Could CBD Play A Role in Pain?

WRITTEN BY TRANG TRAN AND DR. SWATHI

Occasional pain and discomfort affects between millions of American adults, surpassing those affected by heart disease, cancer, and diabetes combined. Despite the therapeutic advances, patients with pain may develop tolerance to conventional medical treatment or experience adverse effects from medications such as non-steroidal anti-inflammatory agents or opioids, which have the risk for physical dependence and addiction. 

Specific components, also known as cannabinoids (i.e., Δ9-tetrahydrocannabinol or THC and cannabidiol or CBD), of the plant Cannabis sativa have gained interest as a treatment option for  occasional pain and discomfort due to the increasing public use and legalization of cannabis in many states in the USA. Given its efficacy and promising results in animal models along with its safety and non-euphoric property, CBD is in the spotlight for its ability to support pain management. 

Evidence from studies has shown that CBD exerts its pain relieving effects through its modulation of the endocannabinoid, inflammatory, and nociceptive systems. 

Of note, CBD alone is not approved for treatment of pain in the United States. However, a  medication (i.e., nabiximols) that contains both THC and CBD in a 1:1 ratio has been evaluated in many international clinical trials–findings support that cannabinoids, like CBD and THC, could play a role in symptomatic pain management. Specifically, nabiximols has been shown in multiple studies to be a beneficial agent as an add-on therapy to reduce spasticity in patients with multiple sclerosis. Because the majority of clinical studies describe the efficacy of CBD and Δ9-THC combined, it is difficult to definitively attribute the therapeutic properties to CBD alone. 

A prospective, single-arm cohort study was conducted to investigate the impact of full hemp extract CBD on opioid use and quality of life indicators among pain patients. The study found that CBD may reduce opioid use and improve pain among patients who are currently using opioids for pain management. Nevertheless, it is important to note that each CBD-rich soft gel used in the study contained 15.7 mg CBD, 0.5 mg THC, 0.3 mg cannabidivarin (CBDV), 0.9 mg cannabidiolic acid (CBDA), 0.8 mg cannabichromene (CBC), and >1% botanical terpene blend. 

Studies show that cannabidiol treatment may reduce pain associated with multiple sclerosis, spinal cord injury, neck and torso nerve injury, and limb amputation, but the varied disease states suggest that the beneficial effects of CBD are dependent on the context.

In a study of 29 patients, cannabidiol demonstrated potential to support pain management associated with kidney transplants and nerve pain of the lower extremities when applied on the skin (topically). It has been theorized that the blockade of the CB2 receptors during an inflammatory state may help limit the development of nerve pain.

All in all, although there is currently no rigorous research study in humans that supports the use of CBD alone for the treatment of pain, CBD does exhibit therapeutic potential and further studies are warranted to evaluate the possible role of CBD monotherapy (used alone) in pain management. 

References:

1. Argueta DA, Ventura CM, Kiven S, Sagi V, Gupta K. A Balanced Approach for Cannabidiol Use in Chronic Pain. Front Pharmacol. 2020;11:561. Published 2020 Apr 30. doi:10.3389/fphar.2020.00561
2. Boyaji S, Merkow J, Elman RNM, Kaye AD, Yong RJ, Urman RD. The Role of Cannabidiol (CBD) in Chronic Pain Management: An Assessment of Current Evidence. Curr Pain Headache Rep. 2020;24(2):4. Published 2020 Jan 24. doi:10.1007/s11916-020-0835-4
3. Capano A, Weaver R, Burkman E. Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgrad Med. 2020;132(1):56-61. doi:10.1080/00325481.2019.1685298
4. Mlost J, Bryk M, Starowicz K. Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action. Int J Mol Sci. 2020;21(22):8870. Published 2020 Nov 23. doi:10.3390/ijms21228870
5. Shafik Boyaji MD. CBD for chronic pain: The science doesn't match the marketing. Harvard Health. https://www.health.harvard.edu/blog/cbd-for-chronic-pain-the-science-doesnt-match-the-marketing-2020092321003. Published September 23, 2020. Accessed February 20, 2022. 
6. Urits I, Gress K, Charipova K, et al. Use of cannabidiol (CBD) for the treatment of chronic pain. Best Pract Res Clin Anaesthesiol. 2020;34(3):463-477. doi:10.1016/j.bpa.2020.06.004
7. Xu DH, Cullen BD, Tang M, Fang Y. The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Curr Pharm Biotechnol. 2020;21(5):390-402. doi:10.2174/1389201020666191202111534

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This article was edited by Dr. Swathi and was written by Element Apothec Scientific Communications Intern, Trang Tran. She is a Doctor of Pharmacy (PharmD) student at Oregon State University and Oregon Health & Science University College of Pharmacy in Portland, Oregon.