Cannabis and CBD for Pain Management: A Patient Guide

Cannabis and cannabinoids have exploded in popularity since the government legalized hemp-based CBD in 2018 at the federal level. Research has revealed the powerful healing effects of the cannabis plant which are inherent in the pharmacologically active molecules aka cannabinoids and terpenes.

The two primary compounds found in cannabis are THC and CBD. THC is psychoactive and produces a high when someone consumes marijuana. The second compound, CBD, is non-psychoactive and can even counter the euphoric effects of THC.

In the last decade, researchers have zeroed in on CBD which is the most popular non-psychoactive cannabinoid. It has emerged that CBD has numerous therapeutic properties that can be exploited by medical marijuana patients. Research suggests that among the many medical applications of CBD is the management of pain.

About one in five adults in America suffer from chronic pain. This translates to a staggering 50 million Americans who are hooked or dependent on opioids, the first-line treatment for chronic pain. It is no surprise that the nation is in the middle of an opioid addiction epidemic. While opioids relieve pain well, with time the body builds tolerance which can result in addiction. In turn, many people need stronger doses to get the same effect. Once the level of opioid gets too high, it can become dangerous. It can even lead to death.

With all the risks associated with chronic use of opioids, clinicians and patients alike have been out on a search of safer alternatives for pain management. Several out-of-the-box have been considered including relaxation techniques, acupuncture, cognitive behavioral therapy, and massage are a few of them.

Cannabis has been used to manage pain for several decades. It is believed that the practice began in Central Asia and Western China and spread to the rest of the world. The first documented use of marihuana dates back to 2800 BC. Emperor Shen Nung who is regarded as the father of Chinese medicine holds the earliest cannabis pharmacopeia records. It is also believed that Queen Victoria used cannabis to manage painful menses.

Scientific evidence from recent research has revealed the potential of CBD in managing different kinds of pain. But how do cannabis products and CBD relieve pain?

How Does Cannabis Treat Pain?

Cannabis interacts with the body through a dynamic system that is known as the endocannabinoid system (ECS). This is a system that is responsible for maintaining balance between the different parameters in the body. When all parameters are in check, the body is said to be in a state of homeostasis.

The ECS keep the systems of the body in check by modulating various essential functions that include the following:

• Pain
• Inflammation
• Sleep
• Hormonal function
• Reproduction
• Immunity
• Memory and learning
• Temperature
• Digestion
• Emotions

The ECS is made of three components:

• Endocannabinoids (anandamide and 2-AG)
• Endocannabinoid receptors
• Metabolic enzymes that degrade the endocannabinoids

When there is a deviation from homeostasis the ECS is stimulated to release endocannabinoids that bind to the ECS receptors to trigger a chain of reactions that reestablish homeostasis. When the body is in a state of disease, the ECS system is also affected and will therefore need support. That is where the cannabis plant comes in.

What Do The Endocannabinoid System And Pain Have In Common?

When a tissue injury or some sort of potentially negative change to the tissue occurs, usually in a local area like a cut or sprain, endocannabinoids are synthesized and act to help regulate the pain by sending signals to the brain. These signals are what tell the brain that there is something wrong and then the body should begin a corrective process. The endocannabinoid system then keeps an eye on the situation, monitoring how the tissue is doing. If it heals up nicely, or the negative change subsides, the endocannabinoid system adjusts the amount of endocannabinoid production, which stops the pain signals being sent to the brain.

Cannabinoids or endocannabinoids by simply binding to these receptors could have the potential to reduce pain signals. When the brain stops receiving pain signals we automatically stop feeling the pain. We know that if you increase the activation of both CB1 and CB2 receptors by using products like CBD oil, there is a decrease in pain signaling messages. Other sources claim that CBD does not reduce pain but reduces the perception of pain.

Side Note: pairing CBD with adaptogens

Botanical adaptogens such as astragalus, burdock root and turmeric have pain relieving properties. This means that they enhance pain relief when combined with a cbd product such as CBD oil.

How Does CBD Work to Treat Pain?

The 2018 Farm Bill legalized hemp derived products at the federal level. However, for hemp to be considered legal by the food and drug administration, it must contain less than 0.3 percent THC.

The big discovery that showed how CBD works is the existence of the endocannabinoid system in the body. The receptors in this system have control over things like how you feel pain, your immune system, and inflammation. This is why CBD has so many effects on the body and is used for so many conditions.

Studies have shown that CBD does not have binding properties to the ECS receptors. However, this does not take away from the powerful healing effects of CBD. At the CB1 receptor which is abundant in the central nervous system (CNS), CBD may act as an antagonist. This means that it has opposing effects. It is no surprise that CBD is able to offset some of the negative effects of THC such as euphoria (THC binds strongly to the CB1 receptors).

At the CB2 receptors, CBD is a weak agonist. This means that it has a positive effect on these receptors which are involved in regulating immunity and other important functions.

The mechanisms of CBD have not been fully elucidated. However, it is apparent that CBD modulates inflammatory and nociceptive pathways and in this way it is able to relieve pain.

A 2007 study concluded that cannabinoids, including cannabidiol, was effective in relieving the neuropathic pain that is experienced by 50%-70% of multiple sclerosis patients.

A more recent 2014 study showed that analgesia is one of the principal therapeutic targets of the endocannabinoid system and many studies have confirmed the efficacy of cannabinoids to treat neuropathic pain.

What seems to be the key thing with CBD is the reduction in inflammation. Inflammation has been targeted as a cause of many chronic health conditions.

Another benefit to CBD is that you do not build a tolerance to the compound. Unlike opioids, CBD is not addictive. Thus, if it works for your condition, it’s a long-term solution for managing your chronic pain without side effects. This is also why you can get it over the counter. 

How Medical Cannabis Works as an Analgesic

The chemicals in medical marijuana that are only found in the cannabis plant are known as cannabinoids. These compounds have been shown to significantly relieve pain by connecting to the pain receptors in the central nervous system of the human body, and are known to relieve pain in patients even when stronger painkillers derived from opiates are not effective.

This is what research has to say about cannabis and analgesia:

Less delta-9-THC, a cannabinoid, is needed for pain relief when compared to codeine, with the pain relief obtained from a 10 mg dose of delta-9-THC comparable to the pain relief obtained from a 60 mg dose of codeine.

Patients with access to medical marijuana extracts may decrease their use of opioid pain relievers, non-steroidal anti-inflammatory drugs (NSAIDs), and antidepressants. Patients administered inhaled medical marijuana may achieve significant relief from neuropathic pain, a common symptom in patients undergoing chemotherapy or taking certain anticancer drugs that causes pain, tingling, or muscle weakness, especially in the hands or feet.

If medical marijuana is taken before chemotherapy or anticancer drugs, peripheral neuropathy might be prevented entirely.

Those with extremely severe and/or chronic pain might be able to find relief by combining the use of medical marijuana with sustained-release morphine when neither drug alone provides sufficient pain relief.

Best Cannabis Strains for Pain Relief

Both cannabis and CBD strains can offer pain relief. However, one study has shown that patients prefer indica strains for pain relief while sativa strains are preferred for managing stress and depression. Indica strains are believed to work primarily on the body causing deep relaxation and offering relief from chronic aches.

Other studies have shown that marijuana strains that have a balance between THC and cannabidiol (CBD) are ideal for pain management. Combining CBD and THC provides an opportunity for the cannabinoids to work in synergy. This results in the entourage effect. The entourage effect is a mechanism whereby cannabinoids and terpenes act synergistically to amplify the therapeutic effects of the cannabis plant. When combined, medical CBD also helps to offset some of the negative effects of THC.

Indica strains that are good for pain management:

• Death Star
• Purple Kush
• Strawberry Banana
• Skywalker OG
• Green Gelato

Balanced strains that are good for pain management include:

• Argyle
• Dancehall
• Shark Shock
• Royal Highness
• Huckle

Marijuana for Chronic Pain

Unpleasant as it is, pain serves an important purpose. It tries to protect our bodies from causing further damage by making known the presence of some sort of injury.  In the early stages of an injury or infection, this information (pain perception) is very useful. It encourages us to stop moving around and rest, thereby preventing further damage and allow time for healing. But sometimes the pain may persist and become chronic. In this case, our mobility may become limited and the quality of life diminishes.  An example is chronic back pain that occurs due to years of constantly straining our backs. An overstimulated endocannabinoid system may also cause chronic pain.

Cannabinoids have shown immense potential benefits in the management of chronic pain. Cannabinoid receptors are abundant in peripheral nerves that detect pain and send signals to the brain. Cannabinoids are able to block the transmission of these pain signals and hence prevent the perception of pain. Some studies have found that marijuana can be combined with opioids to boost pain relieving properties and also reduce adverse effects that are associated with the long term use of opioids to manage chronic pain. In addition, cannabis is being considered as an antidote for opioid abuse disorder.

Marijuana for Arthritis

CBD oil affects cytokine production. Cytokines are the modulating factors that both initiate, and resolve inflammation.  So for example, if you are out hiking on an icy path, and end up taking a spill on your elbow, it would be the cytokines job to start off a process of inflammation on your now injured elbow. In this sense, inflammation itself is not inherently bad, but part of a natural process within the body related to healing. Without the initiation of positive inflammation, our bodies wouldn’t be able to recover from an injury. 

However, sometimes cytokines get out of control with their signaling for inflammation. The root of this issue can be overactive immune cells. 

When an immune cell becomes overactive, the inflammation that results from this can build up unnecessarily in our joints, body and the brain. High amounts of inflammation in any joint can lead to swelling, pain in that joint, or loss of function.

However, CBD oil can be used to directly mitigate the inflammation build up by overactive immune cells, and cytokines simply by enabling the body to utilize its endocannabinoids more effectively. But moreover, CBD can reduce the production of pro-inflammatory cytokines, as research has now revealed. 

Here is the magic.

CBD reduces the production of pro-inflammatory cytokines and at the same time increases the efficiency with which the body is using its own endocannabinoids. The result is reduced inflammation and the pain that is associated with inflammation.

Marijuana for Fibromyalgia

Fibromyalgia is a disorder that is characterized by generalized musculoskeletal pain that is accompanied by other symptoms such as nausea, mood disturbance, fatigue, poor sleep, and memory loss. This condition affects how our bodies process pain. In other words, painful stimuli becomes exaggerated when one is suffering from fibromyalgia. The painful stimuli is likely to start after a trauma or a severe infection. Women are more likely to suffer from this condition.

Research has shown that marijuana can help to quell fibromyalgia pain. A study that was conducted in Israel demonstrated the effectiveness of medical cannabis for the treatment of fibromyalgia. Very few side effects were observed in this study.

Best CBD and CBD Oil for Pain

If you check out online sites that sell, or at least claim to sell, CBD oil you will find hundreds to choose from. While you could go for the lowest price or best bargain cost wise, this is not recommended. There have been several incidents of people consuming adulterated CBD oil, a few that have ended in emergency room visits and hospitalizations. Without wasting much time, let’s dive into the most important indicators of high quality CBD oil. 

Lab Testing

Unfortunately the cannabidiol CBD market is still mostly unregulated. This is why you should only buy CBD from companies that are transparent about the quality of each batch of CBD products that they put out to the market. 

Lab testing is mandatory for reputable CBD brands. This is the only way that a consumer will be able to ascertain that the CBD product is free of contaminants such as heavy metals, solvents, and pesticides. Hemp is a sponge from these types of things and if grown in the wrong condition can soak up nasty things from its environment.  As you search for lab-tested CBD oil, keep the following testing requirements in mind.

The Certificate Of Analysis Or COA

A certificate of analysis aka COA is a document that shows the amount and type of cannabinoids in the product. It also lists the terpenes that are present and the presence and concentration of contaminants. The COA shows that the product has been tested by a third-party lab. Always ask to see an up-to-date COA before purchasing any CBD product. You can check the name of the third-party lab and confirm the authenticity of the COA. You ideally want these lab reports to be less than 6 months old. If your CBD oil doesn’t have a certificate of analysis (COA).  Run, run far away!

Potency

How much CBD is in the product that you are purchasing? When dealing with a CBD Isolate, potency is measured by the percentage of CBD or CBDa in hemp oil. CBDa converts to CBD at low heat, so it’s best to look at the “total CBD” percentage instead of the CBD and CBDa concentrations in the lab report’s cannabinoid breakdown.

Terpene profile

Terpenes are a fragrant, diverse group of organic compounds that are found all throughout nature. There are over 50,000 + terpenes that exist in nature and hemp plants are just one of many plants that create terpenes. Terpenes, just like cannabinoids, have therapeutic potential. Researchers are now looking into how this potential can be harnessed to support cannabinoid-based therapies. Some terpenes have pain relieving properties. They include: limonene, linalool, myrcene, pinene, and caryophyllene. You should ensure that your CBD product contains pain-relieving terpenes. Terpenes also enhance the pain relieving effects of cannabis through the entourage effect.

THC Compliance

What level of THC do labs test for? Most labs can detect cannabinoids down to 0.01%, which is well below the 0.3 percent THC threshold that’s important due to federal law. Testing for THC is another important reason that CBD manufacturers test their products.

Contaminants

A COA should also list the contaminants that are present in the product and their concentration. Make sure you know how the hemp used to make the CBD oil is grown and if the extract is clean and healthful. This plays a huge role in those test results you see in the COA. Always look for an organic product to reduce any environmental toxin risks. You want to know that the soil and water it’s grown in is as clean as possible. That’s because hemp plants are really good sponges and can absorb contaminants as they grow, some even refer to it as mop weed. This reason is why heavy metal toxicity can be a concern when looking at CBD oils. So be sure that you check the COA for any contaminants such as pesticides, heavy metals and solvent residues.

How to Use Cannabis and CBD for Pain

Cannabis and hemp derived CBD products can be consumed in several ways. When it comes to the management of acute pain, a fast-acting consumption method is preferred. Smoking and vaping cannabis can provide instant pain relief. Tinctures may also provide quick relief when they are consumed sublingually.

For the management of chronic pain, smoking is not advisable. Smoking marijuana introduces contaminants to the lungs which may trigger lung disease. CBD pills and capsules are easy to use and very portable. This makes them ideal for managing chronic pain.

Edibles bring some excitement into the mix. Cannabis oil can be used to infuse foods and beverages and confer upon them pain-relieving properties. The effects from edibles take a long time to kick in. Therefore, it is advisable to give enough time before consuming more. Once the effects kick in they may last for a longer time. For this reason, it is easy to over-do it with cannabis edibles.

When choosing the best way to consume CBD for pain, it is advisable to consider how long it takes for the pain relief to kick in. If you want to manage acute pain, you may opt to go for smoking or vaping the product. However, if you want sustained relief for chronic pain, cannabis or CBD edibles will be a great option. Also consider the availability of the method and the ease of use, along with how much or how little food intake you have consumes prior.

Cannabis vs. opioids for pain relief

Opioids are a class of drugs that are derived from the opium poppy plant. This class of drugs act on the brain and are used as a treatment for chronic pain. Examples of opioids include fentanyl, morphine, and codeine. These strong medications can provide instant relief from pain, hence they are a favorite among patients who suffer from chronic pain.

However, when opioids are used for a long time they may cause physiological dependence and addiction. Currently, the US is facing an unprecedented rate of opioid addiction which has been labeled as an epidemic due to its magnitude.

Medical cannabis can be a suitable and effective alternative to addictive opioids. Some studies have shown that cannabis can be used to reduce opioid use. When cannabis is used in conjunction with opioids, patients are able to wean off dependence on opioids and/or the amount consumed.

Side Effects of CBD

Most people tolerate cannabidiol CBD well, but there are a few potential side effects that you need to be aware of, particularly with higher doses of CBD. This is why it’s best to use the minimum effective dose. These side-effects include:

• Tiredness
• Diarrhea
• Changes in appetite
• Weight loss or weight gain
• Dry mouth
• Sedation
• Lightheadedness
• Mild low blood pressure

Conclusion

Cannabis has been used for several decades to manage pain. With the current opioid epidemic crisis, the world at large has been compelled to rethink pain management. This plant is providing us a way to get back to our safe roots.

Science has revealed that tetrahydrocannabinol (THC) and CBD work through various mechanisms to offer pain relief. The bottom line is that patients can now turn to cannabis and CBD to manage different kinds of pain including arthritis, back pain, joint pain, fibromyalgia, and neuropathic pain to name a few.

Thanks to the long prohibition on marijuana, research into the medical effects of CBD, THC, and other cannabis-derived medicines is far behind where it could have been. But scientists are making up for lost time. As more research from human studies come in, we’ll gain a much better understanding of how to use cannabis and CBD to manage pain and other medical conditions.

References

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