Chronic pain relief | Neuropathic pain relief | Inflammatory pain relief | Mechanisms of action | Headache pain relief | Arthritis pain relief | Abdominal pain relief | Additional information
Medically reviewed by Dr. Anna Schwabe, PhD, Cannabis Geneticist & Evolutionary Biologist
CBD, or cannabidiol, is a cannabinoid produced by hemp (a.k.a. the cannabis Cannabis sativa plant). CBD is famous for its ability to interact with our body's endocannabinoid system without producing a euphoric high like its even more famous cousin tetrahydrocannabinol (THC).
Studies have identified that CBD interacts with at least 76 different molecular targets in our body, which helps explain its ability to affect varied processes related to pain and inflammation.
Some individuals with experiencing pain use topical CBD products, such as CBD oil, to manage their symptoms. CBD oil may support:
-pain
-inflammation
-discomfort
Studies have demonstrated CBD’s analgesic — or pain-relieving effects — on various, but not all, types of pain [1].
CBD may offer an alternative for individuals with chronic pain who rely on pain medications, such as opioids or over the counter anti-inflammatories such as Ibuprofen. However, additional human studies are necessary to verify CBD oil’s pain relieving effects.
A 2019 survey found that as many as 80% of people on traditional pain medications are turning to cannabis products for pain relief instead. Of those, 53% reported substituting cannabis for opioids and 22% substituted cannabis for benzodiazepines [2].
This article explains the current scientific evidence behind CBD oil’s potential in pain management for certain conditions. Talk with your doctor to see if CBD may help you.
CBD for chronic pain relief
Chronic pain affects between 50 and 116 million American adults [3]. There are two types of chronic pain:
1. Neuropathic pain (nerve related pain)
2. Inflammatory pain (inflammation related pain)
Research suggests that orally administrated CBD oil may affect both [4].
Multiple studies have found that CBD could impact certain kinds of chronic pain, as well as pain related processes such as sleep, inflammation, and overall quality of life [5].
CBD, like its cousin THC has been demonstrated to have benefits for chronic neuropathic (nerve related) pain [6].
Dr. Ethan Russo has been investigating the potential clinical applications of cannabis and the role it may play in blocking spinal, peripheral and gastrointestinal pathways that promote pain in headache, fibromyalgia, irritable bowel syndrome and related conditions [7].
Notably, CBD does not reduce chronic pain in all contexts. A study on generalized chronic pain found CBD did not produce significant pain reductions, but did improve patient-reported quality of life and quality of sleep metrics [8].
More research is necessary to determine which conditions may benefit from CBD oil.
Neuropathic pain relief
Neuropathic pain is caused by damage to nerve cells or neurons and can be unresponsive to standard treatments.
However, along with anecdotal evidence that CBD provides relief for this type of pain, research is also uncovering the potential for CBD treatment in neuropathic pain disorders [4][9].
Neuropathic pain is associated with herniated discs, infections such as shingles, and conditions such as multiple sclerosis, rheumatoid arthritis, and fibromyalgia.
Research has demonstrated that CBD rich full spectrum or whole plant cannabis extract significantly improved pain in some patients with pain disorders [10][11]. However, additional research is needed [12].
Even so, there is mounting evidence that CBD improves chronic neuropathy pain [11].
A proposed mechanism by which CBD may reduce neuropathic pain is through the glutamate system, which is largely responsible for creating and sustaining nerve pain [13].
The glutamate system is a network of excitatory pathways where glutamate is the neurotransmitter responsible for sending signals between nerve cells.
It appears that the neuroprotective antioxidant effects of CBD and THC, both of which are found in full spectrum hemp oil, can reduce glutamate toxicity, thereby reducing pain [14].
In fact, CBD may be even more more protective against glutamate neurotoxicity than other antioxidants such as ascorbate (vitamin C) and alpha-tocopherol (vitamin E) [14].
Interestingly, when the endocannabinoid receptors are blocked, the neuroprotection observed with CBD and THC was unaffected, suggesting their antioxidant effects occur outside of endocannabinoid system pathways [14].
A double-blind placebo-controlled study suggests neuropathic pain that is treatment resistant may be greatly improved by taking CBD and other cannabinoids [15].
Past and present research indicates CBD oil has the potential to alleviate neuropathic pain associated with certain conditions and that CBD may help diminish the tingling, prickling and burning sensations often associated with neuropathic pain.
Recently, we interviewed Ironman Chad Soloman who describes using Ned's CBD Body Butter to help alleviate his nerve pain after back surgery and during training:
"After having back surgery, I have some nerve pain on my right leg and within minutes of rubbing the Body Butter on it, the pain and numbness dissipated which was huge for recovery and mentally relaxing."
You can read the full interview here.Inflammatory pain relief
Pain from inflammation causes many conditions such as headaches, cramps, muscle aches and pains, arthritis, and some autoimmune diseases.
When compared to anti-inflammatory NSAIDs like Ibuprofen, cannabinoids such as THC and CBD were found to be up to twenty times more effective in the treatment of inflammatory conditions [16].
In rodents treatment with CBD was found to significantly suppress chronic inflammatory pain without causing apparent analgesic tolerance [17].
In another study, rats with induced paw injuries were treated with oral CBD. After seven days the injuries were markedly improved, suggesting that CBD has substantial anti-inflammatory effects [4].
In mice, CBD was found to significantly suppress chronic inflammatory pain caused by noxious heat stimulation [1].
Research into the potential applications of CBD in inflammatory pain for conditions such as headache is limited, but ongoing. The limited data is encouraging because traditional anti-inflammatory drugs may lead to an increased risk of developing gastrointestinal ulcers or heart attacks.
Many of the receptors CBD binds to are associated with anti-inflammatory pathways [18].
CBD has also been shown to inhibit the release of neurotransmitters that control pain inputs which may be effective in treating inflammatory pain disorders such as migraine headaches [19].
Mechanisms of action
CBD works by directly and indirectly interacting with various receptors, ion channels, and enzymes located all throughout our bodies.[20]
In fact, studies have identified at least 76 different molecular targets to which CBD may bind and/or interact with to enact some sort of cellular change or response.[21]
The molecular targets for CBD include various receptors, enzymes and ion channels involved in pain perception and analgesia [20].
For example, CBD binds to opioid receptors which are part of the body's internal system for regulating pain, reward, and addictive behaviors [22].
CBD also interacts with our body’s endocannabinoid system. Discovered only three decades ago, the endocannabinoid system (ECS) is a communication network common to all animals except insects.
The ECS can be activated by both our own body-made endocannabinoids such as anandamide and by cannabinoids manufactured by plants (phytocannabinoids) such as CBD. This system is integral to maintaining balance or homeostasis throughout the body [23].
The endocannabinoid system has emerged as a target for pain treatment due to its involvement in the control of inflammatory and nociceptive, or pain-related responses. Endocannabinoids have been shown to inhibit the release of neurotransmitters that control pain inputs [19].
Levels of endocannabinoids are high in regions known to be involved in the transmission and modulation of pain signals. These include regions like our skin, sensory terminals, and the dorsal root ganglia.
Painful conditions including migraine headaches, fibromyalgia, irritable bowel syndrome and related disorders display common patterns that researchers believe may point to an underlying endocannabinoid deficiency [24].
Some researchers believe that the endocannabinoid system is involved in essentially all human diseases and that endocannabinoid deficiency may be treated with cannabinoid medicines [24, 25].
CBD for headache pain relief
In theory, CBD may help alleviate headache pain, but to date no CBD specific headache studies have been published.
A deficiency of the endocannabinoid anandamide has been observed in patients with chronic migraine. This suggests an under-responsive endocannabinoid system may play a role in migraine susceptibility [22].
THC mimics the actions of anandamide, whereas CBD appears to inhibit anandamide breakdown.
Studies on Nabilone (a THC-type pharmaceutical drug formulation) and THC rich cannabis show that they appear to reduce intensity and frequency of headache and migraine pain [26, 27, 28].
However, research is needed to determine if CBD is effective in treating migraine pain.
CBD for arthritis related pain relief
Rheumatoid arthritis is an inflammatory joint condition. It is characterized by the proliferation of rheumatoid arthritis synovial fibroblasts (RASFs), which mediate the most relevant pathways of joint destruction [29].
CBD possesses anti-arthritic activity and may reduce cell viability, proliferation and production of RASF cells, thereby alleviating arthritis pain [30].
Preliminary research also suggests that when taken orally after the onset of clinical symptoms, CBD may block progression of arthritis [31]. This may be due to the combination of immunosuppressive and anti-inflammatory actions of CBD.
Additionally, topical application of CBD may help people manage arthritis pain by reducing inflammation and joint swelling [32].
In A First Time Ultra Runner's Guide to CBD for Muscle Pain friend of Ned Emma Walker describes how after years of being in pain topical CBD finally helped her run and feel good doing so.
CBD for abdominal pain relief
Abdominal pain is a common symptom of inflammatory bowel disease [33]. CBD may help alleviate certain types of inflammation related abdominal pain and inflammatory bowel disease [34].
Biopsies from patients with ulcerative colitis and biopsies from intestinal segments of mice with induced intestinal inflammation, both showed that CBD attenuated inflammatory markers and led to a reduction of intestinal damage.[35]
Also, CBD rich full spectrum cannabis extract can decrease the extent of intestinal damage and reduce intestinal hypermotility associated with intestinal inflammation in rodent models. These findings support the clinical development of CBD rich cannabis extracts for inflammatory bowel disease [36].
Additional human studies are necessary to verify these effects, but existing research suggests CBD may be helpful for intestinal inflammation.
CBD for fibromyalgia pain relief
Fibromyalgia or myofascial pain syndrome is a condition characterized by widespread musculoskeletal pain and hyperalgesia, or an increased sensitivity to painful stimuli [37].
Research suggests a relationship between clinical endocannabinoid deficiency and fibromyalgia as well as that an underactive cannabinoid system is responsible for hyperalgesia.[38, 39].
The absence of endocannabinoids may underlie the hyperalgesic tender muscle points that are characteristic of this condition, and CBD may serve to bolster the underperforming endocannabinoid system.[39]
Research also shows that pain is greatly improved in fibromyalgia patients who inhale vaporized cannabis containing moderate levels of THC and CBD [40].
Emerging data suggests a positive effect of cannabis and CBD on fibromyalgia [12].
While more studies are needed, preliminary research on the benefits of treating fibromyalgia pain with CBD is promising.
Additional information
Although the data to support CBD oil as a therapy for pain management is inconclusive, researchers agree that CBD rich hemp extracts have a lot of potential.
According to research, adults with chronic pain treated with cannabinoids are more likely to experience significant reductions in pain symptoms [41].
Following 3 weeks of CBD use, chronic pain sufferers report quality of life increases as well as improvements in pain, depression and anxiety symptoms without any major adverse effects [42].
CBD oil and other cannabinoid products containing less than 0.3% THC are not regulated in the United States. Therefore, it is important to check for third-party lab results to verify cannabinoid content in the oil or products you purchase.
CBD is just one of hundreds of bioactive compounds manufactured by the cannabis plant. Active cannabis compounds include various cannabinoids, terpenes, stilbenes, flavonoids and others. Studies have shown that like CBD, many of these compounds also have anti-inflammatory, antioxidant, and analgesic effects [43].
Studies have shown that the various cannabis compounds work together in what is known as the entourage effect to enhance each other’s desired effects.[44, 45] To capture these combined benefits we recommend opting for a full spectrum hemp oil.
If you’re interested in testing cannabidiol for your chronic pain, speak to your doctor.
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