CBD for Pain Management
If you are like many others, you are wondering if CBD actually helps a person manage pain better. In this article, we will answer any questions or concerns you have about CBD for pain.
The short answer is yes, CBD definitely helps many people manage their pain symptoms better. But let’s look at how and why CBD is a good supplement for an overall healthy lifestyle.
Here’s what you need to know before you give topical CBD a try
You don’t need me to tell you that CBD (cannabidiol) is everywhere. You can eat it, you can drink it, you can vape it, you can even bathe in it. And although there’s still plenty to learn about this fascinating little compound, fans of it claim that it has some pretty impressive benefits—particularly when it comes to managing pain.
Personally, I always keep a few jars of it around at home to help with the shoulder and neck muscle tension inherent in a job consisting mainly of typing and holding a phone next to my face. But it turns out that the research behind these claims is limited, to say the least.
What is CBD exactly?
CBD is one of 100+ chemical compounds (called cannabinoids) found in the cannabis plant, which produces both marijuana and hemp. CBD is an extremely close chemical cousin of THC, which is the cannabinoid in marijuana that can give people a high. No matter how much CBD you consume, though, it cannot get you stoned.
CBD's lack of psychotropic effects is what's pushed it into the spotlight recently. “Given that a 1:1 combination of CBD to THC has proven beneficial to improve pain, we are hopeful that CBD alone will improve pain," explains Kim Jones, Ph.D., FNP, FAAN, dean and professor of Nursing at Linfield College.
CBD and the FDA
What's more, at the end of September 2018, the Food and Drug Administration (FDA) approved the anti-seizure drug Epidiolex, which contains cannabis-sourced CBD. Regular cannabis is a Schedule I substance, which, according to the United States Drug Enforcement Administration (DEA), means it has no currently accepted medical use and a high potential for abuse. Epidiolex, on the other hand, is a Schedule V drug, which means it can be used to treat medical issues and has a low potential for abuse.
“That really opened the door for a lot of CBD-only plant extract products,” Jones explains. Now, you can find CBD-infused oils, lotions, drinks, and more basically everywhere. Unlike Epidiolex, though, these products are considered nutraceuticals—not pharmaceutical drugs. This means they cannot make any health claims; however, no law prevents celebrities (or that hot dude from your gym) from telling you that they work.
As the anecdotal evidence continues to pile up, these products are slowly but surely being put into the spotlight. In turn, there has been a lot of hearsay and confusion regarding CBD's efficacy. Which leads us to...
Can CBD actually help with pain?
At this point, there aren't too many studies to back the growing pool of anecdotal evidence. A few test tube and animal studies have found that CBD may have anti-inflammatory properties, and pain is often related to inflammation. And according to some small, preliminary human trials, there's a chance CBD may also help alleviate neuropathic pain (pain caused by nerve damage).
Here’s what the research says about using CBD for pain.
The most common medical reason for which people report using CBD is to manage chronic pain, followed closely by managing arthritis or joint pain. But does it actually work?
When the National Academies of Sciences, Medicine, and Engineering evaluated decades of cannabis research, they concluded that "in adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms."
But that’s not quite as exciting for CBD as it sounds: “We don’t know cannabidiol’s effects on its own,” says Cooper, who was part of the National Academies committee that put together this report. “[The conclusions about cannabis and cannabinoids] were based on what we know about THC or THC plus cannabidiol.”
In fact, the most compelling research they found for using cannabinoids for pain came from a large review and meta-analysis published in JAMA in 2015. For the study, researchers looked at results from 79 previous studies of cannabinoids and various medical conditions, including chronic pain. However, of those studies, only four involved CBD (without THC)—none of which were looking at pain. So although we might assume that CBD is doing something to help address pain—according to the studies involving the whole cannabis plant—we don’t have great evidence to prove it.
“It might be that cannabidiol by itself is helpful for pain, but at this point we don’t know that,” Cooper says.
CBD Studies on Animals
The studies we do have about CBD for pain are all animal studies. For example, in a 2017 study published in Pain, researchers gave rats an injection into one of their knee joints to model osteoarthritis. Rats then either received doses of CBD or saline directly into an artery in the knee joint. Results showed that, after receiving CBD, rats showed less inflammation in the joint area and fewer pain-related behaviors (like shaking or withdrawing the affected paw or not being able to bear weight in that paw) compared to those that received saline.
Another study published in 2016 in the European Journal of Pain also looked at arthritis in rats but did so with a topical formulation of CBD. After the rats received an injection into one knee joint to model arthritis, they received a gel that contained either 10 percent CBD (in four different total amounts) or 1 percent CBD (the control) on four consecutive days. The gel was massaged into the rats’ shaved backs for 30 seconds each time.
Then the researchers measured the inflammation in each rat’s knee joint, the level of CBD that made it into their bloodstream, and their pain-related behaviors. They found that the rats that were given the two highest doses of CBD showed significantly lower levels of inflammation and lower pain behavior scores compared to those that got the control. The two lower doses didn’t show much of an effect.
But if you’re reading this, you are probably not a rat, which means these results aren’t directly applicable to your life. Although we know that rats do share much of our physiology—including CB1 and CB2 receptors—these studies don’t really tell us if humans would have the same results with CBD.
CBD Studies on Humans
“There’s really no substitute for doing proper human studies, which are difficult, expensive, and ethically complicated,” Dr. Tishler says. And we simply don’t have them for CBD and pain.
The only thing that comes close is a Phase 2 clinical trial using a proprietary CBD transdermal gel (meaning it’s meant to go through the skin into the bloodstream) in 320 patients with knee osteoarthritis over 12 weeks, which has not been peer-reviewed to date. Unfortunately, in almost all of the study’s measures of pain, those who received CBD didn’t have statistically different scores from those who got a placebo. But “they found some reductions in pain and improvements in physical function,” Boehnke says.
Despite this growing pool of research, "We don't have what we'd want in terms of clinical trials on [CBD's] safety and efficacy for anything beyond the treatment of rare seizure disorder. We need more research,” says Ryan Vandrey, Ph.D., associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine
Is there any harm in trying CBD?
CBD seems to be safe and well-tolerated, and, unlike THC or opioids, there doesn't seem to be a risk of dependence or abuse.
However, if you take blood thinners or anti-seizure drugs, do not take CBD, as it can interact with those medications. (And if you take any other medications, always talk to your doctor before trying something OTC.
CBD and Regulations
Another thing to consider is the lack of regulation. In a research letter published in JAMA in 2017, scientists tested 84 CBD products. A quarter of them contained less CBD than labeled. They also found THC in 18 of the products in large enough quantities to cause intoxication or impairment, especially among children.
In a research letter published in JAMA in 2017, scientists tested 84 CBD products. A quarter of them contained less CBD than labeled. They also found THC in 18 of the products in large enough quantities to cause intoxication or impairment, especially among children.
Final Thoughts on CBD for Pain
If you want to give CBD a try, products that you apply topically may be a good start. Allure Hemp has a 1000 mg hemp-based salve that works very well. Rate your pain on a scale of 1 to 10 each day, and also note what else is going on, like if you didn't get enough sleep. That way, you can see if the product is actually doing anything for you.