CBD Oil for Pain: Impacting Perception and Inflammation

Millions of people struggle with daily chronic pain. But pharmaceutical treatments are fraught with dangerous side effects, leaving people to choose between pain relief or their long-term health.

Dr. Debra Kimless, cannabinoid researcher and board-certified anesthesiologist, understands the difficulties that come from living with chronic pain. “People want to feel okay. They don’t want to be sidelined by pain or by pain meds.”

This desire has led people to turn to alternative therapies in the hopes of finding safer, more effective ways to manage pain.

CBD oil is one of the most talked-about natural remedies for pain — can it truly bring relief?

About Pain

We have all experienced pain. The most common type is acute pain, or pain that is short-lived. When you stub your toe, twist your ankle, or cut your finger, the pain you experience is acute.

More problematic than acute pain is chronic pain, which is any pain that lasts for more than six months. It is this type of pain that is particularly challenging to treat.

One in five adults in the United States suffers from chronic pain, according to the Centers for Disease Control and Prevention.

This pain can rob people of the activities that they enjoy most. It can make work impossible, resulting in financial difficulties for individuals, their families, and the economy at large. Over time, the effects of chronic pain can lead to anxiety and depression.

Understanding the Different Types of Pain

Both acute and chronic pain can be further classified to help doctors and patients identify and treat pain. Pain is typically categorized based on its cause and its location.

When it comes to the cause of pain, pain is defined as either nociceptive or neuropathic.

Nociceptive pain is caused by tissue damage. This is the type of pain associated with inflammation, such as a physical injury or arthritis pain.

Neuropathic pain is caused by damage to or dysfunction of the system responsible for pain signaling, the nervous system. Diabetic neuropathy, carpal tunnel syndrome, and Multiple Sclerosis all result in neuropathic pain.

Another way to classify pain is by where the pain is located. Musculoskeletal pain, for example, is pain that occurs in muscles, joints, bone, or tendons. Neuropathic pain is often broken down by where the pain originates.

For example, peripheral neuropathic pain results from injury or dysfunction along peripheral nerves (like those in your hands and feet). Central neuropathic pain is caused by damage or dysfunction in the brain or spinal cord.

However, categorizing pain is more challenging than it seems on the surface. Many types of pain are hard to identify or do not fit neatly into any one category.

One example is the pain associated with fibromyalgia. Fibromyalgia patients can experience full-body aching, burning, or stabbing pain with an unidentified source. This lack of understanding makes fibromyalgia-related pain difficult to treat.

Treating Chronic Pain

Pain management for those with chronic pain is challenging. Pharmaceutical medications are rarely a cure for chronic pain conditions due to their limited efficacy and dangerous side effects.

Let’s look at one of the most common categories of over-the-counter pain-relieving drugs: non-steroidal anti-inflammatory drugs (NSAIDs).

NSAIDs are largely effective at temporarily relieving inflammatory pain like that associated with injuries or headaches. However, they are not very effective against neuropathic pain.

Additionally, the long-term use of NSAIDs is dangerous for the health of your cardiovascular system, kidneys, and gastrointestinal tract. These long-term side effects make NSAIDs a poor treatment option for chronic inflammatory conditions, such as irritable bowel disease or arthritis.

Opioids are another popular category of pain-relieving drugs. Drowsiness and constipation are common side effects, but the most significant danger is opioid addiction. Over time, patients can experience tolerance to opioids, leading to the need to take more. Tolerance and withdrawal are dangerous, with the resultant opioid epidemic sweeping the nation.

In spite of these and other treatment options, many chronic pain sufferers are left with intense, lasting pain with no known cure. People need safer, more effective solutions. This is why people are turning to alternative treatments, such as cannabinoid therapy.

How CBD Could Affect Pain

The cannabis plant has been used for millennia as a natural therapy for pain. Today, the most commonly cited reason for the use of medical marijuana is for pain relief from conditions like multiple sclerosis, cancer, and HIV.

Many people would prefer to get the pain-relieving benefits of cannabis without the “high” associated with THC. For this, people are turning to CBD oil.

What Is CBD?

CBD, or cannabidiol, belongs to a group of compounds called phytocannabinoids. THC, or tetrahydrocannabinol, is the other most well-known phytocannabinoid. Researchers are studying these and other cannabis-derived substances for their potential in human health and disease.

THC is the chemical compound that causes the mind-altering effects often associated with cannabis. Unlike THC, though, CBD is not intoxicating. As a result, CBD oils without THC will not cause a “stoned” sensation.

CBD oil is usually extracted from industrial hemp plants. By definition, hemp plants must contain very little THC. Because most CBD oil is sourced from hemp, you will sometimes hear it referred to as “CBD hemp oil” or “phytocannabinoid rich hemp oil.”

Interest in the therapeutic benefits of CBD and other phytocannabinoids is steadily growing. This growth is thanks to promising studies, increasing legality, and mainstream popularity.

How CBD Oil Might Help with Pain

CBD may prove to be beneficial for chronic pain conditions because of how it interacts with the systems in our bodies involved in pain perception and inflammation.

CBD, THC, and other phytocannabinoids work through interacting with receptors, enzymes, and ion channels found throughout the human body. Many of the receptors and enzymes that they influence are found in the endocannabinoid system (ECS).

The ECS is a vast system with receptors located in nearly every cell in the human body. Its primary role appears to be maintaining balance, and it does so through its connection with all other bodily systems.

Researchers have discovered that the ECS plays a central role in our immune system, inflammation, and pain perception. The ECS creates endocannabinoids as a way to exert its effects.

Endocannabinoids are signaling molecules that tell the ECS what to do by binding to its receptors. In essence, everything that the ECS does is dictated by cannabinoids binding to receptors.

External phytocannabinoids like CBD and THC can influence the ECS. They can bind to receptors, inhibit enzymes, and increase the abundance of naturally occurring endocannabinoids.

Through this interaction, CBD may enhance the health and function of the ECS, thereby impacting pain sensation and inflammation.

CBD can also interact with other receptor systems in addition to those of the ECS. For instance, animal studies have found CBD to interact with 5-HT/serotonin receptors. These receptors are involved in anxiety, addiction, appetite, sleep, pain, vomiting, and nausea. As people with chronic pain conditions often struggle with each of these, CBD might help with pain as well as its consequences.

Does CBD Help with Pain?

Scientists are still in the early stages of CBD research. For many decades, researching Cannabis sativa or any of its constituents was challenging due to legal restrictions. Hemp only became legal with the passing of the 2018 Farm Bill. With increased legality comes more research – but this research takes time.

As it stands today, very few studies exist on the potential of CBD alone for pain. The vast majority of research has been preclinical studies, leaving consumers to experiment for themselves when it comes to the ability of CBD to help with pain.

And as you may know, many people have decided to see if CBD oil can help with their medical conditions. In a study published in Cannabis and Cannabinoid Research, Dr. Corroon and his team surveyed over 2,400 CBD users. Chronic pain was the most common medical condition that participants reported using CBD to treat.

When it comes to human studies examining the analgesic potential of CBD, most have investigated a combination of CBD with THC. The early findings have been promising, but more research is needed before conclusions can be drawn.

CBD Oil for Pain: Research Highlights

2019: CANNABIS AND CHRONIC PAIN IN FIBROMYALGIA PATIENTS

In this randomized, placebo-controlled human trial, researchers set out to determine the effects of inhaled pharmaceutical-grade cannabis on pain in fibromyalgia patients.

The three cannabis formulations tested were:

1. High THC/Low CBD
2. High THC/High CBD
3. Low THC/High CBD

Both formulations that were high in THC resulted in analgesic benefits, but high CBD, low THC formulas did not lead to any significant difference compared to placebo.

This study supports the use of cannabinoid therapy in fibromyalgia patients, particularly cannabis compounds that are high in THC. It did not find any significant benefit of a high CBD, low THC product.

2018: CBD AND THC IN CANCER PAIN

In a double-blind, randomized, placebo-controlled human clinical trial, researchers studied the efficacy of nabiximols (Sativex®) against treatment-resistant cancer pain. Nabiximols is a cannabis extract with a roughly 1:1 THC to CBD ratio.

The researchers found nabiximols to be more effective than placebo by the fifth week of treatment in all pain-related endpoints. After further analysis, however, they found that the treatment was statistically beneficial for patients in the US, but not those from the rest of the world. Differences in opioid doses or the cause of the pain may be the reason for this difference.

2018: CANNABINOIDS FOR PAIN

In this recent meta-analysis, the authors examined the current evidence surrounding the efficacy and safety of cannabis or cannabinoids for the treatment of pain in adults. They concluded that “the evidence from current research supports the use of medical cannabis in the treatment of chronic pain in adults.”

The authors highlight that CBD-only therapy has not been extensively studied. However, CBD has demonstrated the potential to act synergistically with THC to help relieve pain. Additionally, CBD has shown an ability to reduce THC’s side effects.

The authors highlighted the need for more extensive human studies to determine the potential long-term safety and efficacy of cannabis and cannabinoids for the treatment of pain.

2018: CBD IN MULTIPLE SCLEROSIS

A recent review published in Frontiers in Neurology examined the current research into the potential for CBD to help with symptoms of multiple sclerosis (MS). They concluded that CBD might be beneficial for mobility in those with MS due to related decreases in pain, inflammation, spasticity, fatigue, and depression.

Medical Professionals on CBD, Cannabis, and Pain

Early research provides promise for CBD and other cannabinoids for chronic pain sufferers. But with so few human clinical trials, we must wait until more research is conducted before we can draw definitive conclusions.

In spite of limited research, patients are turning to cannabis products in the hope of finding relief. Fortunately, there are medical experts across the United States who have expertise in helping patients manage their chronic pain. Some of these medical professionals include cannabinoid therapy in their treatments.

So, what do these doctors have to say about CBD, cannabis, and pain relief?

We spoke with Dr. Debra Kimless, a doctor and researcher who specializes in pain relief and cannabinoid therapy.

According to Dr. Kimless, “CBD-only therapy is most helpful for those suffering from neuropathic pain and musculoskeletal pain. CBD doesn’t work well for acute pain. Someone wouldn’t be very happy if they broke their arm and were only given CBD.”

This is where a combination of THC and CBD might benefit a patient. “When you combine CBD and THC, the sky’s the limit when it comes to painful conditions.”

However, Dr. Kimless stresses the importance of lifestyle changes when it comes to treating any condition, including chronic pain. Her private patients must commit to a whole-food, plant-based diet before she works with them. “Just throw a pill at it, whether pharmaceutical or cannabinoid, that’s not the solution.”

And when it comes to cannabis therapies, there is no one-size-fits-all solution. “Remember, this is a truly individualized medicine. Everyone responds differently.”

Can CBD Replace Pharmaceutical Pain Killers?

When you review cannabis literature, you find reports of patients replacing some or all of their pharmaceutical pain medications with medical cannabis or CBD.

We spoke with Dr. Jamie Corroon, a leading cannabis researcher and founder of the Center for Medical Cannabis Education, to ask him about his experience with cannabis and pharmaceutical use.

In Dr. Corroon’s experience, “Patients are reducing the dose and frequency of prescription drugs by using phytocannabinoids. In some cases, they are discontinuing these medications entirely. This is a real-world phenomenon, but it’s not a given. It can be challenging, depending on the person and the clinical circumstances.”

In a 2017 study published by Dr. Corroon and his colleagues, 2,774 cannabis users took a survey that asked questions regarding the use of cannabis in place of prescription drugs. 36% of respondents reported substituting cannabis for narcotics or opioid drugs.

These findings support those from a recent study that found that medicinal cannabis may decrease opioid use and benefit those with treatment-resistant pain. And with rising concerns regarding the opioid crisis, many experts are optimistic about the potential for cannabis as a safer alternative or adjunct therapy for chronic pain patients.

So, what type of cannabinoid therapy might help the most when it comes to substituting for prescription pain meds?

According to Dr. Corroon, “THC and CBD in combination seem to be the most effective for treating pain. CBD alone, meaning without meaningful levels of THC, only seems to help a minority of patients. At least this is my clinical observation.”

Using CBD Oil for Pain

Before you go shopping for CBD, you first must decide what you want in a cannabis product.

According to both Dr. Corroon and Dr. Kimless, a cannabis product with both THC and CBD may be the best option for many chronic pain patients. But only those who live in states with legalized recreational or medical marijuana will have access to products with more than 0.3% THC.

If you have access to legal marijuana and would like to try cannabis for pain, know that you can limit the psychoactive effects of cannabis products. To do so, determine the lowest quantity of THC that helps with your pain. The less THC that you consume, the less intoxication that you will feel. Additionally, a product with high amounts of CBD may help to reduce THC’s intoxicating effects.

For those who would prefer a hemp-derived product, or for anyone living in a state without legalized marijuana, a broad spectrum or full-spectrum CBD oil is a good option. These CBD oils will not get you high, but still contain additional healthful compounds that may boost the benefits of the CBD oil. The ability of compounds in cannabis to work better together than apart is known as the entourage effect.

Finding a Good CBD Product

The use of CBD hemp oil is federally legal, but you should familiarize yourself with any CBD-specific laws in your state.

It’s also important to remember that the Food and Drug Administration (FDA) has not approved CBD oil as a supplement. In fact, the only FDA-approved CBD product is the prescription medication Epidiolex, which is used for rare childhood seizure disorders.

All other hemp-derived CBD products are operating in a regulatory gray area, and inconsistent product quality is a consequence of this lack of regulation.

In a recent study, researchers found that the majority of CBD products tested were mislabeled. Some contained more or less CBD or THC than was listed on the label. This study highlights the importance of sourcing a high-quality CBD product.

Medical marijuana dispensaries are your best bet for sourcing cannabidiol oil (with or without high levels of THC) that is regulated to the same standards as medical cannabis. These facilities require testing for products found within, confirming their safety and chemical composition.

Yet, not everyone has access to a marijuana dispensary. And even for those that do, CBD oil can cost more there. If you decide to buy your CBD oil elsewhere, ask for a Certificate of Analysis (COA). These test results show you what the product contains. Dig in a bit to understand what the results mean before you make a purchase.

What Dosage to Take

Everyone responds to cannabinoids differently. To get the greatest benefit while reducing the risk of side effects, you will want to find the lowest effective dosage for you. The general guideline when it comes to dosing CBD or THC is to start low and go slow. Many products suggest a standard dose for reference.

And if you are also taking other medications, be sure to work with your healthcare provider to determine a safe dosage and avoid drug interactions. Read on to learn more.

Is CBD for Pain Safe? CBD’s Side Effects

There is a misconception in our society that “natural” means safe. While CBD has been found to be well tolerated in humans, that does not mean that it is without risks or side effects.

The most significant risk when taking CBD is its interaction with other medications. Because of how CBD is metabolized in the liver, it can influence the metabolism of other medications, both prescription and over-the-counter. Be sure to check with your health care provider if you are taking other medicines and would like to add in cannabinoid therapy.

To minimize drug interactions, take CBD at least an hour apart from any other medications. Additionally, the lower the dose of CBD, the less likely you are to experience interactions.

Will CBD cause you to fail a drug test?

While the two cannabinoids could be most effective in combination, there are a few things that you should keep in mind if you choose a CBD product with THC.

If you may be subject to drug testing, either through your job or through a pain management program, you might want to be safe and avoid THC. This is especially true if you will be using CBD regularly for chronic pain, as THC can build up in your body over time. Even if you choose a product that contains a very low quantity of THC, there is a small possibility that it could cause a positive result on a drug test.

There are alternatives, though. Look for products that use CBD isolate, and talk to your doctor about what will be most effective for you.