CBD for Pain: What The Research Tells Us

By | last updated January 27, 2023

Evidence Based 40

Chronic pain is notoriously difficult to treat since pharmaceutical medications used don’t always work and can have serious side effects.

That’s why more and more people are turning to safer alternatives such as cannabis and cannabidiol (CBD). In fact, surveys suggest that pain relief is among the most common reasons for CBD use (1, 2).

The good news is that there’s a growing body of research evidence showing that CBD may help relieve various types of pain. However, more proper clinical studies are needed before CBD is accepted as a treatment option.

Here’s what the science tells us about using CBD for pain, how it works, the right dosage, and other tips.

CBD and Pain: What Does the Research Say?

There are more human studies each year showing that CBD may help relieve various types of pain, including inflammatory, chronic, neuropathic, arthritis, and cancer pain.

However, most of these studies lack the rigorous design needed for high-quality evidence. Another issue is that they typically examine pure CBD, which is arguably less effective than full-spectrum preparations that contain other beneficial active ingredients. 

There are also multiple studies showing positive results with Sativex, a 1:1 pharmaceutical extract of CBD and THC. But the issue is that we don’t know how much of the pain relief comes from CBD. 

Human Studies of CBD for Pain

One 2020 placebo-controlled study looked at the effects of CBD in 29 people with peripheral neuropathy, a type of neuropathic (nerve-related) pain that usually affects the hands and feet. CBD oil was applied topically, resulting in improvements in pain and cold and itching sensations (3).

Another placebo-controlled study done in 2004 looked at the effects of whole-plant cannabis extracts of THC, CBD, and a 1:1 formulation in 24 chronic pain patients (most suffered from multiple sclerosis). The extracts were applied sublingually (under the tongue) and led to reduced pain and spasticity (a painful symptom of MS), unlike the placebo (4).  

Meanwhile, a 2019 study looked at the effects of CBD capsules in 97 chronic pain patients who used opioids. This study is particularly important because it evaluated the effects of full-spectrum CBD, which is rarely studied by researchers and considered superior to pure CBD. 

More than half (53%) of the patients reduced or totally stopped using opioids within 8 weeks, with 94% reporting better quality of life, including improvements in pain and sleep (5). 

Similarly, a 2017 study of girls vaccinated against the human papillomavirus reported improvements in body pain symptoms after taking full-spectrum CBD oil (150 mg/ml CBD daily maximum) (6).

Several studies also found that CBD may help relieve pain and other symptoms caused by inflammatory bowel disease (IBD). Most notably, a 2021 placebo-controlled trial of CBD-rich cannabis oil (160 mg CBD/40 mg THC per ml) improved general well-being and abdominal pain in 56 Crohn’s disease sufferers (7). 

Meanwhile, a 2018 study of elderly kidney transplant patients treated with 50-150 mg of CBD twice daily for 3 weeks reported improvements in pain in 6 out of 7 patients (8).

One 2020 paper also discussed two case reports (detailed reports of individual patients) of people with lower back pain from falling and surgery who experienced relief with a topical CBD cream (9). 

Finally, a handful of human studies of CBD found that it had no effects on pain, possibly due to low dosage or other factors (10).

using cbd oil for pain

Patient Surveys of CBD for Pain

A 2022 survey of 428 arthritis patients who used CBD found that 83% experienced less pain and 66% improved physical function, with an average 44% reduction in pain. The majority (60.5%) also reduced or stopped taking other pain medications (11).

Meanwhile, a 2020 study out of New Zealand surveyed 400 patients taking CBD oil, finding significant improvements in self-reported quality of life and chronic pain (12). Another 2020 survey of 58 palliative care patients in Florida reported that 24% used CBD, with half reporting reduced pain (13).

A similar 2021 survey of 253 patients suffering from chronic pain found that the majority (62%) tried a CBD product, with 59% reporting reductions in pain and 68% saying they reduced their pain medication usage (14). 

Another 2021 survey of 2701 people with fibromyalgia and other chronic pain conditions reported that 29% used CBD in the past and 32% currently use it, with slight to serious improvements in pain and other symptoms (15).

Studies of Sativex (CBD plus THC) 

Sativex is a pharmaceutical drug that combines CBD and THC at a 1:1 ratio. It’s applied as a sublingual spray, which is similar to how you’d use CBD oil. Sativex has shown positive results in multiple pain-related studies:

  • In a 2006 study of 75 rheumatoid arthritis patients, Sativex resulted in reduced pain and disease activity (16)
  • In a 2015 study of 234 people with peripheral neuropathic pain, Sativex treatment led to reduced pain severity, with more than half experiencing a 30% or greater improvement (17)
  • A 2017 review of multiple studies of Sativex in multiple sclerosis (MS) patients concluded that it’s effective in improving muscle spasticity and quality of life (18)

There’s also some evidence that Sativex may help with cancer-related pain. A 2010 placebo-controlled study of 177 patients with advanced cancer pain who weren’t getting sufficient relief from opioids compared the effects of pure THC, a 1:1 CBD and THC formula, and a placebo.

Only the combination treatment resulted in significant pain relief over placebo, suggesting that CBD works in synergy with THC (19). A follow-up study of 43 patients in 2013 reported that the 1:1 treatment was tolerated well and remained effective during long-term use (5 weeks and more) (20).

Finally, a 2012 study of Sativex in chronic cancer pain sufferers reported improvements in some patients (21).

cbd plus thc cannabis

Animal Studies of CBD for Pain

The bulk of what we know about CBD’s potential pain-relieving effects comes from animal studies. Here’s a quick look at the key findings:

  • In a 2018 placebo-controlled study of dogs with osteoarthritis, CBD oil improved pain and activity levels (22)
  • In a 2016 study of rats with arthritis, transdermal CBD gel improved pain and inflammation without side effects (23)
  • A 2015 study in mice found that CBD strengthened the effects of the painkiller morphine (24)
  • CBD protected mice against chemotherapy-induced neuropathic pain in a 2014 study (25)
  • In a 2021 study of rats, CBD reduced both inflammatory and non-inflammatory pain, with 40 mg/kg doses providing similar relief to 100 mg/kg doses of the common painkiller ibuprofen (26
  • CBD protected mice against diabetic neuropathic pain in a 2010 study (27)

In summary, CBD holds serious promise in the treatment of different types of pain, but more evidence from high-quality randomized controlled trials (RCTs) — the gold standard of medical research — is needed.

As concluded by a trio of esteemed researchers, including Raphael Mechoulam, the chemist who discovered THC: 

There is obviously an abundance of in vitro and preclinical in vivo evidence for the efficacy of CBD to treat many human medical conditions but few human clinical trials to support this evidence. It is critical that these claims are evaluated in high-quality human RCTs (10).

CBD: What Does the Science Say? by Erin M. Rock, Linda A. Parker, and Raphael Mechoulam

How Does CBD Work?

Although we don’t yet have the full picture, CBD appears to interact with multiple bodily systems that regulate pain and inflammation.

CBD and the ECS

One way CBD may help with pain is through the endocannabinoid system (ECS), which is made up of cannabinoid receptors, endocannabinoids, and special enzymes.  

This crucial system regulates many important processes, including immunity, brain function, metabolism, and pain perception to maintain a healthy state of balance called homeostasis (28).

In fact, research suggests that the ECS regulates every stage of pain-processing pathways, with endocannabinoids working much like a “brake” that reduces the sensation of pain and provides relief (29). 

That’s why multiple animal studies have reported that suppressing enzymes that break down the two main endocannabinoids, anandamide and 2-AG, may reduce pain (30, 31).

As it happens, CBD also suppresses one of these enzymes — FAAH — which breaks down anandamide (32). In doing so, CBD may elevate anandamide levels, promoting its anti-inflammatory and pain-relieving effects (33, 34).

Other Mechanisms

Studies suggest that CBD can also help with pain by influencing other inflammation and pain-regulating molecules, including: (35)

  • Glycine receptors
  • PPARγ receptors
  • TRP channels
  • Serotonin 5HT1a receptors, which may be involved in neuropathic pain
  • “Orphan” receptors like GPR3 and GPR6

How to Best Use CBD for Pain

There are several factors to consider when using CBD for pain. First and foremost, I always recommend opting for full-spectrum CBD products instead of those containing pure CBD. 

Full-spectrum CBD extracts carry a wide array of cannabinoids, terpenes, flavonoids, and other beneficial molecules that work in synergy and are widely considered superior to pure CBD (36).

cbd oil dropper choosing dose

Choosing the Right Administration Route

You should also choose the best way to take CBD for your particular kind of pain: oil, oral products (capsules & gummies), vapes, or topicals. 

CBD oil is generally best for whole-body relief because it’s absorbed well, makes it easy to change the dose, works relatively quickly (15-45 min), and has long-lasting effects (about 6-8 hours) (28).

Vaping can be a decent alternative if you want immediate relief, but the effects last shorter (2-4 hours. Meanwhile, topical products are ideal for localized relief because they only work where you apply them. 

The last option is capsules, gummies, and other edible products, which are convenient and long-lasting but not ideal because they’re poorly absorbed by the body. although you can improve this by taking them alongside a fat-containing meal (37).

You can also combine multiple products (like CBD oil and a balm) for optimal relief.

Dosage: How Much CBD to Take

CBD dosage is different for every individual because it depends on body weight, age, genetics, the type of product you’re taking, and other factors.

Your best bet is to “start low and go slow” (38). If you’re a beginner, 10-15 mg is a good starting point. Wait and watch the effects over the next two hours. If you don’t feel anything, you can slowly raise the dose until you find the amount that provides the desired relief.

Another option is to follow the dosage recommended by your CBD product. 

CBD Safety & Side Effects

Decades of research have shown CBD to be a relatively safe compound with minor side effects (1). The World Health Organization (WHO) also recognized it as “generally well tolerated with a good safety profile” in a 2018 review (39).

Common side effects of CBD include tiredness, lightheadedness, low blood pressure, and dry mouth (40). There’s also some evidence that CBD may interact with certain prescription medications. For example, it may increase the concentrations of opioids, and work synergistically with morphine (24). 

CBD’s side effects have been mostly reported by studies using large oral doses of purified CBD, which isn’t how most people use it. Still, I recommend talking to your doctor before using CBD, especially if you’re taking prescription medications. 

CBD for Pain: Serious Potential But Lacking Human Studies

To sum up, research suggests that CBD may help relieve different types of pain. However, more high-quality evidence is needed to confirm CBD’s pain-relieving effects.

If you’re interested in trying CBD for pain relief, I recommend using a quality full-spectrum CBD oil for body-wide issues and a topical product for localized concerns. 

CBD’s relative safety makes it an attractive alternative to prescription pain medications and opioids in particular, which are notorious for their addictive potential and possibility of overdose. 

As explained by leading cannabis and CBD researchers, “There is significant interest in determining whether medical cannabis, or particular cannabinoids such as CBD, could replace opiates as analgesics or act as opioid-sparing compounds” (10). 

References

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  2. Fortin, Davide, et al. “Reasons for using cannabidiol: a cross-sectional study of French cannabidiol users.” Journal of Cannabis Research 3.1 (2021): 1-5.
  3. Xu, Dixon H., et al. “The effectiveness of topical cannabidiol oil in symptomatic relief of peripheral neuropathy of the lower extremities.” Current pharmaceutical biotechnology 21.5 (2020): 390-402.
  4. Wade, Derick T., et al. “A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms.” Clinical rehabilitation 17.1 (2003): 21-29.
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