Can CBD Oil Relieve Pain?

With its recent legalization in many countries, the popularity of CBD oil is booming. Most people take this oil to relieve the pain caused by conditions such as arthritis, multiple sclerosis, migraine, and IBS. But are any of these uses backed by science? And which delivery method provides the fastest and most effective pain relief? Read on to find out.

What is CBD Oil?

CBD oil is a therapeutic oil made from the cannabis-derived compound cannabidiol or CBD. Unlike THC, CBD won’t get you high.

The only FDA-approved use of CBD oil is for reducing epileptic seizures. However, many people take CBD oil for other investigational, non-proven uses. Among them, the most common one is for pain relief [1].

People commonly take both CBD and THC-containing medical cannabis for this purpose. In 2 surveys on over 3.5k people using them, over 50% reported suffering from different painful conditions. The ones most commonly managed with CBD – and other cannabis products – include [2, 3]:

• Arthritis (both rheumatoid and osteoarthritis)
• Multiple sclerosis
• Headaches (migraines, cluster, and drug overuse)
• Low back pain
• Cancer pain
• Fibromyalgia
• Nerve pain
• Irritable bowel syndrome

Hemp-derived CBD oil is legal in the US and many other countries, while oil derived from marijuana may contain higher THC levels and is more strictly regulated.

A mouth spray supplying similar amounts of CBD and THC (nabiximols or Sativex) is approved in Canada and several European countries (but not in the US) for the involuntary and often painful muscle contractions caused by multiple sclerosis. It has also been widely investigated worldwide for other painful conditions [4].

CBD Oil for Pain Relief

How Does It Work?

Interaction with the Endocannabinoid System

The endocannabinoid system is made up of two receptors: CB1 and CB2. The cannabinoids naturally produced by the body, including the “bliss molecule” anandamide, bind to them. CB1 is mostly found in brain cells, while CB2 is most abundant in immune cells [5+, 6+, 7].

Cannabinoids in general – including anandamide and THC – reduce pain by activating these receptors. In fact, anandamide deficiency is linked to painful conditions such as migraines, fibromyalgia, and IBS [8, 9].

CBD is less likely to bind to CB receptors and blocks rather than activates them. However, CBD indirectly increases cannabinoids in the body: it stops anandamide from being broken down and removed. This probably explains why it seems to enhance the pain-relieving effects of THC [8, 10, 11, 12, 13].

CBD and cannabis products are not the only way to increase your cannabinoids. There are 49 other natural ways to boost cannabinoids, as far as we’re aware.

Anti-Inflammatory Mechanisms

CBD oil is a strong anti-inflammatory, which probably explains why it may prevent and lessen pain.

When we zoom into its effects on a cellular level, we see that it impacts over a dozen anti-inflammatory pathways and molecules.

For one, CBD activates receptors that reduce sensitivity to inflammation (TRPV1 and TRPA1) and nerve pain (5HT1A and glycine receptors) [12, 14, 15, 16, 17, 18, 19].

It also blocks the major inflammatory hub NF-kB, activates anti-inflammatory PPAR-gamma, and prevents the removal of anti-inflammatory adenosine. In turn, CBD also reduces the production of many pro-inflammatory messengers (IL-1beta, IL-6, TNF-alpha, IFN-gamma, NO, and prostaglandins) [20, 21, 22, 23, 24, 25, 26, 27, 28].

What’s more, it increases the levels of the anti-inflammatory cytokines IL-4 and IL-10 [29, 30].

Finally, CBD enhances the pain-relieving effect of opioids such as morphine [31].

Next, we’ll review whether CBD oil works for over 11 painful conditions. Get ready for a deep dive into the research.

When Does It Work?

Preliminary evidence suggests that CBD oil may help with some painful conditions. However, remember that CBD oil is not approved for any of these uses and, because it’s sold as a supplement, regulations only set manufacturing standards but don’t guarantee that they are safe or effective. Talk to your doctor before using CBD oil to avoid unexpected interactions and never use it to replace any proven therapies for pain relief prescribed by your doctor.

Insufficient Evidence for:

Pain after Medical Procedures

The HPV vaccination may cause several adverse effects including severe pain, fatigue, and sleep disturbances. In a small trial on 12 girls who developed symptoms after the vaccination, CBD-enriched hemp oil reduced pain and improved vitality and well-being [32].

Chronic pain is an occasional adverse effect of kidney transplantation. People normally manage it with painkillers, which can damage the kidneys. In a small trial on 7 people with kidney transplants, CBD was safe and reduced pain in all but one person [33].

CBD (injected into both the bloodstream and the brain) reduced postoperative pain in rats. An oral cannabis extract also reduced postoperative pain in a small trial on 11 people, but it contained 2x more THC than CBD [34, 35].

Two small clinical trials (one of which didn’t use pure CBD but CBD-enriched hemp oil) and two animal studies cannot be considered sufficient evidence to support this health benefit. Further clinical research is needed.

Lack of Evidence

Researchers have investigated medicinal cannabis for other painful conditions. Because the only studies had mixed results, tested cannabis preparations that also contained THC, or were done only in animals, they provide no evidence that CBD alone relieves these painful conditions in humans.

Multiple Sclerosis

In multiple sclerosis, pain is caused by involuntary muscle contractions and damage to the nerves, muscles, and joints. THC, CBD, and their combination were similarly effective at reducing pain and involuntary muscle contractions in a small trial on 24 people with this condition [36].

In mice with multiple sclerosis, CBD reduced inflammation and nerve damage, which slowed the progression of the condition. Its effects may vary when CBD is combined with other hemp-derived cannabinoids: THC provided additional relief, while another compound (palmitoylethanolamide) blocked the positive effects of CBD [37, 38, 39, 40, 41, 42].

However, the evidence to support the effectiveness of CBD alone at relieving multiple sclerosis pain is lacking. An FDA-approved mouthspray with similar amounts of THC and CBD – nabiximols – is more commonly used for this condition (see “Nabiximols for Pain Relief” below).

Arthritis

Arthritis is the damage of joint cartilages due to wear and tear (osteoarthritis) or autoimmunity (rheumatoid arthritis). In a survey on almost 3k people using medical cannabis, 21% did so to relieve arthritic pain and often reported good results [43+, 44+].

Although the only clinical trial carried out so far tested the spray with CBD and THC (nabiximols), a follow-up trial is underway to study the effect of CBD – both alone and followed by THC – on joint pain in people with rheumatoid arthritis and arthritis that mostly affects the spine (ankylosing spondylitis) [45].

CBD (both oral and topical) relieved pain and inflammation in dogs and rats with osteoarthritis. It was also effective in mice and rats with rheumatoid arthritis [46, 47, 24, 48].

IBS and IBD

IBS and IBD both cause pain, cramps, and diarrhea or constipation. Although similar, IBD leads to stronger inflammation and damage to the gut lining [49+].

In one survey on over 2k people, almost 4% used medicinal cannabis to reduce digestive pain. In another study on 67 people with IBD, 22% managed it with cannabis oil [50+, 51].

CBD hasn’t been tested in people with IBS. However, IBS likely causes pain by increasing the production of the TRPV1 receptor in the bowels. Although TRPV1 triggers inflammatory pain, its stimulation with CBD (or other substances such as the chili pepper compound capsaicin) reduces pain perception – explaining why CBD may provide IBS pain relief [52, 12].

Bowel inflammation increases intestinal permeability – i.e. “leaky gut” – which worsens IBD. In a clinical trial on 30 healthy men, CBD reduced gut permeability. Similarly, it prevented leakiness from inflammatory cytokines in gut lining cells [53].

Alternatively, CB1 activation by anandamide and other cannabinoids reduced inflammation in cells that line the gut. CBD mostly binds to other receptors but may indirectly activate CB1; thus, CBD may reduce bowel inflammation by increasing anandamide levels [54, 12].

Nevertheless, CBD had little or no effect on IBD symptoms in 2 clinical trials on 80 people [55, 56].

It was, however, more effective in rats and mice with IBD. CBD relieved inflammation and tissue damage, presumably reducing pain, and enhanced the anti-inflammatory effects of THC [27, 57, 58, 59].

Nerve Pain (Neuropathy)

CBD reduced nerve pain – from brain injury, repeated nerve stimulation, anticancer drugs, and diabetes – in mice and rats. It activated three receptors that reduce pain sensitivity (TRPV1, 5-HT1A, and glycine receptors), lowered inflammatory cytokines, and prevented T cells from developing and invading the nerves [26, 60, 15, 16, 17, 18].

What’s more, CBD enhanced the pain-relieving effects of THC in mice [61, 62].

As is the case for multiple sclerosis, clinical trials more frequently tested the spray combining THC and CBD – nabiximols – for difficult-to-treat nerve pain.

Complex Movement Disorders

Complex movement disorders are an umbrella term for all conditions with abnormal movements and postures, mostly caused by brain injury. Tourette syndrome, tics, and cerebral palsy fall under this group. CBD-enriched medical cannabis preparations improved pain and reduced involuntary muscle contractions in a clinical trial on 25 children [63+].

Back Pain

In a clinical trial on 11 people with back pain despite surgical interventions, a cannabis oil with CBD and THC as an add-on therapy reduced pain and improved quality of life. However, the oil contained 20x more THC than CBD [64].

In a study on almost 200 people with chronic pain, 19% of whom had low-back pain, medicinal cannabis (with both THC and CBD) reduced pain and opioid use [65].

Headaches and Migraines

People often take medicinal cannabis for all types of headaches. In a study on over 100 people with migraines using medicinal cannabis, 85% reported reduced pain and migraine frequency [66].

Although CB1 receptor activation by THC might account for most of the effects, CBD may help prevent migraines by stimulating serotonin release – which reduces migraine pain [67, 68, 69, 70].

On the other hand, CBD may also trigger migraines by activating the TRPV1 receptor and releasing a brain vessel-widening protein (CGRP) [67, 68, 69, 70].

In a clinical trial on 13 people with headaches from overusing painkillers, two cannabis preparations (decoction and oil) reduced pain. However, the preparation with the highest THC content (oil) was more effective. In line with this, a synthetic THC analog (nabilone) relieved pain and reduced pain-killer use in another trial on 26 people [71, 72].

In a trial on over 100 people with cluster headaches, cannabis use was relatively frequent (45%) although it relieved the attacks in only 25% and worsened them in 22% [73].

Fibromyalgia

Fibromyalgia can cause widespread pain, possibly because the brain becomes more sensitive to pain signals [74+].

In a clinical trial on 20 people with fibromyalgia, a vape containing a cannabis variety with similar THC and CBD content slightly reduced pain. In contrast, vapes with more of either compound were ineffective [75].

CBD injected directly into muscles might be more effective for fibromyalgia, since it relieved pain in rats with a similar muscle disorder (myofascial pain) [76].

Other Types of Pain

Some case studies report successful pain management with CBD (mostly combined with THC) in people with:

• Endometriosis [77]
• Two rare inflammatory skin conditions (epidermolysis bullosa and pyoderma gangrenosum) [78, 79]
• Benign tumors in the nerves (schwannomatosis) [80]

Limitations and Caveats

The majority of human studies discussed above all used CBD in combination with varying amounts of THC (either as extracts or specific cannabis strains). Animal research suggests CBD oil alone may also relieve pain, but clinical trials have yet to determine if it works.

Nabiximols for Pain Relief

As hinted above, the mouth spray supplying similar amounts of CBD and THC – nabiximols – is approved in several countries for people with involuntary muscle contractions from multiple sclerosis. It has also been widely investigated for other painful conditions. Below is a short overview of the clinical research with this spray.

Effective for:

Multiple Sclerosis

Nabiximols is approved in some countries for the involuntary muscle contractions from multiple sclerosis. This spray relieved pain, reduced muscle contractions, and improved quality of life in 13 studies on over 1k people with multiple sclerosis. Nabiximols showed sustained effectiveness in follow-up studies of up to 52 weeks [81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93].

Possibly Effective for:

Nerve Pain

In 6 clinical trials on over 700 people with hard-to-treat nerve pain – from repeated nerve cell stimulation, diabetes, nerve injury, multiple sclerosis, and anticancer drugs – nabiximols was effective and well tolerated [94, 95, 36, 96, 97, 98].

Despite its promising results, remember that nabiximols is not approved for nerve pain by the FDA.

Insufficient Evidence for:

Cancer Pain

In 2 clinical trials on over 400 people with advanced cancer and difficult-to-treat pain, nabiximols relieved pain better than the placebo while THC alone didn’t. Low and medium doses were more effective and better tolerated than higher doses. The spray remained effective in the long term without needing to increase the dose or take other pain-killers [99, 100, 101].

However, 2 more recent trials on over 600 people from the US and Europe found nabiximols ineffective for cancer pain management in both groups. It only improved quality of life in the US, possibly because the US center used lower opioid doses or had a different distribution of cancer types [102, 103].

Because the effects of nabiximols on cancer pain have only been tested in a few clinical trials with contradictory results, the evidence supporting its use in this case is insufficient until further clinical research is carried out.

Arthritis

In a small trial on 58 people with rheumatoid arthritis, nabiximols reduced pain and morning stiffness while improving sleep quality [104].

Larger, more robust clinical research should confirm this preliminary finding.

CBD Oil Dosage for Pain Relief

Dosage

Because CBD oil is not approved for pain relief, there is no official dose. Users and supplement manufacturers have established unofficial doses based on their experience.

Most clinical studies tested CBD with THC. The single clinical trial with CBD alone for pain after kidney transplants used a high dosage: they started with 100 mg/day and increased the dosage to 300 mg/day over 3 weeks [33].

The doses normally used are lower and based on the recommendations from manufacturers and users. The optimal dose will depend on your:

• Body weight: heavier people will need a higher dose to experience pain relief.
• Type of pain: severe or chronic pain will normally require a higher dose than mild pain.
• Tolerance: frequent CBD users may develop tolerance over time and need to increase the dose.

With this in mind, the recommended CBD doses (taken 1x-3x/day) are:

• Light people (below 135 lbs): 10-17 mg
• Medium-weight people (135-200 lbs): 15-25 mg
• Heavy people (over 200 lbs): 22-45 mg

Consult your doctor about the best starting dose when using CBD oil for the first time. Start with a low dose and track your response. If you tolerate CBD oil well, increase the dosage gradually until you achieve the desired effect.

How to Take

CBD oil comes in different forms:

• Oil tinctures
• Capsules and tablets
• Edibles (gummies and lollipops)
• Teas
• Mouth sprays
• Vaping oil
• Topical lotions, salves, and creams
• Patches

Your form of choice may depend on your type of pain [105+]:

• Capsules, edibles, and teas release the CBD more slowly but their effects also last longer. They are preferred for chronic conditions.
• Vaping, mouth sprays, and oil tinctures are absorbed more quickly and are preferable in case of acute or episodic pain.
• Topical forms act locally and are mainly used for muscle and joint pain.

How Long Does It Take to Work?

The time until you may notice pain-relieving effects will depend on the delivery method – which determines the rate at which CBD is released into your bloodstream. You can expect the effects to start kicking in after approximately [105+, 106]:

• Vaped or smoked: 5-15 min
• Mouth sprays and oral tinctures: 15-30 min
• Oral capsules, edibles, and teas: 30-180 min
• Topical forms: 30-120 min

Finding the Best CBD Oil for Pain Relief

Tips

In addition to choosing a CBD oil adjusted to your budget (you may want to calculate the price per mL or mg to compare different brands), you should also evaluate the product quality. Read here about how to choose the best CBD oil in detail.

Out of various factors, CBD content is the most important one: make sure that the oil contains enough CBD, clearly stated on the label. If you want to avoid unwanted effects of THC, choose products with little or no THC. Otherwise, you may prefer the oil to contain THC as well to obtain some added pain-relief effects.

Legality is also important. Unlike marijuana-derived products, hemp-derived CBD oil is legal in all US states and in many countries around the world. Go for CBD oil from hemp to stay on the safe side and read through this post to make sure you’re not breaking any laws.

Reviews

The opinions expressed in this section are solely those of CBD oil users who may or may not have medical or scientific training. Their reviews do not represent the opinions of SelfHacked. SelfHacked does not endorse any specific product, service, or treatment.

Do not consider user experiences as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare providers because of something you have read on SelfHacked. We understand that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.

Most people used CBD oil for painful conditions such as multiple sclerosis, arthritis, nerve pain, fibromyalgia, IBS, and lower back pain. Users were normally satisfied and most of them reported pain relief.

In some cases, the users complained that the oil didn’t work for them. Adverse effects most commonly reported in negative reviews included upset digestion, dry mouth, headaches, and fatigue. Depending on the brand and form of supplementation, some users complained about its high price, poor customer service, and bad taste.

CBD Oil Side Effects

CBD Alone

Keep in mind that CBD oil is an insufficiently researched supplement with a relatively unknown safety profile. The list of side effects below is, therefore, not a definite one. You should consult your doctor about other potential side effects based on your health condition and possible drug or supplement interactions.

CBD is generally well-tolerated and causes few, normally mild adverse effects. Those most commonly reported by people using it for pain relief include [2, 33+]:

• Dry mouth
• Euphoria
• Hunger
• Dizziness
• Drowsiness and fatigue
• Nausea

CBD & THC Extracts

In the case of nabiximols (extract with CBD and THC), the most frequent adverse effects observed in clinical trials included [104+, 107+, 95+, 102]:

• Dizziness, vertigo, and feeling drunk
• Drowsiness
• Confusion and disorientation
• Disturbances in attention and memory
• Mood changes
• Dry mouth
• Bad taste, nausea, and vomiting
• Diarrhea or constipation
• Headache

Although some of these (such as confusion, disorientation, disturbances in attention and memory, or feeling drunk) may be caused by THC, it’s important to note that CBD partly opposes its effects by blocking CB receptors. Nabiximols – and other reparations with a balanced CBD and THC composition – may have fewer unwanted effects than others with higher THC levels [105+].