Using CBD for pain has emerged from the epidemic of pain sweeping the world without effective treatments that don't come with the risk of dependency or death.
Consider the following scenario:
1:08 AM. You’ve been asleep for two hours, and it’s already the second time you’ve woken up from the pain. You do your best to assume the position you were in when you fell asleep the first time, but it looks like that position will no longer bring you comfort.
1:45 AM. After 30 minutes of searching for a sleeping position that will allow you to temporarily sink into blackness and escape the pain. You contemplate your misery while praying for at least four hours of sleep tonight.
If you suffer from chronic pain, you know what it’s like to run your life by the light of unending discomfort, interrupted too rarely by those blissful, pain-free moments.
It's been estimated that 1 out of 5 people worldwide experience moderate to severe chronic pain, and in the U.S. alone, more people suffer from chronic pain than suffer from diabetes, cardiovascular disease, and cancer combined (source).
A 2006 survey conducted for the American Pain Foundation and sponsored by Endo Pharmaceuticals evaluated the impact that chronic pain had on 303 chronic pain sufferers who sought care from their physician and were currently using an opioid to treat their pain (source). The results are as follows:
Control Over Chronic Pain
- More than half of respondents (51%) felt they had little or no control over their pain.
- Six out of ten patients (60%) said they experience breakthrough pain one or more times daily, severely impacting their quality of life and overall well-being.
Impact on Quality of Life
- Almost two-thirds (59%) reported an impact on their overall enjoyment of life.
- More than three quarters of patients (77%) reported feeling depressed.
- 70% said they have trouble concentrating.
- 74% said their energy level is impacted by their pain.
- 86% reported an inability to sleep well.
Given the ubiquity and pervasiveness of pain, it’s almost incredible to believe that thousands of people have found relief using just CBD.
In this article we'll go over the biology of pain, the science behind pain modulation and the endocannabinoid system, and how to treat your pain with CBD and other cannabis treatments. As always, feel free to skip ahead using the table of contents below.
The Science of Pain
Chronic pain is defined by pain in the body lasting more than 3 months. Pain is a common symptom of many other underlying illnesses, but chronic pain has emerged condition in and of itself. Chronic pain is different from acute pain in that the signals communicating pain sensation to the brain don't stop.
In acute pain, the pain ceases when the cause of the pain or injury is removed of addressed. Many bouts of chronic pain begin with an acute pain event. Acute pain turns into chronic pain when pain signaling to the brain persists for months and sometimes even years.
To understand how CBD helps with pain, it’s a useful exercise to explore the origin of pain in the body. As scientist attempt to understand pain, different ways of classifying, categorizing, and defining pain have been used.
To keeps things simple, we're going to use the categorizations of nociceptive pain, and neuropathic pain. These two ‘types’ of pain cover mostly all pain experienced by the body.
Types of Chronic Pain
Chronic pain is a completely different animal than acute pain is - mostly because of the additional cognitive symptoms brought on by being in a state of continual pain.
Michael Clark, a psychiatrist and director of the pain treatment program at Johns Hopkins Hospital, explains the underlying neurobiology: “The disease of chronic pain is more than just acute pain that lasts longer. It has greater intensity, causes impaired function and can migrate beyond the original pain site. The nervous system becomes distorted. Pain receptors get amplified and internal pain blockers minimized, which can make even the lightest touch be perceived as painful.”
In nociception, your sensory nervous system is responding to potentially harmful chemical, mechanical, or thermal stimulation of sensory nerve cells called nociceptors. This signal travels along nerve fibers to the brain triggering a pain response (source).
When experiencing chemical pain, such as the kind induced by spicy food, a signal is sent if receptors bond to certain elements. Thermal pain responses are produced by a change in receptor shape due to a temperature change. Responses to mechanical pain are produced through the depression of cells (like touch).
This type of pain results from damaged peripheral or spinal nerves, or when pain pathways in the peripheral nerves and spinal cord become over stimulated. An example of the former includes diabetic nerve pain, while the former is exemplified by phantom limb pain (source).
The phantom limb phenomenon is also referred to as psychogenic pain. This type of pain almost always has a physical origin (i.e. tissue or nerve damage), but the resulting pain is increased or prolonged due to the presence of negative psychological states such as fear, depression, stress, and anxiety. Although it is rare, it is possible that psychogenic pain originates entirely from a psychological condition.
The remainder of this article is going to be focused on nociceptive pain, as we've already put together a whole guide for neuropathic pain.
Developing Chronic Pain
Nociception is a normal part of animal biology. Without the ability to feel pain, we would be in regular danger, and we would constantly run the risk of seriously injuring ourselves.
No. Nociception is not the problem. The problem occurs when initially healthy pain signaling turns into pathological pain signaling. This happens when pain signaling does not translate into the healthy and normal function of the nervous system (i.e. when pain is signaled but nothing can be done about it).
So while pain is a normal and necessary biological function, chronic pain is a sign of homeostasis in the body gone horribly wrong.
Most Common Sources of Chronic Pain
Other than neuropathy, these are the most common pain complaints given by patients suffering from moderate to severe chronic pain.
These are just the most common sources of pain. For a complete A-Z list of all possible pain sources, click here.
Cannabis: The Ancient Pain Reliever
Cannabis was used for pain relief in all of the major ancient civilizations from Asia through the Middle East an into Europe and the Americas. The Chinese found evidence of medical use of cannabis for pain more than 4 millennia ago. In the 9th century, the Persian physician Shapur ibn Sahl put juice from cannabis into the nose of migraine sufferersto treat their headache pain. Cannabis was widely used in the U.S. in patent medicines for pain as early as the mid-1800's (study).
The Research: Pain & The Endocannabinoid System
The endocannabinoid system helps modulate pain signaling through the nervous system by a variety of mechanisms. Several studies have demonstrated that the endocannabinoid system is both centrally and peripherally involved in the processing of pain signals (study).
These mechanisms include producing analgesic and anti-inflammatory effects, the modulation of neurotransmitter release, and the stimulation of the release of the body's own natural opioids.
First of all, pain is the most common condition for which cannabis doctors recommend treatment for. As always, the efficacy of the treatment is tied inextricably to getting the dose right, but with the right dose, chronic pain can be managed effectively with cannabis.
While the research on CBD is still ongoing, that hasn’t stopped thousands of people all over the world from using it to treat pain, and share their stories with the world. Now we'll see if the research lives up to the hype.
A 2011 study showed that CBD and CBC stimulated descending pain-b locking pathways in the nervous system and caused analgesia by interacting with several target proteins involved in nociceptive control (study).
Then, a study using Sativex cannabinoid spray on intractable cancer pain showed that cannabis was most effective at lower and medium doses (study). Higher doses of cannabis do not necessarily provide increased pain relief, and may actually make pain worse in high doses (study).
Endocannabinoids have also been shown to reduce the wind-up phenomena, which occurs when pain appears to increase in intensity as the pain stimulus is repeated. They can also reduce allodynia (the sensation of pain from stimuli that are normally not considered painful). Endocannabinoids also modulate pain signaling in the descending pain pathway from the brain to the affected region.
Additionally, medical cannabis also decreases the intensity of the pain experience, calms patients, and lessens secondary adrenalin-type response to pain. According to patients, medical cannabis gives them a sense of control over the pain.
All in all, most of the studies done on treating chronic pain with cannabis have been encouraging.
How Cannabis Hemp/CBD Compares to Modern Medicine
Before moving into using CBD for pain, including discussions on which products are shown to be the most effective against pain, let's talk about the current treatments for chronic pain.
Pain relief treatments target your nervous system in different ways:
- Blocking or turning down pain messages in the brain
- Stopping inflammatory chemicals from communicating with nerves
- Quieting overactive nerves and/or blocking them from sending pain messages
- Stimulating the release of natural pain-relieving chemicals called endorphins
These treatments include oral and topical medication, an array of surgical/more invasive procedures, and other alternative treatments aimed at mitigating primary and secondary symptoms of chronic pain.
Cannabinoids affect the transmission of pain signals from the affected region to the brain (ascending) and from the brain to the affected region (descending).
Oral & Injections
Much of the pain symptoms in the U.S. are managed with oral medication. In fact, normal bouts of acute pain have increasingly been treated with opioids, leading to an epidemic more deadly than chronic pain: opioid abuse. Additional oral medications used to treat chronic pain include:
- OTC NSAIDs & Acetaminophen - NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain. Acetaminophen works on the parts of the brain that receive the "pain messages." Major adverse effects of NSAIDs include internal bleeding, heart attacks, strokes, and renal failure (study).
- Antidepressants - used to interrupt pain signals in the central nervous system.
- Corticosteroids - provide relief for inflamed areas of the body by easing swelling, redness, itching and allergic reactions.
- Anticonvulsant - the exact way in which these medicines control pain is unclear but it is thought that they minimize the effects of nerves that cause pain.
- Muscle Relaxants - used to treat neuropathic pain and centralized pain through their effects on the central nervous system.
- Opioids - work on receptors located in the nerve pathways that start in the brain and move to the joints and other tissues. Adverse effects include dependency, overdose, and constipation. Oxycodone and fentanyl are responsible for thousands of fatalities.
Topical pain relievers are common mostly for musculature pain. The ingredients used in these medications either block pain signals, or are an attempt to distract the patient from pain signals. Topical medication ingredients commonly include:
Depending on the pain source, there are a host of more invasive procedures to consider if the pain is debilitating enough, and/or does not respond to other treatments.
These types of treatments include, but are not limited to:
- Microvascular decompression - a procedure involving the exposure of the trigeminal nerve root and identification of the source of compression (i.e. blood vessel). "Decompression" reduces nerve sensitivity and allows the nerve to return to a more normal, pain-free state.
- Radiofrequency rhizotomy - this procedure treats the same nerve by warming it electronically.
- Glycerol rhizotomy - glycerol is injected into the nerve to damage it, causing interference with pain transmission signaling.
- Stereotactic radiation - this procedure targets a pain source with radiation, causing the formation of a lesion that disrupts pain signaling.
- Motor cortex stimulation - this procedure is performed only rarely, as the efficacy is not consistent and results are usually short term.
- Deep brain stimulation (DBS) - this is where an electrode is placed into specific parts of the brain to deliver a continuous electrical pulse to regions of the brain processing pain signaling. DBS helps up to 80 percent of patients in whom it is used and is most effective in the treatment of intractable back pain. The rate of reduction in pain varies from patient to patient but, on average, pain is cut in half.
- Spinal cord stimulation is a pain relief technique that delivers a low-voltage electrical current continuously to the spinal cord to block the sensation of pain. It works by stopping painful impulses from reaching the brain. It may be effective in treating refractory pain from prior back surgeries, chronic sciatica, nerve damage and peripheral vascular disease. Researchers have reported that about 60 percent of people receiving spinal cord stimulation have pain reduction or relief when surveyed one to two years after having the procedure (source).
Other Current Treatments
The treatments listed below are usually used in conjunction with one of the medications or surgical treatments above. Their main goals are to help us connect with our body and/or reframe the way we perceive illness and chronic pain.
Unlike all the other pain medications and treatments listed, medical cannabis has been proved effective for all types of pain, whether neuropathic, or nociceptive or even psychogenic (tension headaches, panic attacks, etc). The best part about it is the lack of adverse side effects.
The same cannot be said, of over-the-counter medicine, most notably the aforementioned NSAIDs. They may be effective sometimes, however, if you have arthritis or other forms of chronic pain, you may develop dependency over time. Additionally, long-term NSAID use is linked to a number of serious ailments. This includes gastrointestinal problems like gas, bloating, stomach pain, vomiting, and diarrhea. Studies also link prolonged NSAID use to renal failure and peptic ulcer disease.
Even acetaminophen accounts for more than 56,000 emergency room visits, 2,600 hospitalizations, and is the leading cause for calls to Poison Control Centers. It's been estimated that acetaminophen kills 458 people each year through liver failure.
According to the Cannabis Health Index, "beyond the anti-inflammatory properties, analgesia, and potential to reduce the use of opiates, cannabis reduces painful spasms, diminishes anxieties associated with the anticipation of pain, induces rest and sleep, and can gently elevate mood - all essential elements to healing.
Our recommendation: CBD-based cannabis treatments are something you should explore, especially if you’ve yet to feel lasting relief on your current treatment plan. We also recommend throwing in THC into your regimen if possible, as studies show that higher ratios of CBD:THC are effective. The side effects are minimal, and the effects of chronic pain on our lives is so big, that giving it a try is a no-brainer.
Tips For Using Cannabis & CBD for Pain
We know that pain is one of the best-substantiated medical uses of cannabinoids. Now let's talk about how to use these cannabinoids to treat our own pain. We'll go over some medicinal characteristics you should prioritize when choosing your medicine, recommended delivery methods for pain based on patient experiences, and dosing guidelines for using CBD for pain.
Strains, Terpenoids, & Cannabinoids For Chronic Pain
When CBD-dominant products alone aren't enough to treat your case of pain, products with a higher ratio of THC are sometimes recommended to better manage pain. In fact, professionals believe that THC is the most important and powerful pain relieving cannabinoid available. For use during the day, 'sativa' cannabis varieties with THC and higher concentrations of myrcene are best.
However, for pain in general, and especially for relief during the evening and nighttime, indica strains are preferred for their overall sedative and relaxing effects. When THC isn't available, CBD and terpenes can contribute significantly to pain, anxiety relief, and restorative rest. High CBD varieties work best for neuropathic pain, while high-THC varieties may be better for distraction from pain or sleep support (Cannabis Pharmacy).
Research and patient feedback have indicated that, in general, a ratio of 4:1 CBD:THC is the most effective for both neuropathic and inflammatory pain. With that said, it's important to remember how different the effects can be between individuals. Some patients may prefer higher concentrations of THC (some report a 1:1 ratio being the most effective for them).
Other cannabinoids shown to be effective pain relievers include CBC, CBG, THCV, and THCA.
In terms of terpenes, try to find chemotypes high in beta-caryophyllene, myrcene, and linalool. Strains with beta-caryophyllene are found in Cookies and Kryptonite. Low THC varieties like ACDC can be effective at addressing the inflammatory and neuropathic aspects of your pain.
Best Delivery Methods For Pain Patients
The methods we recommend for pain are oral, inhalation, and topical.
Oral cannabis products have been reported by patients to have a hypnotic effect that makes sleep possible and reduces the perception of pain at night. Additionally, oral cannabis is reported to have longer-lasting effects, making it unnecessary to dose more than 2-3 times daily.
Patients also informed researchers that inhaled cannabis, or cannabis consumed as a sublingual tincture/spray removes anticipatory bad pain memories, just as it treats PTSD (Cannabis Pharmacy).
Vaporizers that use a cartridge filled with CO2 concentrate are highly effective, and are available in various CBD:THC ratios. Vaporizers that vaporize whole plant flower are also an effective delivery method.
When pain is localized, a topical product can be useful. For skin application, the ratio of 1:1 CBD:THC is recommended.
CBD Dosage For Pain
Chronic pain relief from cannabis is going to depend heavily on the dose. More specifically, take the minimum amount of cannabinoids to effectively address your pain symptoms.
Let's go over dosing CBD for pain in terms of oral cannabis and inhaled cannabis. In both delivery methods, the micro to standard dose is recommended. That means that, in the end, 10mg-40mg of CBD or CBD + THC should be enough to treat your pain.
Oral CBD products with a ratio of 20:1 or higher and administered as drops, capsules, or edibles have been shown to be very effective in treating pain, especially pain resulting from inflammation. Finding the right dose using edibles is harder because of the longer onset time. We recommend starting out with 2.5 mg to 7.5 mg of THC orally every three to four hours to manage low level to moderate pain. If you aren't a fan of THC, adding an additional 2.5 mg to 10mg of CBD to the THC dose reduces THC psychoactivity and providing a measure of neuroprotection.
Inhaled delivery methods are good for immediate relief of symptoms such as flare-ups in pain. Vaporize 2.5mg to 7.5 mg to start. 2.5mg of inhaled cannabis flower is going to look like the size of a matchstick head.
Topicals can be applied as often as desired, but usually the recommendation is to apply liberally once every 2-4 hours, or as pain symptoms occur. For topical applications to work, the pain needs to be localized (usually to a joint, peripheral nerve, or muscle). We recommend topicals with higher levels of THC if possible.
Recommended Hemp/CBD Products for Chronic Pain
Since THC-dominant cannabis products can't be sold online, I'm going to just recommend products that are CBD-dominant and have been reported to relieve pain in consumers. Below you'll find a product recommendation for each delivery method recommended above.
We are only going to show one optimal recommendation for each delivery category. For more products, see our recommended products page.
More Posts About Cannabis Hemp/CBD & Chronic Pain
Want more? See the list below for more posts about using CBD for pain.
Can you really take CBD oil for pain? Is this a legitimate form of alternative medicine? More people are asking these questions as they gravitate towards natural and holistic approaches. It is not healthy, after all, to become too dependent on traditional pain relievers, such as NSAIDs like Ibuprofen or Tylenol. Let’s examine the science … Continue reading “CBD Oil for Pain: Cannabidiol’s Role in Pain Management and Opiate Withdrawal”
This post was last updated on 9/10/2018. Burning fingertips, sensations of walking on glass, and sleepless nights. Living with neuropathic pain is no way to live at all. Yet thousands of people like you and me have to deal with, largely unpredictable, bursts of pain. You’re not alone if you feel like your whole life … Continue reading “CBD and Neuropathy: Almost Magical Pain Relief Benefits”
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