CBD for Chronic Pain
Chronic pain is a common reason people seek out Cannabidiol (CBD) products. It makes sense, because chronic pain can reflect chronic inflammation, and CBD has been shown to be effective as an anti-inflammatory substance. It’s been shown in cell studies to reduce inflammatory cytokines TNF, IL-1, and IFN-γ. A review study published in the journal of Free Radical Biology and Medicine showed CBD to have benefits for diseases and disorders that are characterized by chronic inflammation and the associated immune system activation and oxidative stress, including rheumatoid arthritis and neuropathic pain.
What is it about CBD that helps with chronic pain and inflammation? You may have heard talk about the impact of marijuana or hemp on our endocannabinoid system. It was research into the workings of plant cannabinoids from hemp (Cannabis sativa) that led to the discovery of our innate cannabinoid-producing system –our endocannabinoid system (ECS). This system is responsible for helping the body maintain homeostasis (balance) in some key areas –particularly within the nervous system and the immune system, which can translate into pain- and inflammatory control.
However, while the cannabinoid, tetrahydrocannabinol (THC), works by binding to the CB1 and CB2 receptors that are part of that endocannabinoid system to reduce pain and inflammation, CBD actually works outside that system. It works by binding to a key stress- and pain-related receptor called TRPV1 as well as a few other receptors that influence things like pain and dysfunction.
CBD, the Brain, and Pain
It’s well-known that the nervous system, including the brain, is involved in the perception of pain through nociceptors and the afferent pain pathways. In fact, it’s the impact on brain circuitry and chemistry that is the mechanism behind how the placebo effect works.
Chronic pain may actually be tied to an overactive limbic system, seen in anxiety disorders and states of chronic stress. The limbic system includes the hippocampus, amygdala, and ventromedial prefrontal cortex and plays an important role in learning and making decisions. This circuitry can become disrupted and remodeled in conditions such as posttraumatic stress disorder (PTSD) and chronic pain where the brain holds on to the physical or emotional trauma rather than letting it go and returning to balance. As a result, pain persists and becomes chronic.
CBD oil has been shown to be helpful for anxiety disorders because of its impact on the limbic system of the brain. In a study of 10 people with generalized social anxiety disorder, CBD at an oral dose of 400 mg reduced blood flow to the limbic system (often overactive in those with anxiety), normalizing its activity.
What other evidence is there that CBD could help with pain?
The use of cannabis for pain has a long history. The Chinese were already using it for that purpose (including rheumatic pain, constipation, women’s reproductive disorders, and malaria) in 2900 B.C. While the Chinese primarily used the seeds containing trace amounts of THC, other parts of the plant were used in India beginning around 1000 B.C. Flowers from the female plant were made into medicines of varying strengths and used for spasms, pain, and inflammation; even as a hypnotic and tranquilizer.
Now, modern medicine is looking into cannabis as a pain treatment. At this point, most studies of CBD for pain have been done in animals –particularly in mice and rats. As of halfway through 2019, there aren’t a lot of human trials out there yet. While more human studies are needed, CBD oil has shown promise for a number of types of chronic pain.
In a 2016 animal study, a topical gel containing CBD was shown to significantly reduce swelling and pain associated with arthritis. In a 2017 study, injections of 300 micrograms of CBD into the joints reduced pain and inflammation without side effects in an animal model of osteoarthritis.
CBD has also shown promise for difficult to treat neuropathic pain conditions. In a 2012 study published in the Journal of Experimental Medicine, CBD in the form of spinal injections was able to help chronic inflammation and neuropathic pain in rodents.
A series of double-blind, randomized, placebo-controlled trials in 24 patients with multiple sclerosis (MS), spinal cord injury, or other conditions with pain and spasms. The CBD group experienced significant pain relief compared to the placebo.
A trial done in 7 kidney transplant patients with chronic pain found CBD to be effective in reducing pain. The dosage ranged from 50 mg to 150 mg twice a day and resulted in 2 patients having their pain totally resolved, 4 with a partial improvement in the first 15 days, and 1 with no change in symptoms. Another small (12-person) trial was done in young women with chronic pain resulting from the Human Papilloma Virus (HPV) vaccine. CBD-rich hemp oil drops were given sublingually, gradually increasing the dose over a 3-month period. Treatment resulted in decreased body pain and increased quality of life.
A Cochrane review of 16 studies on cannabis-based medicine for adults with neuropathic pain determined that cannabis was more effective than a placebo for reducing pain. These included randomised, double-blind controlled trials of medical cannabis, plant-derived and synthetic cannabis-based medicines.
As you can see, the overall evidence suggests that CBD products can be very beneficial for various types of chronic pain — even difficult to treat pain. However, keep in mind that recommended dosages can vary widely, depending on the condition, and that tolerance by individuals can be all over the map. Start on the lower side and keep your doctor in the loop.
The Federal Food, Drug, and Cosmetic Act requires that we inform you that the efficacy of CBD or CBDV products has not been confirmed by FDA-approved research as a treatment for any medical condition. The information in this document is not intended to diagnose, treat, cure or prevent any disease.