A Guide To Using Cannabidiol (CBD) For Pain
By Dr. Victor Chou
[wpsm_titlebox title=”Medical Disclaimer” style=”1″]
All content in this article was created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
In the heated battle of CBD vs. Pharma regarding pain relief drugs, more and more people start to explore their options and rely on the benefits of CBD, a natural, non-psychoactive compound derived from the hemp plant.
The most common doctor’s advice on treating pain usually revolves around the combination of toxic medications and a healthy, active lifestyle.
However, if used in the long-run, over-the-counter medications present a serious health hazard for the patient.
Which means that, unfortunately, there is little to no, effective, lasting medications for people experiencing chronic pain on a day-to-day basis. Until now.
Although in its early stages of research, CBD offers promising results in pain relief because of its various therapeutic benefits. But, being in the spotlight also brings lots of misconceptions. 
Read on to find out how exactly CBD works for pain relief and how to get the most out of it by choosing the right type of product and dosing.
What is CBD?
CBD, short for cannabidiol, is an all-natural, non-psychoactive compound derived from the hemp plant. The hemp plant and marijuana are different species from the same cannabis family. CBD is the second most abundant compound in cannabis, representing up to 40% of its extracts.
After THC, CBD has become the second most popular of more than 60 cannabinoids found in marijuana and the hemp plant, for one major reason — it doesn’t cause the usual high.
Hemp is high in cannabidiol (CBD), which also acts as THC’s antagonist, protecting against THC’s adverse psychological effects. Various studies examining the protective effects of CBD have shown that CBD can counteract the negative effects of THC. 
On the other hand, marijuana is rich in THC, containing anywhere from 5-20%, even as high as 25-30% THC in premium marijuana.
Good news is, CBD studies show that even if used in high dosages, the substance is safe for the patient, feeding the body with its powerful analgesic, pain-relieving, and anti-inflammatory properties. 
More on the difference between hemp and marijuana, THC and CBD later on.
Psychoactive Effects and The Endocannabinoid System
It all comes down to the endocannabinoid system (ECS) and its immense regulatory roles in neuronal, metabolic, vascular, immune and reproductive systems. 
Naturally present in the human body, the endocannabinoid system is responsible for receiving and translating the signals from cannabinoids – which can be produced by the body itself, known as the endocannabinoids, or introduced from outside agents (diet or smoking) like CBD and THC.
Although we don’t have a complete understanding of the functions of the endocannabinoid system, we know that it is widely distributed in the brain, the peripheral system, and most glands and organs in the body. The two primary and well-documented endocannabinoids are arachidonylethanolamine, nicknamed anandamide (AEA) and 2-arachidonylglycerol (2-AG). Anandamide is also known as the “bliss molecule”.
These two endocannabinoids work as agonists (chemicals that bind to a receptor and produces a biological response) to the essential CB1 and CB2 receptors. AEA is a high-affinity, partial agonist of CB1 receptor, and almost inactive at CB2 receptor, while 2-AG acts as a full agonist at both CBRs with moderate-to-low affinity 
This is important because THC and CBD affect the cannabinoid 1 (CB1) and 2 (CB2) receptors in a different way. Namely, THC directly activates both receptors, particularly the CB1 receptor mostly found in the brain. The CB1 receptors deal with coordination of movement, pain, emotions, thinking, appetite and memories, and most importantly, are guilty for getting someone “stoned”. The mechanisms and actions of CBD are not completely clear yet, but the compound does not bind to the CB1 receptor or the CB2 receptor. 
In fact, CBD is not only bad at activating the CB1 receptor, but also interferes with its activity. Meaning, if taken together, THC and CBD work in activating the CB1 receptor as polar opposites, making the patient feel a more mellow high with much lower chances of experiencing paranoia. If CBD is absent, no other component inhibits the activation of the CB1 receptor, leaving the path open for THC to trigger its regular “high.” 
How CBD Affects The Endocannabinoid System In Reducing Pain
Both CB receptors communicate with each other, with the difference that one is more commonly found in the brain, while the other — CB2 — is more common in the body, particularly in the immune system, affecting inflammation and pain.
While THC directly activates both CB1 and CB2 receptors, there is a misconception that CBD affects only the CB2 receptors. In fact, CBD ( let’s say in the form of oil) doesn’t directly affect these receptors at all.
What it does instead, it influences the body to utilize more of its occurring endocannabinoids naturally. It’s interesting that the endocannabinoids can be created by the human body and consumed through food. But for the body to use more of the endocannabinoids that are already existing, it needs the help of the CBD oil. CBD oil enhances the body’s mechanism of using other receptors, such as the vanilloid receptor, where THC shows no activity. These activities reinforce the conception of CBD as an endocannabinoid modulator. 
It is believed that the result of a CBD oil consumption for treating pain lies in its mediation with various receptors such as the Vanilloid receptors, directly correlated to the endocannabinoid receptors in the body.  Vanilloid receptors are connected to body temperature, with higher body temperature affecting inflammation and causing higher pain.
It is proven that CBD enhances the effects of anandamide (AEA), one of the two primary endocannabinoids in the body. Cannabidiol enhances the anandamide signaling. By inhibiting the FAAH enzyme responsible for breaking down anandamide in the body. Less FAAH means more anandamide in the body.  What’s even more fascinating is that a 2010 study found that anandamide suppresses pain initiation in the body through a peripheral endocannabinoid mechanism. 
Moreover, the only reasonably well-characterized, non-cannabinoid site of action for AEA is the vanilloid receptor type 1 (VR1). The VR1 channel is gated by protons and heat and is considered that under certain conditions, mediates effects ranging from vasodilation, smooth muscle tone modulation, inhibition of tumor cell growth and induction of apoptosis (death of cells). 
Another explanation of the inflammatory and analgesic effects of CBD has recently come to light with the discovery that it is able to promote signaling of the adenosine receptor A2A by inhibiting the adenosine transporter. 
CBD increases the effect of the adenosine receptor (opposite of caffeine) giving a more relaxed, a calming effect, but not a sleepy one. Caffeine, on the other hand, blocks the adenosine receptors, making the person consuming it, more excited.
Eight Proven Benefits of Using CBD For Pain
Over the years, it was thought that THC was the compound that may help with pain, nausea, loss of appetite while CBD was considered as biologically inactive in humans. In the last decade however, studies have shown that CBD is effective in treating epilepsy and other illnesses, such as anxiety, cancer, and schizophrenia, among many other ailments. 
The number of people using CBD products is on the rise. In fact, 42% of CBD users have left traditional medications behind and use only medical marijuana, while the major portion of 57% of the surveyed continues to use both CBD and their regular medication. 
What is even more fascinating is that almost 66% of CBD users claim that CBD products are more effective in relieving medical conditions than their regular over-the-counter medications.
Pre-clinical research shows CBD to have a variety of therapeutic effects, including anti-seizure, anti-inflammatory, antioxidant, neuroprotective, analgesic, anti-tumor, anti-anxiety and anti-psychotic. Read on for the scientifically proven eight benefits of CBD:
Therapeutic Benefits of CBD for Pain Relief
Natural pain relief is one of the most significant benefits of CBD. Most diseases listed below unfortunately, can’t be cured by CBD, but this powerful cannabinoid may help manage or eliminate pain and other symptoms.
CBD vs NSAIDS for Pain Relief
Over-the-counter pain relievers known as NSAIDs are a go-to pain relieving source for many adults. But, regardless of the recommended lowest dosage for the shortest amount of time, people tend to take NSAIDs chronically. Which is unfortunate because these drugs are extremely toxic, each year causing an estimated 41,000 hospitalizations and 3,300 deaths among older adults. 
CBD is a much safer, natural alternative to NSAIDs, showing promising results in effectively reducing pain and inflammation. Both types of drugs are believed to potentially increase the levels of anandamide — an endocannabinoid responsible for pain perception and inflammation.
For more on the relationship between CBD vs. NSAIDs click here.
CBD Dosing Guidelines: How Much Should You Take
Important: The information presented in the article is for informational purposes only – it should never be considered as individualized medical advice. That being said, there is no universally prescribed dosage for the diseases treated with CBD. The following advice is based on current best practices.
CBD is not regulated, so there are no official guidelines for dosages appropriate for pain or other issues. It is safe to say that CBD dosage depends on other factors, such as weight, age, metabolism, genetics, type and severity of pain.
At the beginning, it is very likely that you’ll experiment before finding the dosage that works best for you. Some patients benefit from 0.25 milligrams of CBD, while others need 50 to 100 milligrams or more.
A tip: Start low and increase as you start noticing an effect.
The daily recommendations for various illnesses according to Mayo Clinic research-based CBD dosage:
- Chronic Pain:5-20mg of CBD for 25 days [with or without THC] (orally). 
- Loss of Appetite in Cancer Patients:5mg of THC (orally), with or without 1mg of CBD for six weeks. 
- Epilepsy: 200-300mg of CBD (orally) daily, up to 4.5 months. 
- Multiple Sclerosis (MS) symptoms: Cannabis plant extracts containing 2.5-120 milligrams of a THC/CBD combination daily for 2-15 weeks. Patients typically use eight sprays within any three hours, with a maximum of 48 sprays in any 24-hour period. 
- Migraine and chronic headaches: 10-50 mg; oral
- Schizophrenia: 40-1,280mg oral CBD daily. 
Which CBD Product Is The Most Effective For Your Pain?
It is important to understand that, once formulated, a recommended CBD regimen for pain management should be used regularly for maximum pain relief.
It is recommended to start with 5-10 mg per day of pure cannabidiol for treating chronic pain. If you don’t feel relief, increase the dose by 5-10 mg per day, until achieving desired results.
For pain caused by headaches, arthritis and osteoarthritis, depending on the severity try taking cannabidiol orally using tinctures. Typically, people use the 300 mg’s for mild pain, 600mg for moderate pain, or 1800mg or more for severe pain. Another option is CBD Gum. It contains 10 mg of cannabidiol per piece and is a great choice for chronic pain issues caused by inflammatory diseases. The best thing is, you are constantly absorbing the cannabidiol as you chew.
All of the Ways to Take CBD – Which One is Right for You?
Choosing the right brand is important. But, after choosing a brand, you might get confused by how each CBD product works and which one would be the best type to buy. Here are advantages and disadvantages of the top six ways to take and use CBD oil:
How CBD Bioavailability Affects the Effectiveness of CBD for Pain Relief?
Now that we’ve talked about proper dosage and various forms of consuming CBD, it’s time to address an important topic: bioavailability.
Shortly, bioavailability is “the degree and rate at which a substance (such a drug) is absorbed into a living system or is made available at the site of physiological activity.”
For example, a substance delivered intravenously is likely to have 100% bioavailability. Other routes of administration of CBD include oral, inhalation, sublingual, and rectal. How effective is each of these routes?
THC vs. CBD and Hemp vs. Marijuana
Choosing between THC and CBD for your pain relief is quite the dilemma. Most people go to CBD purely for its non-psychoactive effect, which is not the best criteria. Depending on your pain treatment, sometimes, it is best to use both THC and CBD oil because these two natural components work in synergy.
In practice, doctors and patients prefer CBD over THC because of the lack of side effects. Although temporary, THC’s side effects include increased heart rate, dry mouth and red eyes, memory loss, coordination problems, and slower reaction times.
THC offers essential health benefits such as: an antispasmodic, analgesic, anti-tremor, anti-inflammatory, appetite-stimulating, and anti-emetic properties. However, because of its psychotic influence, CBD has gained more popularity in patients looking for a somewhat “normal” way to reduce pain.
Aside from its anti-inflammatory, anticonvulsant, antipsychotic, antioxidant, neuroprotective, and immunomodulatory effects, CBD reduces the intoxicating effects produced by THC, such as paranoia and memory impairment. 
It is interesting how both CBD and THC have the exact molecular structure and are chemically similar to the body’s endocannabinoids. The biggest difference between these two components also causes different interpretations in the legal system. Considered more of a recreational drug, THC is on the list of controlled substances. But, in the US, 20 states have passed marijuana related laws to legalize the use of medical marijuana, at the same time legalizing CBD.
Hemp Plant vs. Marijuana
Hemp plant and marijuana differ in their function, application, and cultivation. Marijuana is widely used for its recreational purposes, while hemp is used in the production of clothing, accessories, healthy dietary supplements, and skin products.
They even look different. Marijuana is usually with broad leaves, while hemp has skinnier leaves concentrated at the top. The difference between hemp and marijuana is also a legal one. According to law regulations, the hemp plant contains less than 0.3% THC, while marijuana has more than 0.3% THC.
Chronic pain is becoming a serious issue for patients around the world. The official opioid crisis showcases a severe problem affecting the US.
I hope that I have put together enough proof to get you on board to try CBD oil to treat pain and testify for its benefits. Of course, it’s always recommended to speak with a doctor before starting any new regiment. If you want to get in touch with me, Dr. Chou, you can do so by contacting me via the links below!
  The National Academies of Sciences, Engineering, and Medicine. 4 Therapeutic Effects of Cannabis and Cannabinoids. Washington, DC: The National Academies Press., 2017. https://www.ncbi.nlm.nih.gov/books/NBK425767/.
  Niesnik, Raymond, J.M., and Margriet W. van Laar. “Does Cannabidiol Protect Against Adverse Psychological Effects of THC?” Frontiers in Psychiatry (2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797438/.
   Iffland, Kerstin, and Franjo Grotenhermen. “An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies.” Cannabis and Cannabinoid Research (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569602/.
 Zou, Shenglong and Ujendra Kumar. “Cannabinoid Receptors and the Endocannabinoid System: Signaling and Function in the Central Nervous System.” International Journal of Molecular Sciences (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877694/5
 “International Union of Basic and Clinical Pharmacology. LXXIX. Cannabinoid Receptors and Their Ligands: Beyond CB1 and CB2.” Pharamacological Reviews (2010): 588–631. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993256/.
 Hayakawa, Kazuhide, et al. “Cannabidiol potentiates pharmacological effects of Delta(9)-tetrahydrocannabinol via CB(1) receptor-dependent mechanism.” Brain Research (2008). https://www.ncbi.nlm.nih.gov/pubmed/18021759.
 Englund, Amir, et al. “Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment.” Journal of Psychopharmacology (2012). https://journals.sagepub.com/doi/abs/10.1177/0269881112460109?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=jopa.
  Russo, Ethan and Geoffrey W. Guy. “A tale of two cannabinoids: The therapeutic rationale for combining tetrahydrocannabinol and cannabidiol.” Medical Hypotheses 66.2 (2006): 234-246. https://www.sciencedirect.com/science/article/pii/S0306987705004317.
 Costa, Barbara, et al. “Vanilloid TRPV1 receptor mediates the antihyperalgesic effect of the nonpsychoactive cannabinoid, cannabidiol, in a rat model of acute inflammation.” British Journal of Pharmacology (2004): 247–250. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1575333/.
 Leweke, MF, et al. “Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia.” Translational Psychiatry (2012). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316151/.
 Clapper, Jason R., et al. “Anandamide suppresses pain initiation through a peripheral endocannabinoid mechanism.” Nature Neuroscience (2010). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3260554/.
 Carrier, Erica J., et al. “Inhibition of an equilibrative nucleoside transporter by cannabidiol: A mechanism of cannabinoid immunosuppression.” Proceedings of the National Academy of Sciences of the United States (n.d.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472541/.
 “Various Research on Cannabidiol.” (n.d.). https://www.ncbi.nlm.nih.gov/pubmed?term=cannabidiol%5BTitle%2FAbstract%5D.
 “Understanding Cannabidiol | CBD.” 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579247/.
  Xiong, Wei, et al. “Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors.” Journal of Experimental Medicine (2012). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371734/.
 McDonough, Patrick, et al. “Neuropathic orofacial pain: cannabinoids as a therapeutic avenue.” The International Journal of Biochemistry & Cell Biology (2014). https://www.ncbi.nlm.nih.gov/pubmed/25150831.
 Zuardi, Antonio W., et al. “A critical review of the antipsychotic effects of cannabidiol: 30 years of a translational investigation.” Current Pharmaceutical Design (2012). https://www.ncbi.nlm.nih.gov/pubmed/22716160.
 Bergamaschi, Mateus M., et al. “Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients.” Neuropsychopharmacology (2011). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079847/.
 Ligresti, Alessia, et al. “Antitumor activity of plant cannabinoids with emphasis on the effect of cannabidiol on human breast carcinoma.” Journal of Pharmacology and Experimental Therapeutics (2006). https://www.ncbi.nlm.nih.gov/pubmed/16728591/.
  Massi, Paola, et al. “Cannabidiol as potential anticancer drug.” British Journal of CLinical Pharmacology (2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579246/.
 Devinsky, Orrin, et al. “Efficacy and Safety of Epidiolex (Cannbidiol) in Children and Young Adults with Treatment-Resistant Epilepsy: Initial Data from Expanded Access Program.” The New England Journal of Medicine (2014). https://www.aesnet.org/meetings_events/annual_meeting_abstracts/view/1868751.
 Rock, EM, et al. “Cannabidiol, a non-psychotropic component of cannabis, attenuates vomiting and nausea-like behaviour via indirect agonism of 5-HT(1A) somatodendritic autoreceptors in the dorsal raphe nucleus.” British Journal of Pharmacology (2012): 2620–2634. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423241/.
 Stanley, Christopher P., et al. “Is the cardiovascular system a therapeutic target for cannabidiol?” British Journal of Clinical Pharmacology (2013). https://www.ncbi.nlm.nih.gov/pubmed/22670794.
 Penner, Elizabeth A., et al. “The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults.” The American Journal of Medicine 126.7 (2013): 583–589. https://www.amjmed.com/article/S0002-9343%2813%2900200-3/abstract.
 Hammell D.C., et al. “Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis.” European Journal of Pain (2016): 936–948. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/.
 Iskedjian, Michael, et al. “Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain.” Current Medical Research and Opinion (2007): 17-24. https://www.ncbi.nlm.nih.gov/pubmed/17257464.
 Russo, Ethan B. “Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes.” Cannabis and Cannabinoid Research (2016). https://www.liebertpub.com/doi/10.1089/can.2016.0009.
 Rhyne, Danielle N., et al. “Effects of Medical Marijuana on Migraine Headache Frequency in an Adult Population.” Pharmacotherapy (2016). https://onlinelibrary.wiley.com/doi/full/10.1002/phar.1673.
 Lochte, Bryson C., et al. “The Use of Cannabis for Headache Disorders.” Cannabis and Cannabioids Research (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436334/.
 Hasenoehri, Carina, et al. “Cannabinoids for treating inflammatory bowel diseases: where are we and where do we go?” Expert Review of Gastroenterology and Hepatology (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388177/.
 National Cancer Institute. Cannabis and Cannabioids (PDQ) – Patient Version. 2017. https://www.cancer.gov/about-cancer/treatment/cam/patient/cannabis-pdq#link/_76.
 Ward, Sara J., et al. “Cannabidiol inhibits paclitaxel-induced neuropathic pain through 5-HT(1A) receptors without diminishing nervous system function or chemotherapy efficacy.” British Journal of Pharmacology (2014). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969077/.
 Marcum, Zachary A., and Joseph T. Hanlon. “Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults.” Annals of Long-Term Care (2011): 24–27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158445/.
 Russo, Ethan B. “Cannabinoids in the management of difficult to treat pain.” Therapeutics and CLinical Risk Management (2008). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/.
 Oxford University Press (OUP). Cannabis ingredient can help cancer patients regain their appetites and sense of taste, study finds. 2011. https://www.sciencedaily.com/releases/2011/02/110222192830.htm.
 Kluger, Benzi, et al. “The Therapeutic Potential of Cannabinoids for Movement Disorders.” Movement Disorders Journal (2016): 313–327. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357541/.
 Ohisson A., et al. “Single-dose kinetics of deuterium-labelled cannabidiol in man after smoking and intravenous administration.” Biomedical and Environmental Mass Spectrometry (1986). https://www.ncbi.nlm.nih.gov/pubmed/2937482.
 Huestis, Marilyn A. “Human Cannabinoid Pharmacokinetics.” Chemistry and Biodiversity (2007). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/.
 Schoedel, Kerri A. and Sarah Jane Harrison. “Subjective and physiological effects of oromucosal sprays containing cannabinoids (nabiximols): potentials and limitations for psychosis research.” Current Pharmaceutical Design (2012). https://www.ncbi.nlm.nih.gov/pubmed/22716155.
 Paudel, Kalpana S., et al. “Cannabidiol bioavailability after nasal and transdermal application: effect of permeation enhancers.” Drug Development and Industrial Pharmacy (2010). https://www.ncbi.nlm.nih.gov/pubmed/20545522.