Cannabidiol or CBD, is one of more than 113 phytocannabinoids derived from the hemp plant. It is of particular interest in the management of pain and chronic pain conditions as it has been reported to reduce pain and overall inflammation in a number of chronic conditions.
Patients who struggle with chronic conditions that cause pain, long to have access to a safe alternative to pharmaceutical compounds that may have long term side-effects or have detrimental health consequences. Research in the field of pain management has shed new light on the useful effects of cannabis-based medicines as an alternative to common painkillers such as non-steroidal anti-inflammatory drugs (NSAIDS), steroids, and opiates.
CBD has been used as a safe alternative to opioids, which have been traditionally prescribed as the first line of treatment for chronic pain. Dependance on opiates as a means to treat pain has led to the wide-spread opiate crisis. For many patients, pain relief is essential to being able to function and to carry out normal day to day activities. Even when used for a short period of time, opioid painkillers may cause addiction, leading to devastating consequences for addicts and their families. Besides the potential for addiction, opiates may also cause many side effects such as dizziness, nausea, anxiety, and irritability.
The last decade has seen a vast expansion in research on the beneficial effects of cannabinoids such as CBD. One recent research review went over the findings of 42 studies and 24 randomized clinical trials on cannabinoids and pain reduction, and examined adverse events associated with these compounds. 1 The analysis found a high quality of evidence that demonstrated the efficacy of cannabinoids for treatment of chronic pain. The study also found a lower number of adverse events in patients using cannabinoids, compared to those using traditional painkillers.
CBD exerts its effects on the body through its interactions with the endocannabinoid system. This system is part of the central and peripheral nervous system, and regulates a number of different physiological processes including cognition, mood, and pain modulation. Unlike other cannabinoids such as Tetrahydrocannabinol (THC), CBD does not have an intoxicating effect, and has calming properties that diminish anxiety. 2, 3, 4 CBD’s properties make it a safe and effective alternative for management of pain, especially in chronic conditions and pain of neuropathic origin. 5
Pain can be controlled through different neurotransmitters that operate within the central nervous system. An important neurotransmitter involved in the regulation of pain is anandamide, a naturally occurring analgesic that can stop the initiation of pain signals. CBD has a powerful effect on anandamide and the inhibition of pain. 6 Anandamide is produced endogenously by the body and is also released during exercise, its effects have been sometimes referred to as “runner’s high”. Most importantly, CBD inhibits pain in a similar manner as opioid painkillers without the detrimental side effects and risk of addiction associated with these type of medications.
Studies done in animal models have examined the therapeutic implications of CBD on arthritic pain. One study examined the effects of transdermal application of CBD for the treatment of pain from knee arthritis. 7 Study subjects who received the CBD compound showed marked improvement of their knee pain. Transdermal application of the compound not only accomplished relief from the pain, but also avoided the gastrointestinal discomfort associated with oral administration of conventional painkillers.
Another study examined the long term effect and potential preventive benefits of CBD on osteoarthritis. 8 Left untreated, osteoarthritis leads to joint degeneration, chronic inflammation, and nerve damage. Local administration of CBD not only blocked osteoarthritic pain, but also prevented the development of chronic inflammation and nerve damage. A recent study published in the journal Clinical and Experimental Rheumatology recognized CBD as a new and important emergent therapeutic agent for managing joint pain. 9
As the beneficial effects of CBD have come to light, the medical community has continued to review available data on these compounds. Studies on CBD and other cannabinoids have explored the use of these compounds in the treatment of chronic pain.
A review of randomized clinical studies published by The Journal of the American Medical Association JAMA went over the results of 28 studies on chronic pain and the use of cannabinoids. 10 These studies included 2454 patients. Researchers from the study concluded that compared to placebo, cannabinoids were associated with a greater reduction of pain, and a greater average reduction on numerical pain ratings. Researchers studying available therapies and presentations of CBD for the treatment of malignant diseases such as cancer and multiple sclerosis have identified a target dose of 25 mg of CBD for relief of pain. 11 Another important finding from this study is that cannabinoid preparations containing THC improve their effect on pain with the addition of CBD.
In addition to its properties as a modulator of pain, CBD can also reduce free radical damage on tissues that is produced as a result of inflammation. 12 Researchers have studied the effect of CBD on the immune system, and its specific effects on Macrophages and other specialized white blood cells. 13 Studies carried out in animal models have shown that because of its interactions with the cellular response to inflammation, CBD also has a direct effect on swelling and hypersensitivity after an injury. 14 Furthermore, due to the analgesic and anti-inflammatory properties displayed by CBD, its capacity to reduce free-radical induced oxidative stress may play an important therapeutic role in the prevention of many chronic conditions such as rheumatoid arthritis, Alzheimer’s disease, atherosclerosis, hypertension, and depression.
CBD has emerged as a safe alternative for the treatment of pain in acute and chronic conditions. Its use as an analgesic has been documented in numerous clinical studies. Therapies including CBD have been used to successfully treat the pain associated with conditions such as osteoarthritis, migraines, neuropathic pain, and pain associated with cancer. CBD is a great alternative for pain management since it lacks common side effects associated with traditional painkillers.
- Aviram J, Samuelly-Leichtag G. Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Physician. 2017 Sep;20(6):E755-E796.
- Pisanti S, Malfitano AM, Ciaglia E, et al. Cannabidiol: State of the art and new challenges for therapeutic applications. Pharmacol Ther. 2017 Jul;175:133-150. doi: 10.1016/j.pharmthera.2017.02.041. Epub 2017 Feb 22.
- Iseger TA, Bossong MG. A systematic review of the antipsychotic properties of cannabidiol in humans. Schizophr Res. 2015 Mar;162(1-3):153-61. doi: 10.1016/j.schres.2015.01.033. Epub 2015 Feb 7.
- Jurkus R, Day HL, Guimarães FS, Lee JL, Bertoglio LJ, Stevenson CW. Cannabidiol Regulation of Learned Fear: Implications for Treating Anxiety-Related Disorders. Front Pharmacol. 2016 Nov 24;7:454. eCollection 2016.
- Ethan B Russo. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008 Feb; 4(1): 245–259.
- Clapper JR, Moreno-Sanz G,Russo R, Anandamide suppresses pain initiation through a peripheral endocannabinoid mechanism. Nat Neurosci. 2010 Oct; 13(10): 1265–1270.
- Hammell DC, Zhang LP, Ma F, Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. Eur J Pain. 2016 Jul; 20(6): 936–948.
- Philpott HT, O'Brien M, McDougall JJ. Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis. Pain. 2017 Dec; 158 (12): 2442–2451.
- Miller R, Miller R. Is cannabis an effective treatment for joint pain? Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):59-67. Epub 2017 Sep 28.
- Whiting PF, Wolff RF, Deshpande S. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015 Jun 23-30;313(24):2456-73. doi: 10.1001/jama.2015.6358.
- Darkovska-Serafimovska M, Serafimovska T, Arsova-Sarafinovska Z, Stefanoski S, Keskovski Z, Balkanov T. Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases. J Pain Res. 2018; 11: 837–842
- Booz GW. Cannabidiol as an emergent therapeutic strategy for lessening the impact of inflammation on oxidative stress. Free Radic Biol Med. 2011 Sep 1;51(5):1054-61. doi: 10.1016/j.freeradbiomed.2011.01.007. Epub 2011 Jan 14.
- Oláh A, Szekanecz Z, Bíró T. Targeting Cannabinoid Signaling in the Immune System: "High"-ly Exciting Questions, Possibilities, and Challenges. Front Immunol. 2017 Nov 10;8:1487. doi: 10.3389/fimmu.2017.01487. eCollection 2017.
- Burstein S. Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorg Med Chem. 2015 Apr 1;23(7):1377-85. doi:10.1016/j.bmc.2015.01.059. Epub 2015 Feb 7