4 Important Questions (and Answers) About Chronic Pain and CBD

Your questions answered about CBD oil for chronic pain

So, you've unanswered questions in relation to CBD for treating pain? Not to worry, we got you sorted. Image Credit: By SNeG17 on Shutterstock

Retired NFL players know chronic pain intimately–they live with it every day. Very few other careers result in the broken bones, concussions, back pain and joint pain that former NFL players deal with. Retirement is painful, and has lead to players medicating with alcohol, illega
l drugs and opioids. The Federal Drug Administration has launched investigations into the NFL as a result of studies that have shown that retired NFL players use four times the amount of opioids as the rest of the population.

A story in the Washington Post earlier this year reported that former professional NFL players are looking to medical marijuana or CBD to manage their chronic pain as an alternative to prescription drugs and alcohol, and many players are finding relief.

Does CBD work? How does it work? Because CBD is a relative newcomer to modern medical science, it might feel like there are more questions than answers. Educating yourself is the first step to answering your most important question, “Can CBD relieve my chronic pain?”

According to the Mayo Clinic, everybody experiences pain at one time or another, but not always in the same way.

Pain involves a complex interaction between specialized nerves, your spinal cord and your brain. Imagine a complicated traffic system, with on-ramps, different speeds, traffic lights, varying weather and road conditions, a traffic control center, an emergency response system, and more. And the vehicle you’re in also makes a difference, because the experience of pain varies from one person to another

Most people have felt the pain of a headache, or the pain of a small injury such as a paper cut, or a stubbed toe. Pain is a warning system that tells you something is wrong. We get these warning signals from the peripheral nervous system, specifically from specialized nerve endings called “nociceptors.” These nociceptors are all throughout the body, both internally and externally. Millions of these nerve endings can send a signal about temperature, injury, and any other kind damage or danger to the body. Nociceptors send a pain signal to the brain, and then the brain attempts to control the problem by releasing chemicals to dull the pain, or by signaling the body to send white blood cells to fight an infection.

Another problem arises when the nerves themselves are damaged or malfunction, and they send false pain signals to the brain, even when there is not an injury. This causes pain, usually in the extremities, that may feel like tingling, burning or freezing.

Classifications of Pain

There are two types or classifications of pain. Pain that is short-term, sudden, and goes away within a short period of time is acute pain. Pain that lasts for months or longer, usually as a result of an illness or injury, is called chronic pain. Chronic pain is incredibly difficult to manage because sometimes there is no explanation for the pain. It may prevent a patient from holding down a job, supporting his or her family, caring for children, or developing relationships. It is difficult to concentrate on anything when you are in a constant state of pain. The pain itself has become the illness, and treating that illness can seem like a daunting task.

Chronic pain is defined as pain lasting longer than 12 weeks. Chronic pain is usually a result of an injury or illness that seems to heal, but the pain continues. The nerves continue to send warning signals to the brain, causing the patient to feel pain. Some of the most common conditions that result in chronic pain are headache, pain after surgery or after an injury, lower back pain, cancer pain, arthritis pain, or pain caused by nerve damage. But sometimes it is difficult to pinpoint where the chronic pain originated.

According to the American Academy of Pain Medicine, it is estimated that about 1.5 billion people in the world have chronic pain, it affects 100 million U.S citizens and is responsible for disability in the long term. Just to put that into perspective, 25.8 million Americans have diabetes, 16.3 have coronary heart disease, and 11.9 million Americans have cancer. Chronic pain truly is epidemic.

Chronic pain is currently treated within the medical community in a wide variety of ways. One of the first treatments is medication. Over-the-counter medications such as acetaminophen or ibuprofen are usually a starting place. If the pain is too severe, a doctor may prescribe morphine, codeine, or hydrocodone. Because the pain has additional side effects, doctors may also prescribe antidepressants or anti-anxiety medication.

If medication does not work, then sometimes a medical procedure will be attempted in order to reduce the pain. According to Healthline.com, this may include:

  • Stimulation of electrics, sending shocks into the muscles
  • Nerve block
  • Acupuncture
  • Surgery

Some patients find relief with alternative treatments such as physical therapy, yoga, or psychiatric counseling as well.

Chronic Pain, Inflammation – What Are They?

When dealing with chronic pain, the treatment plan must include managing inflammation as there is a well-established link between inflammation and pain. Inflammation is another way that the body sends a pain signal. The chemical process that takes place in the body during inflammation makes the nociceptors more sensitive. This is why when you have a sprained ankle, it swells up and the swelling is painful. It may also be red, or have a feeling of warmth. Inflammation often happens when there is an injury to the body.

Swelling is helpful and promotes healing. Even though our first impulse is always to try to reduce the swelling, the swelling triggers the healing process and can help with repairing tissue.

Some swelling takes place inside the body, and because there may not be any nerve endings near the internal organ, there is generally no pain associated with it. In this case, there are different signs and symptoms, including fatigue, fever, chest or abdominal pain, rash, or joint pain. These can be signs of chronic inflammation.

Chronic inflammation can happen over a period of months or years, and can be associated with conditions such as asthma, rheumatoid arthritis, ulcers, colitis and hepatitis. Inflammation can also contribute to some cancers.

There is a correlation between chronic pain and chronic inflammation. Inflammation can increase the body’s sensitivity to the nerve signals to the point that the brain registers constant pain. This can be one reason why people who have chronic pain may not be able to pinpoint a cause for the pain.

Inflammation, especially in the joints, is frequently treated with rest, medication, and sometimes surgery. NSAIDS (non-steroidal anti-inflammatory drugs) are used to treat pain and inflammation as a result of tissue injuries and joint pain. NSAIDS are available as over-the-counter medications. You are probably familiar with many NSAIDs, including Aleve, Advil, and Excedrin among others. NSAIDS are an alternative to corticosteroids, which can have side effects like weight gain, eye problems, and high blood pressure. NSAIDS are not without side effects, however. Some common side effects of NSAIDS are:

  • Headaches and dizziness
  • Allergic symptoms such as rashes and throat swelling
  • Liver or kidney problems
  • High blood pressure
  • Lower extremity swelling

When over-the-counter NSAIDS are not effective in treating the inflammation or pain, stronger prescription-strength NSAIDS may be recommended by your doctor. The Food and Drug Administration (FDA) warns that taking NSAIDS can heighten the risk of heart attack or stroke. They may also increase the risk of bowel disorders. These risks increase if the medication is taken long term, which makes it a difficult choice for people who deal with chronic pain or inflammation.

What are the alternatives for someone who has chronic pain and/or inflammation? The risks of long-term NSAIDS or prescription medicines can be scary. Harvard Medical School confirmed what most of us already know, stating that “Exercise, weight loss, physical therapy, joint-supporting splints, massage, and acupuncture are all possible ways to reduce pain and reliance on pain relievers.”

Treating Pain and Inflammation With Alternative Drugs

As it turns out, many people have had success treating pain and inflammation with herbs, foods and spices. Some of the the foods that appear to have anti-inflammatory properties are Omega-3 fatty acids that are found in fish and nuts, and even chocolate! Many spices have been used before prescription medications came onto the scene. Ginger, turmeric, garlic, cayenne, black pepper and cinnamon are some of the many spices that have been used for pain relief. It is difficult to prove the efficacy of using spices to fight inflammation though, as most of the proof is anecdotal. While we wait for more proof about how these spices might work, it doesn’t hurt to add some spices to your everyday diet. Just remember not to overdo it – eating too much spice can actually be detrimental to your health.

Another plant, cannabis, has made a recent entry into the options for treating pain and inflammation. Medical marijuana is in the news almost daily. Specifically CBD, a cannabis compound, has been reported to treat everything from depression to Parkinson’s to cancer. There is evidence that CBD is a promising treatment options for chronic pain and inflammation, without the side effects of prescription drugs.

Want to know more about how CBD works on inflammation? Go to Is Enduring Back Pain Simply a Fact of Life? With CBD Oil, Maybe Not.

The Chemicals in Cannabis Known as Cannabiniods and How They Help

Cannabidiol (CBD) is one of of over a hundred different chemical compounds called cannabinoids. For the most part, CBD is extracted from the hemp plant which has a very low concentration of THC, the compound responsible for the “high” that most people associate with marijuana. CBD does not have any mind altering effects, and actually has been used to treat people with addictions to other substances.

The excitement of the medical use of cannabinoids came around the same time that the endocannabinoid system (ES) was first discovered. That system holds the cannabinoids produced within the body itself as well as the receptors(CB1 & CB2) they communicate with to hold the body in a perfect equilibrium. When there is an imbalance due to a major or minor illness such as PTSD, Acne or Parkinson’s etc the endocannabinoid system creates more endocannabinoids as well as other proteins to communicate with the receptors to help fight these ailments.

When the endocannabinoid system cannot fight off the ailments by itself, medications such as opioids (codeine, diazepam etc) are used to treat them. Cannabinoids such as CBD are natural cannabinoids that can act in a similar way to the opioids but because they are natural they have more benefits and less harmful side effects. CBD does not directly communicate with the endocannabinoids, it actually causes a reaction which allows the body to create more of its own cannabinoids naturally. These findings clearly show CBD as being a much more logical and beneficial medical treatment that others.

The History of Cannabis- Where It Began, When Was It Illegal?

Cannabis has been used for thousands of years. The earliest known use of marijuana was in 2700 BC in China where it was used as a treatment for rheumatism among other things. There are additional accounts of marijuana being used in Africa, the Middle East, and in India. There, it was used for pain relief. Early American journals recommended parts of the cannabis plant, the hemp seeds and roots for skin disorders. Shortly thereafter, doctors in both the British Isles and America began using it for “rheumatism” and nausea.

Some Americans were becoming addicted to liniments and potions that actually contained a small amounts of morphine by the close of the 19th century. In response to the popularity of these items, the Food and Drug Administration was created in 1906. This regulated morphine and opium, and required that these items be prescribed by a doctor. By 1914, use of these drugs was a crime, and by 1937 many of the states made marijuana illegal as well. There has been a lot of back and forth about whether marijuana should be considered a drug and controlled by the FDA.

Medical marijuana is used in the United States legally for several different purposes. The most common use is for pain relief, and it seems to be particularly effective for neuropathic pain. Sativex, a prescription cannabinoid, is used to treat pain and nausea in cancer patients. One particular strain that is very low in THC and high in CBD, Charlotte’s Web, has been used effectively to reduce seizures in juvenile epilepsy patients.

One current focus of study is the use of CBD in treating traumatic brain injuries. Another focus of researchers is on using CBD to treat Alzheimer’s as well as disorders such as bipolar disorder. Because of the legal issues, studies are difficult to conduct and the research is developing more slowly than many people would like. This means that valid research results are difficult to obtain, and a lot of the results are anecdotal.

Currently, marijuana is legal in 29 states. All of those states have limits on use, and many of those states require a doctor to prescribe it. In 16 additional states, there are laws that allow CBD to be used for medical purposes. They do not allow other cannabis products that have higher levels of the psychotropic compound THC. All parts of the marijuana plant, including CBD, are illegal in Idaho, South Dakota, Nebraska, Kansas, Indiana, and West Virginia. In many states, CBD can be prescribed by a doctor for many uses including treating childhood epilepsy and for pain.

How can Cannbiniold (CBD Oil) treat chronic pain?

So by now, hopefully you know a bit more about chronic pain and inflammation, as well as what CBD is. Here is the information you need about how CBD oil can be a part of your chronic pain management strategy.

The way CBD works is complex, and scientists still don’t have a clear understanding of all the ways that it works specifically on pain. CBD does not have a direct effect on the endocannabinoid system, but it does affect the way the bodies own cannabinoids work within that system. According Dr. Debra Rose Wilson, “CBD stops the body from absorbing anandamide, one compound associated with regulating pain. Increased levels of anandamide in the bloodstream may reduce the amount of pain a person feels. Cannabidiol may also limit inflammation in the brain and nervous system, which may help people experiencing pain.”

A study published by the National Institute of Health (NIH) examined what scientists currently know about how and why CBD relieves pain. They noted that “cannabinoids have anti-nociceptive mechanisms” that work differently than more commonly used prescription drugs, which makes them appealing for further research. One interesting side effect, the administration of THC for pain relief in some studies has shown an increase in blood pressure, making it contraindicated for patients with coronary disease.

Very specific studies have been done on how CBD works on certain medical conditions, specifically those that have a component of chronic pain and inflammation.

A study in the Journal of Experimental Medicine examined cannabinoids and their effect on neuropathic pain and inflammation. This research, conducted with mice as the subjects, Dr. Xiong W reported that

Systemic and intrathecal administration of cannabidiol (CBD), a major non-psychoactive component of marijuana, and its modified derivatives significantly suppress chronic inflammatory and neuropathic pain without causing apparent analgesic tolerance in rodents.

Specifically, the study noted that cannabinoids (not the psychoactive components like THC) improved the function of glycine receptors (GlyRs). These glycine receptors play a part in regulating nociceptors of the spine. The nociceptors are what carries the pain signal to the spine and brain. The cannabinoids had no effect in mice that were lacking the glycine receptors, showing that the pain relief was a result of the cannabinoids acting on those receptors.

One of the most common uses of CBD and other cannabinoids is to cure a headache or a migraine. As with most conditions, the actual research about CBD and headaches is thin. However, there is some research showing that cannabinoids can block the receptors in the brain which cause nausea and pain associated with migraine headaches. Researchers also believe that people who suffer from migraines may lack natural cannabinoids which can calm parts of the brain that could trigger a migraine.

If there are not enough endocannabinoids to calm triggers such as bright light, sound, hormones, or a certain smell, then the result is a migraine. If migraines do in fact result from a deficiency of endocannabinoids in the brain, that could explain why using CBD would stimulate the body to produce endocannabinoids, and therefore have fewer symptoms and potentially fewer migraines. CBD has also shown to help people sleep longer and deeper, which could benefit migraine sufferers who have migraines triggered by lack of sleep.

Arthritis pain is also a target for CBD studies and medical use. This is a condition that involves both inflammation and chronic pain. A study into the benefits of CBD showed positive results in rats who had arthritis like conditions, with inflammation reduced after 3 days of treatment using CBD orally. A further study found that there where imbalances in receptors in patients with arthritis compared to those with rheumatoid arthritis. Patients with rheumatoid arthritis had more CB2 receptors and those with normal arthritis. It is unknown as to why this happens however in this case, the CBD stimulated the body to help repair its own immune system.

CBD is also being used to control the pain associated with multiple sclerosis. According to Healthline.com, “Nabiximols (Sativex), a multiple sclerosis drug made from a combination of TCH and CBD, is approved in the United Kingdom and Canada to treat MS pain. However, researchers think the CBD in the drug may be contributing more with its anti-inflammatory properties than by acting against the pain. Clinical trials of CBD are necessary to determine whether it should be used for pain management.”

Sativex and another cannabinoid that is available by prescription called dronabinol are available in the United States for very limited use for cancer patients. The drugs are not meant to treat the cancer itself, but to treat the pain and nausea that result not only from the cancer itself but from the cancer treatment.

In nearly all the studies that involve using CBD to treat any type of chronic pain, researchers cite the need for more studies, especially more studies using human study subjects. Until medical science backs up the results people report anecdotally, treatment with CBD and other cannabinoids can be difficult.

Although the side effects associated with CBD are few, and in general not as severe as side effects seen with prescription drugs, you do need to be aware of a few side effects. The most common side effects are drowsiness, changes in blood pressure, changes in appetite, and stomach upset. Some patients report headaches or difficulty sleeping. In general, CBD is well tolerated medically.

By this point, you are intrigued by a new option for treating chronic pain. But what do you do next?

  1. The first step is to know what the laws are in your state. Is CBD legal and available for medical use in your area? You may need to consult with a legal professional before pursuing this treatment option, or at the very least, do your research.
  2. Secondly, if you choose to use CBD to treat your chronic pain, make sure that you are using a reputable source of CBD. CBD oil and cannabinoid formulations are abundantly available online, but they are not generally regulated. When choosing a product, make sure that the product lists the strength and ingredients, and that it is tested by a third party. Many of the more severe side effects reported with CBD use such as chronic headaches and diarrhea are a result of using impure or substandard products.
  3. Third, make sure that your doctor is a partner in your care plan. You should never discontinue a prescribed medication in order to take CBD without your doctor’s advice. In addition, CBD can affect how your prescriptions work, making a consultation with your doctor imperative.

With the answers to these four important questions about CBD and chronic pain relief, you are ready to talk to your doctor and find relief for chronic pain and inflammation. The more you know about your options, the better able you will be to find treatment options that work for you.

Editorial Staff
Editorial Staff
At cannabisMD we aim to provide you with all the information and knowledge you need to take the next step in your personal cannabis journey! Read about our team

Leave a Reply

Your email address will not be published. Required fields are marked *