Cannabidiol (CBD): How To Use for Pain Management

Cannabidiol (CBD) is being used widely across the health and wellness industry to treat a variety of ailments and unpleasant symptoms that millions of Americans face daily. Though cannabis and its compounds in it have been used medicinally almost since the beginning of civilization, recent changes legalizing the hemp plant have led to a boon of interest and consumption in hemp-derived CBD, or hemp oil extract. The CBD industry is growing quite rapidly, with some projections even anticipating a market size of $20 billion by 2024.  Some physicians are recommending use of CBD to their patients. Even veterinarians are using it to treat pets; particularly for its benefit in treating arthritic pain in older dogs. For humans, obviously a far greater degree of evidence and statistical certainty is required before CBD can be claimed to cure anything (other than the specifically approved use of a seizure medication used for severe pediatric seizure disorders). That level of certainty is approaching but has not yet arrived.

While dozens of studies have provided supporting evidence that CBD may assist in treating a wide range of ailments including arthritis, anxiety, schizophrenia and insomnia and pain management the substance does not have the critical mass of evidence necessary, particularly in human trials, to achieve FDA approval as a medicine to treat many of the conditions studies are finding and consumers are reporting that it can help with. Unlike its better known and more controversial cousin tetrahydrocannabinol (THC), cannabidiol (CBD) does not possess mind-altering or addictive qualities. According to a report by the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.” Anyone who has experienced personally dealing with pain management will find that statement important. Millions of Americans have dealt with the harsh physical, social and financial consequences that can rapidly occur upon becoming physically addicted to their opiate pain medications. Thus, many who have had this experience or who wish to avert it have a powerful incentive to see for themselves if CBD works. Doctors in general have been cutting down on the prescription of these medications and pharmaceutical companies that encouraged their over-distribution have been sued successfully and on a widespread basis. Currently, more than 130 people a day die from opiate overdoses.

Therefore there is perhaps no area outside of pain management where it may be more beneficial to try CBD first before, or in tandem with, traditional pain medications.  The use of prescription opiates can result in addiction and even death, CBD cannot.  That is not to minimize the risks of taking CBD, of which there are many. However, an informed consumer can avoid these risks with a little due diligence. As millions of Americans have become addicted to opiate medications, many consumers are choosing to seek alternative methods of pain management that do not have the addictive properties of mainstream pharmaceutical remedies.

It is important to always remember that any supplement, which most CBD is sold as, is not regulated by the FDA. This means, until further medical research and validation of results amongst human trial participants, the proper dose of CBD (most effective) is not known. Though CBD shows a lot of promise; it is not currently a medicine except for sufferers of a pediatric seizure condition. You should not use CBD instead of a prescription medication, or at all without talking to your physician. CBD is known to have side effects such as fatigue, irritability and dry mouth. It can also interact with medications in the same way as grapefruit juice. CBD is not known to cure any ailments, only to help with aforementioned symptoms. Also, because the supplements are not regulated for purity the FDA and independent research groups have found a large amount of CBD vendors who mislabel or misrepresent the contents of their products. Other government certifications like the USDA Certified Organic seal and private methods like batch numbers, and Certificates of Analysis (COAs, i.e. lab testing) can help ensure you select only quality CBD products that are what they purport to be.

How Does CBD Help With Pain Management?

CBD acts in the brain by effecting the endocannabinoid system. The endocannabinoid system regulates homeostasis across the body’s systems. The primary receptors of this system are the CB1 and CB2 receptors. Our body produces endogenous cannabinoids, just as we produce endogenous opiates. The reason most drugs that produce psychoactive effects work is because they are molecularly similar to a compound we already produce in our brain and they can thus bind to the appropriate receptors. CB1 activation effects physiological processes such as sleeping, appetite, vomiting, mood and pain while CB2 activation is connected to the immune system and particularly to the body’s inflammation mechanism. Inflammation often plays a major role in chronic and temporary pain. The chemicals the body produces internally that bind to the CB1 and CB2 receptors are anandamide and 2-arachidonoylglycerol (2AG). Anandamide binds to the CB1 receptor while 2AG binds to both.

This binding (to the CB1 and CB2 receptors) causes all sorts of physiological and mental changes and regulation of physiological processes depending on the compound that is binding and whether that compound is produced in or out of the body. The psychoactive component in cannabis, tetrahydrocannabinol (THC) binds to the CB1 receptors (causing the notorious “high” from marijuana). One of the reasons the therapeutic potential of cannabidiol (CBD) is more complicated and less understood is because it’s effects on the brain are less direct than that of its better-known cousin. However, in a very general sense, it seems that CBD promotes equanimity of the mind and has a neuroprotective effect, hence the preliminary evidence there is for anti-anxiety, anti-psychotic, anti-seizure and anti-insomnia therapeutic applications. In more detail; CBD has a limited binding affinity with the actual cannabinoid receptors. Instead, CBD acts as an Anandamide uptake inhibitor; meaning it prevents the breakdown of the chemical allowing that chemical to more efficiently regulate the physiological functions associated with the endocannabinoid system. It also makes it more difficult for shortages of this chemical (which is now being used more efficiently by the brain) to cause imbalances that may result in undesirable effects upon physiological processes regulated by endocannabinoid system.

CBD is believed to reduce certain kinds of pain by inhibiting neuronal transmission, and thus providing analgesic effects, without causing an analgesic tolerance. Analgesic tolerance is one of the biggest problems associated with opiate medications; patients must take more and more to achieve the same effect in pain mitigation. In addition to this, CBD has been found in some studies to reduce the analgesic tolerance of other pain medications like opiates, so if you have to take opiate medication for acute pain using CBD may be able to assist you in lowering the amount of pills you’re taking and thus reducing chances of becoming physically dependent. In other words, CBD can act as an opiate sparing agent in the treatment of chronic pain.

CBD also binds to receptors outside of the endocannabinoid system like the serotonin 1A receptor which regulates mood and cognition and the Vanilloid TRPV1 receptor which affects pain and inflammation.

CBD should not be treated as a first-line defense against acute pain. It should not be used as the primary remedy for the underlying cause of pain either (unless it works for you and you follow this path under the advisement of your physician). Even THC, which also has pain relief effects, particularly when combined with CBD, is not considered a first-line defense against pain. However, anecdotally many consumers have found CBD to have a miraculous result on particular types of pain. A CBD/THC combination is recommended by the European Federation of Neurological Societies and Canadian experts as a secondary or tertiary treatment for neuropathic pain and central pain in multiple sclerosis. Canadians also approved its use for intractable cancer pain in 2007. In 22 out of 29 trials investigating cannabinoid use for chronic, non-cancer pain found a significant pain mitigating effect and reported other positive outcomes like better sleep and spasticity.

A Cochrane Review is a systematic approach to identifying and synthesizing all the quantitative data available to answer a specific research question. The process is considered highly reputable and aims particularly to remove bias and let the data speak for itself. A review found cannabinoid based medicines superior to placebo or conventional drugs for neuropathic pain; although there are side effects which can mitigate the benefits.

Cannabidiol (CBD):  Pain It Can Help With

The above gives a simple description of some of the ways the CBD acts in the brain and why it might be a particularly beneficial addition to a pain management regiment. Here are some of the particular types of pain CBD can help with:

Chronic Pain: As noted before, CBD can act synergistically with opiates in the treatment of chronic pain. CBD specifically may be able to suppress neuropathic and chronic inflammatory pain. The compound also likely has a positive effect on the subjective perception of pain because of its effect on serotonin receptors.

Cancer Treatment Symptom Mitigation: Cannabis is known for its treatment of cancer. The receptors in the endocannabinoid system are integrally associated with many of the physiological symptoms that are adversely effected during chemo-therapy and radiation treatment for cancer. Additionally, anti-anxiety effects may be beneficial to those undergoing cancer treatment who have obvious reason for severely elevated anxiety. CBD can also mitigate the psychoactive effects of THC for cancer patients who prefer to regulate their level of impairment from cannabis containing THC.

Multiple Sclerosis:  CBD has been found by research to help MS patients in multiple ways. Firstly, CBD is a powerful anti-inflammatory and early chronic inflammation has been shown to be responsible for relapsing-remitting MS. CBD has also been shown to reduce muscle spasticity and pain in MS patients. Thirdly, CBD’s effect on mood and its ability to reduce dependence on opiate medications help manage the difficulties and depression that can be associated with MS.

Arthritis Pain: CBD has been shown to cause pain relief from arthritis-caused inflammation in humans and animals. Research found that transdermal application directly to the effected area is an effective method to reduce pain.

How to Take CBD

Check recommended amounts for each product. Remember to only buy quality products with verifiable contents. Check pain management blogs of people who have your condition and may have successfully used CBD. Always consult your physician and be careful to make sure to start out on the lower side of dosage first and work your way up to the desired effect to avoid undesirable side-effects.

  • CBD Tinctures: CBD oil tinctures are the most popular CBD-based product. There are three basic types of CBD tinctures: Isolate, broad-spectrum, and full spectrum. CBD isolate is simply 100% pure CBD oil and contains no other cannabinoids.  

  • CBD Supplements: CBD supplements are increasingly popular among people who take CBD for minor chronic or acute pain and other health issues. This can include those who are not familiar with self-administering from a tincture and want the certainty of a pre-dosed pill, so they know precisely how much CBD they are getting. Some CBD companies have begun creating CBD-hybrids by adding caffeine to their supplements for day-time usage and melatonin to take before bed.
  • CBD Gummies: CBD gummies are popular among those who don’t like to swallow pills. Gummies can be just as potent and helpful as CBD supplements or tinctures; it’s merely a matter of preference and experience.

  • CBD Creams: CBD creams are increasingly popular in specific communities, including weightlifters, bodybuilders, and professional and amateur athletes. These people and others face issues associated with constant sore and tired muscles, as well as tissue damage. Thankfully CBD is an effective topical treatment that can help relieve muscle pain and reduce inflammation. CBD creams are also popular among those who have rheumatoid arthritis. 

  • CBD Lotions: CBD lotions are great for helping skin tone, reducing redness, and can even help with acne.

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