Chronic pain is a difficult condition to treat
Chronic pain is one of the most common and challenging health problems that people face. It is a persistent and multifaceted experience that affects not only our physical body, but also our mood, our social relationships, and our past memories. If you or someone you care about is living with chronic pain, you know how hard it can be.
People are searching for new and safer ways to manage pain
Because of the limitations and risks of chronic pain treatment, especially with opioids, pain management specialists and their patients are looking for alternative and effective solutions to reduce pain. One of the emerging options is cannabis, which has been legalized in many states for both recreational and medical purposes. Cannabis has been used for various medical conditions, including pain.
Cannabis has different components with different effects
Cannabis is a plant that contains three main groups of compounds: cannabinoids, terpenoids, and flavonoids. There are more than a hundred cannabinoids, but the two most important ones are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive component that causes the “high” feeling, while CBD is the non-psychoactive component that has many potential medical benefits.
Why is CBD considered a promising pain reliever?
CBD is gaining popularity as a potential drug to treat pain, inflammation, seizures, and anxiety without the unwanted effects of THC. CBD works by interacting with various systems in the body, such as the endocannabinoid, inflammatory, and nociceptive systems. The endocannabinoid system is composed of cannabinoid receptors that bind to our own natural cannabinoids. This system regulates many functions in the body, such as metabolism and appetite, mood and anxiety, and pain sensation.
What is the evidence that CBD works for pain in humans?
CBD has shown promising results in animal studies, and it has a good safety profile, non-psychoactive properties, and low potential for abuse. However, the human studies on CBD for pain are scarce and low-quality. There are also many commercial claims about the miraculous effects of CBD, and it is often marketed as a panacea that can cure everything from diabetes, depression, cancer, chronic pain, and even your dog’s anxiety!
The only FDA-approved use of CBD is as an add-on therapy for a rare and severe form of epilepsy. CBD is not approved for pain treatment in the United States. However, there is a combination drug (that contains both THC and CBD in a 1:1 ratio) that is approved by Health Canada for prescription for certain types of pain, such as central neuropathic pain in multiple sclerosis, and cancer pain that does not respond to optimal opioid therapy. There is no high-quality research study that supports the use of CBD alone for pain treatment.
Why is CBD advertised to the public this way, when it has risks?
The legal status of cannabis has changed rapidly in many states, and there is a high demand for new products, especially with high profit margins. The advertising for cannabinoids in general and CBD in particular has gone out of control. The FDA has made it clear that it is illegal to sell CBD by adding it to a food or labeling it as a dietary supplement. The FDA also warns the public about the possible side effects of CBD, as it is often presented in a way that may make people think that using CBD is harmless. CBD can cause liver damage, and can affect the male reproductive system (as shown in laboratory animal studies).
Moreover, CBD can interact with other important medications like blood thinners, heart medications, and immunosuppressants (medications given after organ transplantation), potentially altering the levels of these medications in the blood and leading to serious consequences, including death. Also, more information is needed about the safety of CBD in special populations such as the elderly, children, those who have weakened immune systems, and pregnant and breastfeeding women.
Many of the CBD products on the market are not regulated
The FDA has issued several warning letters to companies and individuals that sell unapproved new drugs that claim to contain CBD. The FDA has analyzed the chemical content of some of the products, and many were found to not have the levels of CBD that the manufacturers claimed they have.
Be careful of powerful testimonials
Lastly, there is anecdotal evidence, when patients and health professionals report positive outcomes. While the experience or medication may be helpful, that does not mean it will work for everyone. This is especially true for pain, where many other factors (our mood and stress level, our environment and other medical conditions, and our previous experiences) can influence the perception of pain. Please be cautious, and remember that some of these amazing-sounding testimonials are just marketing strategies to attract consumers to buy more products, as the CBD market is expected to reach $20 billion by 2024.
The bottom line: Don’t make CBD your first or only choice for pain relief
If you or someone you love is thinking about trying CBD, I would suggest Dr. Robert Shmerling’s advice about the dos and don’ts in selecting a suitable product. Until there is high-quality scientific evidence in humans, it is hard to make a recommendation for the regular use of CBD in chronic pain management.
About the Author
Shafik Boyaji, MD, Contributor
Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
