Consumer interest in CBD is growing as quickly as questions surrounding its safe use and efficacy. That’s why we created our CBD School Guide and related educational series. Aimed at supporting CBD interest, exploration, and usage, we hope that this series helps to answer commonly asked questions about CBD. -Editor
Last update 3/3/2021. THE PAIN CHRONICLE – Pain does not always come with a cane, cast or bandage – that is why the 50 to 116 million American adults in chronic pain often feel invisible, incredibly stigmatized and frequently misunderstood.
Although the number of those with chronic pain surpasses individuals affected by heart disease, cancer and diabetes combined, they face additional challenges. Since there are frequently few or no tangible signs of chronic pain, people in pain don’t get much sympathy from friends, family, co-workers or the community.
People in pain are frequently afraid of being stigmatized as a faker or drug addict. What can make the situation worse is they often avoid seeking professional help and mask their condition from others.
One additional challenge? Chronic pain can be difficult to diagnose and even harder to manage.
Why? It can manifest itself in one part of the body, while living in another.
Many of the conditions that cause chronic pain are poorly understood. Moreover, researchers have yet to clearly identify how the brain processes different types of pain due to irregular pain pathways around the central nervous system.
So it’s not unlikely to discover that the origin of your intense elbow pain actually originates in your neck.
Pain is an elusive condition that changes over time. What hurts or helps can change frequently, which is frustrating to researchers, practitioners and patients alike.
But there is hope ahead.
A significant percentage of individuals living with chronic pain are arthritic. Among those, about 80% use or are considering CBD use, according to a 2019 survey by the Arthritis Foundation, which is among numerous advocacy organizations calling for the expedited study and regulation of CBD.
“Some, but not all, survey respondents report noticeable pain relief, sleep improvement and/or anxiety reduction,” according to Arthritis Foundation spokesperson Claire Villines.
The interest in CBD is so sizable that the Foundation issued a CBD Guide to help members navigate education, dosage and safe shopping.
The American Academy of Pain Medicine also urged federal agencies to refine regulations and research around cannabis and related cannabidiol (CBD) in May 2019.
“CBD is generally well tolerated with a good safety profile. Reported adverse effects may be as a result of drug-drug interactions between CBD and patients’ existing medications,” according to the World Health Organization.
Among consumers nationwide, more than 80% want to see CBD regulated and available for consumer use, according to Sally Greenberg, executive director of the National Consumer League, a consumer advocacy organization calling for the regulation of CBD.
There is an array of research on the topic of CBD and its connection to pain management. Consider this: In regard to overall pain management, one 2018 review conducted between 1975 and March 2018 on cancer pain, fibromyalgia, neuropathic and other types of pain found that CBD was “effective in overall pain management and didn’t cause negative side effects.”
A separate animal study published in the Journal of Experimental Medicine supports these results, suggesting CBD can reduce pain and inflammation.
Researchers in a 2017 study reported that CBD and THC can lead to less acute pain and less intense pain for people with migraine. That same year, a study conducted by the Departments of Pharmacology and Anesthesia in Canada, animal tests revealed that CBD inhibits both pain and sensitivity characteristic of osteoarthritis.
A 2018 animal study in Pain explored how CBD may interact with serotonin receptors, inhibiting pain, depression and anxiety. Researchers cited “clinically relevant” results and called for the initiation of clinical trials testing the efficacy of CBD-based compounds for treating neuropathic pain.
Similarly, a 2015 animal study published in the European Journal of Pain concluded that CBD helps reduce inflammation and pain, showing promising signs for arthritis suffers.
Researchers Alyssa S. Laun and Zhao-Hui Song from the University of Louisville, Kentucky, reported that CBD acts as an “inverse agonist” in the brain’s receptors and has potential therapeutic effect (treatment) in both Alzheimer’s and Parkinson’s disease in Biochemical and Biophysical Research Communications.
According to Dr. Daniel Clauw of the University of Michigan, men and women respond differently to cannabinoids (CBD) when they are used for pain. Men have a “lower amplifier setting” for pain, Clauw said, while women have 1.5-2 times more chronic pain than men, which originates more from the central nervous system, on average.
There are promising signs for women with endometriosis, a disorder characterized by uterine tissue growth outside the uterine cavity.
For women who have endometriosis, CBD may help in a variety of ways. For example, CBD has been shown to prevent cell proliferation and cell migration – at the root of endometriosis.
Researchers have discovered that CBD can regulate hormonal balance and desensitize pain-transmitting nerves. It can inhibit lesion blood vessel and nerve development, responsible for “feeding” external uterine tissue growth and sparking pain. It can also slow or stop our body’s synthesis of inflammatory prostaglandins, or fat compounds, responsible for cramping and sensitivity to pain.
In order for anything to grow, you’ve got to feed it. Multiple studies on the potential for CBD to inhibit the production of nutrient-carrying blood vessels (vascularization) required for growth have yielded positive results, according to Practical Pain Management’s Samantha Moore.
But pain relief is arguably the most obvious benefit of CBD.
Clauw, who teaches medicine, anesthesiology, and psychiatry, said that cannabinoids (CBD) exert potential pain-relieving effects through different mechanisms of action.
CBD, in particular, has peripheral anti-inflammatory effects responsible for pain relief, and might be more effective for nociceptive pain — originating from the periphery such as acute pain, osteoarthritis and rheumatoid arthritis — as well as centralized or nociplastic pain, which originates from the central nervous system.
The National Football League and NFL Players Association is among organizations taking a closer look at the efficacy of cannabis. The organizations recently announced that they are collectively recruiting scientists to look into how THC-containing cannabis and CBD can work as pain medicine alternatives, as well as how cannabis impacts athletic performance.
CBD-based products come in many forms. It can be taken orally, applied to the skin, or inhaled. Talk to your doctor and/or a CBD specialist to explore which might be best for you.
TINCTURE/SPRAY (Under Tongue). Tinctures are one of the most popular forms of CBD. Place tincture liquid under the tongue (sublingual) for 60 to 120 seconds to aid absorption and speed delivery into your bloodstream. Sprays are becoming more popular and work in a similar fashion. Whether you use a tincture or spray, most users feel effects within 15 to 45 minutes of dosing.
When you place CBD under your tongue, it gets absorbed directly into your bloodstream, bypassing the digestive system and metabolization by the liver.
Product taste varies by brand, so it may take some experimentation to find the right product for you. There are enough flavors and varieties to suit most any taste preference from mint and fruity flavors to more earthy varieties.
ORALLY (By Mouth). Whether in capsule, food or liquid form, CBD is absorbed more slowly through the digestive tract. The process can delay the onset of the effect (1- 2 hours) depending on your stomach acids, food consumption, and other factors.
CAPSULES. (By Mouth). Capsules are a very reliable method that allows users to manage a consistent dosage of CBD. They are also are tasteless, odorless and convenient for individuals who are always on-the-go.
TOPICAL (On the Skin). Topical CBD lotions, balms, and rubs can be applied directly to the skin. Some contain additives like menthol, capsaicin or camphor, which enhance the effect of the product. Critics note that these additives may mask the efficacy of the CBD product. Users that question CBD’s impact are encouraged to use CBD products that don’t contain additional additives so they can evaluate CBD’s effectiveness.
Studies are underway to determine exactly how much CBD is absorbed via topical applications. Most users feel effects near immediately.
VAPE/INHALER (Inhaled). CBD can be inhaled via a vaporizing or vape pen. The Centers for Disease Control and Prevention is investigating vaping-related hospitalization and deaths, which appear to be associated with additives, not the vaping compounds themselves.
CBD use recommendations vary. Experts advise:
Liquid forms of CBD require users to be mindful of both the amount of liquid product (the dose) and the among of CBD in each dose (concentration).
Experts say it is best to “go low and slow,” starting with just a few milligrams of CBD in sublingual form twice a day. Wait about a week before amping-up dosage and increase in small and equal increments over time. Once you find your sweet spot, you’ll have a better idea of how many milligrams you’ll need in order to notice a result.
There are a number of things to look for when buying CBD. Chief among them is where it’s grown. Look for U.S. grown products manufactured with domestically grown ingredients.
Check manufacturing processes. As CBD increases in popularity, more CBD brands are following Good Manufacturing Practice (cGMP) guidelines set forth by the FDA and other regulatory bodies to ensure consumer safety.
Look for a companies COA (Certificate of Analysis) from an accredited independent laboratory that uses validated, standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP) or the Association of Official Agricultural Chemists (AOAC).
The U.S. Hemp Authority provides trusted third-party verification of many of the nation’s largest CBD brands. Look for the Authority’s label on products to assure that the CBD you buy is supported by trusted independent testing organization that maintains rigorous review and quality standards.
Every batch of every product made should be tested and available for customer review.
Leave the research to the researchers. Credible CBD brands cannot nor should not claim that their products cure health conditions.
Editor’s Note: As with any supplement, users should seek medical advice before use. Jackie Berg is the co-founder and CMO of CBD Marketing Hub and head of its Health Hub publication division.