CBD Oil for Pain
Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman’s World, and Natural Health.
Lana Butner, ND, LAc, is a board-certified naturopathic doctor and licensed acupuncturist in New York City.
For many people experiencing chronic pain, cannabidiol (CBD) oil is steadily gaining popularity as a natural approach to pain relief. A compound found in the marijuana plant, cannabidiol is sometimes touted as an alternative to pain medication in the treatment of common conditions like arthritis and back pain.
The use of cannabis for pain relief dates back to ancient China. It’s thought that CBD oil might help ease chronic pain in part by reducing inflammation. In addition, CBD oil is said to promote sounder sleep and, in turn, treat sleep disruption commonly experienced by people with chronic pain.
It’s important to note that many CBD oil products do not contain tetrahydrocannabinol (THC), the compound responsible for producing the “high” associated with marijuana use. Unlike THC, cannabidiol is non-intoxicating and does not have psychoactive effects.
Why People Use CBD Oil
According to the Institute of Medicine of The National Academies, 100 million Americans live with chronic pain. Along with drastically reducing quality of life, chronic pain can increase healthcare costs and have a negative impact on productivity at work.
Common types of chronic pain include:
- Cancer pain
- Irritable bowel syndrome (IBS)
- Low back pain
- Multiple sclerosis pain
- Neuropathic pain
- Temporomandibular joint disorder (TMJ)
Over-the-counter (OTC) and prescription pain medications are often recommended in the treatment of chronic pain, but many people seek out alternative forms of relief, such as herbs, nutritional supplements, and products like CBD oil.
Some of these people wish to avoid the side effects frequently associated with standard pain medication, such as damage to the liver and kidneys, while others have concerns about becoming dependent on such medications.
Some proponents suggest that CBD oil could provide a solution to opioid addiction as concerns over opioid overdoses continue to escalate.
Potential Benefits of CBD Oil
Scientists are still trying to determine how CBD oil might alleviate pain. However, there’s some evidence that cannabidiol may affect the body’s endocannabinoid system (a complex system of cell-to-cell communication). Along with contributing to brain functions like memory and mood, the endocannabinoid system influences how we experience pain.
When taken orally, CBD has poor bioavailability. Topical CBD application to localized areas of pain appears to provide more consistent levels of CBD with less systemic involvement.
So far, much of the evidence for CBD oil’s effects on pain management comes from animal-based research. This research includes a study published in the journal Pain in 2017, in which scientists observed that treatment with topical CBD helped thwart the development of joint pain in rats with osteoarthritis.
Another study, published in the European Journal of Pain in 2016, found that topical CBD gel significantly reduced joint swelling and measures of pain and inflammation in rats with arthritis.
In a report published in Pediatric Dermatology in 2018, scientists reported three cases of topical CBD (applied as an oil, cream, and spray) use in children with a rare, blistering skin condition known as epidermolysis bullosa.
Applied by their parents, all three people reported faster wound healing, fewer blisters, and improvement of pain. One person was able to completely wean off oral opioid analgesic pain medication. There were no adverse effects reported.
Chronic Neuropathic Pain
While very few clinical trials have explored the pain-relieving effects of CBD oil, a report published in the Cochrane Database of Systematic Reviews in 2018 examined the use of a variety of cannabis-based medicines and found they might be of some benefit in the treatment of chronic neuropathic pain.
A type of pain triggered by damage to the somatosensory system (i.e., the system responsible for processing sensory stimuli), neuropathic pain often occurs in people with conditions like diabetes and multiple sclerosis.
In this report, researchers reviewed 16 previously published studies testing the use of various cannabis-based medicines in the treatment of chronic neuropathic pain and found some evidence that cannabis-based medicines may help with pain relief and reduce pain intensity, sleep difficulties, and psychological distress.
Side effects included sleepiness, dizziness, and mental confusion. The authors concluded that the potential harm of such medicines may outweigh their possible benefit.
However, it should be noted that the studies used a variety of cannabis-based medicines (e.g., inhaled cannabis, sprays, and oral tablets containing THC and/or CBD from plant sources or made synthetically), some of which are more likely to result in these side effects than products without THC.
Side Effects and Safety
The research on the side effects of CBD oil is extremely limited. CBD is the major non-psychoactive component of cannabis. Due to the lack of regulation, there is inconsistency in content and purity. The amount of CBD may not be consistent, and products can contain varying amounts of the psychoactive component THC.
In studies using varied doses, routes of administration, and combination or whole products with THC, a number of side effects have been reported. These include anxiety, changes in appetite and mood, diarrhea, dizziness, drowsiness, dry mouth, low blood pressure, mental confusion, nausea, and vomiting.
There’s also some concern that taking high doses of cannabidiol may make muscle movement and tremors worse in people with Parkinson’s disease.
What’s more, CBD oil may interact with certain medicines, such as medications changed by the liver (including chlorzoxazone, theophylline, clozapine, and progesterone) and sedative medications (including benzodiazepines, phenobarbital, fentanyl, and morphine).
When smoked, cannabis has been found to contain Aspergillus (a type of fungus). People with suppressed immune systems should be aware of the risk of fungal infection when using this form of cannabis. Topical CBD application may also cause skin irritation.
CBD oil should not be used as a substitute for standard care. In the case of chronic inflammatory conditions like arthritis, for instance, chronic inflammation can lead to joint damage (causing destruction and disability) if the condition is not effectively managed.
Availability of CBD Oil
As more and more states across the U.S. legalize the use of marijuana, CBD oil has become more widely available. CBD oil is now sold in a range of forms, including capsules, creams, tinctures, and under-the-tongue sprays.
While many companies now sell CBD oil online and in dispensaries, use of the oil isn’t legal in every state. Because state laws vary greatly when it comes to cannabis products, it’s crucial to confirm that use of CBD oil is legal in your state.
Chronic pain is the most common reason for medicinal cannabis use, according to a recent survey. If you have a chronic pain condition and have not been able to manage it with standard treatment (or wish to avoid the adverse effects of other medications), you may be considering CBD oil for pain relief.
Preclinical animal research suggests that CBD may have moderate pain-relieving effects for neuropathic pain without the cannabinoid-like side effects, however, there is currently a lack of large, well-designed clinical trials (the type of research you want to see to put full stock in a treatment) confirming these effects.
If you’re thinking of trying CBD oil for pain relief (and it is legal where you live), talk to your doctor to discuss whether it’s appropriate for you and the safest way to incorporate it into your pain management plan. Keep in mind that due to the lack of regulation, the purity and content of CBD oil products can vary.
A Word From Verywell
If you live with chronic pain, you may have experienced how it can disrupt sleep and, in some cases, can contribute to anxiety and depression. Natural and lifestyle therapies, such as exercising and taking up mind-body practices like meditation and yoga, as well as following an anti-inflammatory diet may help improve quality of life for some people who experience pain regularly.
As many as 100 million Americans experience chronic pain. Could the cannabis-based medicine CBD oil be the cure for pain?
Cannabis and CBD for Back and Neck Pain Q&A
For people who have struggled with chronic back or neck pain, the list of treatments tried is likely long. Some traditional therapies for pain, namely opioid medication, pose significant risks. Seeking safer alternatives, people are increasingly using cannabis, hemp, and cannabinoid products (such as cannabidiol, or CBD) to manage spine pain. But because marijuana-related pain management is legally conflicted in the United States and a relative newcomer to mainstream medicine, questions remain about its safety and efficacy.
Use of cannabis, hemp and cannabinoid products for many different medical conditions, including back pain, is gaining popularity. Photo Source: iStock.com.
This Q&A guide can help clarify the confusion about cannabis-related pain management, so you can better understand the risks and benefits of this potential chronic pain treatment.
What are the key definitions I need to understand regarding medical marijuana?
The terms surrounding medical marijuana can be confusing. Below are some basic definitions.
- Cannabis sativa: The plant that produces both marijuana and hemp. 1
- Cannabinoid: One of the more than 100 compounds that exists in cannabis. 2
- Tetrahydrocannabinol (THC): A cannabinoid known for producing an intoxicating “high,” 2
- Cannabidiol (CBD): A cannabinoid known for its non-intoxicating, nonpsychoactive medicinal effects. 1
How and why might some people use cannabis for medical purposes?
Although cannabis has recently exploded onto the mainstream medicine scene, evidence suggests that people have used cannabis for medical purposes for more than 5,000 years. 3 Common uses for medical marijuana include treatment of epilepsy, sleep disorders, anxiety disorders, and pain (including back, neck, and chronic pain). More recently, people have sought out cannabis and CBD products as alternatives to opioids, which have been linked to addiction and death.
Is it legal to use marijuana for back and neck pain?
State and federal laws differ regarding marijuana, but it largely depends on where you live.
- On the state level, more U.S. states are legalizing both medical and recreational use of marijuana. As of January 2020, in the United States, legalized medical marijuana programs are in 33 U.S. states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. An additional 13 U.S. states have enacted programs legalizing the use of low-THC, high-CBD products to treat specific conditions. 2
- On the federal level, cannabis and its related products that contain more than 0.3% of THC are considered Schedule 1 controlled substances—making them federally illegal. However, industrial hemp, which is cannabis containing very low amounts of THC, was made federally legal in 2018. 2
What does the evidence say about cannabis’ effect on spinal pain?
Overall, more high-quality, human studies are needed to confirm whether cannabis, CBD, and hemp are safe and effective therapeutic options for chronic back and neck pain. However, evidence is mounting that shows CBD and hemp may play a greater role in managing chronic spine pain and curbing opioid-related risks.
A 2018 study found that CBD reduced nerve-related and inflammatory pain in animals, supporting a promising future for CBD as a mainstream pain relief option. Evidence has also found that CBD is a safe effective addiction therapy, leading CBD to rise in popularity for it’s potential to treat opioid abuse and prevent it as a viable chronic pain-relieving alternative. 1
Will I get “high” if I use CBD or hemp products to manage my back pain?
No, CBD and hemp do not cause any intoxicating effects. The “high” resulting from marijuana use is caused by THC, which is just one of the many cannabinoids in cannabis. CBD is also a cannabinoid in cannabis, but it doesn’t cause any “high.” CBD and hemp products may contain trace amount of THC, but the levels are too low to cause any psychoactive effects.
How do people use cannabis and CBD?
Products containing cannabis, hemp, and CBD are exploding. Some people prefer to smoke cannabis, but manufacturers are getting creative when it comes to producing products containing cannabis and its related compounds. Food, beverages, dietary supplements, oils, topicals (like creams and salves), and bath soaks are just a few of the applications consumers can use.
Is vaping a safe way to use cannabis for pain relief?
No. Vaping, or e-cigarette use, grew in popularity as a more discrete alternative to smoking. However, the subsequent rise of lung-related disease directly connected to vaping sickened thousands and even led to the death of dozens of Americans. The Centers for Disease Control and Prevention has encouraged people to stop vaping entirely.
What is known about the safety of CBD products?
The FDA admits research about the safety of CBD products is quite limited. To date, Epidiolex (cannabidiol) is the only FDA-approved prescription drug, and this medication is only indicated for treatment of 2 rare types of epilepsy. Bear in mind that just because a product is FDA-approved doesn’t mean it’s completely safe without potential side effects that could be serious. 4
The FDA warns consumers about illegal CBD marketing strategies and product promises. They also suggest the potential for liver damage, serious side effects when combined with other medications, such as central nervous system depressants (eg, tranquilizers). While CBD products can cause side effects (eg, drowsiness, mood changes), these symptoms may go away when use is stopped. The FDA raises many unanswered questions about the effects on infants and children, not only adults. 4
How can people find a high-quality CBD or hemp product?
Because mass-marketed CBD and hemp oils and other products are not approved or regulated by the FDA, it can be challenging to know whether a product is safe or actually contains the ingredients promised on the label. Products containing synthetic cannabinoids (eg, “spice”) are especially concerning, as they have been linked to serious complications.
To narrow the field, researchers recommend you ask the following questions before buying 1 :
- Does it meet quality standards outlined by a credible certification body, such as Current Good Manufacturing Practices (CGMP), European Union (EU), or Science Foundation (NSF) International?
- Does the manufacturer report adverse events tied to its products?
- Is the product certified organic?
- Does the product undergo laboratory testing to confirm THC levels?
Should you talk to your doctor if you use cannabis or cannabinoids?
Yes. To effectively treat your spinal pain, your doctor needs to understand all the medications, drugs, and supplements you’re taking—and that includes any cannabis, hemp, or CBD products. These products may interact with a drug you’re prescribed, so your doctor needs to know this information to keep you safe. As medicinal uses of marijuana become more commonplace, clinicians understand that more patients are curious about whether it will ease their pain. Don’t be hesitant to share your interest in CBD with your doctor, as he or she may help you choose a reputable product.
More Research Needed but Cannabis May Be a Promising Chronic Pain Therapy
With the rise of opioid-related addiction and death, people have sought out cannabis and cannabinoids (such as cannabidiol, or CBD) as pain-relieving alternatives. And if traditional treatments have failed to ease your back or neck pain, you may be curious to try cannabis or CBD products. As these therapies skyrocket in popularity and become more readily available, don’t forget to keep your doctor looped in. He or she needs to understand how you’re managing your pain to ensure your treatment regimen isn’t doing you more harm than good.
1. VanDolah HJ, Bauer BA, Mauck KF. Clinicians’ Guide to Cannabidiol and Hemp Oils. Mayo Clin Proc. September 2019;94(9):1840-1851. doi.org/10.1016/j.mayocp.2019.01.003. Accessed January 29, 2020.
2. Rubin R. Cannabidiol Products Are Everywhere, but Should People Be Using Them? JAMA. 2019;322(22):2156. https://jamanetwork.com/journals/jama/fullarticle/2756099. Accessed January 29, 2020.
3. Bridgeman MB, Abazia DT. Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting. PT. 2017;42(3):180–188. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/. Accessed January 29, 2020.
4. US Food and Drug Administration (FDA). What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, including CBD. November 25, 2019. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis. Accessed January 29, 2020.
Tyndall DS. CBD Oil, the new medical elixir. NWI Times. July 13, 2018. https://www.nwitimes.com/lifestyles/cbd-oil-the-new-medical-elixir/article_eb5fb3e3-862b-59f5-a859-70dbf5057193.html. Accessed January 29, 2020.
Harris-Taylor M. He Started Vaping THC To Cope With Chronic Pain. Then He Got Sick. NPR. December 11, 2019. https://www.npr.org/sections/health-shots/2019/12/11/776356212/he-started-vaping-thc-to-cope-with-chronic-pain-then-he-got-sick. Accessed January 29, 2020.
The Medical Letter on Drugs and Therapeutics. The Medical Letter, Inc. November 18, 2019;61(1585).
Cannabis, hemp, and cannabinoid products, such as CBD oil, are gaining public popularity to treat back pain. Spine doctor answers 10 key questions.