CBD for Pain Management: What does it help?

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Every day more and more people are choosing CBD to address their pain symptoms. Store aisles are stocked full of CBD oils, capsules, and tablets, topicals such as lotions, balms, salves and creams, vape pens, and hemp flower.

Understanding which forms to use, how to use it correctly, and finding the safest, most reliable products are the most important challenges new CBD consumers face. Since trial and error can be time-consuming and expensive, here is what you need to know about selecting your CBD product and using CBD for pain.

However, if you have not experienced the power of CBDA (and most people haven’t because CBDA is not included in most products that are manufactured with heat), this guide will explain what we are now learning about this powerful minor cannabinoid and how it can work together with CBD or in place of CBD to address and prevent symptoms.

Does CBD help with pain?

Among animal research, it’s clear that CBD can reduce pain and inflammation in various models of pain, including neuropathic pain, inflammatory pain, and arthritis-related pain.[1] Animal models, however, do not always translate to a human experience.

While there’s substantial human research that pharmaceutical combinations of CBD and THC can reduce pain, at the present time there’s much less data on CBD or CBD-dominant hemp products used alone for pain, but there are several small studies that suggest effectiveness, often at higher doses, according to Dr. Sulak.

The available research on CBD for pain in humans includes:

  • In a mixed cohort of 24 patients suffering from intractable pain due to multiple sclerosis, spinal cord injury, brachial plexus injury, and limb amputation, CBD treatment (average 22 mg daily, max 60 mg daily) significantly reduced pain on a visual analog scale.[2]
  • CBD 10 mg daily did not improve outcomes in patients suffering from Crohn’s disease.[3]
  • In an open-label study of 8 girls and young women who had adverse reactions to the HPV vaccine (symptoms included headache, joint, muscle, and abdominal pain). After treatment with CBD oil (max dose 75 mg twice daily), participants achieved significant reductions in pain.[4]
  • CBD 50-150 mg twice daily was effective in the treatment of chronic pain associated with kidney transplantation in 6 of 7 patients during an open-label trial.[5]
  • In patients with fibromyalgia, a single inhalation of CBD 18.4 mg did not decrease pain more than placebo.[6]
  • In patients suffering from peripheral neuropathy of their lower extremities, Emu oil infused with CBD (only 0.2%) and essential oils were applied topically up to 4 times daily, resulting in a statistically significant reduction in intense pain, sharp pain, cold and itchy sensations compared to placebo.[7]
  • Among 97 patients with chronic pain treated with opioids for >1 year, a CBD-dominant hemp extract (~15mg twice daily in most patients) resulted in improvements in quality of life in 94% and reducing or stopping opioid drugs in 53% of participants.[8]
  • A New Zealand study on the safety of CBD treatment in 400 patients indicated its safety for prolonged use, which was accompanied by improvements in pain, quality of life, depression and anxiety among those with non-cancer pain and mental-health symptoms; the dose per day ranged from 40mg/day to 300mg/day.[9]
  • In an open-label trial of 31 subjects with diabetic peripheral neuropathy, 20 mg CBD 3x daily led to a significant reduction in overall pain in all subjects after 3 weeks. One-third of the subjects reported a response within the first 24 hours of taking CBD, while the other ⅔ observed a noticeable change after an average of 7 days.[10]

There is also some evidence, based on animal models, that CBDA is stronger and more potent than CBD, not just because it’s getting absorbed better but because it’s acting more powerfully. For example, animal studies have found CBDA to be:

  • 10 times more potent than CBD in a model of seizures[11]
  • 100x more potent than CBD in a model of inflammatory pain[12]
  • 10,000x more potent than CBD in a model of nausea[13]
  • 50,000x more potent than CBD in a model of anxiety[14]

Here’s the bottom line regarding CBD formulations and pain:

  • Higher doses of CBD are often necessary to effectively address pain but can be too costly to sustain
  • CBD formulations that include the legally allowed amount of THC are more effective and often require lower doses than purified CBD
  • CBD formulations that include CBDA –with or without THC– are usually more potent and effective than products with no CBDA.

How to use CBD for pain management

The key to achieving successful results with CBD is using an appropriate amount, tailored to your individual needs, with the widest array of plant compounds including CBDA. In other words, to get the maximum benefit from CBD, you can find your personal optimal usage amount and the frequency with which you take it (see CBD Usage Guide below). Furthermore, using a formulation that includes significant amounts of CBDA and/or the legal amounts of THC makes the CBD more powerful, so you’ll need less.


CBD oil for pain

For treating and preventing pain symptoms, CBD oil (placed under the tongue) is typically the best method of delivery. Some of the medicine can be absorbed directly through the capillaries in your mouth, and the rest that’s swallowed can be absorbed in the digestive tract. Importantly, the medicine that reaches the gut can be absorbed 4-5x better if it’s taken around the time of a fat-containing meal.

CBD drops allow users to fine-tune their treatment to discover one’s ideal, personalized usage amount. This is particularly evident with Whole Plant Hemp CBD drops which include a 6:1 ratio of CBD: CBDA.

While CBDA tinctures or oil drops are much harder to find, because few manufacturers have been able to capture and maintain CBDA, Healer’s patented extraction technology [https://healercbd.com/healer-spectrum] was developed expressly to do that. Whole Plant Hemp CBDA drops are non-intoxicating and have a high terpene and flavonoid content.

Topical CBD for pain

CBD-containing creams, lotions, salves, balms, and gel preparations can be an effective way to deliver the hemp compounds directly to specific areas of the body such as joints, muscles, and skin, to alleviate pain from muscle spasms, inflammation, and various skin conditions.

Healer Whole Plant Hemp CBD Topical (1:1 CBD: CBDA) is water-based hydrogel cream that feels less oily, dries more quickly, and is formulated with menthol and copaiba for increased skin penetration and effectiveness. This product was specifically designed to help with the pain.

CBD tinctures or oil drops can also be applied directly onto the skin as a topical or mixed with your own lotion for coverage over a greater area.

CBD edibles for pain

When taking CBD oil sublingually (under the tongue) isn’t possible, adding it to food or drinks as an edible is also effective. Results may take longer to kick in and you may need to take a larger amount, as the CBD passes through the digestive system first, which affects onset and potency. Adding oil-based CBD products to drinks can be wasteful, as some of the oil will likely stick to the container and not make its way into your body.

CBD capsules for pain

Although CBD capsules have a slower onset because they must pass through the digestive system before entering the bloodstream, they tend to provide longer-lasting effects. Many customers find CBD capsules are the most convenient way to take CBD. Capsules are easy to take discreetly.

Dr. Sulak recommends taking capsules if you know they work well for you (an indication that you absorb CBD well in the gut); if you know you require a higher CBD amount (which may be inconvenient to take as drops), or if you are sensitive to taste. If one capsule is too strong, or if you feel you would benefit by increasing your dosage in smaller increments, switch to CBD oil taken under the tongue, or in food or drink. For people with poor gut motility, CBD oils or topicals are better choices. As mentioned above, taking CBD capsules with fat-containing food will increase absorption.

CBD for Cancer Related Pain

CBD and CBDA may ease neuropathic pain, a common side effect of chemotherapy. A recent study showed that in patients with cancer undergoing chemotherapy, using CBD was associated with a much lower incidence of chemotherapy-induced neuropathy.[15] CBD and CBDA also have anti-inflammatory and anti-anxiety properties. Emerging preclinical research indicates that in addition to preventing and relieving adverse effects of common chemotherapy drugs, like neuropathy and nausea [16], CBD may work synergistically to improve the anti-cancer effects.[17]

Some animal models demonstrate direct anti-cancer effects of CBD and combinations of CBD with other cannabis constituents[18], though we are still a long way from understanding how to best use CBD to directly affect cancer in humans.

CBD Dosage Guide | How to Use CBD for pain

Cannabis, including hemp-based CBD products, affects everyone differently. Achieving the best results depends on finding your optimal usage amount and frequency. While Dr. Sulak is a proponent of using very low doses to treat medical conditions, when effective, he supports using high doses of CBD if needed, especially when it’s used in the absence of significant quantities of CBDA or THC.

Why? Milligram per milligram, CBD is much less potent than CBDA or THC at relieving symptoms. For example, someone who experiences pain relief with just 3-10 mg of THC or 5-10 mg of CBDA, may require 15-100 mg of CBD to produce similar results.

Because the effects of CBD can be subtle at first, it’s important to always check in with your body and your mind before and 1 hour after taking your product and record your results.

It’s also important to remember that some people may feel relief faster than others and results can build over time, as demonstrated in the neuropathic pain study mentioned above with ⅓ noting benefits after 24 hours and ⅔ noting benefits after an average of 7 days.

How to use CBD Oil for pain

Administering CBD or CBDA oil sublingually ensures faster, more efficient absorption. CBD and CBDA oils are even better absorbed — resulting in a stronger effect– when taken after a meal containing some healthy fat or oil.

If you’re a beginner (have never used CBD, CBDA or have used it occasionally):

  1. Shake the bottle to make sure the cannabinoids and other beneficial plant compounds are well distributed for an even and consistent dose.
  2. Start with 5 mg placed under your tongue. Looking in a mirror can help you count the drops or administer by first placing drops on a spoon, or use an oral syringe.
  3. Hold the drops there for as long as you can (1-5 minutes) before swallowing to allow maximum absorption.
  4. Increase your daily usage by 5 mg every 2 days. When you start feeling results, stop increasing and keep the same number of drops peruse.
  5. If you notice that the effects wear off too early in the day after taking an amount that works well for you, it’s beneficial to add more uses per day. Many people do well taking CBD for pain 2-3 times daily.

How to use CBD or CBDA Capsules for Pain

To get started using CBD capsules is simple:

Day 1 & 2:
– Take 1 capsule by mouth 1-3x per day, waiting 4-5 hours between doses

After Day 2:
– Increase by 1 capsule every two days until you experience satisfactory benefits.
– If you notice unwanted effects or fewer benefits, reduce the amount by 1 capsule each day until you find your optimal response.
– If 1 capsule is too strong or if you experience inconsistent results, switch to CBD or CBDA oil taken sublingually.

How to use CBD or CBDA topicals & lotions for pain

For pain relief, seek a product that can be dispensed precisely with a pump, in order to understand the amount of CBD you’re using. Follow your product’s instructions regarding how much CBD is contained in each pump. Begin with 10-20 mg and apply every 3-6 hours. Rub CBD lotion, oil, or gel onto the affected areas of your body until absorbed.

It’s rare to find a topical with significant amounts of CBDA. However, Topical is a 1:1 CBD: CBDA Hydrogel Cream that includes a blend of menthol, Copaiba, and limonene for better absorption and beneficial healing properties. It’s also water-based, to feel less oily and dry more quickly.

Most people don’t know that CBD and CBDA Tinctures or Drops also can be applied directly to the skin (or mixed with your favorite lotion and applied) as a topical.

How to Choose the best CBD for pain relief

CBD and CBDA products vary widely in their potency, purity, and safety. Unfortunately, several scientific studies and investigative reports have found inaccurate labeling and contamination with pesticides, heavy metals, and other toxins in ~50% of the products tested. Furthermore, even many of the good quality products have confusing labels that make it hard to know how much CBD and CBDA are in each serving.

Few CBD products contain significant levels of CBDA, CBD’s precursor, and hemp-derived terpenes – both will likely improve the effectiveness of the product. CBDA acts similarly to CBD at many of its targets in our body but has been shown to be better absorbed and more potent in several experiments.

Before purchasing a CBD product you intend to use for pain, be sure to look at the certificate of analysis (COA), a test result from a third party laboratory that details the content of CBD and other cannabinoids (like CBDA) and terpenes, and freedom from contamination with heavy metals and pesticides. Be sure the COA has a date and batch number that matches the product for sale. Look at the label of the product and make sure it’s easy to understand the number of mg of CBD per drop or capsule and be wary of labels that only describe the amount of “hemp oil” or “hemp extract” – the CBD content could vary widely.

[1] Mlost, Jakub, Marta Bryk, and Katarzyna Starowicz. “Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action.” International journal of molecular sciences 21.22 (2020): 8870.

[2] Wade DT, Robson P, House H, et al. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil. 2003;17:21-29.

[3]  Naftali, Timna, et al. “Cannabis for inflammatory bowel disease.” Digestive Diseases 32.4 (2014): 468-474.

[4] Palmieri B, Laurino C, Vadala` M. Short-term efficacy of CBD- enriched hemp oil in girls with dysautonomic syndrome after human papillomavirus vaccination. IMAJ. 2017;19:79-84. 

[5] Cuñetti, Leticia, et al. “Chronic pain treatment with cannabidiol in kidney transplant patients in Uruguay.” Transplantation proceedings. Vol. 50. No. 2. Elsevier, 2018.

[6] van de Donk, Tine, et al. “An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia.” Pain 160.4 (2019): 860.

[7] Xu, Dixon H., et al. “The effectiveness of topical cannabidiol oil in symptomatic relief of peripheral neuropathy of the lower extremities.” Current pharmaceutical biotechnology 21.5 (2020): 390-402.

[8] Capano, Alex, Richard Weaver, and Elisa Burkman. “Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study.” Postgraduate medicine 132.1 (2020): 56-61.

[9] Gulbransen, Graham, William Xu, and Bruce Arroll. “Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand.” BJGP open 4.1 (2020).

[10] Kimless D, Caloura MK, Kirakosyan A, Goldner S (2020) The effects of cannabidiol-based sublingual tablets on diabetic neuropathic pain. J Diabetes Metab. 11:860.

[11]  Anderson, Lyndsey L., et al. Journal of natural products 82.11 (2019): 3047-3055.

[12]  Rock, Erin M., et al. Psychopharmacology 235.11 (2018): 3259-3271.

[13]  Rock, E. M., et al. British Journal of Pharmacology 169.3 (2013): 685-692.

[14] Rock, Erin M., et al. Psychopharmacology 234.14 (2017): 2207-2217

[15]  Waissengrin, Barliz, et al. “Effect of cannabis on oxaliplatin-induced peripheral neuropathy among oncology patients: a retrospective analysis.” Therapeutic Advances in Medical Oncology 13 (2021): 1758835921990203.

[16]  Blanton, Henry L., et al. “Cannabinoids: current and future options to treat chronic and chemotherapy-induced neuropathic pain.” Drugs 79.9 (2019): 969-995.

[17]  Fraguas-Sánchez, A. I., et al. “CBD loaded microparticles as a potential formulation to improve paclitaxel and doxorubicin-based chemotherapy in breast cancer.” International journal of pharmaceutics 574 (2020): 118916.

[18] Seltzer, Emily S., et al. “Cannabidiol (CBD) as a Promising Anti-Cancer Drug.” Cancers 12.11 (2020): 3203.   

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