yes and no. CBD can come from both hemp and marijuana, however, only CBD derived from hemp is legal everywhere because it contains under 0.3% THC. CBD that comes from marijuana is illegal, depending on the state in which you live, regardless of its percentage of THC. Currently, 33 states have legalized medical marijuana, and 11 states and Washington, D.C. have legalized marijuana for recreational use for adults over 21.
Unlike the fuzzy, sometimes mind-altering effects of THC, many people report CBD imparts an instant calm, like you’ve just taken a dose of serenity now. However, what you might feel may be different from what your BFF or your grandma experiences. And because it has a relaxing effect, if you tend to worry or be anxious, you might find your angst disappears and a sense of tranquility washes over you, so you’re able to sleep more soundly.
What Is CBD Again?
You’ve seen bottles of CBD lining the shelves of natural food stores, in jars of beauty creams and gummies, and even baked into dog treats. CBD is legit everywhere these days. But what exactly is this so-called wunderkind cure-all? Here’s the science: It’s one of two main cannabinoids, chemical entities found in the cannabis plant (the other one is tetrahydrocannabinol, THC).
Unlike THC, which causes you to get high, CBD has no psychoactive effects, and many people find it to be therapeutic for things like anxiety, insomnia, nausea, and pain. And while everyone from grandmas to dogs are using it, CBD is only FDA-approved for one medication called Epidiolex, which treats the seizures associated with two rare and severe forms of epilepsy. So, essentially, usage for anything else is completely unregulated.
And, not only is it unregulated, but it’s also very difficult for scientists to study. That’s because what you buy at retail is mixed with other plant chemicals—which are often unknown. So, any given sample experts study can seriously vary from the next. (Epidiolex, on the other hand, is made from a chemically pure strain of CBD.) In fact, research has shown that the CBD content in almost 70% of CBD-labeled products available online may be mislabeled.
The moral of this cautionary tale is: You don’t know what you’re getting—so consume at your own risk and always consult with your doctor before you try it.
How Can CBD Relieve Pain?
Researchers don’t exactly know how CBD works in the body to alleviate pain, but they do have several theories. In pre-clinical studies using rat subjects, CBD was found to inhibit the release of glutamate and other inflammatory agents, dulling sensations like prickling, tingling, and burning, which are characteristic of neuropathic pain (the pain caused by damage to or inflammation of the nerves).
It’s also thought to have some serious antioxidant power that’s greater than ascorbic acid (vitamin C) or tocopherol (vitamin E)—antioxidants can neutralize tissue-damaging chemicals that cause inflammation. Plus, CBD is said to promote sounder sleep, which helps minimize the snooze disruptions people with chronic pain often experience.
Some researchers also believe that CBD interacts with certain receptors in the brain (called CB2 receptors), which are primarily found in the immune system and responsible for the body’s response to pain and inflammation. THC, on the other hand, mostly attaches to CB1 receptors, which are found in the brain and associated with cognitive actions like coordination, mood, thinking, memory, and appetite (this is why smoking marijuana, which is high in THC, affects users on a cognitive level). Depending on the condition, doctors may recommend a combination of CBD and THC for even greater pain relief.
What Forms Are Most Effective for Pain Relief?
Generally, CBD is most effective in oil that’s placed under the tongue because it’s concentrated and kicks in quickly, usually in under an hour. CBD swallowed in capsules, food, or liquid is absorbed through the digestive tract and absorption is slower, often taking one-to-two hours but with an extended release so the effects last longer. Topical products, like lotions, gels, and balms, applied to the skin over a painful joint, have been found to reduce inflammation.
Which Types of Pain Can CBD Help Relieve?
While every expert will tell you more research is needed, many patients are proving CBD helps with the pain related to a variety of conditions. Here’s the lowdown on what we know so far.
Arthritis, a condition characterized by joint pain, swelling, stiffness, and a decreased range of motion is the leading cause of disability in America. More than 50 million adults and 300,000 children have some type of arthritis. According to a study of arthritis sufferers by the Arthritis Foundation, 29% of those surveyed use CBD to treat arthritis symptoms.
CBD is thought to help by decreasing joint inflammation and protecting the nerves. A study published in Pain found that CBD even prevented osteoarthritis pain in rats. Another study published in the European Journal of Pain found that topical CBD gel significantly reduced joint swelling, pain, and inflammation in rats with arthritis. Yes, these studies are in small furry rodents and not actual humans. But animal research is the starting point for many trials, so consider them for what they are: a beginning.
Characterized by chronic pain all over the body, as well as related symptoms like fatigue and insomnia, fibromyalgia affects about 4 million people in the United States. While the cause is unknown, some researchers believe fibromyalgia may be the result of an endocannabinoid deficiency syndrome.
Similar to the cannabinoids found in cannabis, endocannabinoids naturally occur in the body, and they manage a diverse range of physiological processes such as regulating the immune system, influencing gastrointestinal functions, and impacting how we perceive pain. But when levels are low or the endocannabinoid system is too weak to carry out its usual commands, body-wide symptoms like those that come with fibromyalgia may result.
So the theory here is that taking plant-based cannabinoids like CBD and THC (basically supplementing what the body needs like a multivitamin) can treat the deficiency and relieve symptoms. Other evidence shows taking CBD oil may even change the way people with fibromyalgia process pain by making cells surrounding nerves less sensitive.
According to the Migraine Research Foundation, 39 million people in the United States suffer from migraines, a neurological disorder that causes debilitating headaches as well as other symptoms such as visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch, and smell, and tingling or numbness in the extremities or face. Most (small-scale) studies have looked at the combined effects of CBD and THC as a treatment, including a study published in Headache, which found that the THC-CBD combo reduced migraine attacks and the pain that comes with them by more than 40%.
While CBD in most forms is basically a top-to-toe treatment, meaning it generally can’t target specific parts of the body, there’s compelling evidence that topical-based CBD creams, gels, and salves work better for back pain. They not only reduce inflammation and neuropathy (nerve dysfunction), but you can place them on the areas that are most affected like an on-the-spot treatment. And, they’ve also been found to reduce the anxiety associated with pain and help improve relaxation, which can be difficult for the chronic back pain sufferer.
Any active person knows, muscle pain and soreness go hand in hand with exercise. Because CBD has been shown to fight inflammation, which is behind muscle soreness, applying a CBD salve right to the area concentrates the treatment and can help ease the aches.
Multiple Sclerosis Pain
In 25 countries including the UK and Canada, a medication called Sativex, a cannabis-derived oral spray containing equal parts THC and CBD is approved for treating spasticity, the painful continuous muscle stiffness, and involuntary contractions that affect about 80% of MS patients. Sativex is thought to inhibit nerve impulses via the cannabinoid receptors in the central nervous system and in immune cells. Studies have shown that within 12 weeks, patients have seen improvement in symptoms as well as an improved quality of life. While Sativex is not yet FDA approved in the U.S., it is undergoing testing here.
CBD is thought to have anti-inflammatory and anti-anxiety properties, which can help minimize cancer pain. And, aside from alleviating the spasticity and pain associated with MS, Sativex has been shown to help relieve pain associated with cancer as well, and particularly in patients who are unresponsive to opioid therapy. There are several THC-based drugs including Marinol (dronabinol), which comes in capsule form and Cesamet (nabilone), an oral synthetic cannabinoid that acts like THC. Both help treat the nausea and vomiting that often come as a side effect of chemotherapy, the treatment most frequently offered to cancer patients.
Who Shouldn’t Use CBD for Pain Relief?
Side effects from CBD are generally mild and may include:
The biggest concern, however, are drug interactions with some other medications, including those for heartburn, migraine, hypertension, and other conditions. This has to do with the way CBD is metabolized in the liver by a group of enzymes called CYPs. Cannabidiol can prevent CYPs from metabolizing other drugs.
There is also evidence that CBD may have interactions with other common drugs like ibuprofen, acetaminophen, some anti-seizure drugs, statins, anti-diabetic drugs, and more. To play it safe, if you’re using any other medications, talk to your doctor before using CBD.
How Can I Find a Doctor Who’s Familiar With Using CBD for Pain?
This can be a little tricky. Because CBD is not FDA approved for general use, your primary care physician may be reluctant to recommend it. If your primary doc isn’t pro-CBD or is unfamiliar with the effects, look for a doctor who specializes in integrative medicine or check with a national organization like the American Medical Marijuana Physicians Association for a provider in your area.
Cannabis Habits Among Users: Cannabis and Cannabinoid Research. (2018). “A Cross-Sectional Study of Cannabidiol Users” ncbi.nlm.nih.gov/pmc/articles/PMC6043845/
Sativex & MS Symptom Management: Drugs. (2017). “Delta-9-Tetrahydrocannabinol/Cannabidiol Oromucosal Spray (Sativex®): A Review in Multiple Sclerosis-Related Spasticity.” link.springer.com/article/10.1007/s40265-017-0720-6
The Antioxidant Power of CBD & THC: PNAS. (1998). “Cannabidiol and (-) Delta9-tetrahydrocannabinol Are Neuroprotective Antioxidants.” pubmed.ncbi.nlm.nih.gov/9653176/
CBD & Inflammation Prevention, Management in Osteoarthritis: Pain. (2017). “Attenuation of Early Phase Inflammation by Cannabidiol Prevents Pain and Nerve Damage in Rat Osteoarthritis.” pubmed.ncbi.nlm.nih.gov/28885454/
CBD & Fibromyalgia Symptom Relief: PLoS One. (2011). “Cannabis Use in Patients with Fibromyalgia: Effect on Symptoms Relief and Health-Related Quality of Life.” ncbi.nlm.nih.gov/pmc/articles/PMC3080871/
Anti-Inflammatory Effects of Cannabinoids: Future Medicinal Chemistry. (2009). “Cannabinoids as novel anti-inflammatory drugs.” ncbi.nlm.nih.gov/pmc/articles/PMC2828614/
CBD Effects on Sleep & Anxiety: The Permanente Journal. (2019). “Cannabidiol in Anxiety and Sleep: A Large Case Series.” thepermanentejournal.org/issues/2019/winter/6960-cannabis.html
CBD & Chronic Pain: Expert Opinion on Therapeutic Targets. (2017). “Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients?” tandfonline.com/doi/abs/10.1080/14728222.2017.1353603
CBD & Cannabis for Headache Pain Management: Cannabis and Cannabinoid Research. (2017). “The Use of Cannabis for Headache Disorders.” ncbi.nlm.nih.gov/pmc/articles/PMC5436334/
CBD Gel & Arthritis Pain Relief: European Journal of Pain. (2015). “Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis.” ncbi.nlm.nih.gov/pmc/articles/PMC4851925/
Cannabinoids & Cancer: Progress in Neuro-Psychopharmacology and Biological Psychiatry. (2016). “The use of cannabinoids as anticancer agents.” sciencedirect.com/science/article/pii/S0278584615001190
Cannabinoids & Chronic Pain: Therapeutics and Clinical Risk Management. (2008). “Cannabinoids in the management of difficult to treat pain.” ncbi.nlm.nih.gov/pmc/articles/PMC2503660/
CBD & Anxiety: Neurotherapeutics. (2015). “Cannabidiol as a Potential Treatment for Anxiety Disorders.” ncbi.nlm.nih.gov/pmc/articles/PMC4604171/