Does CBD really help Relieve Pain – Among the many terrible things about pain are the various forms it comes in? We all know the pain of tender collision—the impact on your shin, say, of that table leg—or the agonies of a slow dawning toothache. Some pain, such as arthritis, is less acute but more seemingly permanently disabling. Other pains, like migraines, are mysterious in origin and dogged in persistence.

Cannabis has a long history in the effective treatment of pain. “For the relief of certain kinds of pain, I believe, there is no more useful medicine than Cannabis within our reach,” wrote Sir John Russell Reynolds, a pioneering neurologist, and physician, in a letter to Queen Victoria in 1859. The queen took her physician’s advice and accepted his prescription: a cannabis tincture she primarily used to lessen the pain of her menstrual cramps.

The evolution of our understanding of the cannabis plant and its components has in the last few decades confirmed that it is a safe and effective treatment in treating many kinds of pain. As CBD has emerged even more recently, its most widespread use has been for the relief of pain. 

Scientific data is still catching up to anecdotal evidence, but as Harvard Medical School reports[1], studies have documented CBD’s effectiveness in treating several different types of chronic pain. A recent study in the European Journal of Pain[2] showed that CBD applied topically on skin lowers pain and inflammation due to arthritis. Another study, which appeared in the Journal of Experimental Medicine[3], demonstrated that CBD is particularly effective at inhibiting two of the most difficult types of chronic pain to treat, inflammatory, and neuropathic pain. As that study noted, the promise of this finding is deeply significant because the need is so great.

“Chronic pain, particularly neuropathic pain, is a major clinical problem that is difficult to treat,” the study said. “Despite an intensive search for new analgesics in the last several decades, the need for novel therapeutic strategies remains unmet because virtually every blockbuster drug for the treatment of chronic pain produces aversive side effects.”

Opioids have been the most powerful drugs in the treatment of pain, but their attendant addiction issues and a wide array of often debilitating side effects have caused great debate regarding the overall utility. Even over-the-counter drugs known as NSAIDs (non-steroidal anti-inflammatory drugs) are accompanied by strong adverse effects. Complications include upper gastrointestinal bleeding and ulcers, heartburn, ringing in the ears, headaches, dizziness, liver or kidney problems, leg swelling, high blood pressure, heart attack, heart failure, stroke, and death. 

Significantly, the World Health Organization has found that CBD is absent both addictive qualities and significant side effects[4], hence its great promise.

CBD’s most far-reaching effect maybe its anti-inflammatory properties, not just in the treatment of joint or muscle pain, but throughout the body—including in the central nervous system and the brain.  Examples of inflammatory pain that have been successfully treated with CBD include all types of arthritis, autoimmune diseases such as Crohn’s and ulcerative colitis, and relatively simple conditions like headaches, cramps, and muscle aches. A study last year at the University of Pittsburgh Medical School found that CBD can even benefit people who have had a concussion.

Neuropathic pain is often the result of nerve damage or a malfunctioning nervous system. Studies on CBD’s effectiveness as a treatment for this type of pain are more preliminary but likewise promising. Nerve pain can be caused by a wide range of conditions, including injury/trauma, cancer, shingles, toxin exposure, or from an inherited genetic disease or an infection like HIV. Some of the most common causes include injury/trauma, cancer, shingles, and diabetes. On top of this, however, nerve pain could arise from anything from kidney disease to toxin exposure, or from an inherited genetic disease or an infection like HIV.

A handful of studies have demonstrated CBD’s ability to help calm neuropathic pain.  One of the most promising studies[5] looked at the effectiveness of Sativex, a prescription spray containing both CBD and THC that is used for the treatment of neuropathic pain. Sativex was given to 63 patients, and their responses were compared with 62 patients given a placebo; those who took Sativex described a significant decrease in pain compared to those who took a placebo. 

 Other studies have shown CBD’s effectiveness in treating the pain associated with multiple sclerosis.[6]  One study has even suggested CBD-based treatments are more potent than opioids in the treatment of pain experienced by patients with advanced stages of cancer.[7]

The combination of CBD and THC, such as Sativex, may be more effective for some conditions than CBD alone. CBD products with a ratio of 20:1 or higher administered as drops, capsules, or edibles have been found most effective in the treatment of pain, especially related to inflammation. Most discussions of CBD pain treatment suggest that finding the right dosage is critical, and advice working with a medical practitioner to determine the best dosage and delivery. When pain is localized, topical products such as oils, ointments, and salves can be applied, most of which likewise use a combination of THC and CBD.

Overall, CBD use in the treatment of pain is still in its infancy in terms of our understanding of it. But every indication thus far is that CBD may be at least part of the solution towards safer and more effective treatment of pain.

[1] Peter Grinspoon, “Cannabidiol (CBD) — what we know and what we don’t.” Harvard Health Publications, August 24, 2018.

[2] D.C. Hammell, L.P. Zhang, F. Ma,2 S.M. Abshire, S.L. McIlwrath, A.L. Stinchcomb, and K.N. Westlund, “Transdermal cannabidiol reduces inflammation and pain-related behavior in a rat model of arthritis.” Eur J Pain. 2016 Jul; 20(6): 936–948.

[3] Wei Xiong, Tanxing Cui,  Kejun Cheng, Fei Yang, Shao-Rui Chen, Dan Willenbring, Yun Guan, Hui-Lin PanKe Ren, Yan Xu, and Li Zhang, “Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors.” J Exp Med. 2012 Jun 4; 209(6): 1121–1134.

[4] World Health Organization, “CANNABIDIOL (CBD) Critical Review Report,”  Expert Committee on Drug Dependence, Fortieth Meeting, Geneva, 4-7 June 2018

[5] T. Nurmikko, Mick G. Serpell, “Sativex successfully treats neuropathic pain characterized by allodynia: A randomized, double-blind, placebo-controlled clinical trial.”  Pain, Dec. 15, 2007.

[6] C. Perras, “Sativex for the management of multiple sclerosis symptoms.” Issues Emerg Health Technol.2005 Sep;(72):1-4.

[7] Aron H. Lichtman, Eberhard Albert Lux, Robert McQuade, Sandro Rossetti, Raymond Sanchez, Wei Sun, Stephen Wright, Elena Kornyeyeva, Marie T. Fallon, “Results of a Double-Blind, Randomized, Placebo-Controlled Study of Nabiximols Oromucosal Spray as an Adjunctive Therapy in Advanced Cancer Patients with Chronic Uncontrolled Pain.” Journal of Pain and Symptom Management, February 2018.

Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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