Chronic Pain Management Alternatives: What the Research Says About CBD
Chronic pain can be challenging to manage as patients become tolerant to treatments or misuse medications, requiring new solutions.
Clinicians who are unfamiliar with natural pain relief methods may question their efficacy and safety. Cannabidiol, or cbd, from hemp, is not only a popular choice for pain control but is gaining research on its efficacy and safety. Recent systematic reviews suggest cbd is effective in managing various types of chronic pain, improving quality of life, and offering a safe alternative to opioids.1,2
How Does CBD Control Pain?
Cannabinoids are molecules naturally produced by the body (endocannabinoids) and are also found in several plants (phytocannabinoids). The body’s endocannabinoid system regulates multiple physiological processes. The body’s built in cannabinoid receptors are located in the peripheral nervous system and various organs and tissues, including articular cartilage.3 The endocannabinoid system regulates appetite, digestion, sleep, pain, inflammation, immune function, mood, metabolism, learning, memory, and other functions.4
Hemp and other plants contain numerous cannabinoids. One cannabinoid, cannabidiol (CBD), is gaining much interest for multiple therapeutic applications including pain. CBD is structurally similar to endocannabinoids and interacts with cannabinoid receptors as well as others that influence pain. CBD inhibits endocannabinoid reuptake, activates vanilloid 1 and G-protein coupled receptors, and increases activity of serotonin 5-HT1A receptors, which results in antioxidant, anti-inflammatory, and anti-nociceptive effects.5,6
Neuropathic Pain
Neuropathic pain is complicated to treat. CBD has neuroprotective, anti-inflammatory, and antioxidant properties, making it an attractive therapeutic candidate.7 Rodent models of neuropathic pain caused by chemotherapy, sciatic nerve trauma, and diabetes show benefit with CBD.8-10 Clinical research on neuropathic pain uses CBD and delta-9-tetrahydrocannabinol (THC) combined, making it difficult to conclude CBD’s efficacy alone in humans.11,12 CBD may benefit as a therapeutic adjuvant with other pain medications.13
Arthritis
Approximately 23% of adults are affected by arthritis, with the majority experiencing osteoarthritis (OA) and rheumatoid arthritis (RA).3 The endocannabinoid receptor system is present in the synovia and cartilage of patients with OA and RA, making this an important therapeutic target for pain management.14,23 Preclinical and animal arthritis models show reduced inflammation and pain with CBD, however, human clinical trials are needed to confirm this benefit. Multiple human trials have demonstrated the benefits of cannabinoids for chronic pain, though they do not specifically focus on arthritis.3 Trials on CBD for hand OA are mixed, and efficacy may depend on dosing, form (natural versus synthetic), and delivery (topical versus oral).6,15
In a survey of arthritis patients who tried CBD, 37.9% reported their average daily pain was “much better,” and 45.1% reported their pain was “a little better.” Over half of individuals were able to reduce or discontinue opioids, acetaminophen, and anti-inflammatory medications.3
Fibromyalgia and Other Pain Conditions
Endocannabinoid deficiency may be the cause of pain conditions like migraines, fibromyalgia, and irritable bowel syndrome, and CBD is suggested as a therapeutic replacement.16 In a large online survey of people with fibromyalgia who tried CBD, around 30 to 40% reported relief across symptoms, including pain, anxiety, and sleep.17
In a pain center study on unspecified chronic pain, 53% of patients who were given CBD were able to reduce their opioid dose within 8 weeks, and 94% reported quality of life improvements, including sleep. Dosing ranged from 15 mg to 60 mg/day over 8 weeks with minimal side effects.18
CBD Safety and Adjunctive Use with Other Pain Methods
In general, major adverse effects are not associated with CBD products.7 Choosing a quality CBD product is essential to reducing the risk of adverse effects reported in the literature due to inaccurate labelling.19
Epidiolex is an FDA-approved CBD product for treating certain forms of epilepsy. Adverse effects from clinical trials reveal somnolence, decreased appetite, diarrhea, and elevated liver function tests with this product. Per the Epidiolex label, titration to the maximum dosage is 20 mg/kg/day, which is around 1360 mg/day for a 150-pound person.20 This dosing is either comparable to or far exceeds other CBD supplement products.
Clinicians may consider using CBD as an adjunctive treatment alongside other pain management strategies, including pain medications. Therefore, studies are important to assess drug-drug interactions. CBD is metabolized via CYP3A4 and CYP2C19 enzymes and competitively inhibits several enzymes, affecting the metabolism of several prescription medications through the cytochrome P450 enzyme system.21 Clinicians should carefully monitor dosing of pain (and other medications) when prescribing CBD. One study reported the safety of oral CBD at doses of 400-800 mg alongside fentanyl for treating pain.22
Because CBD does not activate the cannabinoid 1 receptor (CB1) as compared to the active component in medical marijuana, THC, people don’t experience the psychoactive effects, or the “high” feeling.13 This makes CBD a more attractive therapy for pain management. CBD products contain minimal THC content, not to exceed 0.3% dry weight. However, patients may test positive for marijuana on drug screening.19
CBD: A Promising Pain Management Tool
Prescribing CBD for pain management is both an art and a science, as literature continues to evolve. Anecdotal use of CBD across survey data appears to show efficacy for various pain conditions. More clinical trials are needed to learn effective doses for each subset of pain patients. Its efficacy in preclinical and clinical studies and minimal side effects contribute to its appeal as a safe alternative to other pain medications. Activating the endocannabinoid system can also support pain management indirectly by enhancing mood, improving sleep quality, and promoting healthy digestive function resulting in overall improved quality of life.
References:
References:
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