If you’re struggling to manage chronic pain, you’ve probably heard all about the supposed benefits of CBD. However, knowing where to start — or if it even works like people claim — can be a pretty intimidating task.
Fortunately, there is some very promising evidence to support the use of CBD oil for pain management. However, it’s definitely not a cure-all, and you need to understand what to expect before you purchase CBD oil and start using it.
This article reviews what CBD oil is, how it can be used to reduce pain, what the existing research says about its efficacy, its potential side effects, and how to start using it.
What is CBD oil?
CBD oil, short for cannabidiol oil, is gaining popularity as a natural, holistic pain reliever that doesn’t get you high like tetrahydrocannabinol (THC). For this reason, it has mass appeal and can even be given to children struggling with chronic or short-term pain.
CBD and THC are both extracted from marijuana, or Cannabis sativa or Cannabis indica plants. There are also hybrid plants that have characteristics of both C. sativa and C. indica.
Although CBD and THC can behave similarly, THC has added psychoactive effects that cause you to get high. Many people want to experience the benefits of marijuana or marijuana extracts without getting high, though, which is why they would reach for CBD instead of THC or marijuana itself.
CBD oil is made by extracting CBD from marijuana plants — a process which involves both physical and chemical steps — and combining this CBD with a carrier oil like olive oil or a similar liquid oil. This results in a CBD oil that’s almost completely free of THC. By law, CBD oils in the U.S. can contain up to 0.3% THC, though this amount is extremely unlikely to affect you.
On the other hand, hemp oil is usually made only from the seeds of the hemp or marijuana plant, as opposed to CBD oil, which is made from the plant itself. The seeds contain no THC or CBD, so hemp oil does not have as many benefits as CBD oil.
If you’re intending to use it for pain management, you want to choose CBD oil instead of hemp oil, because it’s much more potent.
How does it work for pain?
To decrease pain and inflammation, CBD oil works in three primary ways: by affecting your endocannabinoid system, through terpene activity, and by improving your sleep.
The endocannabinoid system
The body has a natural endocannabinoid system to harness the power of cannabinoids. Although typically the cannabinoids involved in this system are created by the body, phytocannabinoids — or plant-based cannabinoids — such as CBD and THC are also able to participate in this system.
Cannabinoid receptors line the surfaces of your cells, and there are two main types: CB1 and CB2 receptors. Although most cannabinoids will bind to these receptors, causing certain beneficial or adverse effects, CBD acts a bit differently.
Instead of binding directly to the receptors themselves, CBD alters the receptors so that no other cannabinoids are able to bind to them. Not only does it have this effect on CB1 and CB2, but it also has the same effect on other receptors as well. This can help your body to get more benefit from its naturally-produced endogenous cannabinoids, and can also help decrease pain and inflammation.
Terpenes are another class of compounds found in CBD oil. They are natural, aromatic antioxidants that provide the marijuana plant its strong and unique smell. However, they also have a number of health benefits, one of which is to magnify the effects of CBD.
This synergistic action of CBD and terpenes is sometimes called the “entourage effect.”
Additionally, research has shown that terpenes on their own can improve inflammation and decrease pain and sensitivity.
CBD oil can help you sleep better, which is key to pain management. Healthy sleep is shown to naturally help relieve pain, but it’s difficult to get proper sleep if you suffer from chronic pain.
In an observational study of 72 adults, two-thirds of the participants experienced improvements in sleep quality in the first month of taking CBD.
CBD is thought to help with sleep by improving sleep quality, decreasing interruptions to sleep, and decreasing the time it takes you to fall asleep.
What the research says
To truly understand the benefits of CBD oil and how it affects pain, it’s important to dig into the research. Here is what we know about CBD oil and pain so far, based on research findings from animal studies and human trials.
Enhances opioid effectiveness
CBD oil may improve the effectiveness of opioid pain medications, allowing chronic pain patients to decrease their dose of these medications. As they are highly addictive and have potentially debilitating side effects, this makes CBD oil a great addition for chronic pain management requiring opioid use.
One animal study found that CBD enhanced the pain-reducing action of the opioid medication morphine.
Additionally, an observational study in 97 adults with chronic pain found that — of those using CBD oil daily for 8 weeks — over half were able to decrease their dosage of opioid medications or completely eliminate the use of opioids.
Decreases inflammatory pain
Inflammation can be a significant source of pain. Although short-term inflammation is actually a healthy immune response to injury or illness, chronic inflammation can lead to chronic pain and increase your risk of developing chronic diseases such as arthritis, type 2 diabetes, or heart disease.
One rat study noted that CBD could improve inflammatory markers associated with pain, however, this same study found that THC may be more effective than CBD at managing inflammatory pain.
Another study in dogs with osteoarthritis — a condition characterized by bone and joint pain from aging and “wear and tear” that can lead to chronic inflammation — showed significant benefits of CBD oil in both decreasing pain in these dogs and increasing their activity levels.
Unfortunately, the majority of evidence for CBD oil in inflammatory pain is from animal studies, so more human trials are needed.
Reduces cancer pain
Chronic pain is a big issue for people with cancer which can significantly affect their quality of life, especially since some cancer patients do not respond well to opioid medications.
Lessens neurological and nerve pain
CBD may help improve allodynia, or pain that occurs in response to a stimulus that typically does not cause pain. In an animal study in which mice developed allodynia after a traumatic brain injury, researchers found that CBD oil helped decrease their pain — along with the anxiety, aggression, and antisocial behaviors that developed as a result of their chronic pain.
One of the most challenging types of pain to manage is nerve pain, such as peripheral neuropathy — nerve pain in your limbs that can range in severity from a “pins and needles” sensation to debilitating, sharp pain.
In one study in 29 adults with peripheral neuropathy, topical CBD oil, or CBD oil applied directly to the skin, was found to significantly decrease intense and sharp pains, along with cold and itchy sensations.
Improves quality of life in people with chronic pain
In addition to relieving pain, CBD oil may also improve anxiety and help you sleep better — which can result in a significant improvement in your quality of life — as chronic pain, anxiety, and poor sleep are often linked.
One observational study of 97 adults with chronic pain found that — after taking CBD oil daily for 8 weeks — 94% of participants reported improvements in their quality of life.
Although all of this research is very promising — highlighting the many strong potential benefits of CBD oil for pain — more high-quality human trials are needed for us to fully understand the effect of CBD oil on chronic pain and pain management.
Side effects/potential downsides
CBD oil is widely well-tolerated with few notable side effects.
Some of the most common side effects of CBD usage include fatigue and appetite changes.
However, CBD can also interact with several medications. If you’re taking any medications, it’s important to consult your doctor before you start taking CBD oil.
You should also avoid CBD, along with THC and any other marijuana derivatives, along with marijuana itself, if you’re pregnant or breastfeeding.
Choosing a high-quality CBD oil
Unfortunately, as consumer interest in CBD grows, so do opportunities for unscrupulous companies to take advantage of this interest by providing subpar products. As CBD oil is not currently regulated by the U.S. Food and Drug Administration (FDA), it’s — sadly — pretty easy for fly-by-night companies to manufacture and sell poor-quality CBD oil products.
The most important consideration in choosing a CBD oil product is whether or not it has been third-party tested. Third-party testing gives you, the consumer, some assurance that the label is an accurate representation of what’s in your bottle of CBD oil, and that the CBD oil manufacturer was honest and transparent in their labeling practices.
The best CBD oil manufacturers will post the results of their third-party testing on their website also, so you can read the report — instead of merely claiming that the product was third-party tested.
Because CBD oil products that are not third-party tested actually have no other regulatory oversight, the label could be a false representation of the ingredients in the oil, as well as the amount of these ingredients contained in the product. For example, some supposedly pure CBD oil products have been found to contain more THC than legally allowed. This is why third-party testing is so important.
It’s also important to choose a CBD oil that was sourced from U.S. grown, organic hemp or marijuana. This means that the marijuana meets the strict agricultural codes required by the U.S., and that the marijuana the CBD is sourced from is free of potentially harmful pesticides.
Dosage and how to take it
Because CBD oil is not currently regulated by the FDA, there are no hard-and-fast dosing guidelines. You may want to consult your doctor and see if they have any dosage recommendations for CBD oil, taking into account your own personal medical history and pain levels.
Best practice for taking CBD oil involves starting with the lowest dose you can purchase — which is usually around 25 mg of CBD per serving. Keep track of how well this dose is managing your symptoms, and then increase your dosage by 5-10 mg every week or two until you feel like your pain is manageable and well-controlled.
Research indicates that most people can safely take up to 1,500 mg of CBD daily with no withdrawal symptoms or complications, however, you should only take the amount you need to adequately manage your pain.
CBD oil is best absorbed by placing it under the tongue and allowing it to sit for 60-90 seconds before swallowing it.
If you want to apply CBD oil directly to your skin, you should purchase a CBD product that’s specifically formulated for topical use.
CBD oil is a promising alternative to over-the-counter and prescription pain medications. Unlike marijuana and THC, it doesn’t get you high. It’s also very well-tolerated by most people, with few side effects.
It works to reduce pain and inflammation by acting on your endocannabinoid system, through working synergistically with terpenes, and by improving the quality and duration of your sleep.
Although more research is needed, the existing research to support the use of CBD oil for pain management is very promising.
Remember to start slow and increase your dosage gradually, stopping when you find the lowest dose of CBD that provides the pain-relieving benefit you need.