Clearing's Chronic Pain Blog
CBD for Chronic Pain: The Complete Guide for 2022
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It’s not your imagination: CBD really is popping up a lot, and the public’s curiosity is growing fast. One study published in 2019 showed that Google searches for “CBD” and “cannabidiol” were relatively flat between 2004 and 2014, but have been surging ever since.
Besides on the internet, CBD is also physically everywhere now. You can buy it in products at the drugstore, the pharmacy and even at the gas station. You can see it in creams, teas, gummies and even pet products.
CBD has exploded in popularity and can be found in an increasing number of goods. However, despite this popularity, most people still feel confused about it.
You may also be confused. Is CBD just the latest snake oil being marketed by businesses so they can charge a high price for their products? Or, are there real therapeutic benefits and uses for CBD? And what does CBD even stand for?
What’s the difference between CBD, THC and marijuana?
When people think of CBD, they often get confused about how it’s different from marijuana and THC. And while the three are related, it is important to understand the distinctions between each.
CBD is short for cannabidiol. It is one of more than 100 natural compounds called “cannabinoids,” which are found in the family of cannabis plants, including marijuana. THC, along with CBD, are the two most widely known cannabinoids. While both compounds are found in marijuana, they differ in key ways.
Short for tetrahydrocannabinol, THC is a psychoactive cannabinoid that creates the “high” feeling that people feel when they smoke or ingest marijuana. When consumers buy recreational marijuana, they typically buy it for the psychoactive effect.
In other words: they are seeking a buzz or high. CBD, by contrast, is non-psychoactive, meaning it does not alter a person’s perception of reality, consciousness, or cognition. To put it simply: CBD does not get you high.
Both compounds seem to provide medicinal and therapeutic benefits for many of the same symptoms or conditions, including relief from anxiety, insomnia, chronic pain and fatigue. However, the physiological mechanisms through which these compounds work differ.
How do CBD and THC work?
There’s a good reason why cannabis plants have such strong medicinal and psychoactive effects on us. People have lots of cannabinoid receptors, especially in the brain. These receptors are part of the endocannabinoid system (ECS), which is essentially a large neurotransmitter network that helps maintain balance in the body.
“Endocannabinoid” is short for “endogenous” cannabinoid, meaning cannabinoids produced by the human body. The ECS is involved in the regulation of a variety of physiological processes, including when you get hungry and feel tired.
Certain active compounds from the cannabis plant, including CBD and THC, uniquely affect the body because they can interact with our cannabinoid receptors, like a plant version of our own endocannabinoids. CBD and THC activate different cannabinoid receptors in the body in different ways. When they bind to these receptors, they can stimulate or inhibit the release of certain chemicals and neurotransmitters in brain cells, nerve cells and immune cells.
What are endocannabinoid receptors?
Endocannabinoid receptors are found throughout the body, and are involved in processes like memory and pain-sensation.
The two main endocannabinoid receptors in the human body are CB1 and CB2, sometimes referred to as the “yin and the yang of the ECS.”
- CB1 receptors are present in especially high quantities in certain areas of the brain and central nervous system. They are responsible for psychoactive effects. In fact, studies have shown that CB1 dysfunction may play a role in schizophrenia.
- CB2 receptors are primarily found in the immune system, and to a lesser extent, in neurons. CB2 has been less studied than CB1, and only in 2019 was the full structure of CB2 determined by a group of international scientists.
Even as the research continues, scientists over the last two decades have concluded that CB1 receptors are more involved in memory, cognition, mood and pain perception. On the other hand, CB2 receptors are more involved in immune regulation, inflammation and pain sensation. Studies have shown that CB2 is a promising target for treating inflammation, neuropathic pain and even neurodegenerative diseases like Parkinson’s and Alzheimer’s.
How do CBD and THC interact with these receptors?
The exact mechanisms through which cannabinoids like CBD and THC interact with cannabinoid receptors are still being studied by scientists.
We know that CBD interacts with both CB1 and CB2 receptors. But CBD also activates other receptors besides these. Many receptors, such as the 5-HT1A serotonin receptor, are associated with serotonin, which may explain the calming effects many people feel when using CBD.
What can CBD be used to treat?
CBD has several medicinal and therapeutic benefits, helping to alleviate a number of conditions. It is commonly used to treat mental health conditions, including acute stress, anxiety and insomnia. It has also shown to be safe and effective for various pain conditions, including arthritis and sciatica. In 2018, the FDA approved the first CBD-based drug to treat rare forms of epilepsy.
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Which is better for pain relief: CBD or THC?
There is currently no clear winner in the competition between CBD and THC for pain relief. Both are believed to have analgesic qualities, meaning that they alleviate pain or the perception of pain. There is also evidence that they help mitigate the conditions that can result from having chronic pain, such as anxiety, depression and insomnia.
However, existing research has shown that CBD has strong anti-inflammatory properties not seen in THC. Thus, CBD may be a better choice for inflammatory pain conditions like arthritis, back pain and neck pain. In one study, application of CBD gel to rats with arthritis significantly reduced joint swelling and pain-related behaviors, with no noticeable side-effects.
And in another study, patients with peripheral neuropathy who applied topical CBD oil to the area of pain felt less intense pain than patients who did not apply the oil. Also, patients with multiple sclerosis were able to increase their mobility by using CBD. The product helped to reduce pain, spasticity and fatigue in patients.
According to Dr. Amaresh Vydyanathan, an advisor at Clearing and anesthesiologist and pain specialist at Montefiore Medical Center in New York, CBD treatments are showing a lot of promise for chronic pain, both in neuropathic and musculoskeletal conditions. He has seen many of his patients use them safely, both orally and as a topical application. This is supported by research showing that CBD is generally well-tolerated, and has a good safety profile.
"My patients have told me that they've experienced considerable relief from neuropathic pain from CBD. One patient said that after regular application of a CBD topical for his leg pain, he feels more lasting relief than he has in years,” Dr. Vydyanathan says.
“Another big advantage with CBD is that it seems to reduce cravings for heroin and other opioids. This is particularly relevant given the national opioid crisis,'' continues Dr. Vydyanathan.
Should I take medical marijuana or CBD?
Unlike CBD, THC is not typically sold as an isolate of the cannabis plant: extracted and then added to other products like lotions and teas. Anyone seeking out the effects of THC will therefore typically buy some form of marijuana to smoke or eat.
CBD is an essential component of medical marijuana, and patients who are prescribed marijuana for therapeutic reasons may benefit from both THC and CBD. However, many people today are looking for the therapeutic benefits of cannabis without the disruptive psychoactive effect of THC.
If you are seeking relief from chronic pain, stress, anxiety, or insomnia and don’t want a mind-altering experience, you might be a good candidate for CBD.
Another consideration to take into account is legality. Since marijuana contains THC, its sale and distribution are highly regulated. Both the legality and availability of marijuana vary from state to state, and it may not be easily attainable where you live.
Efforts to legalize marijuana continue to grow. As of April 2021, medical marijuana is legal in 36 states, and recreational marijuana in 16. However, marijuana is still illegal at the federal level. It is classified as a Schedule I drug by the Drug Enforcement Agency (DEA). Even in states where marijuana is legal, the regulations around how it can be grown, bought and sold remain strict.
CBD, on the other hand, is now legal in all 50 states, either over the counter or with a prescription. It is also regulated at the federal level, but not in the same way as marijuana — it is regulated more like cough syrup.
The 2018 Farm Bill passed by Congress removed hemp from the federal list of Schedule I controlled substances, moving oversight of hemp from the DEA to the Food and Drug Administration (FDA). This means that CBD derived from hemp is now legal, but CBD derived from marijuana is considered a marijuana derivative and regulated as such.
So long as the concentration of THC remains under 0.3%, CBD derived from cannabis is now a Class V controlled substance regulated by the FDA, much like cough syrup. This recent change in the regulation of CBD is what has caused the market to be flooded with so many CBD products.
How do I get started?
If you are curious about CBD and have been wanting to try it, you may want to first consult with your primary care physician or local pharmacist. They will be able to provide you with recommendations.
In general, topical treatments have some advantages over oral medications. This is because they typically only minimally absorb into the bloodstream and are associated with fewer systemic side effects. And topical treatments may be especially effective for localized conditions. These are important things to know when deciding what form of CBD you want to try and what benefit you want to achieve.
Trying CBD with Clearing
Although more research is needed to understand the effects of CBD for treating chronic pain, there are several compelling reasons to incorporate CBD into your pain management. To start, CBD-containing products, specifically topicals, tend to have a favorable safety profile. Also, there is a growing body of clinical research suggesting topical CBD may improve inflammatory and neuropathic pain.
At Clearing, we offer a high-quality, hemp-derived CBD-containing botanical cream product as part of a comprehensive plan to help bring comfort.
We also work closely with you to customize a treatment plan for your chronic pain to help bring you relief. Our comprehensive treatment plans combine non-opioid prescription-strength topical creams, nutraceuticals, personalized home exercises and high-quality care from a team of specialized providers. All delivered to you in the comfort of your own home via our telehealth platform and mail. Find out more today!
From what we know so far, CBD does not have the same psychoactive properties as marijuana. Many patients have reported finding relief from using CBD – in a few more years, much more research should be published about CBD, so we’ll all know more. That said, topicals and medications don’t necessarily address the root causes of chronic pain, so it can be a good idea to balance medication use with other pan management strategies, too. CBD does sometimes have side effects, such as causing tiredness and appetite changes.
You’ll want to keep an eye out for a COA (Certificate of Analysis) on CBD products, which testify to the product’s quality. Try to pick a well-known brand with positive reviews that doesn’t make lofty claims. Also search for the kind of CBD product that may work best for you. There are a lot out there, from gummies to oils, each with its own intended function.
If you’d like to try something other than CBD, consider arnica, a homeopathic remedy with a track record of success in addressing osteoarthritis pain, among other kinds of pain. Turmeric, lavender and clove, among others, offer alternative options. You may want to consult a naturopath – if you choose to pursue any of these remedies, do keep your medical team informed.
This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.