How CBD Relieves Chronic Pain
The usual observations of body-based or neurological pain transmission pathways cannot explain chronic pain.4 It is, nonetheless, experienced pain that causes a great deal of suffering.
Cannabis sativa has up to 144 cannabinoids that are all believed to interact meaningfully to address chronic pain. The scientific literature on CBD (cannabidiol) is surprisingly limited, considering how far it goes back. By comparison, the way THC (delta-9-Tetrahydrocannabinol) interacts with the endocannabinoid system is now well-understood. What is clear from many studies is the combined efficacy of CBD and THC used together.
CBD for Chronic Pain
A recent cross-sectional study of CBD users revealed that CBD is being used to treat mental and physical health symptoms.10 These users, employing doses below 50mg CBD, self-reported improved quality of life overall with its use. The survey reasoned that stress, sleep issues, and anxiety constitute pressing societal health problems, but we lack satisfactory remedies.
Another recent study evaluated CBD similarly in the treatment of chronic pain. It concluded that “CBD is a well-tolerated and safe natural compound exerting analgesic effects". It added that the combination of CBD and THC, as found in natural cannabis sativa, favorably reduced the required dose and reduced the intensity of THC's 'high'.9 Both of these recent studies reached the same conclusion as all others. Further research into CBD is currently needed to permit confident prescriptive recommendations by medical practitioners.
Chronic Neuropathic Pain and Transdermal CBD
Chronic neuropathic pain is associated with a complicated collection of neuropathic symptoms, complicated treatment decisions, and inadequate results. The inciting disease and the pain itself significantly diminish overall health and well-being. Prolonged drug prescriptions and repeated visits to health care providers decrease the overall quality of life for patients suffering from neuropathic pain. Medical practitioners and scientific studies agree that a multidisciplinary approach to the management of neuropathic pain is needed.3
It was found that “...the transdermal application of CBD oil can achieve significant improvement in pain and other disturbing sensations in patients with peripheral neuropathy."14 Considering that current therapies for peripheral neuropathy often include opioids, CBD was comparably well-tolerated. CBD's safe and non-addictive characteristics are seen as especially favorable and possibly more effective "compared to other current therapies in the treatment of peripheral neuropathy.”14
Fibromyalgia: Nabilone vs CBD for Pain
Clinicians find fibromyalgia particularly difficult to deal with. Many practitioners conclude that “The fibromyalgia syndrome (FM) seems an unlikely candidate for classification as a neuropathic pain.”12 There are substantial differences in the pathogenetic factors and the spatial distribution of the perceived pain in patients with diabetic neuropathy (DPN) and fibromyalgia. Some studies, however, have “questioned whether, despite these obvious differences, similar abnormal sensory complaints and pain qualities exist in both entities.”7
Studies have conclusively proven that CBD can improve the severity and occurrence of neuropathic pain. There have been interesting studies of nabilone, a synthetic cannabinoid, in treating fibromyalgia, which has similar pain profiles and complaints to neuropathic pain.13
The synthetic nabilone did poorly across the board. The study had to conclude that there is “no convincing, unbiased, high-quality evidence suggesting that nabilone is of value in treating people with fibromyalgia. The tolerability of nabilone was low in people with fibromyalgia.”13
No Relevant Studies of Natural Cannabis in Treating Fibromyalgia
Perhaps the more interesting takeaway of this study was that “no relevant study with herbal cannabis, plant-based cannabinoids or synthetic cannabinoids other than nabilone in fibromyalgia.”13 Just because nabilone wasn’t effective at treating fibromyalgia, doesn’t rule out CBD.
How CBD is administered and the form it comes in is important to pain management. Only the whole cannabis plant, effectively extracted, seems to provide the full benefits that phytocannabinoids have to offer. This is often owed to the entourage effect, the synergy of cannabinoids, terpenes, and flavonoids working in unison. Our article ‘Vaporizing vs. Smoking?’ elaborates on the entourage effect and how vaporizing cannabis is an effective method of achieving it.
Chronic Pain in Sickle Cell Disease (SCD)
The CDC summarizes Sickle Cell Disease (SCD) as “a group of inherited red blood cell disorders” in which “red blood cells become hard and sticky and look like a C-shaped farm tool called a “sickle”. The sickle cells die early, which causes a constant shortage of red blood cells.”2
Chronic pain is a persistent comorbidity of SCD, with the added complication of extreme pain due to reoccurring blood vessel blockages. These symptoms can span an individual’s entire life. The current treatment for this pain is opioids. A recent study, concerned with this reality, concluded that cannabis would be preferable: “Due to recent health crises raised by adverse effects including deaths from opioid use, pain management in SCD is adversely affected.”1
Vaporized Cannabis Enhances Quality of Life in SCD
In this broad analysis, the promising effects of vaporized cannabis were noted in a pilot study of 23 patients with SCD-related chronic pain receiving opioids for treatment. In this randomized double-blind placebo-controlled crossover trial, inhaled cannabis and a placebo were administered during two separate sessions.
The conclusions were extremely promising, particularly for already pained patients facing a serious risk of opioid addiction. Vaporized cannabis significantly improved feelings of well-being and overall mood in SCD patients. The total absence of notable adverse effects in this study “encourages further investigation into the use of cannabis-based interventions including CBD to treat chronic SCD pain in prospective trials with a larger cohort over a longer duration.”1
Epilepsy: CBD for Seizures
Characterized by unpredictable seizures, epilepsy is a spectrum condition with a wide range of seizure types and control varying from person-to-person. Its causes may be related to brain injury or heredity, but is often mostly unknown.6 In a study of 858 epileptic patients, 24 had particularly painful seizures.16
CBD has proven effective in treating the confounding chronic pain of fibromyalgia, neuropathic pain, and SCD. It follows that it could prove effective in treating the varying types of seizures and their severity.
Sure enough, recent studies evaluating CBD’s efficacy in treatment-resistant epilepsy confirmed this. Their findings suggested that CBD could reduce the frequency of seizures. Furthermore, it was widely agreed that CBD’s safety profile was likely suitable for children and young adults. Further randomized controlled trials are warranted to evidence this hope for patients of treatment-resistant epilepsy.5
CBD, Nausea & Chemotherapy Side-Effects
While nausea doesn’t necessarily qualify as chronic pain, it remains one of the most distressing symptoms experienced by cancer patients undergoing chemotherapy treatment. Chemotherapy is already accompanied by so many debilitating side effects. That alone warrants the exploration of safe and meaningful interventions.
Studies have proven that the endocannabinoid system plays a vital role in regulating nausea. CBD, a CB1 receptor agonist, has been shown to reduce acute and anticipatory nausea.11 Interestingly, the same study pointed out that in “a non-cannabinoid mechanism of action, both CBD and CBDA are highly effective antinausea treatments ... without producing sedation or psychoactive effects.”11
Conclusions: CBD is an Effective Add-on Therapy for Chronic Pain
This brings us back full-circle to the mysterious actions of CBD in treating chronic pain. On the one hand, it has been observed to work much like THC, stimulating CB1 and CB2 sites in the endocannabinoid system. What is not predictable are CBD’s non-cannabinoid mechanisms, highlighted by the previous study. Although there is still a lot science hasn’t accounted for, CBD’s effectiveness in people experiencing tremendous suffering cannot be ignored.
It is important to understand that since most scientific findings cannot conclusively recommend CBD for chronic pain, neither can your doctor. Many chronic pain sufferers can find this frustrating. Here at Evolved Smoke we strongly advocate for the use of safe CBD products and hemp as an add-on treatment for chronic pain. We believe that the science offers ample evidence for the mindful use of quality cannabis products.
Our vaporizers, particularly medical-grade desktop vaporizers like the Volcano Vaporizer by Storz & Bickel, are ideal for administering inhaled CBD vapor. For further reading on vaporizing cannabis, we recommend our article 'Vaporizers: The Ultimate Guide'.
Treatments like topical CBD can be used concomitantly for well-rounded pain management. Our article ‘CBD oil: What is it and how is it used?’ explores this in further detail.
1 Argueta, D., Aich, A. and Muqolli, F. (2020) “Considerations for Cannabis Use to Treat Pain in Sickle Cell Disease,” PMC US National Library of Medicine, [online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761429/ (Accessed 16 March 2021).
2 CDC (2021) “What is Sickle Cell Disease?,” Centers for Disease Control and Prevention, [online] Available from: https://www.cdc.gov/ncbddd/sicklecell/facts.html (Accessed 19 March 2021).
3 Colloca, L. and Ludman, T. (2017) “Neuropathic pain,” PMC US National Library of Medicine, [online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371025/ (Accessed 16 March 2021).
4 Crofford, MD, L. (2015) “Chronic Pain: Where the Body Meets the Brain,” PMC US National Library of Medicine, Transactions of the American Clinical and Climatological Association 2015; 126: 167–183., [online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530716/ (Accessed 19 March 2021).
5 Devinsky, MD, D. P. O., Marsh, MD, E. and Friedman, MD, D. (2016) “Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial,” The Lancet: Neurology VOLUME 15, ISSUE 3, P270-278, [online] Available from: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(15)00379-8/fulltext(Accessed 16 March 2021).
6 Epilepsy Foundation of America (2020) “What is Epilepsy?,” Epilepsy Foundation of America, [online] Available from: https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy (Accessed 19 March 2021).
7 Koroschetz, J., Rehm, S. and Gockel, U. (2011) “Fibromyalgia and neuropathic pain - differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia,” BMC Neurology, Part of Springer Nature, [online] Available from: https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-55?report=reader (Accessed 19 March 2021).
8 McGolrick, D. and Frey, N. (2018) “Nabilone for Chronic Pain Management: A Review of Clinical Effectiveness and Guidelines – An Update,” PMC US National Library of Medicine, [online] Available from: https://www.ncbi.nlm.nih.gov/books/NBK538943/ (Accessed 16 March 2021).
9 Mlost, J., Bryk, M. and Starowicz, K. (2020) “Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action,” PMC US National Library of Medicine, [online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700528/ (Accessed 17 March 2021).
10 Moltke, J. and Hindocha, C. (2021) “Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems,” PMC US National Library of Medicine, [online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893882/ (Accessed 17 March 2021).
11 Rock, E., Sticht, M. and Limebeer, C. (2016) “Cannabinoid Regulation of Acute and Anticipatory Nausea,” PMC US National Library of Medicine, [online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576606/ (Accessed 17 March 2021).
12 Rowbotham, M. (2005) “Is fibromyalgia a neuropathic pain syndrome?,” The Journal of Rheumatology, The Journal of Rheumatology Supplement August 2005, 75 38-40, [online] Available from: https://www.jrheum.org/content/75/38.abstract (Accessed 19 March 2021).
13 Walitt, B., Klose, P. and Fitzcharles, M.-A. (2016) “Cannabinoids for fibromyalgia,” PMC US National Library of Medicine, [online] Available from: https://pubmed.ncbi.nlm.nih.gov/27428009/ (Accessed 16 March 2021).
14 Xu, D., Cullen, B. and Tang, M. (2020) “The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities,” PMC US National Library of Medicine, [online] Available from: https://pubmed.ncbi.nlm.nih.gov/31793418/ (Accessed 16 March 2021).
15 Yale, S., Nagib, N. and Guthrie, T. (2000) “Approach to the Vaso-occlusive Crisis in Adults with Sickle Cell Disease,” American Family Physician, Am Fam Physician. 2000 Mar 1;61(5):1349-1356., [online] Available from: https://www.aafp.org/afp/2000/0301/p1349.html (Accessed 19 March 2021).
16 Young, G. B. and Blume, W. T. (1983) “Painful epileptic seizures,” PMC US National Library of Medicine, [online] Available from: https://pubmed.ncbi.nlm.nih.gov/6640268/ (Accessed 16 March 2021).