Studies about CBD Oil & Pain [Simplified]

Pain is usually a symptom of an injury or damage to a body part. It is your body’s way of informing you that there is a problem somewhere. Your nervous system gets the information from the particular body part and sends neurotransmitters to make you aware of the problem by means of pain signals.

If an ache in any part of your body persists for over 12 weeks, you should know it has turned into chronic pain and you need to give it more attention, preferably by consulting a doctor.

According to the Institute of Medicine of The National Academies, “over a 100 million Americans live with chronic pain”.

Women across the world have been found to suffer more from chronic, even debilitating, pain than their male counterpart. In fact, women experience more recurrent pain, in much greater intensity, and for longer periods than men.

However, research shows that most of these cases remain unattended and untreated, mostly due to lack of awareness. Women generally turn to home remedies and alternative methods and seek out the herbal route instead of visiting a doctor. While this may work for many, it is always advisable to consult a certified medical practitioner before turning to self-medication.

Interestingly, a lot of those who DO self-medicate belong to the group of people who have discovered the benefits of Cannabidiol (CBD) oil in managing their chronic pain.

Cannabidiol – Fast facts

  • CBD is a cannabinoid – a chemical compound found in the cannabis plants that influences your endocannabinoid system, usually in a good way. The endocannabinoid system is responsible for modulating several functions of your brain, endocrine system, and immune system tissues.
  • CBD is among the over-400 chemical compounds and over 60 cannabinoids found in the cannabis sativa species.
  • Hemp and marijuana both fall under cannabis sativa species, each having the essential cannabinoids in different proportions.
  • Unlike some other cannabinoids, CBD is non-intoxicating and does not have any psychoactive effects, hence comparatively safer than Tetrahydrocannabinol (or THC), a cannabinoid that is responsible for creating the famous marijuana “high”.
  • CBD does not stimulate those receptors in our brain that influences the feel-good euphoria we associate with marijuana. That’s THC’s doing!
  • Good quality, branded CBD oil products do not contain THC. If at all they do, their traces will be below 0.3%. If not, they should not be used. Always check the label carefully.
  • CBD oil is usually extracted from industrial hemp that contains higher CBD content compared to marijuana.
  • It’s believed that CBD oil reduces inflammation, leading to partial pain relief.
  • CBD oil may also help a person sleep better.
  • Use of cannabis for pain relief dates back to ancient China (1).

Does CBD really help relieve pain? What scientific proof do we have?

Apart from drastically reducing your quality of life, chronic pain can also have a huge negative impact on your finances and productivity at work.

Generally, chronic pain is associated with:

  • Cancer
  • Multiple sclerosis
  • Fibromyalgia
  • Headaches, including migraine
  • Irritable bowel syndrome
  • Lower back pain
  • Neuropathic pain or nerve pain
  • Osteoarthritis & Rheumatoid Arthritis
  • Temporomandibular disorder

Quite a few over-the-counter pharmaceutical pain drugs that are available for treating chronic pain are not always successful (sometimes these drugs don’t even work on certain individuals). Many a time, a patient suffers from its side effects more than the benefits from it… Sometimes, using these drugs may also lead to dependence on them.

This is why a lot of people have turned to cannabidiol oil to find an alternative route to pain relief. Owing to its effect on the endocannabinoid system of our body that influences how we feel pain, CBD oil has been seen to be effective on many people.

As far as research and clinical trials are concerned, however, not many human trials have been conducted. However, often when a patient is immune to the effects of an opioid, CBD oil is administered in attempts to relieve the inflammation and pain.

  • CBD for arthritis: One of the primary symptoms of arthritis is pain – debilitating pain. Both osteoarthritis and its autoimmune cousin, rheumatoid arthritis, can be managed with CBD. At least the animal trials seem to suggest so. A study, published in the European Journal of Pain in December 2016 (9), discovered that CBD can prevent both osteoarthritis pain and joint neuropathy because it reduces joint inflammation and protects the nerves. In this study, the scientists (10) administered the affected rats with a topical gel containing CBD orally (5–40 mg/kg) once a day for 3 days after the onset of acute inflammation. By the fourth day, the swelling was almost gone, that too without any side effects. In fact, according to a 2017 report in journal Pain, it also prevents pain due to nerve damage caused by arthritis (11).
  • CBD for cancer pain: Cancer patients often suffer from a substantial amount of pain, both due to the disease and its treatment. Pain caused by cancer is generally due to inflammation, pressure on internal organs, or nerve injury. Sometimes, the pain gets so severe that even opioids that are powerful pain relief drugs fail to have any effect. In such cases, CBD may be effectively used alongside the usual treatment to help relieve the pain. It can even curb the painful side effects of certain chemotherapy drugs that cause muscle and joint aches, headaches, and stomach cramps.

While a few clinical trials have been conducted on mice to prove CBD’s efficacy in reduction of cancerous tumors, no such studies on human subjects are available at the moment.

For now, most human research has only involved Cannabidiol’s role in managing pain related to cancer and cancer treatment. The National Cancer Institute (NCI) (2) has pointed to CBD as a possible option for relieving symptoms caused by chemotherapy. NCI carried out a CBD test on some subjects by spraying CBD oil extracts into their mouth. This was used alongside opioids. The researchers discovered that using CBD in conjunction with opioids helps manage pain better.

CBD has been found to have anti-inflammatory effects on the body indirectly help in reducing pain. This may particularly help patients who suffer from swelling in their hands and feet due to chemotherapy. Cannabidiol indirectly interacts with the endocannabinoid system’s CB2 receptors, thus suppressing the inflammatory response to chemotherapy through multiple mechanisms (3, 4 &5).

There are a few other studies (6) that have also discovered CBD’s role in preventing neuropathic pain (nerve damage caused by cancer) and thermal sensitivity, without negatively impacting the functioning of the nervous system or the effectiveness of the chemotherapy treatment. Researchers had concluded that this is due to CBD’s strong influence (7) over 5-HT1A receptors that control nerve-related pain (8).

However, this is CBD indirectly curbing nerve pain. On the other hand, THC directly acts on CB1 receptors to alleviate pain resulting from nerve damage.  This deduces that CBD alone may not be capable of reducing pain caused by the disease or its treatment, although it does have a substantial impact.

  • CBD for multiple sclerosis: Multiple sclerosis (MS) is an autoimmune disease that affects the entire body through the nerves and brain, and often leads to cancer in the brain and bowel. Muscle spasms, a common symptom of MS, often cause tremendous and constant pain among a lot of people. According to a 2017 report (12), short-term oral use of CBD oil could reduce spasms in MS patients. But, this test was not solely on CBD’s effect, but the effects of cannabis and cannabinoids on MS patients.

However, CBD was approved in Canada in 2005 for the treatment of central neuropathic pain in multiple sclerosis (13). However, more research and clinical tests are still required at this stage to prove the efficacy of CBD oil on MS patients.

  • CBD for other forms of chronic pain: A study, published in the Journal of Experimental Medicine, supports the claims that cannabinoids, such as CBD, could offer new treatment options for people with chronic pain and inflammation (14). The research also showed evidence that patients aren’t likely to build up a tolerance to CBD’s effects. This means they would not need to continually increase their dose either. The same 2017 report (12) that proved positive effects on MS patients suffering from spasms, also showed that CBD can substantially help patients with chronic pain.

Another study has shown the positive effects of CBD on individuals taking suffering fibromyalgia pain (15).

According to a 2008 review (13) that analyzed studies conducted from the late 1980s to 2007, CBD seems to have an overall positive effect on pain management without any adverse side effects. They also discovered that CBD helped patients with chronic pain sleep better.

Another study (16), published in Pediatric Dermatology in 2018, showed CBD has beneficial effects on a rare, blistering skin condition called epidermolysis bullosa. The study reported three cases of topical CBD – applied as an oil, cream, and spray – on children suffering from this rare condition. After using the medication, patients in all the three cases reported faster healing, less blistering and decreased the sensation of pain. In fact, one child was able to completely wean off oral opioid analgesic pain medication, and the best part was none of the three children experienced any side-effects from its use.

While very few clinical trials have been conducted on the pain-relieving effects of CBD oil, a report (17), published in the Cochrane Database of Systematic Reviews in 2018, discussed the use of different cannabis-based medicines. It was found that they might help treat chronic neuropathic pain that often occurs in people with conditions like diabetes and multiple sclerosis.

Are there any side effects of treating pain with CBD?

The 2018 report published in the Cochrane Database of Systematic Reviews (17) also showed that the potential benefits were far “outweighed by potential harms”. It also revealed that it benefits only those who don’t have “a history of substance abuse”.

While CBD is considered by most researchers as a non-psychoactive component of cannabis plants, it’s safer to call it “non-intoxicating”, as no cases of toxicity or overdose from its use has been reported so far. However, research into its side effects is extremely limited.

Besides, owing to the lack of regulation of CBD products, there is no guarantee on their content and purity. While the CBD concentration in these products may not be consistent, the products may also contain varying amounts of THC, which is, in fact, a psychoactive component.

The studies that were conducted to determine the efficacy of CBD oil as a therapeutic drug, using varying doses and routes of administration, as well as using a combination or whole products with THC, a number of side effects have been reported. They include:

  • Anxiety,
  • Changes in appetite and mood,
  • Diarrhea,
  • Dizziness,
  • Drowsiness,
  • Dry mouth,
  • Low blood pressure,
  • Mental confusion,
  • Nausea,
  • Vomiting, and
  • Application of CBD oil over the skin may also cause irritation.

Risk Factors: When CBD oil shouldn’t be used for pain

Although using CBD oil for pain management is considered a “natural” therapy, it really is not. After undergoing several chemical screening and distillation, the end result is by all means chemical.

Now that, the “natural green” concept is out of the way, let us look at the cases where CBD oil products may have more harmful effects than beneficial ones on your constitution.

  • Interactions with other pharma drugs: People taking any pharmaceutical medication for a pre-existing condition must be particularly wary of CBD’s effects. CBD impedes the activity of certain enzymes in the liver that are required to metabolize pharmaceutical drugs meant for humans because it also needs the same enzymes to metabolize (19). This may put you at a greater risk on many levels. CBD tends to interact with medicines, such as
  • Medications changed by the liver (including chlorzoxazone, theophylline, clozapine, and progesterone)
  • Sedatives (including benzodiazepines, phenobarbital, fentanyl, and morphine)
  • Antidepressants & Antipsychotic drugs
  • Anti-epileptic drugs
  • Patients of Parkinson’s: There are also some concerns over deteriorating muscle movement and tremors among patients of Parkinson’s disease under the influence of cannabidiol taken in doses as high as 300mg/day (18).
  • People with low blood pressure: A lot of people feel lightheaded. This is because CBD tends to lower blood pressure. According to some studies (20), higher doses of CBD can cause a slight drop in blood pressure. So, people who suffer from low blood pressure or are taking medication for it should refrain from consuming CBD or CBD-based products. In fact, some people with normal blood pressure can even feel lightheaded under its influence.
  • Pregnant women: It is still considered unsafe to consume or use any cannabinoid during pregnancy, as they may affect fetal brain development. It’s best to stick to regular pain killers to combat any kind of pain issues, even chronic ones.
  • Contaminants & mislabeling: In the absence of proper regulation, CBD oil manufacturers are selling contaminated products, as well as products having THC in concentrations higher than the permissible level of 0.3%. While THC may initially help in reducing the pain drastically, its side effects may actually make the product far less worthy. According to research, published in the Journal of the American Medical Association in 2017 (21), almost 70% of all CBD products sold online are mislabeled. Higher THC may seriously affect patients with psychotic disorders.

An overview

Even though there is a deluge of anecdotal evidence of CBD’s efficacy in relieving pain, CBD oil can never replace standard medical care. If chronic inflammatory conditions like arthritis are left untreated or only treated with cannabis or CBD oil, it may lead to more devastating results like joint damage, causing destruction and disability.

To effectively manage pain and inflammation, one must still depend mostly on conventional medical care methods. Alternative methods, like using CBD oil, may at times be used in conjunction with them, but only under the strict supervision of a certified medical practitioner who has experience with cannabidiol’s effects and understands your medical history well enough to advise such a pain management treatment.

  1. Cannabis and Cannabinoid Research Vol. 2, No. 1; Cannabis and Pain: A Clinical Review; https://www.liebertpub.com/doi/10.1089/can.2017.0017
  2. Cannabis and Cannabinoids (PDQ®)–Patient Version; National Cancer Institute; Cancer Treatment – Complementary & Alternative Medicine (CAM); https://www.cancer.gov/about-cancer/treatment/cam/patient/cannabis-pdq#link/_15
  3. 7: Naguib M, Diaz P, Xu JJ, Astruc-Diaz F, Craig S, Vivas-Mejia P, et al; MDA7: a novel selective agonist for CB2 receptors that prevents allodynia in rat neuropathic pain models. Br J Pharmacol. 2008;155:1104–1116. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597252/
  4. 8: Rahn EJ, Zvonok AM, Thakur GA, Khanolkar AD, Makriyannis A, Hohmann AG; Selective activation of cannabinoid CB2 receptors suppresses neuropathic nociception induced by treatment with the chemotherapeutic agent paclitaxel in rats. J Pharmacol Exp Ther. 2008;327:584–591. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682949/
  5. Cannabinoids, Endocannabinoids, and Related Analogs in Inflammation; Sumner H. Bursteincorresponding author and Robert B. Zurier; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664885/
  6. Sara Jane Ward, Sean D McAllister, Rumi Kawamura, Ryuchi Murase, Harshini Neelakantan, and Ellen A Walker; Cannabidiol inhibits paclitaxel-induced neuropathic pain through 5-HT1A receptors without diminishing nervous system function or chemotherapy efficacy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969077/#b56
  7. Russo EB, Burnett A, Hall B, Parker KK. Agonistic properties of cannabidiol at 5-HT1a receptors. Neurochem Res. 2005;30:1037–1043. https://www.ncbi.nlm.nih.gov/pubmed/16258853
  8. Colpaert FC. 5-HT(1A) receptor activation: new molecular and neuroadaptive mechanisms of pain relief. Curr Opin Investig Drugs. 2006;7:40–47. https://www.ncbi.nlm.nih.gov/pubmed/16425670
  9. Eur J Pain. 2016 Jul; 20(6): 936–948; Published online 2015 Oct 30; Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/
  10. Naunyn-Schmiedeberg’s Archives of Pharmacology. March 2004, Volume 369, Issue 3, pp 294–299 | Oral anti-inflammatory activity of cannabidiol, a non-psychoactive constituent of cannabis, in acute carrageenan-induced inflammation in the rat paw https://link.springer.com/article/10.1007%2Fs00210-004-0871-3
  11. Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis; Philpott HT1, OʼBrien M, McDougall JJ; Pain. 2017 Dec;158(12):2442-2451. https://www.ncbi.nlm.nih.gov/pubmed/28885454  
  12. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. 4 Therapeutic Effects of Cannabis and Cannabinoids; https://www.ncbi.nlm.nih.gov/books/NBK425767/
  13. Therapeutics and Clinical Risk Management; 2008 Feb; 4(1): 245–259; Cannabinoids in the management of difficult to treat pain; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/
  14. Journal of Experimental Medicine; 2012 Jun 4; 209(6): 1121–1134; Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371734/
  15. PLoS One. 2011; Cannabis Use in Patients with Fibromyalgia: Effect on Symptoms Relief and Health-Related Quality of Life; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080871/
  16. Wiley Online Library; CASE REPORT: Self‐initiated use of topical cannabidiol oil for epidermolysis bullosa; Malcolm P. Chelliah BA  Zachary Zinn MD Phoung Khuu MD Joyce M. C. Teng MD, PhD, FAAD; First published: 22 May 2018;  
  17. https://onlinelibrary.wiley.com/doi/abs/10.1111/pde.13545
  18. Cochrane Database of Systematic Reviews; Cannabis‐based medicines for chronic neuropathic pain in adults; Cochrane Systematic Review – Intervention Version; Published: 07 March 2018; Martin Mücke, Tudor Phillips, Lukas Radbruch, Frank Petzke & Winfried Häuser;  https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012182.pub2/full
  19. Open label evaluation of cannabidiol in dystonic movement disorders; Paul Consroe, Reuven Sandyk & Stuart R. Snider; Pages 277-282 | Received 28 Feb 1986; Taylor & Francis Online, Published: 07 Jul 2009;
  20. https://www.tandfonline.com/doi/abs/10.3109/00207458608985678
  21. Drugs that May Interact with CBD Oil; CBD Oil Review; https://cbdoilreview.org/cbd-cannabidiol/cbd-p-450-enzyme/
  22. JCI Insight. 2017 Jun 15; A single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study; Khalid A. Jadoon,1 Garry D. Tan,2 and Saoirse E. O’Sullivan1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470879/
  23. Study: Nearly 70% of online CBD marijuana extracts are mislabeled https://arstechnica.com/science/2017/11/study-nearly-70-of-online-cbd-marijuana-extracts-tested-were-mislabeled/