CBD as an Effective Therapeutic for Chronic Pain Management

By Roxanne Fraser

Approximately 20% of the general population suffer from some form of chronic pain, which greatly impacts an individual's ability to work, exercise, and their overall quality of life. The most common conditions which result in chronic pain are back pain, joint pain, arthritis, fibromyalgia and cancer. At present, ​analgesics​ are the main treatment for chronic pain management, aside from chronic cancer pain or end-of life care. However, long-term use of non-steroidal anti-inflammatory drugs or opioids to treat chronic pain is rarely appropriate due to safety risks and potential abuse/misuse due to prolonged use of these substances.

The human body has an ​endocannabinoid system (ECS)​ which functions by controlling pain at the peripheral, spinal, and supraspinal level. The ECS receives and utilises signals from cannabinoids and even generates its own cannabinoids, known as endocannabinoids. Research has shown the ECS to play a critical role in the regulation of sleep, immune-system responses, and pain. The discovery of ECS and it’s role in pain management identified cannabinoids as a potential therapeutic in managing chronic pain.

There are over 120 compounds known as cannabinoids, with cannabidiol (CBD) being the most renowned. Many plants contain cannabinoids, however, it is mostly associated with the Cannabis Sativa plant. CBD is a completely different compound from THC, producing intricate effects within the body. It is ​not psychoactive​ and so it will not alter a person’s state of mind - instead it encourages the body to utilise its own endocannabinoids more efficiently. ​For instance, research has demonstrated CBD to both ​stimulate​ and ​inhibit ​activity of the inhibitory glycine-receptor. This prevents the breakdown of a fatty acid neurotransmitter, anandamide, which is associated with regulating pain. This allows anandamide to remain in the body’s system for longer and the increased levels in the blood are thought to alleviate pain and improve brain function.

Furthermore, CBD and certain synthetic atypical cannabinoids have been shown to possess ​anti-inflammatory and antioxidant ​properties, including possible anti-diabetic function. Sadly, ​clinical trials​ administering CBD have not determined a significant improvement in glycemic and lipid parameters in individuals suffering Type 2 diabetes, although, effects of CBD in obesity-linked inflammation and early stages of related diseases are yet to be investigated in depth.

What is CBD oil?

Different cannabis plants possess varying amounts of chemical compounds and the way in which the plant is grown can also affect levels of CBD. There are also various methods of extracting CBD. ​CBD extracts refer to aqueous extracts, extracts by pressing, extracts based on fat extraction or extracts synthesised by traditional extraction agents (e.g. ethanol (alcohol) or Carbon Dioxide (CO2)). The extract is then added to a carrier oil and known as CBD oil.

CBD has been used for centuries as a therapeutic for many forms of pain, however, only in the last decade have medical professionals started to fully investigate its potential.

Arthritis

A ​study​ was performed evaluating the effect of transdermal CBD in reducing inflammation and pain in rats with induced mono-arthritic knee joints. The data obtained from this trial showed 6.2 and 62mg/day to be the most effective doses at reducing inflammation around the knee joint. According to the study, exploratory behaviour was not affected by CBD suggesting little to no effect on higher brain function.

CBD products such as topical creams, CBD patches, oils and sprays may be beneficial in reducing the pain felt by sufferers and research is ongoing to fully confirm these findings.

Multiple Sclerosis (MS)

MS is an autoimmune disease that affects the brain and spinal cord and can result in a range of disabilities. One of the main symptoms of this condition is muscle spasms, with many individuals suffering spasms so extreme that their pain is constant.

One ​study​ provided significant evidence of CBD oil reducing the level of sclerosis spasticity symptoms experienced by adults with MS. Although, there was insufficient evidence to conclude that CBD is an efficient treatment for spasticity in individuals suffering paralysis due to spinal cord injury. This study is limited by the number of participants and the short duration in which CBD oil was used, nonetheless, the results have facilitated further clinical trials involving larger cohorts of MS sufferers.

Chronic Cancer-Related Pain

Placebo-controlled clinical trials investigating the effects of THC:CBD spray in chronic cancer-related pain have produced conflicting results. However, two notable trials using large cohorts provided significant data on the efficiency of THC:CBD in treating chronic pain.

A ​human clinical trial​ involving 177 patients with intractable cancer-related pain showed significant reductions in pain scores of patients administered with the spray following a two week period. According to the study, approximately twice as many patients treated with the CBD:THC spray than the control placebo group gained a 30% reduction from baseline pain. No significant side-effects were reported for either placebo or treatment groups.

The ​subsequent trial​ involved 39 participants of the previous primary study who received the THC:CBD spray. Results showed extended administration of the spray between 2-579 days (mean 25 days) was tolerated well overall. Individuals did not request to increase the dose of spray or other pain-relieving medications throughout the course of the study. The average dose consumed during the last week of the study (5.4 sprays per day) was significantly lower than the sprays consumed in the first week of the primary study (8.75 sprays per day). Suggesting positive effects of the THC:CBD spray on relieving chronic cancer-related pain.

General Chronic Pain

Researchers have also investigated the use of CBD for general chronic pain management by extrapolating data from several systematic reviews discussing numerous trials and studies. This ​review​ confirmed substantial evidence of CBD being an efficient natural treatment for chronic pain in adults.

This was further supported by a review published in the ​Journal of Experimental Medicine​ which determined CBD to reduce pain and inflammation. Furthermore, this review concluded that individuals who regularly consumed CBD were unlikely to develop a tolerance and require increased doses.

Possible Side Effects

The majority of people will tolerate CBD, however, it is important to be aware of possible side effects caused by CBD. ​Side effects of CBD​ can include; tiredness, diarrhoea, changes in appetite, dry mouth, loss of appetite or gain in appetite. Interestingly, the full effects of long-term CBD use on hormones is yet to be fully elucidated.

Before using CBD for the first time, it is recommended to first consult your GP or a medical professional. Especially if you are taking any other medications as CBD can make these drugs more or less effective. Consulting a doctor first will facilitate monitoring and adjustments to be made accordingly.

To conclude, although the majority of studies are still in their infancy, there is overwhelming evidence of CBD being an effective treatment of chronic pain. Long-term studies are currently taking place aiming to determine the effects of CBD on the body over time. CBD offers a truly compelling novel approach to pain management due to its non-intoxicating effects and limited adverse effects in comparison to other medications.