What is CBD's Potential for Pain Relief
In around 2000 B.C., the Chinese emperor Shén Nóng was the first person known to have used cannabis for its medicinal qualities. (1) Even though cannabis and its derivatives have been used for millennia by people of diverse ages, cultures, and geographic places, cannabidiol (CBD) was not identified until the year 1940. (2)At its discovery, the molecule was overlooked in favour of its more potent relative, tetrahydrocannabinol (THC), but as time passed, its benefits and relatively low danger of side effects became more widely appreciated. Since then, it has been a chemical of interest to scientists and aficionados worldwide. Today's CBD market is worth $12.8 billion, and a large portion of this success can be attributed to its pain-relieving effects. (3) CBD is available in tablets, oils, tinctures, capsules and inhalation products, and all can be used for their pain-reducing abilities. Let us have a look at CBD and its effects on pain relief.
The Physiology of Pain:
Understanding the Pathways and Targets of CBD
Pain is a highly significant and intricate bodily feeling involving several receptors, receptor modulators, pathways, and underlying tissues. At first, a chemical signal is received at the receptor level, indicating the presence of a stimulus. (4) Then, the chemical signal crosses a synaptic cleft and is transformed into an electrical one. This electrical signal travels via specialized pathways from the spinal cord to the brain. Specific regions in the brain are responsible for ultimately translating this signal into the "pain" feeling. And so, a stimulus that begins in a receptor is ultimately transformed into an experience. It's important to remember that excitatory and inhibitory pathways might influence this pathway.
Opioids, NSAIDs, and antidepressants are just some medications that can control pain. CBD relieves pain by interacting with the body's endocannabinoid system (ECS), which regulates several functions, including pain perception. Important endocannabinoids, receptors, and enzymes make up the ECS. Naturally occurring endocannabinoids have a solid binding affinity for cannabinoid receptors. Cannabinoid receptors (CB1 and CB2) are found in various tissues and organs. The brain and spinal cord contain CB1 receptors, while CB2 receptors are found mainly in the body's periphery.(5)
CBD modulates the activity of the endocannabinoid system (ECS) by increasing endogenous endocannabinoid levels and inhibiting their breakdown by enzymes. This is accomplished through binding to CB1, CB2 receptors, and some non-cannabinoid receptors. Glutamate and serotonin are neurotransmitters implicated in pain signaling, and CBD can inhibit their production. In the end, this whole process has an analgesic impact by reducing how much pain we feel.(6)
CBD and Pain Relief
Evidence from Preclinical and Clinical Studies
Many researchers have studied the pain-relieving effects of CBD. A randomized study by Xu DH et al. showed that CBD reduced musculoskeletal pain in statistically significant groups without producing any side effects. (7) Similarly, 2019 randomized, double-blind, placebo-controlled study explored the efficacy of CBD in alleviating chronic pain in multiple sclerosis patients. (8) Compared to the placebo group, CBD dramatically reduced pain and improved sleep quality in the study subjects. A study on CBD use in knee osteoarthritis by Hunter et al. showed that 250mg of CBD effectively reduced pain with minimal side effects. (9)
CBD may also be beneficial in the treatment of neuropathic pain, which is caused by nerve damage. A recent review by McDonagh MS et al. examining 18 randomized control trials and 7 cohort studies showed that CBD effectively reduced pain in a large group of people with neuropathic pain. (10) A 2017 study published in the Journal of Pain discovered that CBD alleviated neuropathy in rats. A 2016 study published in the European Journal of Pain explored the effects of transdermal CBD on peripheral neuropathy patients' pain and inflammation. Compared to the placebo group, CBD dramatically reduced pain and improved sleep quality in the study subjects.(11)
Many continuing pieces of research, such as "Cannabidiol for bilateral total knee arthroplasty" and "Osteoarthritis of the knee pain study employing CBD and THC in rapidly dissolving sublingual tablet," are in their phase 2 trials in the United States, with positive outcomes predicted for CBD.(12)
Clinical Applications of CBD for Pain Management:
Dosage, How to, and Safety
Dosage
CBD dosage is not yet established and can vary based on the product and individual variables such as body weight and pain intensity. Studies have used CBD in various doses, but most studies currently use a dose of about 150 to 200mg of CBD. (12)
Generally, a starting dose of 30 to 50mg of CBD is recommended and can be increased gradually as needed. Before beginning any CBD regimen, visiting a healthcare practitioner, especially if using additional drugs, is recommended.
How to take CBD
Many routes have been tried and tested for CBD use, and it can be delivered via oral intake, inhalation, topical application, and sublingual delivery.
The most popular technique is oral use via capsules, tinctures, or edibles. However, the benefits may take longer to manifest and be less intense than other approaches. Inhalation by smoking or vaporization may provide more immediate effects but pose respiratory concerns.(13)
The effects of topical treatment for regional pain alleviation may be confined to the application area but is most suitable for local pain relief.
Safety
CBD is generally considered safe but can cause side effects such as dry mouth, drowsiness, and changes in appetite or mood.
CBD can interact with other medications, particularly those metabolized by the liver, so it is important to consult a healthcare professional before starting any CBD regimen.(14)
Choosing reputable CBD products independently tested for purity and potency is also essential to ensure safety and effectiveness.
CBD Research for Pain Relief
CBD research for pain treatment offers numerous prospects
In recent years, cannabidiol (CBD) has garnered significant interest as a possible medicinal agent for pain management. Yet, CBD research needs to address numerous difficulties and opportunities for pain management.
Any medication or substance used for any of its properties must have a defined dose before it may be administered. One of the obstacles in CBD research for pain management is the lack of dosage and delivery standards. CBD dosage is not yet established and can vary based on the product and individual variables such as body weight and pain intensity. In addition, the ideal route of CBD administration for pain management is still unclear, as different administration techniques have varying degrees of effectiveness.
Another obstacle is the lack of well-designed clinical trials to investigate CBD's efficacy and safety for pain management. Although some studies have shown that CBD may be useful in relieving pain, most of these studies have been small, and more study is required to define the ideal dose and delivery procedures and evaluate the possible hazards and benefits of long-term use.
In addition, doing research on CBD for pain management presents regulatory and legal obstacles. The legal status of cannabis and its derivatives, including CBD, differs from country to country, making international study challenging. In addition, the regulatory environment surrounding CBD is continually shifting, requiring researchers to traverse a complicated web of restrictions to do study.
Notwithstanding these obstacles, CBD research for pain treatment offers numerous prospects. For instance, technological advancements, such as improved delivery systems, may make it possible to administer CBD to the location of pain more effectively. In addition, new research methods, such as using biomarkers to identify patients who are most likely to respond to CBD, may assist in improving CBD's pain-relieving efficacy. (15, 16)
Conclusion:
In conclusion, while CBD research for pain management has numerous obstacles, there are numerous potentials for further study. To fully comprehend CBD's potential as a medicinal agent for pain treatment, additional high-quality clinical trials are required, and researchers must navigate the complex regulatory and legal environment around CBD. With continuous study and improvement, CBD has the potential to provide many people with a safe and effective pain-relieving choice.
References:
1. Kowal MA. Thinking high: the impact of cannabis on human cognition: Leiden University; 2016.
2. Burstein S. Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorganic & medicinal chemistry. 2015;23(7):1377-85.
3. Cannabidiol (CBD) Market Size Apr 2022 : StatPearls Publishing; 2022.
15. Mead A. The legal status of cannabis (marijuana) and cannabidiol (CBD) under US law. Epilepsy & Behavior. 2017;70:288-91.
16. Corroon J, Kight R. Regulatory status of cannabidiol in the United States: a perspective. Cannabis and cannabinoid research. 2018;3(1):190-4.
