Using CBD Oil for Pain Management: Does It Work? | Stem Cell, PRP, Acupuncture in Queens & Long Island, New York
Cannabidiol (CBD) is a type of cannabinoid, a chemical found naturally in cannabis ( marijuana and hemp ) plants. CBD doesn’t cause the “high” feeling often associated with cannabis. That feeling is caused by tetrahydrocannabinol (THC), a different type of cannabinoid.
Some people with chronic pain use topical CBD products, in particular CBD oil, to manage their symptoms. CBD oil may reduce:
- overall discomfort related to a variety of health conditions
The research on CBD products and pain management has been promising.
CBD can offer an alternative for people who have chronic pain and rely on medications, such as opioids, that can be habit-forming and cause more side effects. However, more research is needed to verify the pain-relieving benefits of CBD oil and other products.
Epidiolex, a drug prescribed for epilepsy, is the only CBD product on the market that the Food and Drug Administration (FDA) has approved.
There aren't any FDA-approved, nonprescription CBD products. They aren’t regulated for purity and dosage like other medications.
Keep reading to learn more about the potential benefits of CBD use for pain. You can also talk with your doctor to see if it’s an option for your condition.
Everyone has a cell-signaling system known as the endocannabinoid system (ECS).
Some researchers think that CBD interacts with a core component of the ECS endocannabinoid receptors in your brain and immune system.
Receptors are tiny proteins attached to your cells. They receive signals, mostly chemical ones, from different stimuli and help your cells respond.
This response creates anti-inflammatory and pain-relieving effects that help with pain management. This means that CBD oil and other products may benefit people with chronic pain, such as chronic back pain.
One 2018 review assessed how well CBD works to relieve chronic pain. The review looked at studies conducted between 1975 and March 2018. These studies examined various types of pain, including:
- cancer pain
- neuropathic pain
Based on these studies, researchers concluded that CBD was effective in overall pain management and didn’t cause negative side effects.
A 2016 study looked at CBD use in rats with arthritis.
Researchers applied CBD gel to rats for four days in a row. The rats received either 0.6, 3.1, 6.2, or 62.3 milligrams (mg) per day. The researchers noted reduced inflammation and overall pain in the rats’ affected joints. There were no obvious side effects.
Rats who received low doses of 0.6 or 3.1 mg didn’t improve their pain scores. The researchers found that 6.2 mg/day was a high enough dose to reduce the rats’ pain and swelling.
In addition, rats who received 62.3 mg/day had similar outcomes to the rats that received 6.2 mg/day. Receiving a substantially larger dosage didn’t result in them having less pain.
The anti-inflammatory and pain-relieving effects of CBD gel could potentially help people with arthritis. However, more human studies are needed.
Some people with cancer also use CBD. Research on mice has shown that CBD can lead to the shrinking of cancerous tumors. However, most studies in humans have investigated the role of CBD in managing pain related to cancer and cancer treatment.
The National Cancer Institute (NCI) has pointed to CBD as a possible option for reducing chemotherapy side effects, such as:
- lack of appetite
In a 2010 study on cancer-related pain, study subjects received oral sprays of a combination THC-CBD extract. The THC-CBD extract was used in conjunction with opioids. This study revealed that using the extract provided more effective pain relief than using opioids alone.
A 2013 study on THC and THC-CBD oral sprays had a similar finding. Many researchers from the 2010 study worked on this study as well. More evidence is still needed.
Studies on CBD and migraine are limited. The studies that currently exist also look at CBD when it’s paired with THC, not when it’s used alone.
However, results from a 2017 study indicate that CBD and THC can lead to less acute pain and less intense pain for people with migraines.
In this two-phase study, some participants took a combination of two compounds. One compound contained 9 percent CBD and almost no THC. The other compound contained 19 percent THC. Doses were taken orally.
In phase I, there was no effect on pain when the doses were under 100 mg. When the doses were increased to 200 mg, acute pain fell by 55 percent.
In phase II, participants who received the combination of CBD and THC compounds saw the frequency of their migraine attacks fall by 40.4 percent. The daily dose was 200 mg.
The combination of compounds was slightly more effective than 25 mg of amitriptyline, a tricyclic antidepressant. Amitriptyline reduced migraine attacks by 40.1 percent in study participants.
Participants with cluster headaches also found pain relief with the combination of CBD and THC compounds, but only if they’d had a childhood history of migraine.
CBD doesn’t pose significant risks for users, and most topical CBD products don’t enter the bloodstream.
However, certain side effects are possible, such as:
- changes in appetite
- changes in weight
CBD may interact with:
- certain over-the-counter (OTC) drugs
- prescription medications
- dietary supplements
Proceed with caution if any of your medications or supplements contain a “grapefruit warning.” Grapefruit and CBD both interfere with enzymes that are crucial to drug metabolism.
Like other drugs and supplements, CBD may also increase your risk of liver toxicity.
One study on mice concluded that CBD-rich cannabis extract increased their risk of liver toxicity. However, some of the mice had been force-fed very large amounts of the CBD-rich cannabis extract.
While there isn’t conclusive data to support CBD or CBD oil as the preferred method of pain management, researchers agree that these types of products have a lot of potentials.
CBD products might be able to offer relief for many people who have chronic pain, all without causing drug intoxication and dependence.
If you’re interested in trying CBD for chronic pain, talk to your doctor. They can help you determine a starting dosage that’s right for you.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens and New Hyde Park – Long Island. Call the Richmond Hill office at (718) 215-1888, or (516) 419-4480 for Long Island office, to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko .
Boomers Fuel Boom in Popularity of CBD
The compound from marijuana plants shows promise for age-related health problems
by Garrett Schaffel, AARP, June 7, 2018
Boomers are turning to CBD oil for pain management and other health issues.
En español | Nancy Giacobbe has been a medical marijuana cardholder since the legalization of medicinal use of the plant in California in 2008. But in 2014, her husband Chris had trouble sleeping due to painful spasms and tremors caused by treatments for a rare form of cancer. While Giacobbe, 61, had used the plant for its psychoactive properties (i.e., the high produced by tetrahydrocannabinol, or THC) she soon saw the medicinal benefits of the plant’s other, lesser-known compound — cannabidiol, or CBD — when Chris began to use it for his pain.
Giacobbe realized Chris could just use CBD without psychoactive effects. "When he would sleep, his face would just be at peace," Giacobbe says.
CBD, which comes in a wide variety of forms including salves, edibles and oils, does not produce the high typically associated with marijuana. But CBD seems to help people deal with pain, inflammation and even seizures, although even medical researchers and professionals aren’t sure why it works, how it works or even how much to use for what ailments.
Her husband passed away three years ago, but Giacobbe, who lives in Bodega Bay, Calif., now uses topical CBD for her arthritis, which has the potential to severely hinder her work as an aesthetician because she uses her hands every day. She can use the CBD ointment during the day because it causes no side effects and has no smell. At night, she says, "I put the salve on my hands and put on cotton gloves. Within an hour, I’m a happy person and can do a full 35-hour workweek."
Giacobbe is just one of many older adults who now use CBD as a treatment — both with and without a prescription — for mental and physical health issues. As of March 2018, in Colorado, one of nine states in which marijuana is legal for recreational use (the others being Alaska, California, Maine, Massachusetts, Nevada, Oregon and Washington, as well as the District of Columbia), people 50 and older now make up more than 36 percent of patients on the medical marijuana registry.
“We see really great interest amongst seniors,” says Martin Lee, director of the Northern California nonprofit Project CBD, which promotes the use of the compound as a natural alternative to traditional forms of drug therapy.
Mikhail Kogan, M.D., medical director of the George Washington University Center for Integrative Medicine, has prescribed CBD for his patients since the compound was legalized for medical use in the District of Columbia in 2011. Kogan says cannabinoids are "safer than Tylenol or caffeine by tenfold. If you compare them to opiates, they’re about 10,000 times safer." He recommends placing a few drops of the oil under the tongue.
All cannabis is illegal on the federal level. But cannabis-based CBD products with THC are widely available in states where it is legal. These products have varying ratios of CBD to THC, and because there are no official medical guidelines on dosage, patients are left to determine for themselves how much to take or how to modify their ratio. "You have to find the point at which you’re comfortable, hopefully, and that will include as much THC as works per person," Lee says. "Some people do better at higher doses of CBD. Some people can tolerate higher doses of THC."
For those in states where it is not legal, however, the CBD available is derived from industrial hemp, which is cannabis with a negligible amount of THC. This makes it impossible to modify the ratio as there is no THC present, which means there are fewer products to choose from. And since there is no FDA approval of these products, it can be hard to trust that what you’re buying actually is what’s advertised.
CBD’s cost is not uniform either. Depending on the dosage, strain and dispensary, it can cost from $100 to $1,000 a month. In California, for example, there is a 15 percent excise tax, plus an additional cultivation tax, which means a $50 bottle of CBD oil can cost about $65. You also have to pay for it out of pocket; private health insurance and Medicare don’t cover CBD due to the federal illegality of cannabis.
Even as CBD’s popularity has grown, the medical community is still not sure how it works scientifically. "It clearly has some anti-inflammatory effects, but the exact mechanism is still not known," says Pal Pacher, a pharmacologist and cardiologist at the National Institutes of Health, who has conducted studies on the compound.
Clinical trials both in the U.S. and around the world have shown that CBD works. The compound has been proven to dramatically reduce seizures in children with rare forms of epilepsy, and in 2017, GW Pharmaceuticals submitted Epidiolex, a pure CBD plant extract, to the FDA for approval as an epilepsy drug. It received a recommendation for approval from an administration advisory panel in April.
While there is growing interest among scientists to study CBD’s causes and effects, researchers are hindered by marijuana’s Drug Enforcement Agency Schedule I classification, meaning it is considered in the same drug class as heroin.
As a physician specializing in integrative medicine, Kogan says that CBD and cannabis are excellent components of his care model because of their documented use throughout history. "Cannabis use goes back in every existing society," he says.
Lee, who uses CBD to help with his own health issues stemming from a stroke in 2006, sees people 50 and older as the critical generation that is turning back the stigma of cannabis-based therapy. "It’s the baby boomers," he says. "We have all sorts of health problems. Cannabis can really speak to a lot of those problems."