CBD Oil for Pain; Can CBD Help in the Management of Different Types of Pain?
A large number of people who contact me each week ask me whether CBD or cannabidiol can help relieve their pain. Many of them have already been to their doctor and may have received a diagnosis.
The complexity in treating pain
But unfortunately, if someone is suffering from chronic pain, a diagnosis doesn’t always guarantee a cure and a doctor may simply write out a prescription for a combination of the following drugs:
- non-opioid painkillers - paracetamol
- opioid painkillers - tramadol, codeine
- non-steroidal anti-inflammatory drugs (NSAIDs) -ibuprofen, naproxen, high-dose aspirin
- anti-depressant tablets - amitriptyline
- anti-convulsant medications - gabapentin, pregabalin
So is chronic pain impossible to treat?
Chronic pain, unfortunately, is notoriously difficult to treat. And the problem with taking a cocktail of pharmaceutical drugs such as these is that not only do they often fail to manage pain effectively, they can also cause a whole host of unwanted side effects.
This makes me think that we need a radical rethink about how we manage chronic pain and it explains why so many people are turning to CBD Oil for pain. In fact, surveys carried out in May and June 2019 found that 8-11% of adults, around 4-6 million, have tried CBD with many reporting that it provided medicinal or therapeutic benefits. But can CBD really help manage pain? (1)
So, what is pain?
The definition of pain according to the International Association for the Study of Pain, is:
"an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms."
The perception and experience of pain is a complex process that is controlled by the central nervous system. If something hurts us, receptor nerve cells sense the pain and then send messages via the spinal cord and brain stem to our brain. Once our brain has registered and processed the information it has received, we feel pain.
Chronic pain can be debilitating
There are different types of pain, the severity of which can vary from mild discomfort through to extreme agony. Acute, or short-lived, pain actually functions to protect us: it alerts us to the fact that we’ve been injured, so we look after ourselves both by protecting the injured area and avoiding getting hurt again in the future. But if we don’t treat our pain, or we don’t receive the right treatment, it can become chronic, debilitating and increasingly difficult to manage. (2)
It affects almost half of UK adults
Studies have shown that around 43% of people in the UK experience chronic pain. This figure increases to 62% among adults aged 75 and over. In fact, it’s believed that around 28 million UK adults are suffering from some kind of chronic pain. (3) As these figures show, chronic pain is a serious public health issue, and scientists are now investigating whether cannabinoid-derived medicines can offer a viable addition or alternative to conventional pain relief medication.
Ways to Relieve Pain
The NHS advises those in pain to:
- Take gentle exercise
- Take deep, slow breaths
- Read up on pain
- Talk to a counsellor
- Try to distract yourself
- Share your experiences with someone else who is suffering or has suffered from pain
- Stick to a normal sleep routine
- Enrol on a pain management course
- Stay in touch with friends and family
- Practise relaxation techniques or meditation (4)
The NHS also advises anyone suffering from chronic pain to take painkillers and get physical therapy but to also remain active, go to work and exercise despite the pain. (5) But it’s not always as simple as that. If painkillers are ineffective, it can be impossible for some to stay active or go to work. Also, waiting lists for physical therapy are often extremely long. This all impacts both on the quality of life and the productivity of those in pain.
Cannabis and Pain Relief
In fact, people around the world have been using CBD Oil for pain for thousands of years. The first reference to its use in China by the Chinese Emperor Shen Nung - also known as the Father of Chinese Medicine - dates back to c.2700 BC. (6)
The psychoactive cannabinoid THC
But because it contains the psychoactive cannabinoid THC (tetrahydrocannabinol) which gets the user “stoned”, it was criminalised in the UK in 1928 under the Dangerous Drugs Act of 1920. Doctors were permitted to carry on prescribing it for medical use but even this stopped when the Misuse of Drugs Act came into force in 1971.
While it’s true that THC can cause some unwanted side effects, so too can many prescription drugs. Opioids, for example, also cause intoxication and can be highly addictive.
Criminalisation of Cannabis
Criminalising cannabis also meant that research into the plant’s many other cannabinoids has been limited. But this changed when scientists managed to isolate the various compounds of the cannabis plant. They discovered that the cannabinoid CBD, unlike THC, is not psychoactive so doesn’t get the user high.
CBD is completely legal
So, in 2016, CBD was reclassified as a medicine and is now completely legal. (7) In spite of this, many people continue to associate its use with recreational (and illegal) cannabis use and are afraid to try it.
This is why I continue to wave the flag for this amazing cannabinoid, as I believe it could present an effective and valuable alternative to conventional pain relief medication. But how does it work?
Cannabinoids and the Endocannabinoid System
There are three types of cannabinoids: phytocannabinoids (derived from plants), endocannabinoids (found in the bodies of humans and animals) and synthetically produced cannabinoids. CBD and THC are just two of many phytocannabinoids found in the Cannabis sativa plant and studies have shown that they could both alleviate pain.
How phytocannabinoids help relieve pain
It’s thought that phytocannabinoids’ ability to help relieve pain is down to the different ways in which they interact with our body’s endocannabinoid system (ECS). We still have much to learn about these interactions because the ECS was only discovered in the 1990s, as a result of USA government-backed research into the effects of cannabis on humans. The government hoped this research would back up their view that smoking this “evil weed” should remain illegal, but ironically, it revealed something quite different.
The endocannabinoid system: our body’s cell-signalling system
We now know that the ECS is a complex cell-signalling system whose function is to achieve homeostasis - a healthy balance - within our body by influencing many physiological processes, including those relating to pain and inflammation. In fact, the ECS plays a central role in dealing with pain in our body.
How does ECS work?
In very simple terms, if you’re in pain the endocannabinoid system will send signals to different parts of your body, prompting them into action to both help stop the pain and address its cause - for example, reduce inflammation. This helps to restore our natural balance and make us feel better. Although the ECS doesn’t rely on cannabinoids such as CBD and THC to help it function as it actually contains its own endocannabinoids, they influence it in many ways which could have a positive effect on pain. (8)
CBD + THC For Pain Relief
The reason why CBD and THC can both help in the treatment of pain is that they interact in different ways with various cannabinoid receptors within the endocannabinoid system. Both have neuroprotective, anti-inflammatory and antioxidant effects on the body and studies are ongoing into their potential to relieve arthritic pain, chronic pain, neuropathic pain, muscle pain, multiple sclerosis (MS) pain and spinal cord injuries. (9), (10))
CBD, THC and MS
In Canada, Sativex, an oral spray containing equal quantities of CBD and THC, was approved for the treatment of central neuropathic pain in MS sufferers in 2005. In 2007, it was also approved to treat difficult to control cancer pain.
Various clinical trials have shown that it can safely and effectively help to alleviate central and peripheral neuropathic pain, rheumatoid arthritis and cancer pain, but it’s still not licensed for pain in the UK. (11) Here, it’s licensed to treat MS-related spasticity although patients report that it also alleviates pain. (12) But can CBD without THC relieve pain?
CBD and Pain Relief
In terms of structure, CBD is similar to THC, but they help to alleviate pain in different ways. Cannabidiol’s analgesic properties are thought to be down to its role as an endocannabinoid modulator, making it able to exert powerful antioxidant, anti-inflammatory and neuroprotective effects within the body. Its ability to delay the breakdown of anandamide is thought to play a part in the reduction of both pain and pain perception. (13)
CBD can make THC more efficient in the treatment of pain
Research into the effectiveness of CBD alone to treat pain is limited. However, studies into the treatment of difficult to control chronic pain have found that the CBD/THC medication Sativex works better than medicines containing only THC. This indicates that CBD could potentially be a valuable analgesic in its own right, especially since it’s not psychoactive and is actually thought to help counteract the psychoactive properties of THC. (14)
CBD and Arthritis
Furthermore, according to a study from the European Journal of Pain, CBD applied on the skin of rats caused a reduction in arthritic pain and inflammation. Another study found it useful in treating inflammatory and neuropathic pain, two of the most treatment-resistant types of chronic pain. (15), (16)
CBD and epilepsy
Although the CBD medication Epidiolex has been approved in the U.K. to treat epilepsy, to date no CBD-only medications are licensed for pain management. This could soon change because Europe’s first medical cannabis patient registry was launched last year.
ProjectTWENTY21 aims to enrol 20,000 patients by the end of next year and prescribe either a combination of CBD and THC, THC on its own or CBD on its own, to treat a variety of conditions, including chronic pain. Hopefully, ProjectTWENTY21 will ensure that there’s a large enough body of evidence to convince policymakers of the effectiveness and tolerability of CBD to treat chronic pain. (17)
CBD Side Effects
Scientists believe that one of the benefits of using CBD for pain relief is that it doesn’t appear to cause the same side-effects as some conventional painkillers Non-steroidal anti-inflammatory drugs can cause stomach ulcers and bleeding and opioid medications cause intoxication and are highly addictive.
CBD has been found to be generally well-tolerated in doses of up to 6000mg, although some studies have mentioned potential side effects such as diarrhoea, appetite and weight changes and fatigue.
According to The World Health Organization, pure CBD has a good safety profile and these side effects could simply be the result of drug-drug interactions. So please do consult with your doctor before you take it.
How Should I Take CBD to Manage My Pain?
When it comes to severe, acute pain, pharmaceutical medications such as NSAIDs and opioids are usually your best bet. High doses of THC have been found to manage certain types of acute pain because of how it binds to the receptors in the ECS - but you’ll be breaking the law if you take it unless a specialist consultant has prescribed it.
Understanding how CBD can help with chronic pain
If you’re in chronic pain, this signifies that your ECS isn’t performing to its best abilities and this is where I believe CBD comes in. Cannabidiol has the potential to help manage pain because it can enhance the performance of the ECS.
Research has in fact shown that people with certain painful and difficult to treat syndromes, such as migraine, fibromyalgia and irritable bowel syndrome could be suffering from an endocannabinoid deficiency. When our ECS isn’t functioning properly, it can actually even lower our tolerance to pain. (18)
How to take CBD
How you actually take cannabidiol depends on what type of pain you’re using it for, how quickly you need it to work and how long you need its effects to last. Some people tell me that CBD helps if they’re suffering from general aches and pains, such as post workout muscle strain. Others report that cannabidiol helps them manage other more long-term conditions, such as:
- Irritable bowel syndrome
CBD for muscle recovery
If you have muscle pain after a workout, or any other aches and pains, it may help to take a two-pronged approach. Topical CBD Recovery Balm or cream can be applied exactly where needed. Apply either after a warm bath or shower, or place a hot water bottle on the site of the pain, before use. This can then be supplemented with CBD in a capsule form, which may take 20 minutes to an hour to work.
Faster pain relief with CBD
For much faster pain relief, CBD needs to reach the bloodstream as quickly as possible. To ensure this happens, it’s advisable either to take CBD oil drops or sprays sublingually (in the mouth, under the tongue) or to try a CBD vape pen. Just remember that taking the oil orally means its effects will last longer whereas vaping it will ensure more rapid delivery.
Before you take CBD, please:
- Talk to your GP to ensure that it’s suitable for you and won’t interact with any other medicines or supplements that you take
- Buy from a reputable seller who provides certification of independent laboratory testing to ensure the product contains less than 0.2% THC.
- Make sure the product is made using 100% pure and natural CBD distillate
- Opt for a broad spectrum product as CBD has been found to work better in tandem with other cannabis-derived compounds
CBD Dosage for Pain Management
For creams and balms, I’d recommend applying twice daily. Always check the label, but with a high-quality product, a 100ml tub can contain anywhere from 500-5000mg of pure CBD.
For oral dosage, it’s best to start by taking around 45mg daily, this can be increased until you reach around 70-80mg or when you feel you’re getting optimal results. With capsules, the label should tell you how much each CBD each one contains.
With sublingual CBD, check the label on the dropper bottle to determine dose size. In a 10ml bottle that contains 500mg (5%) pure CBD, each pipette drop will contain 2.2mg of CBD. Taking 20 drops each day will mean your dose is 44mg.
- What is pain? www.voltarol.com
- Almost half of all UK adults may be living with chronic pain www.nhs.uk
- 10 ways to reduce pain, Ways to manage chronic pain www.nhs.uk
- The three main elements of the endocannabinoid system are neurotransmitters called endocannabinoids, endocannabinoid receptors and enzymes, all of which carry out different functions/ perform different roles in these processes.
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- Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis onlinelibrary.wiley.com
- Cannabidiol (CBD) - what we know and what we don’t - Harvard HealthBlog www.health.harvard.edu
→ This article is not intended to diagnose, treat, cure or prevent any ailment, illness or disease.
→ For a full report on the recreational use of CBD read WHO's Critical Review Report on CANNABIDIOL (CBD)
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