Read about the pros and cons of using CBD to treat musculoskeletal pain and chronic disease from Dr. James Nelson, physiatrist at The Center Oregon. The science behind CBD oil for pain is still lacking, but what we do know is promising. Here’s how to use CBD oil for back pain and other types of chronic pain.
A Doctor’s Take on CBD
Our providers are frequently asked by patients about CBD, or Cannabidiol. Patients want to know if it can help manage their pain, whether they suffer from arthritis or another chronic disease. It’s a common question because hemp-based products made with less than .3% THC are now legal, based on the Farm Bill of 2018. Since its legalization, we are now seeing CBD being used in everything from sodas, to lotions, to baked goods, but not so much in mainstream healthcare. Because the federal government and Drug Enforcement Agency still consider marijuana an illegal drug, it is not accepted for medical use in the U.S., which means there is still a lack of research and evidence to support the use of CBD.
“There is very limited evidence to support its (CBD) use at this point given the fact that it is essentially illegal from a federal standpoint. Some studies have been done indicating that there are receptors associated with this substance in the human pain pathway. Many patients are using both topical and oral formulations. These are completely unregulated and many of the ingested products have been found to contain various, but often significant, amounts of THC,” states Dr. James Nelson, physiatrist, at The Center.
CBD is a chemical compound from the Cannabid sativa plant, which is also known as marijuana. The cannabis plant is made up of two main players: CBD and THC. CBD is the non-psychoactive portion of the plant, which means it does not produce a “high.” Some people swear by using CBD, saying that it has helped manage their osteoarthritis pain, back pain, etc.
“From my standpoint, I’m okay with patients utilizing CBD topically, but they need to understand that ingested supplements or CBD products are not subject to regulation and may not contain the expected products,” says Dr. Nelson.
Because CBD is still unregulated by the FDA and typically not held to any federal testing standards, there is no way of knowing that the purchased CBD product contains what the label claims. (1) A 2017 study found about 1 out of every 3 (31%) CBD products bought online had the same amount of CBD as noted on the label. The other 69% of the products had either too much or too little CBD when compared to the label.
CBD could be a promising non-opioid option for musculoskeletal pain, and using a CBD oil topically is seemingly a safe pain control option, as long as the patient understands that more research and substantial scientific data needs to be found to support its effectiveness and safety. Speaking with your provider is always recommended before using any supplements, topical oils, or other alternative medications.
What to Know Before You Try CBD Oil for Pain Relief
The science behind CBD oil for pain is still lacking, but what we do know is promising.
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Cannabidiol, better known as CBD, is having a major moment. Most commonly consumed as an oil, the marijuana compound doesn’t give you that floaty feeling of being high—but it does have its own set of uplifting properties. CBD oil users say it melts away anxiety, eases sleep issues, and relieves depression. And last month, the U.S. Food and Drug Administration approved CBD to treat two severe forms of epilepsy, making it the first marijuana-derived drug approved at the federal level.
But the CBD oil use that might be most intriguing—and could perhaps be the biggest game-changer—is for pain relief. As the United States grapples with the opioid epidemic and struggles to treat the 50 million plus Americans who struggle with chronic pain, CBD oil has emerged as a nonaddictive alternative that people are applying as a topical oil, ingesting as a pill, or smoking through a vape pen.
But does CBD oil for pain really work—or is it just a passing fad amplified by the placebo effect? Here’s what we know so far.
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CBD oil as a painkiller just hasn’t been studied much
There has been lots of anecdotal proof for CBD and pain relief, so researchers have often focused on finding out whether that’s due to the placebo effect, says Rebecca M. Craft, PhD, H. L. Eastlick professor of psychology and director of the experimental psychology doctoral program at Washington State University.
Currently, the U.S. National Library of Medicine lists just 25 clinical studies involving CBD and its effects on pain. Only a handful of those have been completed so far, but there are more in the works. Many of these trials involve pain in people with advanced cancer, and while some show positive pay-offs, others demonstrate that cannabis treatment doesn’t provide any more relief than a placebo. The catch: Most of this science involves both CBD and THC (or Δ9-tetrahydrocannabinol, the part of cannabis that does give you a high).
There are a few other drawbacks to studies on CBD. First off, many involve rats rather than humans (including one that focuses on arthritis-related ache relief). Also, the science that does involve people doesn’t often include a large test group, Craft says. Finally, as Craft notes along with a review of CBD studies, there’s not much research out there about the long-term effects of cannabis-based meds.
In the end, science just needs to catch up with the draw toward CBD, at least in terms of easing aches.
CBD oil for pain relief boils down to your brain
It likely comes down to neurotransmitters in the brain. “One mechanism of action is that it de-sensitizes a particular receptor known to be involved in pain, called TRPV1,” Craft explains. TRPV1 creates that sort of burning sensation pain you might feel from something like nerve damage. As Craft points out, that’s only one particular form of pain that CBD could affect—and one in which scientists are still trying to learn more about.
Trying CBD oil for back pain and other run-of-the-mill aches probably won’t hurt you
None of this is to say trying CBD is off limits. “Cannabidiol is generally well-tolerated, which gives it a distinct advantage over other medications currently available for pain, including (and especially) opioids, non-steroidal anti-inflammatory drugs, steroids, anticonvulsant, and antidepressant medications,” says Seth Waldman, MD, anesthesiologist and director of the pain management division at the Hospital for Special Surgery. “I have seen a number of patients with difficult neuropathic pain syndromes who found it helpful.” (There’s also a study on this neuropathic pain—that burning-like sensation that affects the nervous system as Craft mentioned earlier. Research showed, though weak, it had a positive effect.)
Also, while using it topically as an oil is probably safer, more promising results come from taking it orally, Dr. Waldman notes. So you’ll want to be extra careful going the ingested route.
Your biggest concern should be making sure you’re not getting the THC along with the CBD, Craft says, and that can be difficult to ensure. “Very low doses are unlikely to have side effects,” she says. “But if you have higher concentrations and you’re pre-disposed for mental illness, it could actually make it worse.”
CBD oil for chronic pain has pros and cons
A strong draw to CBD: There’s no record of severe side effects. You might feel a little drowsy—and probably shouldn’t operate a vehicle while on it—but otherwise, you’re likely in the clear.
The bad news: CBD, just like any other supplement sold in the U.S., isn’t regulated. That means you can never be totally sure of the amount of CBD you’re getting. “If you and I go into a local cannabis shop, even a shop with a lot of experience of people coming in for medical reasons—unless you’re in Canada or Netherlands, where they have federally-produced drugs—we can’t trust that what’s on the label is what we’re actually getting,” Craft says. That means you could be getting more or less of CBD, as well as THC (which has its own set of side effects).
Using CBD oil for pain: The takeaway
“If it’s safe and you feel it works for you, then that’s great,” Craft says. “As far as helping the general public make a decision, we just want to know if it’s going to work for more people,” and that calls for more research.
Dr. Waldman says it is worth trying, at least for that neurological pain, but you’ll want to follow a few precautions considering dosage is hard to decipher. “Try only one new treatment at a time, so that any effects or side effects can be attributed to the right one,” he says. Then, “start low and go slow. That is, begin with the lowest dose, used once daily, and if tolerated and necessary, the dose could be increased slowly and deliberately. It is more difficult to gauge the effects of a new treatment if it is used irregularly.” One last important note is, of course, talk to your doctor first before trying.
This type of pain treatment, “is trendy and may have legitimate medicinal properties that are incredible—or it could go by to the wayside in a few years,” Craft says. “We just have to wait and see.”
Mallory Creveling, an ACE-certified personal trainer and RRCA-certified run coach, joined the Runner’s World and Bicycling team in August 2021. She has more than a decade of experience covering fitness, health, and nutrition. As a freelance writer, her work appeared in Women’s Health, Self, Men’s Journal, Reader’s Digest, and more. She has also held staff editorial positions at Family Circle and Shape magazines, as well as DailyBurn.com. A former New Yorker/Brooklynite, she’s now based in Easton, PA.