One of the most well-known properties of cannabis is its ability to reduce pain. However, there are different types of pain , and not all of them respond to cannabis-based treatments. In the same way, cannabis has many components and not all of them are responsible for its potential to treat pain.
In this post we are going to describe how cannabis interacts with pain and if it can really relieve it.
What is pain?
To understand whether cannabis can help decrease pain, we first need to know what exactly pain is and its classification. Pain is one of the most frequent reasons for medical consultation. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience, associated with an actual tissue injury or potency”; (Puebla Díaz, 2005).
Types of pain
On the one hand, pain can be classified in terms of its duration:
- Acute pain: Short-lived, it alerts to immediate damage and generally responds well to treatments.
- Chronic Pain: It persists for prolonged periods, often beyond the expected healing time, usually has a psychological component, and affects quality of life.
On the other hand, pain can be classified in terms of its pathogenesis:
- Nociceptive Pain: It arises as a response to actual or potential tissue damage. It can be somatic or visceral and superficial or deep, affecting the perception of location (defined or diffuse) and sensation (sharp or dull).
- Neuropathic Pain: It results from injuries or dysfunctions of the nervous system, manifesting as abnormal sensations such as tingling, burning or electric shocks.
- Psychogenic Pain: It has no obvious physical origin, linked to psychological or emotional factors, and can vary in intensity and location.
CBD and pain
Among the types of pain we have just seen, the only scientific evidence that points to
Slightly to the fact that CBD can help with pain, it would be for chronic neuropathic pain.
Does CBD relieve pain? Preclinical research
In the case of preclinical research, evidence points to CBD having analgesic properties in animal models of chronic pain (Silva-Cardoso & Leite-Panissi, 2023).
These analgesic properties are probably related to Transient Receptor Potential Vanilloid 1 (TRPV1). This receptor is located in the nerve endings of our body and is responsible, among other things, for the transmission of pain.
It turns out that when cannabinoids enter our body, they are able to modulate this receptor, thereby modifying the transmission of pain signals (Louis-Gray et al., 2022).
However, preclinical studies are done with cells in-vitro or with animals, and the results of these studies are not always replicable in humans.
Let’s see what the most recent scientific literature reviews say about the therapeutic potential of CBD to treat pain in humans.
How can CBD work against pain? Clinical research
Overall, we find that the scientific evidence on the effect of cannabinoids to treat pain in humans is higher for the combination of CBD with THC than for CBD alone. In addition, this evidence is specific for chronic neuropathic pain and for pain with inflammatory components (Henson et al., 2022; McDonagh et al., 2022; Porter et al., 2021; Sainsbury et al., 2021).
One of the most comprehensive literature reviews to date is that of Chou et al. (2023), where researchers update the list of published scientific articles on the potential therapeutic effects of CBD for treating pain every year. Once the new articles are included, they reevaluate and update the quality of the scientific evidence. In their latest version from 2023, they conclude that the evidence is low to moderate for the effects of CBD combined with THC to treat pain, mainly neuropathic. In the case of CBD alone, the scientific evidence is non-existent as they have not found sufficient quality studies to be able to evaluate it.
Probably the researchers used a fairly strict criterion to select the scientific articles on CBD and that is why they did not include any, let’s see what other literary reviews on the subject say:
- Moore et al. (2023) identified 16 randomized clinical studies on the effects of CBD on pain and 15 of them were negative.
Mohammed et al. (2023) found that most of the selected randomized clinical trials indicated a reduction in pain of 42% to 66%, some studies referring only to CBD and others referring to the combination of CBD with THC. - Sklenárová et al. (2023) concluded that the available scientific evidence is not sufficient to conclude that CBD can help treat pain. The methodological differences of the different types of studies do not allow the results to be generalized, but they suggest that CBD could be useful for pain associated with arthritis.
- Kulesza et al. (2023) reviewed the therapeutic potential of CBD to relieve acute and chronic low back pain, finding that there are hardly any published studies investigating whether CBD can help for back pain when it is acute. In fact, the researchers only found one study and the result was that CBD was no better than placebo for this type of ailment. In the case of chronic low back pain, there are more studies published and these do suggest that CBD may be useful. However, the level of scientific evidence is considered low as the number of published studies is not enough to conclude that CBD can effectively treat this type of pain.
As we can see, scientists are not at all clear that CBD, on its own, can help treat pain. And if it did, it seems that it would only help with neuropathic pain.
User perception
What we have told you so far is based on the clinical research that has been carried out to date. This does not necessarily mean that CBD does not have therapeutic potential to treat pain, but it could be that science has not yet done enough studies with CBD, or that for methodological reasons it has not been able to capture the effects against pain.
In fact, in contrast to the results of clinical studies, a recent study evaluated the perception of therapeutic properties in patients who used CBD for their ailments and found that 72.2% of participants considered CBD to be helpful or extremely helpful in treating chronic pain (Nguyen et al., 2023).
However, in the same way that the lack of clinical evidence does not mean that CBD does not work to treat pain, the perception of users does not imply that it really works either. The bias of the selection of study participants or the placebo effect could explain why the perception was positive regarding the therapeutic properties of CBD. In addition, not all people are the same and perhaps it could work for some and not
for others.
So, does CBD work to treat pain?
Despite the fact that preclinical studies support the therapeutic potential of CBD to treat pain, human research is not able to provide enough evidence to revalidate those studies. Meanwhile, there are CBD users who claim that it helps them treat pain. So, with the information currently available, we cannot reach a clear conclusion and only the consumer will be able to evaluate whether CBD really works for them to treat pain.
Bibliography and Digital Sources
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Chou, R., Ahmed, A. Y., Morasco, B. J., Bougatsos, C., Dana, T., Fu, R., & Gilbreath, T. (2023). Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: 2023 Update. Agency for Healthcare Research and Quality (US). http://www.ncbi.nlm.nih.gov/books/NBK596193/
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Henson, J. D., Vitetta, L., & Hall, S. (2022). Tetrahydrocannabinol and cannabidiol medicines for chronic pain and mental health conditions. Inflammopharmacology, 30(4), 1167–1178. https://doi.org/10.1007/s10787-022-01020-z
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Kulesza, B., Mazurek, M., & Kurzepa, J. (2023). Can cannabidiol (CBD) help with low back pain? Annals of Agricultural and Environmental Medicine: AAEM, 30(3), 549–554.
https://doi.org/10.26444/aaem/168674 -
Louis-Gray, K., Tupal, S., & Premkumar, L. S. (2022). TRPV1: A Common Denominator
Mediating Antinociceptive and Antiemetic Effects of Cannabinoids. International Journal of Molecular Sciences, 23(17), 10016. https://doi.org/10.3390/ijms231710016 -
McDonagh, M. S., Morasco, B. J., Wagner, J., Ahmed, A. Y., Fu, R., Kansagara, D., & Chou, R. (2022). Cannabis-Based Products for Chronic Pain: A Systematic Review. Annals of Internal Medicine, 175(8), 1143–1153. https://doi.org/10.7326/M21-4520
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Mohammed, S. Y. M., Leis, K., Mercado, R. E., Castillo, M. M. S., Miranda, K. J., & Carandang, R. R. (2023). Effectiveness of Cannabidiol to Manage Chronic Pain: A Systematic Review. Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses, S1524-9042(23)00193-5. https://doi.org/10.1016/j.pmn.2023.10.002
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Moore, A., Straube, S., Fisher, E., & Eccleston, C. (2023). Cannabidiol (CBD) Products for Pain: Ineffective, Expensive, and With Potential Harms. The Journal of Pain, 0(0).
https://doi.org/10.1016/j.jpain.2023.10.009 -
Nguyen, C., Moeller, K. E., McGuire, M., & Melton, B. L. (2023). Consumer perception,
knowledge, and uses of cannabidiol. The Mental Health Clinician, 13(5), 217–224.
https://doi.org/10.9740/mhc.2023.10.217 -
Porter, B., St. Marie, B., Milavetz, G., & Herr, K. (2021). Cannabidiol (CBD) Use by Older Adults for Acute and Chronic Pain. Journal of Gerontological Nursing, 47(7), 6–15.
https://doi.org/10.3928/00989134-20210610-02 -
Puebla Díaz, F. (2005). Types of pain and therapeutic scale of the W.H.O.: Iatrogenic pain.
Oncology (Barcelona), 28(3), 33–37. -
Sainsbury, B., Bloxham, J., Pour, M. H., Padilla, M., & Enciso, R. (2021). Efficacy of cannabis-based medications compared to placebo for the treatment of chronic neuropathic
pain: A systematic review with meta-analysis. Journal of Dental Anesthesia and Pain
Medicine, 21(6), 479–506. https://doi.org/10.17245/jdapm.2021.21.6.479 -
Silva-Cardoso, G. K., & Leite-Panissi, C. R. A. (2023). Chronic Pain and Cannabidiol in Animal Models: Behavioral Pharmacology and Future Perspectives. Cannabis and
Cannabinoid Research, 8(2), 241–253. https://doi.org/10.1089/can.2022.0096 -
Sklenárová, M., Šíma, M., & Slanař, O. (2023). Effects of Cannabidiol in Inflammation: A Review of Pre-clinical and Clinical Findings. Prague Medical Report, 124(3), 216–229.
https://doi.org/10.14712/23362936.2023.17
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