Medically reviewed by Dr. Anna Schwabe, PhD, Cannabis Geneticist & Evolutionary Biologist
Cannabidiol (CBD) is a cannabinoid manufactured by the cannabis Cannabis sativa plant. Unlike its famous cousin tetrahydrocannabinol (THC), CBD doesn’t produce a euphoric high.
Some individuals with chronic pain use CBD products to manage their symptoms. CBD oil may help alleviate:
Studies have demonstrated CBD’s analgesic — or pain-relieving effects — on various types of pain .
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 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 .
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 . There are two types of chronic pain:
-Neuropathic pain (nerve related pain)
-Inflammatory pain (inflammation related pain)
Research suggests that orally administrated CBD oil may help benefit both .
Multiple studies have found CBD could have benefits for certain kinds of chronic pain, as well as pain related metrics like improving sleep, reducing inflammation, and improving quality of life .
Both THC and CBD, have been demonstrated to have benefits for chronic neuropathic or nerve related pain .
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 .
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 .
Therefore, 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.
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 . However, additional research is needed .
Even so, there is mounting evidence that CBD improves chronic neuropathy pain .
A proposed mechanism by which CBD reduces neuropathic pain is through the glutamatergic system. This system is a network of excitatory pathways where glutamate is the neurotransmitter responsible for sending signals between nerve cells.
The glutamate system is largely responsible for creating and sustaining nerve pain .
It appears that the neuroprotective antioxidant effects of CBD and THC can reduce glutamate toxicity, thereby reducing pain .
In fact, CBD may be more more protective against glutamate neurotoxicity than other antioxidants such as ascorbate (vitamin C) and alpha-tocopherol (vitamin E) .
Interestingly, when the endocannabinoid receptors are blocked, the neuroprotection observed with CBD and THC was unaffected. This suggests that the antioxidant effects of CBD happen outside the endocannabinoid system pathways .
A double-blind placebo-controlled study suggests neuropathic pain that is treatment resistant may be greatly improved by taking CBD and other cannabinoids .
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 can be up to twenty times more effective in the treatment of inflammatory conditions .
In rodents treatment with CBD was found to significantly suppress chronic inflammatory pain without causing apparent analgesic tolerance .
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 .
In mice, CBD was found to significantly suppress chronic inflammatory pain caused by noxious heat stimulation .
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 .
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 .
Mechanisms of action
CBD works by directly and indirectly interacting with various receptors, ion channels, and enzymes located all throughout our bodies.
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.
The molecular targets for CBD include various receptors, enzymes and ion channels involved in pain perception and analgesia .
For example, CBD binds to opioid receptors which are part of the body's internal system for regulating pain, reward, and addictive behaviors .
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 .
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 .
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 .
CBD for headache pain relief
In theory, CBD may help alleviate headache pain in theory, 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 .
THC mimics the actions of anandamide, whereas CBD appears to inhibit anandamide breakdown.
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 .
CBD possesses anti-arthritic activity and may reduce cell viability, proliferation and production of RASF cells, thereby alleviating arthritis pain .
Preliminary research also suggests that when taken orally after the onset of clinical symptoms, CBD may block progression of arthritis . 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 .
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.
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 .
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 .
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.
Research also shows that pain is greatly improved in fibromyalgia patients who inhale vaporized cannabis containing moderate levels of THC and CBD .
Emerging data suggests a positive effect of cannabis and CBD on fibromyalgia .
While more studies are needed, preliminary research on the benefits of treating fibromyalgia pain with CBD is promising.
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 .
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 .
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 .
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.
 Lu, J., Fan, S., Zou, G., Hou, Y., Pan, T., Guo, W., ... & Xiong, W. (2018). Involvement of glycine receptor α1 subunits in cannabinoid-induced analgesia. Neuropharmacology, 133, 224-232.
 Boehnke, K. F., Scott, J. R., Litinas, E., Sisley, S., Williams, D. A., & Clauw, D. J. (2019). Pills to Pot: Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain. The journal of pain, 20(7), 830–841.
 Committee on Advancing Pain Research, Care, and Education; Board on Health Sciences Policy; Institute of Medicine. (2011). A Call for Cultural Transformation of Attitudes Toward Pain and Its Prevention and Management. Journal of Pain & Palliative Care Pharmacotherapy, 25(4), 365-369.
 Costa, B., Trovato, A. E., Comelli, F., Giagnoni, G., & Colleoni, M. (2007). The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. European journal of pharmacology, 556(1-3), 75–83.
 Argueta, D. A., Ventura, C. M., Kiven, S., Sagi, V., & Gupta, K. (2020). A Balanced Approach for Cannabidiol Use in Chronic Pain. Frontiers in pharmacology, 11, 561.
 Linher-Melville, K., Zhu, Y. F., Sidhu, J., Parzei, N., Shahid, A., Seesankar, G., ... & Singh, G. (2020). Evaluation of the preclinical analgesic efficacy of naturally derived, orally administered oil forms of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), and their 1: 1 combination. Plos one, 15(6), e0234176.
 Russo, E. B. (2008). Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?. Neuro endocrinology letters, 29(2), 192-200.
 Notcutt, W., Price, M., Miller, R., Newport, S., Phillips, C., Simmons, S., & Sansom, C. (2004). Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 ‘N of 1’studies. Anaesthesia, 59(5), 440-452.
 Comelli, F., Giagnoni, G., Bettoni, I., Colleoni, M., & Costa, B. (2008). Antihyperalgesic effect of a Cannabis sativa extract in a rat model of neuropathic pain: mechanisms involved. Phytotherapy research, 22(8), 1017-1024.
 Wade, D. T., Robson, P., House, H., Makela, P., & Aram, J. (2003). A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clinical rehabilitation, 17(1), 21-29.
 Meng, H., Johnston, B., Englesakis, M., Moulin, D. E., & Bhatia, A. (2017). Selective cannabinoids for chronic neuropathic pain: a systematic review and meta-analysis. Anesthesia & Analgesia, 125(5), 1638-1652.
 Boehnke, K. F., Gagnier, J. J., Matallana, L., & Williams, D. A. (2021). Cannabidiol Use for Fibromyalgia: Prevalence of Use and Perceptions of Effectiveness in a Large Online Survey. The Journal of Pain.
 Osikowicz, M., Mika, J., & Przewlocka, B. (2013). The glutamatergic system as a target for neuropathic pain relief. Experimental physiology, 98(2), 372–384.
 Hampson, A. J., Grimaldi, M., Axelrod, J., & Wink, D. (1998). Cannabidiol and (-)Delta9-tetrahydrocannabinol are neuroprotective antioxidants. Proceedings of the National Academy of Sciences of the United States of America, 95(14), 8268–8273.
 Serpell M, Ratcliffe S, Hovorka J, et al. A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment. Eur J Pain. 2014;18:999–1012.
 Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245–259.
 Xiong, W., Cui, T., Cheng, K., Yang, F., Chen, S. R., Willenbring, D., Guan, Y., Pan, H. L., Ren, K., Xu, Y., & Zhang, L. (2012). Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors. The Journal of experimental medicine, 209(6), 1121–1134.
 Welty TE, Luebke A, Gidal BE. Cannabidiol: promise and pitfalls. Epilepsy Curr. 2014;14:250–2.  Ward SJ, McAllister SD, Kawamura R, Murase R, Neelakantan H, Walker EA. Cannabidiol inhibits paclitaxel-induced neuropathic pain through 5-HT 1A receptors without diminishing nervous system function or chemotherapy efficacy. Br J Pharmacol. 2014;171:636–45.
 Greco, R., Gasperi, V., Maccarrone, M., & Tassorelli, C. (2010). The endocannabinoid system and migraine. Experimental neurology, 224(1), 85-91.
 Tham, M., Yilmaz, O., Alaverdashvili, M., Kelly, M., Denovan-Wright, E. M., & Laprairie, R. B. (2019). Allosteric and orthosteric pharmacology of cannabidiol and cannabidiol-dimethylheptyl at the type 1 and type 2 cannabinoid receptors. British journal of pharmacology, 176(10), 1455–1469.
 Mlost, J., Bryk, M., & Starowicz, K. (2020). Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action. International journal of molecular sciences, 21(22), 8870.
 Bian, Ym., He, Xb., Jing, Yk. et al. Computational systems pharmacology analysis of cannabidiol: a combination of chemogenomics-knowledgebase network analysis and integrated in silico modeling and simulation. Acta Pharmacol Sin 40, 374–386 (2019).
 McPartland, J. M., Guy, G. W., & Di Marzo, V. (2014). Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid system. PloS one, 9(3), e89566.
 Smith, S. C., & Wagner, M. S. (2014). Clinical endocannabinoid deficiency (CECD) revisited: can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?. Neuro endocrinology letters, 35(3), 198-201.
 Richardson, J. D., Aanonsen, L., & Hargreaves, K. M. (1997). SR 141716A, a cannabinoid receptor antagonist, produces hyperalgesia in untreated mice. European journal of pharmacology, 319(2-3), R3-R4.
 Pini, L. A., Guerzoni, S., Cainazzo, M. M., Ferrari, A., Sarchielli, P., Tiraferri, I., Ciccarese, M., & Zappaterra, M. (2012). Nabilone for the treatment of medication overuse headache: results of a preliminary double-blind, active-controlled, randomized trial. The journal of headache and pain, 13(8), 677–684.
 Rhyne, D. N., Anderson, S. L., Gedde, M., & Borgelt, L. M. (2016). Effects of Medical Marijuana on Migraine Headache Frequency in an Adult Population. Pharmacotherapy, 36(5), 505–510.
 Cuttler, C., Spradlin, A., Cleveland, M. J., & Craft, R. M. (2020). Short-and long-term effects of cannabis on headache and migraine. The Journal of Pain, 21(5-6), 722-730.
 Huber, L. C., Distler, O., Tarner, I., Gay, R. E., Gay, S., & Pap, T. (2006). Synovial fibroblasts: key players in rheumatoid arthritis. Rheumatology (Oxford, England), 45(6), 669–675.
 Lowin, T., Tingting, R., Zurmahr, J., Classen, T., Schneider, M. and Pongratz, G., 2020. Cannabidiol (CBD): A killer for inflammatory rheumatoid arthritis synovial fibroblasts. Cell death & disease, 11(8), pp.1-11.
 Malfait, A.M., Gallily, R., Sumariwalla, P.F., Malik, A.S., Andreakos, E., Mechoulam, R. and Feldmann, M., 2000. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proceedings of the National Academy of Sciences, 97(17), pp.9561-9566.
 Hammell, D.C., Zhang, L.P., Ma, F., Abshire, S.M., McIlwrath, S.L., Stinchcomb, A.L. and Westlund, K.N., 2016. Transdermal cannabidiol reduces inflammation and pain‐related behaviours in a rat model of arthritis. European Journal of Pain, 20(6), pp.936-948.
 Bielefeldt, K., Davis, B. and Binion, D.G., 2009. Pain and inflammatory bowel disease. Inflammatory bowel diseases, 15(5), pp.778-788.
 Esposito, G., Filippis, D.D., Cirillo, C., Iuvone, T., Capoccia, E., Scuderi, C., Steardo, A., Cuomo, R. and Steardo, L., 2013. Cannabidiol in inflammatory bowel diseases: a brief overview. Phytotherapy Research, 27(5), pp.633-636.
 De Filippis, D., Esposito, G., Cirillo, C., Cipriano, M., De Winter, B.Y., Scuderi, C., Sarnelli, G., Cuomo, R., Steardo, L., Joris, G. and Iuvone, T., 2011. Cannabidiol reduces intestinal inflammation through the control of neuroimmune axis. PLoS One, 6(12), p.e28159.
 Pagano, E., Capasso, R., Piscitelli, F., Romano, B., Parisi, O.A., Finizio, S., Lauritano, A., Marzo, V.D., Izzo, A.A. and Borrelli, F., 2016. An orally active cannabis extract with high content in cannabidiol attenuates chemically-induced intestinal inflammation and hypermotility in the mouse. Frontiers in pharmacology, 7, p.341.
 Sluka, K.A. and Clauw, D.J., 2016. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience, 338, pp.114-129.
 Richardson, J.D., Aanonsen, L. and Hargreaves, K.M., 1998. Hypoactivity of the spinal cannabinoid system results in NMDA-dependent hyperalgesia. Journal of Neuroscience, 18(1), pp.451-457.
 Bohr, T., 1996. Problems with myofascial pain syndrome and fibromyalgia syndrome. Neurology, 46(3), pp.593-597.
 van de Donk, T., Niesters, M., Kowal, M.A., Olofsen, E., Dahan, A. and van Velzen, M., 2019. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain, 160(4), p.860.
 National Academies of Sciences, Engineering, and Medicine, 2017. Therapeutic effects of cannabis and cannabinoids. In The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies Press (US).
 Gulbransen, G., Xu, W. and Arroll, B., 2020. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand. BJGP open, 4(1).
 Pollastro, F., Minassi, A. and Fresu, L.G., 2018. Cannabis phenolics and their bioactivities. Current medicinal chemistry, 25(10), pp.1160-1185.
 Russo, E.B., 2019. The case for the entourage effect and conventional breeding of clinical cannabis: no “strain,” no gain. Frontiers in plant science, 9, p.1969.
 Finlay, D.B., Sircombe, K.J., Nimick, M., Jones, C. and Glass, M., 2020. Terpenoids from cannabis do not mediate an entourage effect by acting at cannabinoid receptors. Frontiers in pharmacology, 11, p.359.