I’m Canadian so cannabis is entirely legal here.
Ever since it became legal here I have explored it for different types of pain. From CBD, to CBD/THC, to THC. Rubs, creams, capsules, joints, and edibles.
Both CBD and THC are listed to be used for pain. So when we are looking to have something to help with our pain management either are an option to try, depending on tolerance of side effects and legality. Or both together. Which is the best for chronic pain though? There is a whole lot of research going on so what does it say about it?
What do they do for pain?
Chemically speaking, cannabis is complicated. To date, 568 unique molecules have been identified in the cannabis; of these, more than 60 are cannabinoids — these are compounds that act on receptors in the body’s endocannabinoid sy stem. This system plays a key role in endogenous pain control.4
Two of the cannabinoids found in cannabis, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), along with other cannabinoids, terpenes, and flavonoid compounds, are thought to exhibit synergistic effects that promote pain relief.5Practical pain management
- Only use it if it is legal
- Only use if your doctor is aware
- Never use if it is illegal… you have No Idea what they put in there
- This is my Personal experience and yours may be different
- Be aware if you have anxiety certain strains will make that worse
CBD by itself
CBD is said to be beneficial for:
- seizures (There is an approved treatment for CBD and epilepsy: Epidiolex)
- inflammatory bowel disease
Some of these have studies to back them but there has not been a whole lot of research on CBD all on its Own.
CBD and fibromyalgia
I have recently been using CBD every day and I wondered what recent research had to say about using CBD for fibromyalgia. In a recent survey in the Journal of Pain study of 2701 participants they looked into fibromyalgia and CBD use.
Of those 2701 fibromyalgia participants:
- 38.1% reported never using CBD
- 29.4% reported past CBD use
- 32.4% reported current CBD use
Of those that used it it was often reported to be used due to inadequate symptom relief.
The survey indicated:
- Around 32% of participants currently used CBD, mostly for pain, anxiety, and sleep.
- Around 30 to 40% reported much or very much relief across symptom domains.
There is research to suggest CBD alone can help with anxiety and sleep issues.
In fact, most of the research into CBD by itself indicated it wasn’t sufficient for pain management at the dosages used in the research but that it could be used for symptoms of depression, sleep and anxiety. These factors though are all beneficial for people with chronic pain though.
But it can’t be ruled out due to lack of research. It has the potential (it just seems to be enhanced by THC):
It is thought to have significant analgesic, anti-inflammatory, anti-convulsant and anxiolytic activities without the psychoactive effect of THC (Costa et al., 2007). CBD has little binding affinity for either CB1 or CB2 receptors, but it is capable of antagonizing them in the presence of THC (Thomas et al., 2007). In fact, CBD behaves as a non-competitive negative allosteric modulator of CB1 receptor, and it reduces the efficacy and potency of THC and AEA (Laprairie et al., 2015). CBD also regulates the perception of pain by affecting the activity of a significant number of other targets, including non-cannabinoid GPCRs (e.g., 5-HT1A), ion channels (TRPV1, TRPA1 and TPRM8, GlyR), PPARs, while also inhibiting uptake of AEA and weakly inhibiting its hydrolysis by the enzyme fatty acid amide hydrolase (FAAH) (Russo et al., 2005; Staton et al., 2008; Ahrens et al., 2009; De Petrocellis et al., 2011; Burstein, 2015; Morales et al., 2017). It has been demonstrated that cannabidiol can act synergistically with THC and contribute to the analgesic effect of medicinal-based cannabis extract (Russo, 2011).Frontiers in pharmacology
I think my lack of success historically with CBD by itself is because a) I have different types of pain at different intensities and b) I think it takes a little more consistent usage to have an effect. I also think it does work well as a combo in 1:1 with THC.
Is said to help with:
- muscle spasticity
- low appetite
Chronic pain and CBD, vs. CBD/THC and THC research
The main issue with research is a great deal of studies have been on CBD/THC at a 1:1 ratio for therapeutic use. I found a study that compared just CBD, CBD/THC and just THC with chronic pain (mostly MS patients) and the results were: “THC and THC : CBD were effective in relieving pain and improving sleep in a small group of patients.” CBD was not effective by itself at the dosage used. The study was small and some participants couldn’t complete it for various reasons. However, again it seems like the combo of THC and CBD helps with pain management whereas CBD alone alone doesn’t.
When we look at a review study of CBD/THC research into chronic pain it gets interesting
The results of this research showed that:
THC:CBD oromucosal spray (nabiximols), a cannabis-derived medicine approved for symptomatic relief of MS-related spasticity, has also been investigated as an add-on treatment for pain. Results of placebo-controlled clinical trials of THC:CBD oromucosal spray (nabiximols) in chronic cancer-related pain were equivocal. The analgesic efficacy of THC:CBD oromucosal spray (nabiximols) was more apparent in placebo-controlled clinical trials of chronic neuropathic pain, particularly MS-associated neuropathic pain, with some patients maintaining long-term (up to 2 years) benefit. A German Pain e-Registry analysis of patients with severe chronic pain treated in daily practice with THC:CBD oromucosal spray (nabiximols) showed best results in the neuropathic pain subgroup versus nociceptive or mixed pain subgroups. Across all reviewed studies in patients with chronic cancer-related or nonmalignant pain, no new safety concerns were identified with THC:CBD oromucosal spray (nabiximols) and there was no evidence of tolerance during extended useStudy
In some of that research stress and anxiety were shown to improve and those are important factors in coping with chronic pain.
But the limits in the studies were the number of participants and lack of long-term research.
There are a lot of indications for neuropathic pain treatment anyway, especially in regards to MS.
The review concluded:
To conclude, as improvement rates appeared to be lower in patients with pain types other than chronic neuropathic pain, proper diagnosis is key towards identifying patients most likely to benefit from THC:CBD oromucosal spray (nabiximols) as an adjunct to other treatment.Study
So sort of wonder about other types of pain. I would like to see some specific research on other pain conditions, larger studies and long term.
See other posts I have written about research into other types of pain
There is research to show with chronic pain of various sorts THC:CBD combo treatments can help with pain management. Much more research needs to be done, however, as it is still limited. With CBD alone the benefits are more aligned with reductions in stress, anxiety and improved sleep and not so much with improved pain by itself although it has properties the indicate it might help with some types of pain. Just not as much research on its Own. Nevertheless, the things it is shown to help with (sleep, depression, stress, anxiety) are beneficial to coping with chronic pain and do not come with the side effects some have experienced with THC or THC:CBD treatment. The research I have read for migraine and fibromyalgia chronic pain show the most improvement with THC treatments.
My experience when it comes to chronic pain management is that THC or THC:CBD is necessary. That is when it comes to chronic migraine and fibromyalgia and nerve pain. Most effective is smoking however, I do not like the side effects. Less effective is edibles but far less side effects. However, I am trying CBD by itself again and will see if I get any benefits from it by itself since I do like the fact it has no annoying side effects.
What can we say for sure? Not much. Not until they do larger studies and long term studies. On more types of pain. I think if it legal where you are then these therapies are worth an option in this extremely opiate negative environment. Personally, I started with straight CBD to see what would happen there. Then a more CBD:THC combo approach and Then into a stronger THC. I do use THC when needed but not often as I find it just works better for me when I do not use regularly. And as I said, I do want to see what sort of results I get trying just CBD again by itself for a longer duration.
What dosage helps with chronic pain
Well we are all different. Best to start low though for sure.
For those with concerns about the psychogenic effects, he recommends starting with a one-to-one ratio of THC to CBD for chronic pain. “I usually suggest that people start with 7.5 mg [which, using a standard unit converter amounts to 0.003 oz.] of THC and 7.5 mg of CBD, three or four times a day,” he told Practical Pain Management. “I tell them that the most likely effect is that (a) it’s not going to make their pain go away, and (b) they’re not going to get high.”
For pain relief, he recommends a dose of 15mg THC (0.0005 oz) to 15 mg CBD. In his experience, doses of THC less than 15 mg generally don’t provide pain relief. Doses may be increased if necessary, best guided under a doctor’s orders, to achieve pain relief without unacceptable side effectsPractice Pain Management
I actually agree with this recommendation for chronic pain. It seemed to be the most effective for me when I have explored treatment and with the least side effects.
However, as with a lot of these sorts of treatments cost is a factor for me. Not the sort of treatment I do a lot of given the overall cost.