CBD for Pain Relief

Every day in the pharmacy, patients come to our counter, see our display right there next to the register, and ask us ‘what the heck is cannabidiol’, otherwise known as CBD oil? Can I use CBD oil for pain relief? They’ve heard the news, talked with friends and family, and of course see it in our pharmacy, but is it something I would recommend for patients far and wide? A lot of questions usually relate to whether it’s useful for pain, and it’s one subject that this pharmacist set out to research.

First, what is CBD? At least with the products we carry at the store, I am confident to say that it is not weed. Usually, the general public associates anything related to cannabis products as stereotypical images of marijuana and stoners. The concern with those afraid of marijuana is the active component tetrahydrocannabidiol (THC). It has been shown to produce psychoactive effects (“getting high”) in users at improper doses as well as potentially lead to addiction and addictive patterns if overused. However, CBD sold in pharmacies per the FDA contain only trace amounts of THC, none of which is high enough to produce any of these effects.

On top of CBD products not being like marijuana, there is the source of the CBD extract. According to the 2014 Agricultural Act signed by President Obama, the law allowed for the industrialized production of Hemp plants — different from more restricted marijuana plants — for many purposes. One of which has allowed the proliferation of CBD use in over-the-counter treatments. Furthermore, the 2018 US Farm Bill that is currently being negotiated in Congress can expand the market of CBD treatments profoundly. Given that the CBD derived from hemp plants is bio-identical to the CBD extracts from the marijuana plants, patients can still derive therapeutic use out of CBD extracted from hemp.

Most Rated CBD Oil for Pain Relief

CBD from hemp has been shown to contain only trace amounts of THC, which is great for decreasing the potential for getting high but what good is CBD alone for patients? Both CBD and THC are in a class of chemicals called cannabinoids that affect endogenous receptors in the body; that means your body already has receptors that are activated by compounds like CBD. Particularly, CBD acts on the CB2 receptor that is found throughout the body, including your immune cells, the smooth muscle of your intestines, and the interstitial cells of your central nervous system. After being absorbed into the body, CBD acts on inhibiting this receptor which can help modulate the excitability of the nerve or cell it’s acting on to help either decrease inflammation or slow down signals that affect pain pathways to the brain. Although the full explanation of how CBD acts on the body is still being investigated, the action of the CB2 receptor alone is fairly substantial. And given its wide spread nature within the body, that is why many people have found many uses for CBD products.

When I find out about a new product like CBD, I’m almost always skeptical about recommending it and usually spend a weekend (or two) learning about it through scientific studies I find published by reputable scientific journals and relay what I can to my patients. For those inquiring about pain relief, there are a few studies out there that have some promise. A 2017 animal study published in the Journal of Pain found that administering oral CBD in rats diagnosed with osteoarthritis significantly increased the pain thresholds of those tested compared to the control group. To the authors, this meant that administering CBD – in their case, by oral routes – caused rats to sense less pain from their arthritis and allowed them to function more during their life activities. However, the major limitations to this study related to the sample size as well as it being an animal study. Yet, this only appears to be the beginning of many studies out there that aim to apply similar methods to human trials to gain more useful knowledge.

The need for further clinical trials was expanded in a 2018 article from the Journal of Clinical and Experimental Rheumatology. The authors noted that there are currently no randomized controlled trials for the use of CBD for joint pain or arthritis. The only data they could find were from informal surveys and anecdotal evidence which ultimately found majorly positive effects reported from participants in these studies. Authors also noted that more formal trials to assess the impact of CBD — and other cannabinoid treatments – performed in Canada and Germany were found to have inadequate data reported based on public perception of cannabis-like products as well as bias against the use of cannabinoid products. Regardless, it was ultimately concluded that CBD products were generally recommended as a trial to help add to and possibly augment current treatment for patients.

What was perhaps most interesting to me as a pharmacist was the use of CBD to help decrease dependence and reliance on prescription opioid medications. In researching the mechanism of how CBD acts on the body, evidence shows that it can amplify the enhance the effect of activating endogenous opioid receptors , meaning the body can achieve similar levels of pain relief at lower doses of opioid medication. On top of it, there was a limited study that found patients who tried over the counter CBD products were able to decrease their pill burden of prescription opioids by at least half regardless of whether they received any perceived benefit from the CBD alone. This is exciting news to me, no matter how preliminary the results may be. With patients across the country struggling in the opioid epidemic and finding it hard to adequately treat their pain without opioids, CBD may offer something extremely useful in this field.

Given the efficacy of CBD, we also have to consider the side effects and drawbacks of its use. Given that it has no psychoactive effects like its cousin, THC, there is limited to no risk for addiction and has limited ability to affect cognitive function. The most common side effect reported from CBD is drowsiness and stomach upset. These are understandable since CBD can also have inhibitory actions on serotonin receptors which can lead to someone feeling tired. And since a majority of available products on the market are derived from hemp plant oils and extracts, stomach upset can occur since cannabinoids can be a direct irritant to the stomach lining. However, both of these side effects are easily managed by being aware of how and when to take it. I would recommend taking any preparation at night, so you can easily fall asleep and with food, so it minimizes its effect on your stomach. With CBD having a half-life of 9 hours, it should have a therapeutic effect for a majority of the day and more than likely only need once daily dosing.

Speaking of dosing, this was by far the hardest to suss out in the research because dosings range far and wide when it comes to the treatment of pain, let alone any of the other indications people pair with CBD. With products I’m more familiar with, doses generally range anywhere between 8-20mg in either liquid or capsule forms. Topical creams and salves are also available on the market and given that CBD has the potential to penetrate the skin fairly easily, there may be a use for such applications; however, the dose a patient may receive will depend on how much is applied and that itself is hard to standardize. Generally from the studies, any dose between 10-20mg by mouth daily should be able to have an effect on joint pain. This can be achieved by either capsule or liquid, but I would hazard caution by relying on liquid unless you know the calibration of the dropper used; otherwise, if you want to be more precise, I’d ask the pharmacy if they have extra oral syringes that are already measured to give you an exact dose

As a pharmacist, I have to say that I was extremely skeptical of the use of CBD products when it first came to our pharmacy. Given how many different patients were sharing various indications for why they chose CBD, I couldn’t help myself in thinking this was a “Snake Oil Remedy” of our generation. That’s why I rely on the evidence that scientific trials provide. From what I could find, the evidence is rather light, yet fairly positive in its use for joint pain as well as other pain modalities that affect patients every day. Given that side effects are low and as long as patients are adequately aware of what to expect from the ingredients, I happily recommend its use to people who are curious about what I have on my counter. Overall, I encourage everyone to be educated in their own health, especially when new products become available like CBD. Having a good relationship with a healthcare professional like your neighborhood pharmacist is great, but also taking the time to look through the articles themselves that study the impact of these kinds of treatments will ensure you get the full picture of how to impact your life.

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