The non-psychotropic cannabinoid cannabidiol (CBD) is becoming increasingly popular among patients with chronic pain. A survey of pain patients in America found that cannabis-based medications and CBD reduced chronic pain in a large proportion of patients. Strong opiate-based painkillers could also be reduced in dose.

Survey in seven pain clinics

The American research team surveyed a total of 253 sufferers with an average age of 45.4 years from seven pain centres in Southern California. Patients were invited to participate in the survey via posters and flyers between December 2018 and February 2019.

152 people (62.0%) reported experience with CBD products. The most commonly treated pain conditions were back pain (67.3%), nerve pain (46.7%) and neck pain (44.7%). In 56.3% of the cases the CBD product also contained the psychotropic and also pain-relieving tetrahydrocannabinol (THC).

Chronic pain disorders treated included:

Back pain
Neuropathic pain
Neck pain
Migraines
Pain in the limbs
Fibromyalgia

CBD was most commonly used by inhalation (62.9%) followed by edibles (54.3%) and oral cannabis tinctures (52.3%). Most of the CBD users have experience with several dosage forms.

The forms of administration used included:

Inhalation or smoking
Edibles
Oral tinctures
Topical cannabis preparations (cream, ointment, oil)
Capsules
Spray

Improvement and reduced pain medication for most suffers

59 percent of the respondents reported pain relief through the use of CBD. In addition about two thirds (67.6 %) were able to reduce the dose of other pain medication. Just over half (53.7 %) were also able to reduce strongly effective opiate-containing medications.

The experiences from the environment of the respondents were also predominantly positive: 78.1 % of the participants stated that they knew people from their family, circle of friends or neighbourhood who successfully treated their complaints with CBD. The tolerability was mostly good: Only 7.3% of patients know people who have reported adverse effects.

The vast majority, which means 91.9% said they wanted to learn more about the medical use of CBD.

Study situation of CBD in chronic pain

Scientific research on the effect of CBD on chronic pain is still in its infancy. It is considered certain that pure CBD has a low abuse potential. On the contrary: An American study from 2019 showed that Epidiolex®, a CBD-containing medication, can reduce addiction pressure and anxiety in abstinent heroin-dependent patients.

Current data suggest that for chronic pain especially neuropathic pain, THC has a stronger analgesic effect than CBD. It is therefore possible that the remaining minimal THC content in full-spectrum extracts also contributes to the analgesic effect of CBD products. Therefore, it is important that users know the CBD and THC content of cannabis products.

Another American study from 2020 showed that chronic pain patients were able to reduce their opiate painkillers after 8 weeks of treatment with CBD. Cannabis-based medicines can therefore improve painful symptoms regardless of whether they contain THC or CBD.

Difficulties when taking CBD products

People who want to use CBD should only use CBD products with a tested active ingredient content. Many products on the market do not meet these quality requirements. The fluctuating cannabinoid content in combination with the often lacking experience of the users makes targeted therapy with CBD preparations difficult. Furthermore it is often unknown whether and how much THC is contained in full-spectrum extracts. This can lead to the danger of a positive drug test in case of increased concentrations.

The experiences of the survey participants with cannabis-based medicines and CBD are predominantly positive. Further scientific studies are needed to clarify whether CBD can be an effective treatment option for the various pain disorders. Research should also continue to investigate the differences between CBD isolates and full-spectrum extracts. In order to improve the problem of the incorrect CBD concentration, quality guidelines for CBD-containing preparations with control of the CBD and THC content are useful.

Sources:

Schilling JM, Hughes CG, Wallace MS, Sexton M, Backonja M, Moeller-Bertram T. Cannabidiol as a Treatment for Chronic Pain: A Survey of Patients’ Perspectives and Attitudes. J Pain Res. 2021;14:1241-1250 https://doi.org/10.2147/JPR.S278718