“There’s really no substitute for doing proper human studies, which are difficult, expensive, and ethically complicated,” Dr. Tishler says. And we simply don’t have them for CBD and pain.
In fact, the most compelling research they found for using cannabinoids for pain came from a large review and meta-analysis published in JAMA in 2015. For the study, researchers looked at results from 79 previous studies of cannabinoids and various medical conditions, including chronic pain. However, of those studies, only four involved CBD (without THC)—none of which were looking at pain. So although we might assume that CBD is doing something to help address pain—according to the studies involving the whole cannabis plant—we don’t have great evidence to prove it.
The studies we do have about CBD for pain are all animal studies. For example, in a 2017 study published in Pain, researchers gave rats an injection into one of their knee joints to model osteoarthritis. Rats then either received doses of CBD or saline directly into an artery in the knee joint. Results showed that, after receiving CBD, rats showed less inflammation in the joint area and fewer pain-related behaviors (like shaking or withdrawing the affected paw or not being able to bear weight in that paw) compared to those that received saline.
The only thing that comes close is a Phase 2 clinical trial using a proprietary CBD transdermal gel (meaning it’s meant to go through the skin into the bloodstream) in 320 patients with knee osteoarthritis over 12 weeks, which has not been peer-reviewed to date. Unfortunately, in almost all of the study’s measures of pain, those who received CBD didn’t have statistically different scores from those who got placebo. But “they found some reductions in pain and improvements in physical function,” Boehnke says.
Here’s what the research says about using CBD for pain.
Cannabidiol, commonly referred to as CBD, is a cannabinoid, a type of compound found in cannabis (marijuana). Unlike the more well-known cannabinoid THC (tetrahydrocannabinol), CBD does not produce a high.
The most common medical reason for which people report using CBD is to manage chronic pain, followed closely by managing arthritis or joint pain. But does it actually work?
If you’re ingesting something that only has CBD in it and no THC, you won’t have significant effects in the brain. This is why CBD is often referred to as being “non-psychoactive,” although that’s clearly a bit of an oversimplification because it does do something to the central nervous system.
What is CBD?
When the National Academies of Sciences, Medicine, and Engineering evaluated decades of cannabis research, they concluded that "in adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms."
More recent research suggests that many of CBD’s effects may occur outside of CB receptors, Jordan Tishler, M.D., medical cannabis expert at InhaleMD in Boston, tells SELF. In fact, according to a recent review published in Molecules, CBD may have effects on some serotonin receptors (known to play a role in depression and anxiety), adenosine receptors (one of the neurological targets for caffeine), and even TRPV-1 receptors (more commonly associated with taste and the sensation of spiciness).
So far, though, most larger scientific studies on CBD have been limited to animals. A handful of small human trials are now underway to evaluate the extent of cannabidiol's pain relief potential. Even without clinical trials, many people already use legal CBD to counteract the intense discomfort brought on by chemotherapy, and to ease pain in arthritic joints. Texas-based dermatologist Jennifer Clay Cather, who cares for people with complicated skin problems, says most of her patients come from oncology. She also owns a research company that develops CBD skin products. “We need large, evidence-based trials testing different conditions, and also testing the reproducibility of the molecule,” Cather says.
Our knees ache, our backs hurt, our feet throb. Pain is one thing everybody wants gone. Unfortunately for chronic pain sufferers, many treatments come with unwanted side effects.
Researchers have confirmed that CBD works against pain and inflammation , and they’re still finding new ways that it works in the body . They're also working to nail down the proper dose of topical CBD needed for pain relief. For example, the dose that brings relief to achy joints may be insufficient to effectively treat nerve damage in feet. While rubbing topical CBD onto the skin seems to work, researchers still need to figure out how much skin coverage is most effective. Some skin creams also contain menthols, which carry their own pain relief and anti-inflammatory properties, possibly masking any effect from the CBD itself.
Skin in the Game
Opioid pain relief can cause nausea, constipation and addiction. Standard anti-inflammatory meds carry the risk of stomach issues, including bleeding. The limited options prompt many folks to try creams and lotions containing cannabidiol (CBD).
Consumers need to be educated, as well, says Cather. She works to develop a trusting relationship with her patients, so that they’ll feel comfortable talking about using CBD. She also urges her patients to find companies that document what’s actually in the bottle or jar. Asking the company about their quality control, such as how often they document ingredients, can help also vet the product.
Sidestepping the CB1 and CB2 receptors means that CBD can mute pain without the high sensation delivered by THC. Not only does CBD have very little interest in switching on CB1, cannabidiol can actually mute any signals sent to that receptor. Researchers looking for safer pain treatments want to take advantage of this action because it means that CBD won’t spark addiction.
Topical CBD creams can treat pain, discomfort and inflammation. Here’s what science knows about how they work.
CBD is one of the hundreds of biologically active ingredients produced in Cannabis sativa plants. Unlike THC, its psychoactive cousin that makes people feel high, CBD can ease pain without the euphoria or fear of addiction. The cannabinoid has similar effects whether absorbed through the skin or ingested by mouth.
Pain is a big driver behind opioid addiction. Many people who began treating chronic pain with prescription opioids have switched to heroin when other drugs became difficult to get. A lot of people have died as a result, says Yasmin Hurd , an addiction specialist at the Icahn School of Medicine at Mount Sinai in New York. “We have so many people in our society now experimenting with CBD to manage pain,” she says. “They are going to their clinicians and asking them for CBD.”