How to use CBD oil for pain

by Apoorva Shivankar, M.D

how to use cbd oil for pain

Cannabidiol or CBD, a powerhouse of health benefits, is the most sought-after health supplement available in the market. It has proven itself as a strong analgesic, anti-oxidant, anti-inflammatory, anti-depressant, anxiolytic cannabis product since its legalization and clearance of the farm bill in 2018.

By modulating the working of the Endocannabinoid system of the body, the cannabis products bring to you the most desired calmness and peace while taking care of almost all other health issues we may be facing. If the origin cannabis bothers you, we are glad to tell you that the legal hemp-derived CBD contains all the goodness of cannabis with nil psycho-activity.

Yes, the level of psychoactive THC is maintained below 0.3% in all hemp-derived CBD products. For people who are uncomfortable even with traces of THC, there are THC-free CBD formulations like broad-spectrum CBD and CBD isolates.

For any drug to show its effects, it is very important that they are used correctly. The same is true for cannabidiol too. So, let’s take a look at how to use CBD oil for pain relief- one of its most appreciated health benefits.

What’s the need?

Pain is the manifestation of nearly every ailment we face. It can be a disease like arthritis, or injury or body ache after laborious work or just a tooth infection. To all such patients, painkillers seem heavenly. Over-the-counter (OTC) drugs like NSAIDS and prescription pain medications like opioids are great pain-relievers but they come with a baggage of side effects including gastric upsets, ulcers, liver or kidney issues and even addictions in case of opioids.

All these negative effects led people to turn to more natural remedies of pain relief, such as cannabidiol oils especially for patients suffering from chronic pain. They act as natural, safe, non-addictive, potent pain relief medication with some more added health benefits.

How does CBD oil relieve pain?

By a 2-way action:

  1. Being an anti-inflammatory agent, CBD oils efficiently reduce inflammation - the most common cause of pain in conditions like arthritis, multiple sclerosis,  neuropathic pains, injury and infections.

  2. CBD oils bring down the nerve signals that transmit pain sensations to the brain by binding to the cation channels TPRV1 in the nervous system. It also stimulates the reuptake of the neurotransmitter, adenosine, thereby boosting adenosine levels in the brain and inhibiting pain sensations. 

Which painful conditions can CBD oils manage?

Almost every pain including

  • Systemic inflammatory conditions (rheumatoid arthritis)
  • Autoimmune conditions (Multiple sclerosis),
  • Generalized body ache or localized pain
  • Neurological conditions such as fibromyalgia or cancer pain.
  • Common pains due to trauma, infection, toothache or menstrual cramps.

How to use CBD oil for pain?

There are 6 major factors to consider in order to gain the maximum analgesic benefits of CBD oils. Let’s take them one by one:

Orally:

CBD oil can be directly swallowed as drops or taken sublingually which means adding a few drops underneath the tongue and holding the medicine there for 30 to 60 seconds without swallowing. The sublingual form is more effective and rapid as it is directly absorbed in the bloodstream bypassing the GI tract and liver. Effects can be felt as early as 15-30minutes with sublingual forms. 

Points to be kept in mind while using CBD orally:

  • Taking CBD oil with food improves systemic absorption. Rodent studies2 have shown that CBD being fat-soluble, if consumed with the fatty diet can increase CBD absorption by almost 3 times.

  • Pure CBD oil can have a grassy or earthy taste that can discourage patients. To mask this, it can be added to any food items or favourite smoothie before consuming, especially for kids and pets. Yes, animals too are benefitted from CBD’s magic.

  • The possibility of drug interaction should never be ignored. Ingested CBD oil competitively inhibits CYP450 liver enzymes which are also involved in the metabolism of many other drugs like blood thinners, cardiac medications like amiodarone, antiseizure medications, thyroid medications(levothyroxine) and many more. Thus, by inhibiting CYP450, CBD oil can either induce or slow down the processing of these drugs resulting in decreased effects or accumulation and overdose toxicity. So, proceed with caution when taking CBD oil if you are already on medications.

  • Oral CBD oil can increase the effects of blood thinners. So, it’s logical to stop it 10-14 days prior to surgeries or any other invasive procedure.

  • Direct oral dose is very useful if you want to maintain a steady level of CBD throughout the day. But for pains of neuropathic origin, the sublingual route is preferred.

Topically:

A most common question that health and wellness professionals come across is,

Can I rub CBD oil on my skin for pain?

The answer is YES.

CBD oils can help topically too, especially to relieve localized muscle aches or menstrual cramps.

Actually, it is more advantageous in case of localised pain as

  • drug directly targets the site saving time (focussed use).
  • no loss of oil in GI and liver encounters. 

Daily application of oil provides great pain relief for patients struggling with chronic joint pains like arthritis. For severe pains in advanced cases, a combination of oral CBD oil and topical applications can do magic.

How much CBD oil should I take for pain?

Wrong dosage can leave CBD oil non-functional. Hence, it is really important to get the correct dosage for CBD users. But the difficulty is,

  • There are no established clinical guidelines regarding the CBD dosages.
  • Effective doses are not the same for everyone, they even differ in a single individual as per the purpose, they are being used for.

Dose keep varying as per the individual’s:

  • weight
  • age
  • tolerance to CBD
  • body chemistry
  • type and severity of condition
  • form of CBD oil used
  • Carrier oil present

So, figuring out the right amount can be tricky and experimentation may be required to find out the optimal dose for you and your specific needs.

Yes. Try the following steps:

  • Check with your doctor to determine the doses.
  • Experiment: Try different doses using the golden rule ‘Start low and go slow’ that suggests

‘Begin with the lowest possible dose, wait to see the results, raise the dose gradually till you get the desired effect and then stabilize.’

CBD experts suggest starting with as low as 0.2mg/kg for mild pain whereas for severe pain, begin with 1.0-1.2 mg /kg.

  • Do some mathematical calculations:

The oil bottle label usually mentions the CBD concentration of the entire bottle.

Consider a CBD bottle whose label states 300mg in 30 ml.

Let’s calculate how much oil from this bottle should be used by a 50kg patient suffering from severe chronic pain,

Step1: Determine the exact milligrams(mgs) needed to start the treatment.

For severe pain, the starting dose is 1.0 mg/kg

So, for the 50 kg person, it comes around 1x 50= 50mg

Step 2: Calculate CBD content per ml of CBD oil by

= Total CBD concentration/total volume in ml

=300 divided by 30

= 10mg/ml

Step 3: If 10mg is present in 1ml, then 50mg will be in= 50/10= 5ml

Step 4: Start with 5ml. wait and watch for one week, increase the dose by 5mg each time till you get the desired results.

  • If you experience any unwanted side-effects like fatigue, lethargy, diarrhoea or drowsiness, discontinue CBD immediately and consult the doctor.

    Form of CBD oil should also be looked for

    CBD oil occurs in 3 forms

    CBD isolate:

    • 99% pure CBD
    • no THC
    • no other cannabinoids, terpenes, flavonoids or other chemicals from cannabis plant.
    • cons: Lacks the benefits of other hemp-derived cannabinoids and terpenes.

    Broad-spectrum CBD: 

    • Contains CBD
    • most cannabinoids,
    • no THC

    Full-spectrum CBD: 

    • CBD
    • all of the plant’s cannabinoids
    • THC- in meagre amounts (<0.3%) not enough to create the ‘high’ effect.

    Unless contraindicated, full-spectrum should be preferred as they show superior results due to ‘THE ENTOURAGE EFFECT’ which hypothesizes that combination of more than one active agent maximizes the overall effect by complementing and enhancing each other’s actions.

    Quality Matters 

    Check the following points to get the best quality:

    • Where and how the hemp is grown:

      Hemp plant grown organically within the USDA (United States Department of Agriculture)-compliant state regulatory norms of cultivation should be preferred. The reason being hemp plants easily absorb almost everything from the soil irrespective of good or bad.  Farms under USDA norms are regularly checked for heavy metals, petroleum, toxic chemicals bacteria, fungus, solvent residue, or any other foreign matter. 

      • Mode of CBD extraction:

        Supercritical CO or ethanol CBD extraction methods leave no harmful residues post-extraction and hence yield better CBD oil than those extracted using chemicals like propane, butane, pentane, or hexane.

        • THC concentration should not be more than 0.3%:

          Inferior quality CBD products can have a higher THC level making it both psychoactive and illegal.

          • Potency:

            A potent CBD oil can show effects in much lower doses and the bottle lasts longer as compared to a lesser potent CBD oil bottle serving the same volume.

            • Check for additional contents:

              More natural, more superior.

              Preservatives, colouring or flavouring agents, artificial chemicals, fragrances, parabens or sulphates should be avoided. Also, check if it contains something you are allergic to. 

              • Should be well-labelled:

                A good label describing the CBD concentration, ingredients, purity, mode of extraction, etc. imparts transparency and confidence towards the quality of the drug. 

                • Certificate of analysis (COA):

                  CBD products are neither Food and Drug Administration fda approved nor there are any strict regulations for the product development and labelling providing scope for malpractices. The bottles may be inaccurately labelled. COA is an answer to such wrong deeds. In-home and third-party testing verifies the quality. COA is a written guarantee regarding the CBD content, formulation, purity, and truthfulness of the label provided by a laboratory having no stake in the product.

                  • Information about carrier oils:

                    MCT oils like coconut oil or hemp seed oil nurture the quality of CBD in contrast to cheap oils like grapeseed oil.

                    • Check the reviews given by patients who use CBD for the same purpose. 
                    • Prefer a reputed brand:

                      A good brand comes with a proper back-ground research, and has already earned a significant amount of customers’ trust making it more reliable amongst others. 

                      • Always follow your doctor’s recommendation rather than falling for the advice of marketers. This will help preventing fraud and debug. 

                      Storage is important

                        Proper storage is the key to maintain quality and longevity of any product. The same goes for CBD oils too. CBD oils should be stored in cool, dark, moisture-free, clean places like kitchen cabinets or pantry to prevent or slow down its degradation and any chances of contamination.

                        Consistency is the key.

                        Intermittent use may lead to drug failure and is one of the commonest mistake encountered with CBD use. Patients begin with full enthusiasm, don’t see much effect in the initial 2-3 days, get disappointed, lose interest, drop one or 2 doses, pain intensifies and then the cycle starts again.

                        In order to get rid of pain and sufferings, it is important to consistently follow the recommended CBD oil dose, especially for chronic pain. Some may see changes immediately; others may take time. Don’t lose hope, continue using.

                        Conclusion:

                        As there are not enough human studies done using CBD oil for pain relief, there is a lack of full-blown health information regarding how to use CBD oil for pain management. But still, research suggests using high-quality full-spectrum CBD oils orally or topically, in a well-calculated dose consistently can very well walk you through your pain management journey smoothly in a safe and natural way.

                        FAQs:

                        Q. Can we use CBD oil for pain management in kids?

                        No, except for epidiolex, a cannabidiol drug used for rare forms of seizure disorders, no other CBD products are recommended in children, as there is little research on the effects of CBD oil on a child’s developing brain.

                        Q. Will CBD products used for pain relief clear drug test?

                        There is no issue with topical use. In case of oral use, CBD isolates and broad-spectrum CBD will surely clear the test but full-spectrum CBD carries some risk of being detected like marijuana due to its THC content.

                        Q. Can these nonprescription CBD products replace prescription drugs for pain management?

                        As per the research till now, CBD products alone may not completely replace the opiates but they can definitely reduce the dose required and dependency on these prescription medications.

                        Q. What are the side-effects of CBD?

                        It may rarely lead to minor effects like dry mouth, drowsiness, light-headedness, nausea, diarrhoea, etc when taken in large doses. In addition, using CBD oil with other medications may make those medications more or less effective.

                        References:

                        1. Ribeiro A, Ferraz-de-Paula V, Pinheiro ML, Vitoretti LB, Mariano-Souza DP, Quinteiro-Filho WM, Akamine AT, Almeida VI, Quevedo J, Dal-Pizzol F, Hallak JE, Zuardi AW, Crippa JA, Palermo-Neto J. Cannabidiol, a non-psychotropic plant-derived cannabinoid, decreases inflammation in a murine model of acute lung injury: role for the adenosine A(2A) receptor. Eur J Pharmacol. 2012 Mar 5;678(1-3):78-85. doi: 10.1016/j.ejphar.2011.12.043. Epub 2012 Jan 12. PMID: 22265864.
                        2. Zgair A, Wong JC, Lee JB, Mistry J, Sivak O, Wasan KM, Hennig IM, Barrett DA, Constantinescu CS, Fischer PM, Gershkovich P. Dietary fats and pharmaceutical lipid excipients increase systemic exposure to orally administered cannabis and cannabis-based medicines. Am J Transl Res. 2016 Aug 15;8(8):3448-59. PMID: 27648135; PMCID: PMC5009397.
                        3. Meng H, Johnston B, Englesakis M, Moulin DE, Bhatia A. Selective Cannabinoids for Chronic Neuropathic Pain: A Systematic Review and Meta-analysis. Anesth Analg. 2017 Nov;125(5):1638-1652. doi: 10.1213/ANE.0000000000002110. PMID: 28537982.
                        4. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008 Feb;4(1):245-59. doi: 10.2147/tcrm.s1928. PMID: 18728714; PMCID: PMC2503660.
                        5. https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know
                        6. Mücke  M, Phillips  T, Radbruch  L, Petzke  F, Häuser  W. Cannabis‐based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD012182. DOI: 10.1002/14651858.CD012182.pub2. Accessed 16 April 2021.
                        7. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press (US); 2017 Jan 12. 4, Therapeutic Effects of Cannabis and Cannabinoids. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425767/
                        8. Xiong W, Cui T, Cheng K, Yang F, Chen SR, Willenbring D, Guan Y, Pan HL, Ren K, Xu Y, Zhang L. Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors. J Exp Med. 2012 Jun 4;209(6):1121-34. doi: 10.1084/jem.20120242. Epub 2012 May 14. PMID: 22585736; PMCID: PMC3371734.

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