How Do CBD Gummies Help Pain

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CBD and THC are both found in cannabis plants but are very different compounds. Learn more about how each treats pain here. Scientists have tested CBD’s efficacy as an analgesic—and with promising results. Here’s what we know so far about how we can use CBD oil for pain relief. CBD, a non-psychoactive component in cannabis, is emerging as a promising pharmaceutical agent to treat pain and other conditions. Unfortunately, few studies in humans have examined its effectiveness, and the cannabis industry’s profit motive is driving a wave of dubious claims about what CBD can do.

THC vs. CBD for Pain Relief: What’s Better?

People with arthritis and other chronic musculoskeletal pain are increasingly turning to cannabis products for relief from different symptoms, such as pain, fatigue, insomnia, and anxiety. In fact, a recent CreakyJoints survey of people with arthritis found that more than half had tried marijuana or CBD for a medical reason.

While cannabis plants are complex and different varieties have different chemical compositions, almost all of them contain some combination of two medically important compounds: tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC is responsible for that “high” that people get from marijuana, which may also play a role in pain relief. CBD doesn’t usually cause an intoxicating feeling, but research suggests it, too, may help ease arthritis symptoms.

These two chemicals both show potential in easing pain, but in different ways. Choosing a product rich in THC, CBD, or both could make a difference in the kind of pain relief you experience — if any. (Here are reasons your CBD product might not be working for you.)

Here’s what experts say about the differences between THC and CBD for pain relief.

How THC and CBD May Offer Pain Relief

CBD and THC activate different cannabinoid receptors in your body that can stimulate or inhibit brain chemicals and cause certain effects.

“We know a lot more about how THC works in terms of the molecular mechanism [than CBD],” says Steve Alexander, associate professor of molecular pharmacology at the University of Nottingham Medical School, who researches cannabinoids.

“THC activates certain cannabinoid receptors, one of which is in the nerve cells and the other is in the immune cells. When it activates the one in the nerve cells, it reduces the sensation of pain,” he adds.

The high that THC provides can also play a role in how people experience pain. “A little bit of euphoria can help us not care that we’re experiencing quite as much pain, much in the same way that other pain medications work,” says Angela D. Bryan, PhD, professor of psychology and neuroscience at the University of Colorado Boulder, who has studied cannabis and health.

CBD is much less understood than THC by researchers, although there is anecdotal evidence that it may provide pain relief in some people.

“We’ve got a hypothesis that CBD might have some interference with [the brain chemical] serotonin and some influence on glycine receptors, which may be involved with pain. We think it may do what it does by hitting multiple targets with a fairly light touch,” says Dr. Alexander. “It’s difficult to pick apart — lots of people are trying [to study it], but no one has yet succeeded.”

Researchers have not found much evidence that CBD can offer mental relief from pain. However, the placebo effect may help some individuals experience less pain after taking CBD.

“The human mind is a very powerful thing, and a lot of the ways we experience medication is related to our expectancies about that medication,” says Dr. Bryan.

How CBD Can Help with Anxiety

Scientists suspect that CBD may help relieve anxiety, though. That, in turn, could affect someone’s perception of pain and potentially make them more comfortable. The research is still developing, though, and it’s too early to draw anything conclusive.

“We know that chronic pain patients also have a number of other morbidities, like stress, anxiety, and depression. I’m interested in the possibility that cannabidiol might also have mechanisms by which we can relieve some of those additional problems,” says Dr. Alexander.

That said, CBD may offer pain relief in more physical ways. It seems to show promise in reducing inflammation, which could provide pain relief from autoimmune diseases like rheumatoid arthritis, says Dr. Bryan.

The bottom line: THC seems to have a greater effect on the way the mind perceives pain, whereas CBD may work to ease pain at the local source.

Which Is Better for Pain Relief: THC or CBD?

There’s no definitive answer to the debate between THC and CBD for pain relief. Cannabis is still considered a Schedule 1 drug by the federal government — a legal status that limits the kinds of research that can be conducted.

Using the current research available, Dr. Bryan says she believes that a combination of THC and CBD together shows the most promise for pain relief.

“To the extent that we have good data, it’s unlikely that either THC or CBD on its own is going to be particularly effective for pain. It probably needs to be a combination of the two,” she explained. “We’re totally speculating at this point, but the way they work together might be that CBD has anti-inflammatory properties while THC has properties that can help us better cope with pain.”

CBD and THC: Side Effects and Legal Concerns

THC might not be an option for everyone, though. Some people may live in states where THC is illegal; while others simply don’t want the psychoactive effects of the substance. In those cases, it might be worth trying CBD on its own to see if it offers pain relief for you.

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CBD isn’t legal everywhere either. And in states where CBD is legal, laws can vary as to how much THC is permissible in CBD products in order for them to be legally sold. Many states in which certain CBD products are legal require them to contain less than 0.3 percent THC.

Before trying either substance, it’s worth considering potential side effects they may cause. Side effects of CBD include nausea, fatigue, and irritability, according to Harvard Health. CBD can also interact with certain medications (such as blood thinners) and either increase or decrease the concentration of certain drugs in the bloodstream.

THC has its own set of side effects, including sleepiness and lethargy, increased appetite, increased heart rate, coordination problems, dry mouth, red eyes, slower reaction times, memory loss, anxiety, and mood changes.

“It’s quite likely that individuals will respond to different versions of these cannabinoids, and some may not respond at all,” says Dr. Alexander. “There’s a tendency for anecdotal evidence to highlight the positives of people who do respond [to CBD], which is useful, but it’s difficult to measure the numbers of people who don’t get a lasting benefit.”

If you’re interested in trying CBD or THC to manage your pain, talk to your doctor and experiment to see whether CBD or THC (or both) relieves some pain.

You can also learn more in a new, free course on the health effects of THC and CBD, created by Kent Hutchison, PhD, professor of psychology and neuroscience at the University of Colorado in Boulder.

“Start with low doses and go slowly to find out what works for you,” says Dr. Alexander. “I find it difficult to believe that there is one version of cannabis or CBD that will be best for everyone.” Learn more here about how to find your optimal CBD dose.

How To Use CBD To Help Manage Pain

Dr. Bindiya Gandhi is an integrative medicine physician with expertise in functional and holistic medicine based in Atlanta, Georgia.

Commissions we earn from partner links on this page do not affect our opinions or evaluations. Our editorial content is based on thorough research and guidance from the Forbes Health Advisory Board.

Table of Contents

  • CBD for Pain Relief
  • CBD for Chronic Pain
  • CBD for Arthritis and Joint Pain
  • CBD for Neuropathic Pain

Without the intoxicating properties of its cousin delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) can provide the human body with a handful of health benefits. Cannabinoids like CBD interact with receptors in the endocannabinoid system, which plays a role in signaling bodily functions, from emotional responses to motor control to energy balance [1] Mouslech Z, Valla V. Endocannabinoid system: An overview of its potential in current medical practice. Neuro Endocrinol Lett. 2009;30(2):153-179. .

Over the last two decades, scientists have tested CBD’s efficacy as an analgesic, or painkiller, specifically—and with promising results. While research is ongoing, here’s what we know so far about how we can use CBD oil for pain relief.

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CBD for Pain Relief

For now, no CBD-based medications are approved as painkillers in the U.S. Epidiolex, which is used for rare forms of epilepsy, is the only CBD treatment approved by the Food and Drug Administration (FDA).

Meanwhile, several countries have approved CBD to treat certain conditions. For instance, the U.K. approved it for multiple sclerosis, and Canada approved it for cancer pain. Ongoing research suggests CBD oil for pain can aid medical conditions, including arthritis and fibromyalgia, at varying doses. Some pain may not be treatable by CBD alone, but it can help when paired with THC or Western medication applications.

Interestingly, 60% of U.S. adults who use CBD products do so for its potential pain-relieving effects, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll.

What’s more, 60% of U.S. adults have tried CBD and believe it has medicinal benefits.

CBD for Chronic Pain

Chronic pain is defined as any pain lasting longer than several months. Studies have found CBD, often alongside THC, to be an effective pain reliever for various chronic conditions.

In clinical trials, Sativex, a spray with equal parts CBD and THC, proved significantly successful as an analgesic for cancer-related pain [2] Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008;4(1):245-259. . The spray, also used for multiple sclerosis-related pain, is approved in Canada to treat cancer pain and is currently undergoing trials for approval and use in the U.S.

A 2019 study found Sativex to be an “effective and well-tolerated add-on treatment” for patients with severe chronic pain stemming from various ailments. The study identified three types of pain: nociceptive (affecting body tissue), neuropathic (affecting nerves) and mixed pain. Sativex helped treat all three kinds but proved especially effective against neuropathic pain.

An earlier study also found CBD to be effective in chronic pain relief for conditions like multiple sclerosis and spinal cord injury, although across a much smaller sample size [4] Wade DT, Robson P, House H, Makela P, Aram J. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil. 2003;17(1):21-29. .

CBD for Arthritis and Joint Pain

Arthritis is a broad term that encompasses hundreds of joint-related conditions and pains. Common symptoms include swelling, pain and stiffness in the joints and may progress over time.

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Already a proven analgesic for other conditions, CBD shows promise as an anti-inflammatory substance in both animal and preclinical trials, which bodes well for arthritis treatment [5] Nichols JM, Kaplan BLF. Immune Responses Regulated by Cannabidiol. Cannabis Cannabinoid Res. 2020;5(1):12-31. [6] Mlost J, Bryk M, Starowicz K. Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action. Int J Mol Sci. 2020;21(22):8870. [7] Kosgodage US, Mould R, Henley AB, et al. Cannabidiol (CBD) Is a Novel Inhibitor for Exosome and Microvesicle (EMV) Release in Cancer. Front Pharmacol. 2018;9:889. [8] Lowin T, Tingting R, Zurmahr J, Classen T, Schneider M, Pongratz G. Cannabidiol (CBD): a killer for inflammatory rheumatoid arthritis synovial fibroblasts. Cell Death Dis. 2020;11(8):714. . However, clinical research dedicated to CBD administration for arthritis is less robust and ongoing.

The first controlled trial conducted in 2006 focused on patients with rheumatoid arthritis, an autoimmune disease that causes inflammation in the joints and other affected areas [9] Blake DR, Robson P, Ho M, Jubb RW, McCabe CS. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology (Oxford). 2006;45(1):50-52. . Researchers found that, compared to a placebo, Sativex significantly improved participants’ pain during movement, pain at rest and quality of sleep. Any adverse reactions to the treatment were mild or moderate, and there were no complications with withdrawal.

In 2018 researchers tested the efficacy of topical CBD gel on participants with osteoarthritis-related knee pain over the course of 12 weeks [10] Hunter D, Oldfield G, Tich N, Messenheimer J, Sebree T. Synthetic transdermal cannabidiol for the treatment of knee pain due to osteoarthritis. Osteoarthritis and Cartilage. 2018;26:S26. . Participants used either 250 milligrams or 500 milligrams, split into two applications, daily. Overall, participants’ weekly pain levels didn’t improve much with CBD compared to placebo. However, when researchers evaluated the average weekly worst pain scores and Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical function scores, participants who applied 250 milligrams of CBD daily experienced significant improvement over placebo participants.

Meanwhile, a small 2019 trial suggests a mix of CBD and THC may prove beneficial for people with fibromyalgia, a type of arthritis that results in whole-body pain and fatigue [11] van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain. 2019;160(4):860-869. . The study found that, via a single inhalation, a CBD-THC solution performed better than a placebo and either substance on its own.

CBD for Neuropathic Pain

Various conditions and injuries that damage nerves or the nervous system can result in neuropathic pain. This kind of pain manifests as tingling, numbness, muscle weakness and a sharp, shooting, burning or stabbing pain.

Multiple sclerosis (MS) is a common cause of neuropathic pain. The disease wears down myelin, a mixture of proteins and phospholipids that coats nerve cells. Sativex is already approved as an MS treatment around the world due to its success in clinical trials. As a spray, Sativex is absorbed in the mouth. Studies support a median dose of eight sprays a day for patients with MS, which provides about 20 milligrams of CBD and 21.6 milligrams of THC [12] Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC). Datapharm. Accessed 7/9/2021. . However, doses vary between patients, and each person needs to find their optimal dose.

A 2020 study also tested topically administered CBD oil as a treatment for patients with peripheral neuropathy, or damage to the peripheral nervous system, which sends information throughout your body from the central nervous system [13] Xu DH, Cullen BD, Tang M, Fang Y. The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Curr Pharm Biotechnol. 2020;21(5):390-402. . When compared to placebo, the topical CBD significantly reduced patients’ intense pain and sharp pain, as well as cold and itchy sensations.

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CBD for chronic pain: The science doesn’t match the marketing

If you ask health care providers about the most challenging condition to treat, chronic pain is mentioned frequently. By its nature, chronic pain is a complex and multidimensional experience. Pain perception is affected by our unique biology, our mood, our social environment, and past experiences. If you or a loved one is suffering from chronic pain, you already know the heavy burden.

People are looking for novel, nonaddictive ways to treat pain

Given the ongoing challenges of chronic pain management coupled with the consequences of the opioid epidemic, pain management practitioners and their patients are searching for effective and safer alternatives to opioids to alleviate pain. With the legalization of marijuana in many states and resulting cultural acceptance of this drug for recreational and medical use, there has been an increased interest in using cannabis for a myriad of medical problems, including pain.

Cannabis (most commonly obtained from the Cannabis indica and Cannabis sativa plants) has three major components: cannabinoids, terpenoids, and flavonoids. While there are over a hundred different cannabinoids, the two major components are tetrahydrocannabional (THC) and cannabidiol (CBD). Historically more attention has been paid to the psychoactive (euphoric “getting high”) component of the cannabis plant, THC; there have been fewer scientific studies on the medical use of CBD, a non-psychoactive component of the plant.

What’s the thinking behind using cannabis for chronic pain?

CBD is emerging as a promising pharmaceutical agent to treat pain, inflammation, seizures, and anxiety without the psychoactive effects of THC. Our understanding of the role of CBD in pain management continues to evolve, and evidence from animal studies has shown that CBD exerts its pain-relieving effects through its various interactions and modulation of the endocannabinoid, inflammatory, and nociceptive (pain sensing) systems. The endocannabinoid system consists of cannabinoid receptors that interact with our own naturally occurring cannabinoids. This system is involved in regulating many functions in the body, including metabolism and appetite, mood and anxiety, and pain perception.

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What’s the research that CBD works in humans?

Given its promising results in animal models, along with its relative safety, non-psychoactive properties, and low potential for abuse, CBD is an attractive candidate to relieve pain. Unfortunately, there is a lack of human studies about the effectiveness of CBD. However, there is an abundance of commercial advertisements about the magical effects of CBD, and it is frequently presented as a cure-it-all potion that will treat everything including diabetes, depression, cancer, chronic pain, and even your dog’s anxiety!

So far, pharmaceutical CBD is only approved by the FDA as adjunct therapy for the treatment of a special and rare form of epilepsy. Currently, CBD alone is not approved for treatment of pain in the United States. But a combination medication (that contains both THC and CBD in a 1:1 ratio) was approved by Health Canada for prescription for certain types of pain, specifically central neuropathic pain in multiple sclerosis, and the treatment of cancer pain unresponsive to optimized opioid therapy. There is currently no high-quality research study that supports the use of CBD alone for the treatment of pain.

Why is CBD presented to the public this way, when it is not without risks?

Given the rapid change in the legality of cannabis coupled with the increased appetite for something new, and driven by unprecedented profit margins, the advertising for cannabinoids in general and CBD in particular has gone wild. The FDA is very clear that it is illegal to market CBD by adding it to a food or labeling it as a dietary supplement. And it warns the public about its potential side effects, as it’s often advertised in a way that may lead people to mistakenly believe using CBD “can’t hurt.” CBD can cause liver injury, and can affect the male reproductive system (as demonstrated in laboratory animal studies).

Most importantly, CBD can interact with other important medications like blood thinners, heart medications, and immunosuppressants (medications given after organ transplantation), potentially changing the levels of these important medications in the blood and leading to catastrophic results, including death. Also, more information needs to be gathered about its safety in special populations such as the elderly, children, those who are immunocompromised, and pregnant and breastfeeding women.

Many of the CBD products on the market are unregulated

In fact, the FDA has issued several warning letters to companies and individuals that market unapproved new drugs that allegedly contain CBD. The FDA has tested the chemical content of cannabinoid compounds in some of the products, and many were found to not contain the levels of CBD the manufacturers had claimed they contain.

Beware of powerful testimonials

Finally, there is anecdotal wisdom, when experiences by patients and health professionals have positive results. While the experience or medication could be beneficial, that doesn’t mean it is going to work for everyone. That’s because each and every person is unique, and what works perfectly for one patient could have no effect on another patient. This is especially true for pain, where many other factors (our mood and stress level, our environment and other medical conditions, and our previous experiences) can affect the perception of pain. Please be careful, and keep in mind that some of these incredible-sounding testimonials are merely marketing materials meant to lure consumers to buy more products, as the CBD market is expected to hit $20 billion by 2024.

The bottom line: Don’t make CBD your first or only choice for pain relief

If you or someone close to you is considering trying CBD, I would recommend Dr. Robert Shmerling’s advice about the dos and don’ts in choosing an appropriate product. Until there is high-quality scientific evidence in humans, it is difficult to make a recommendation for the regular use of CBD in chronic pain management.

About the Author

Shafik Boyaji, MD , Contributor

Dr. Boyaji earned his medical degree from University of Aleppo, Syria. He completed an Internal Medicine residency at Michigan State University and an Anesthesiology residency at the Brigham and Women’s Hospital. Currently he is in fellowship … See Full Bio

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Comments

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