Today, you’re going to learn everything about how to use CBD oil for pain management.
We reviewed over 50 scientific articles that looked at:
- The potential benefits and effects of CBD, including for pain;
- The mechanisms of action that give CBD its painkilling properties, and;
- What doses of CBD were found effective in different studies for reducing pain.
The results we found are a MUST-read for anyone interested to explore the potential benefits of CBD oil for pain management.
The best part?
You’re going to learn exactly what type of CBD oil has the most potential to give you pain-relieving effects.
What you need to do to maximize CBD oil's potential for pain relief. Plus, you're going to learn whether topical CBD products may be a better alternative or not.
Table of contents:
The Types of Pain CBD May Relieve (Review of Studies)
How CBD Works for Pain Relief: CBD's Mechanism of Action
What's the Best CBD Oil for Pain Relief?
Are Topical CBD Products an Effective Alternative?
How to Use CBD Oil for Pain
How to Dose CBD Oil for Pain
Below you can find a quick step-by-step summary on how to use CBD oil for pain. If you want to dive deeper into the science of using CBD for pain, please read the full article.
The Types of Pain CBD May Relieve (Review of Studies)
While commercially produced and sold CBD oil is not a medicine, scientific research has shown that CBD, the main constituent of CBD oil, can have beneficial effects on pain-related conditions.
CBD and Chronic Pain
Various studies found beneficial effects of CBD for chronic pain.
However, most of these studies are done on animals.
For example, a study published in 2012 by the Journal of Experimental Medicine, looked at the effects of CBD on chronic inflammatory and neuropathic pain in mice.
They found that CBD significantly suppresses chronic inflammatory and neuropathic pain through interacting with glycine receptors, without building any tolerance levels or side effects.
Glycine receptors (GlyRs) play an important role in the regulation of pain at the spinal level.
One recent 2018 study done on human kidney transplant patients study that looked at the effects of CBD in chronic pain treatment found that:
- 2 out of 7 patients had a total pain improvement with an initial dose of 100 mg of CBD/day and a progressive increase of up to 300 mg of CBD/day (spread out over the day in smaller doses);
- 4 out of 7 patients had a partial pain improvement with an initial dose of 100 mg of CBD/day and a progressive increase of up to 300 mg of CBD/day (spread out over the day in smaller doses). With these patients the pain lessened significantly but didn't completely disappear, and;
- 1 patient didn't improve at all.
Interestingly enough, this same study found that 1 patient experienced much better pain control with a lower dose of CBD (less than 300 mg of CBD/day). This means that more CBD is not always better!
CBD and Digestive Pain/Inflammatory Bowel Disease
There has been some research in regard to cannabinoids and improving gut health as well as relieving the pain associated with conditions like inflammatory bowel disease.
Researchers have found evidence, as suggested in “Cannabinoids for treating inflammatory bowel diseases: where are we and where do we go?”, that cannabinoids can have beneficial effects on inflammatory bowel diseases (IBDs).
Of all cannabinoids both THC and CBD have the biggest potential.
CBD is protective in intestinal inflammation.
Pre-clinical studies have shown that CBD has an anti-inflammatory effect on intestinal inflammation.
While the exact mechanism responsible for this effect needs further research, researchers have found at least some evidence that CBD acts as an antagonist to GPR55, a receptor that plays a crucial role in intestinal inflammation.
By binding to the GPR55 receptor, CBD could work as a desensitizing agent on this receptor, which might lead to a decrease in inflammation.
CBD and Arthritis Pain
Arthritis is characterized by inflammation of the joints.
Research published in 2016 in the “European Journal of Pain” found a dramatic reduction in inflammation and signs of pain, without adverse side effects in rats with arthritis after the animals were given a topical gel that contained CBD for four days.
It makes sense that CBD could help relieve any inflammation-related pain condition due to its powerful anti-inflammatory effects.
There are many users of CBD oil who have anecdotally reported that it helps to relieve not only pain but other inflammatory conditions as well, like: multiple sclerosis, nausea, PTSD, Alzheimer’s disease, insomnia, and epilepsy, in addition to all of the above though, studies are still needed to confirm these effects.
Note: CBD may not only relieve physical pain but mental pain like anxiety and depression as well.
CBD and Cancer-related Pain
Different studies have found that oromucosal sprays containing both CBD and THC, were effective in improving cancer-related pain.
For example, one study looked at the effects of a CBD- and THC-containing spray called Sativex on pain in patients that were diagnosed with pain related to terminal cancer and that was not fully relieved by strong opioid painkillers.
The study found that the CBD-containing spray improved pain as measured by different metrics like ‘pain severity'. The CBD-containing spray was generally well tolerated and showed no loss of effect.
Important to note here is that the used spray contained significantly higher concentrations of THC than is found in the average CBD oil. The question remains as to how much of these painkilling effects can be attributed to CBD, THC, or to the combination of both cannabinoids.
CBD and Headaches like Migraine
Various studies also looked at the effects of cannabinoids on headaches like migraine and chronic cluster headache.
For example, one study done in 2017 looked at the effects of two different cannabinoid formulations on migraine and cluster headache.
In phase 1 of the study, a group of 49 chronic migraine patients was given an oral dose of THC and CBD. The approximate THC to CBD ratio of the oral dose was 2:1 for THC:CBD (the exact percentages were 19.4% THC and 9% CBD). The outcome was that doses of less than 100mg produced no effects. When an oral dose of 200mg was administered, the acute pain dropped by 55%.
In phase 2 of the study, 79 chronic migraine patients were given a daily dose of 200mg of the THC-CBD combination for a period of three months.
The severity and number of cluster headache attacks only fell slightly. However, the cannabinoid formulation reduced pain intensity among migraine patients by 43.5%.
Important to note here is that the used spray contained significantly higher concentrations of THC than is found in the average CBD oil. The question remains as to how much of these painkilling effects can be attributed to CBD, THC or to the combination of both cannabinoids.
Now we know that there's at least some scientific evidence indicating that CBD could be beneficial for pain relief.
But what makes CBD a potential painkiller? What's CBD's mechanism of action in human physiological processes?
How CBD Works for Pain Relief: CBD's Mechanism of Action
CBD interacts directly with a variety of receptors like:
- CB1 and CB2 receptors;
- Glycerine receptors;
- Opioid receptors;
- Serotonin receptors;
- Adenosine receptors, and;
- TRPV1 receptors.
Some of these receptors and their neurotransmitters are associated with important pain-related physiological processes like pain-signaling and pain-sensation.
As you can see:
CBD's interaction with these receptor systems is exactly what makes CBD oil a potential candidate for relieving symptoms of pain-related conditions.
When you ingest CBD, you can alter the functioning of some of these receptors.
The CBD inside CBD oil in some cases:
- Activates pain-related receptors, stimulating and increasing the activity of pain-reducing neurotransmitters that communicate with these receptors.
In other cases:
- CBD blocks these pain-related receptors. The blocking of pain-related receptors sometimes increases the presence of pain-reducing neurotransmitters in the brain by blocking re-uptake. And other times it leads to desensitizing of these receptors, decreasing the activity of pain-increasing neurotransmitters.
Current research shows that CBD has a strong affinity for interacting with 4 particular receptors that are associated with experiencing feelings of pain:
- Delta-opioid receptors;
- 5-HT1A (hydroxytryptamine) serotonin receptors;
- Adenosine receptors;
- TRPV1 receptors (vanilloid receptors). and;
- Glycine receptors.
Let's explore these a bit further.
CBD and Its Interaction with Delta-Opioid Receptors
Opioid receptors are a set of receptors that are associated with important physiological processes like:
- Pain signaling in the central and the peripheral nervous system;
- Respiration, and;
- Immunological response.
Opioid drugs like morphine are highly effective as painkillers because they target opioid receptors.
And while CBD doesn't target opioid receptors directly, different studies have shown that CBD acts as an ‘allosteric modulator' to opioid receptors.
What this means in layman's terms is the following:
CBD can increase the effectiveness of compounds that directly interact with opioid receptors (this is called allosteric modulation).
By increasing the effectiveness of opioid-receptor targeting agents, CBD could help with pain relief.
CBD and Its Interaction with 5-HT1A (hydroxytryptamine) Serotonin Receptors
Serotonin receptors and neurotransmitters are associated with a huge list of biological processes like:
- Pain perception;
- Sensory pain-processing at multiple levels within the central and peripheral nervous systems;
- Cardiovascular function;
- Bowel motility;
- Ejaculatory latency, and;
- Bladder control.
Serotonin is often referred to as a “feel-good neurotransmitter.” When serotonin neurotransmitters are active they can act as an anti-depressant, improving your general sense of well-being.
Now, here comes the interesting part about serotonin receptors and neurotransmitters:
Recent studies have found that the activation of 5-HT(1A) receptors (a specific type of serotonin receptor) can decrease chronic pain.
The exact mechanism of action needs further research …
But CBD is known to activate 5-HT(1A) serotonin receptors.
CBD's potential to activate 5-HT(1A) receptors could be partially responsible for its analgesic (painkilling) effects.
CBD and Its Interaction with Adenosine Receptors
Adenosine receptors are associated with many biological functions like:
- Heart function;
- Regulation of myocardial oxygen consumption and coronary blood flow;
- Inflammation and immune responses throughout the body;
- Regulating the release of neurotransmitters such as dopamine and glutamate.
Adenosine signaling has been associated with anti-inflammatory effects.
Adenosine uptake is the primary mechanism that stops adenosine signaling.
Compounds that prevent adenosine uptake, promote adenosine signaling, and thus promote anti-inflammatory effects.
Studies have shown that CBD increases adenosine A2A receptor signaling by inhibition of the adenosine transporter.
Researchers think that CBD's affinity to bind to adenosine receptors is a mechanism of action that results in its anti-inflammatory properties.
CBD and Its Interaction with Vanilloid Receptor 1 (TRPV1)
Vanilloid receptor 1 (TRPV1) is also called the ‘capsaicin receptor' because it gets activated by:
- Capsaicin (the irritating compound in hot chili peppers);
- A temperature greater than 109 °F (43 °C ), and;
- Acidic conditions.
Vanilloid receptor 1 is involved in processing various painful stimuli and the transmission and modulation of pain.
TRPV1 receptors work the opposite way of 5-HT(1A) serotonin receptors when it comes to pain. When they're active, you experience a heightened sense of pain.
CBD has been shown to bind to (block) vanilloid receptors, blocking their activity.
Researchers have hypothesized that when CBD binds to vanilloid receptors it leads to the desensitization of TRPV1 receptors, which in turn, leads to painkilling effects.
CBD and Its Interaction with Glycine Receptors (GlyRs)
Glycine receptors are involved in inhibitory neurotransmission in the spinal cord and the brainstem.
What this means is that the activation of glycine receptors decreases neuronal signaling of specific neurons that are associated with motor control and pain perception.
CBD has been shown to activate glycine receptors and the activation of glycine receptors has been associated with a reduction in pain.
What's the Best CBD Oil for Pain Relief?
The best CBD oil to explore CBD's potential for pain relief is any full-spectrum CBD oil that's packed with a variety of:
- Cannabinoids, and;
Hemp plants contain many other beneficial compounds besides CBD.
Cannabinoids like THC and CBG have been associated with painkilling effects. Hemp plants also contain terpenes, of which a few have been associated with painkilling effects as well.
All of these different cannabinoids and terpenes have beneficial effects in and of themselves, but more importantly, some researchers suggest that CBD works best in combination with other naturally occurring compounds (like other cannabinoids and terpenes) found in the Hemp plant, through a process they call ‘the entourage effect’.
A full spectrum or full-plant extract CBD oil makes the best case for the entourage effect and will let you experience CBD's effects for improving pain in the most potent way.
In fact, as you'll learn in the dosing paragraph: one study has found that full-plant extract CBD oil indeed is more potent than purified CBD products that only contain CBD.
For best effects, you want a CBD oil that's biochemically as close as possible to the original biochemical composition of high-resin Hemp plants.
This means that your CBD oil should not only contain large concentrations of cannabinoids and terpenes but it should contain a wide spectrum of cannabinoids and terpenes.
For a current list of CBD oils that we recommend for exploring the potential benefits of CBD for pain relief, click the link below:
Are Topical CBD Products a Good Alternative to Oil When It Comes to Pain Relief?
Topically applied CBD may prove to be useful for certain pain-related conditions.
Although there are no human studies that looked at the effects of topically applied CBD on specific pain-related conditions, one animal study has found that topical CBD application significantly reduced pain and inflammation in rats with arthritis.
Topically applied CBD has also been found effective for inflammatory skin conditions and may help reduce pain associated with these types of skin conditions. For example, one study with 20 patients with two frequent skin disorders: psoriasis, atopic dermatitis found that CBD's anti-inflammatory effects can provide significant relief.
But are topical CBD products like balms and creams more effective than oils/tinctures?
Without a properly conducted scientific study, we can't say with certainty…
But in our subjective experience, a combination of both works best when it comes to certain types of pain like exercise-induced inflammation/pain.
How to Use CBD Oil for Pain Relief (Administration Methods)
Taking a full-spectrum CBD oil sublingually is our most recommended method to take CBD oil for pain relief.
- With edible CBD oils, it's very easy and reliable to dose the exact amount of CBD you ingest;
- Full-spectrum, edible CBD oils are the most potent CBD products that you can get because they contain the widest variety of hemp-derived compounds of all CBD products, and;
- The effects last the longest (2-5 hours).
Taking CBD for pain relief through oral consumption also has a few downsides:
While the effects of taking CBD orally last longer compared to vaping, for example, the time before effects are at their peak take also significantly longer (2 to 4-hours compared to 5 to 15 minutes)
We always recommend taking your edible CBD oil sublingually to avoid the ‘first-pass effect’. The first-pass effect refers to the metabolization/reduction in the concentration of drugs and other substances before they reach the bloodstream. When you take CBD oil sublingually, at least part of the compounds inside will be directly absorbed through the mucous membrane beneath your tongue.
How you take your CBD oil sublingually is by keeping it under your tongue for at least 60 seconds, and only after that, swallowing it.
Another option you have is taking CBD gummies, although CBD gummies generally don't contain as many and different hemp-derived compounds compared to oil/tinctures.
We wrote an extensive guide on the topic of the best methods to take CBD oil (including vaping CBD vape oil), which you can read below:
How to Dose CBD Oil for Pain
As CBD oil isn’t an officially approved medicine for pain conditions, there are no official dosage guidelines.
So where do you start?
The kidney-transplant-study found painkilling effects of CBD with an initial dose of 100 mg/day and a progressive increase of up to 300 mg/day (spread out over the day in smaller doses).
Realize that with high doses like these, taking full-plant extract CBD oil is going to turn out expensive. For example, a NuLeaf Naturals CBD oil has a strength of 50mg CBD/milliliter. A 0.5 FL OZ (15ml) bottle of their pure CBD hemp oil contains 725mg of CBD and costs $70. If you're going to take 100mg of CBD, a $70 bottle is only going to last you 7 days.
You might not need such a high dose, start with low amounts, especially if you're using a full-spectrum CBD oil. There's a study that showed epilepsy patients that used full-spectrum cannabis-extract, needed 4-times less of a dose to improve their condition than epilepsy patients that used a purified CBD product. Something similar might hold true pain relief.
To find the best full-spectrum CBD oil, go to our list of:
Whatever you do, never use more than 1500mg/day, this is the current maximum recommended dose according to several studies.
Also make sure that if you're taking other medicines, be extra careful with high doses, as CBD could potentially interact with many pharmaceutical drugs and create various side effects.
Note that how many drops you need to take to achieve a set amount of CBD in milligrams, is highly dependent on the CBD oil that you're using. CBD oils come in many different strengths with potencies of 1% CBD to 30% CBD.
For example, NuLeaf Naturals CBD oil has a strength of 50mg CBD/milliliter or 6.94%. A 0.5 FL OZ (15ml) bottle of their pure CBD hemp oil contains 725mg of CBD. In their case, 1 drop = 2.4 mg of CBD, which means there are 300-320 drops in total. Start with a full serving as recommended by the manufacturer. in the case of this particular oil, this would amount to 30mg of CBD + additional hemp-derived cannabinoids and terpenes.
Now, if you notice that your body doesn't have any adverse reactions, you can slowly start to increase the dose IF you don't feel any positive effects from your initial dose.
There are also dosage instructions that come with the CBD oil you purchase to read before taking that first dose. Continue taking up to the maximum amounts slowly over your first four weeks. Evaluate how it helps to relieve your symptoms, taking notes and journaling. Keep in mind that peak effects of orally consumed CBD appear only after 2 to 4 hours.
If you do experience side effects like drowsiness, which is unlikely at lower doses, you may want to take CBD oil in the evening, just before bedtime. Or you could spread let's say a dosage of 100mg CBD in smaller portions throughout the day. This is exactly the method that was used in the kidney-transplant-study, which means this method of dosing has at least some scientific support.
For a guide on unofficial CBD dosages, click the link below:
How Long Does It Take for CBD Oil to Work for Pain Relief?
Again, commercially produced and sold CBD oil is not medicine.
That said, you can use anecdotal reports and the results of a few studies as a guide for knowing when to expect what when using CBD oil.
The kidney-transplant-study, for example, found that patients experienced positive effects within 15 days of daily CBD oil use.
Side Effects of CBD Oil
CBD has no known severe side effects. Opioid painkillers, in contrast, come with side effects such as overdose, increased likelihood of heart attack, and addiction.
The side effects associated with CBD use are minor and include:
- Dry mouth;
- A slight sedative reaction (feeling sleepy), and;
- A reduction in the liver’s ability to metabolize certain pharmaceutical medications.
For a non-exhaustive overview of currently known interactions of CBD and side effects, click here. Anyone taking a prescribed drug should speak with their healthcare provider before using CBD oil.
Is CBD Legal?
CBD oil that’s been extracted from hemp under the Farm Bill of 2014, and contains less than 0.3% THC, is legal to sell and purchase in all 50 states, with no doctor’s recommendation.
If you're going to use CBD oil, always consult with your healthcare practitioner first, especially if you're already taking prescription-based medicines. Be very careful when combining CBD oil with pharmaceutical drugs!
Check the article below to find the best CBD oils:
If you want to use a topical product, check out:
If you want to read up on more potential benefits of CBD, check out our article on:
If you want to become an expert on CBD oil in just 5 minutes, check out our guide on:
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