By Lucille Vega, MD on 16 Aug, 2023
Millions of people are turning to CBD in their search for more natural options in dealing with common issues like mood, sleep, comfort, and all around better wellness. It’s no surprise, then, that CBD is also becoming increasingly popular for those seeking relief from daily aches and pains.
As I discussed before, CBD can indeed be beneficial for those of us looking to ease sore muscles, aching joints, and the various other discomforts we face in our busy, overextended lives. Because CBD can be used both topically and internally, it is a great, non-addictive option for finding relief.
Understanding Chronic Pain and Its Treatment Challenges
According to the International Association for the Study of Pain (IASP), chronic pain is defined as pain that persists or recurs for longer than three months. It can happen anywhere in the body and can interfere with activities of daily living such as working, routine household activities, socializing, self care, and sleep. Approximately 25% of adults in the United States experience chronic pain, which is described in multiple ways such as aching, burning, shooting, squeezing, stiffness, stinging, and throbbing.
Beyond just discomfort, chronic pain can lead to depression, anxiety, fatigue, and insomnia. Chronic pain is found in many medical diagnoses including arthritis, cancer, diabetes, migraines, fibromyalgia, and neurogenic pain.
Conventional treatments often include anti-inflammatories, physical therapy, anticonvulsants, antidepressants, corticosteroids, muscle relaxers, topical products, sedatives, opioids, transcutaneous electric nerve stimulation (TENS), nerve blocks, and epidural steroid injections.
The result of one particular treatment for pain is the ongoing opioid crisis, which has led to addiction and mortality worldwide. Unfortunately, many folks have become tolerant and/or addicted to opioid prescription medication for the treatment of acute or chronic back pain.
One of the reasons I am so passionate about CBD is that I strongly believe that it can help offset the opioid crisis by offering another pathway in the effort to reduce the opioid load.
CBD 101: What You Need to Know
As I explained in my post about using CBD for wellness, every mammal (including us!) has a unique system of receptors and neurotransmitters in our bodies called the endocannabinoid system (ECS). This system hosts CB1 and CB2 cannabinoid receptor sites throughout the brain, central nervous system, immune system, and many organs. The ECS is constantly working to keep all our systems in balance and plays a role in protecting us from the stimulus in our environment.
At its most basic level, cannabinoids modulate certain aspects of physical and emotional pain and can help diminish the communication of stress hormones in the brain. This in turn may decrease anxiety and depression that comes from suffering chronic pain. It is also believed that cannabinoids may help decrease painful and fearful memories that can contribute to chronic pain.
Of course, every person is unique, and CBD products that work for one person may not work the same for another person. Fortunately, there are different types of CBD so you can find what works best for you: CBD isolate (CBD alone), broad spectrum CBD (CBD and CBD-alpha), and full spectrum CBD (CBD, CBD alpha, and a trace amount of THC and other cannabinoids).
While most states allow the sale and use of CBD products, it’s important to check your state’s regulations and laws to know which forms are legal. Some states allow edibles and other states allow only tincture formulations.
Choosing the Best CBD Products for Pain
If you decide that CBD might be a good option for your situation, it’s crucial to remember that not all CBD is the same. Even though a product may be labeled as CBD, it’s important to understand if it’s isolate, broad spectrum, or full spectrum.
Types of CBD Formulas
I always recommend that my patients start with a THC-free CBD option (isolate or broad spectrum) first, especially if drug testing is a part of their life. Even then, I encourage checking their work or athletic policies, as even products free of THC may be an issue depending on rules and regulations.
While many folks find relief with the isolate or broad spectrum CBD, some people require a trace amount of THC added to the product to create full spectrum CBD to help support the analgesic (pain relief) effect (often referred to as the “entourage effect”). If testing is not a concern, and someone feels a full spectrum CBD option may be more beneficial, I suggest starting with the lowest strength available to see how they react before making further adjustments.
CBD Dosages
Since everyone will have their own response to CBD, there are no hard and fast rules on dosages. However, it’s always best to start low and go slow. Meaning if you need to start with one drop under the tongue or a fourth of an edible, do so. If you do not feel any effect, that means you can start to increase your serving size by either adding one more drop to the next dose or adding another quarter of that gummy until you find the effects you’re looking for.
In medicine, we are taught “first do no harm.” This means if a low-dose helps you, then use that dose. There is no need to expose yourself to a higher dose if you don’t need it. Now, with that being said, it is very common that eventually you may have to increase the dose since our bodies are very dynamic and may upregulate receptors, therefore requiring just a little bit more CBD for full results.
Remember, everyone is different in their ability to feel the effects of CBD. I have women in my practice that are 5’2” and can tolerate 50mg/dose, and then a man of 6’1” that gets relief at 15mg dose.
Types of CBD Products
You may be wondering why there are so many different tu[es of CBD products. That’s because it all depends on how fast you need relief versus how long you need the relief.
A CBD topical product is applied directly to the skin and may start to work within a minute to two and last a couple hours. It is ideal for targeted relief right away and can be used in combination with other forms of CBD.
A CBD tincture/oil will usually start to work quickly if taken under the tongue, but lasts somewhere between 2 to 4 hours. If tincture/oil is placed in drinks and food it can take longer for the effect (since it has to go through the digestive process), but may last up to 6 hrs. This may be ideal for acute minor pain and perhaps requires multiple doses throughout the day.
A CBD gummy/edible or CBD capsule may take 30 to 60 minutes to start working, but may last 6 to 8 hours, depending on the dose and the diet for that day. It may be ideal for those who suffer from chronic pain daily, as it may help ease the pain burden, the opioid burden, and the NSAID burden when added to the regimen.
Purchasing Quality CBD Products
When you decide to try CBD products, do your research and go with a CBD company that provides education and transparency and adheres to GMP manufacturing standards to ensure your products are made in a clean and safe environment.
You want to avoid companies that make “miracle” claims or outrageous promises. You want to choose a company that uses organic hemp and CO2 extraction methods. And you definitely want to look at the company's product lab findings (batch specific certificates of analysis, or "COAs").
It’s also a good idea to read the reviews online, both the good and the bad. If you know a physician, medical provider, or pharmacist who is knowledgeable and willing to discuss CBD, you may want to ask them for their opinion.
Exploring a Comprehensive CBD Pain Management Strategy
The normal regimen for treating pain is usually NSAIDs (anti-inflammatories), ice, and temporary rest of the problem area. If that does not work after a week or so, then we tend to add physical therapy to the treatment. In some cases, people have been started on pain medication and referred to a specialist (orthopedic, neurosurgeon, neurologist, chiropractor, acupuncturist, etc.).
Physical Therapy and CBD
If physical therapy is part of a pain management strategy, consider adding CBD – both topical and ingestible – to your regimen, as it may help with inflammation and pain relief before and after therapy sessions. It is important to keep the body moving to build up tolerance and prevent the big joints from building up adhesions from lack of movement.
Nutrition and CBD
Also, many chronic pain patients suffer from poor nutritional habits and inflammation from processed foods. It is advisable to choose healthy foods, and organic if possible, to eliminate additives that tax our inflammatory system, therefore undermining all the efforts to control chronic pain.
The saying “You are what you eat” can be interpreted as "You feel what you eat” instead.
Adding magnesium, Vitamin D, and Vitamin B complex supplementation is often recommended for chronic pain relief. Adding CBD may also help, as it supports your ECS to keep your body systems balanced. Some CBD gummies even come in formulations with added immune boosting ingredients.
Sleep and CBD
A lack of restorative sleep can make us more sensitive to pain. If you’re struggling with sleep, you may want to try a CBD sleep aid gummy or capsule at night to get a longer time of relief (6 to 8 hours). I also often recommend trying a full spectrum CBD with THC product, as many people can tolerate it much better while sleeping.
Of course, always check with your work or sport activity guidelines before using a product with THC in it. It is also advisable to check with your health provider before starting any CBD. It may be as easy as informing your doctor that you would like to give it a try and watch clinically. It's always best to include your doctor since they may be able to pick up on any side effects before the individual can.
CBD Pain Relief Success
I have had many patients that have reduced their opioid pain medication with the aid of full spectrum CBD withTHC. For example, one patient went from 10mg of Methadone 3x/day down to 5mg 2x/day with the help of full spectrum CBD oil. He was taking 37.5mg, 3x/day for a month and then down to 2x/day thereafter.
Of course, everyone is different and this particular patient required that specific dose to alleviate what he called “that anxious feeling that my med was running out.” He said he didn’t realize there was so much anxiety that came to him when his pain medication was wearing off and the pain was starting to seep in quickly.
This patient reported that the full spectrum CBD oil helped him space out his methadone dose a little longer each day. He told me that the CBD calmed the anxiety component greatly and his pain control lasted longer between doses since his neck muscles were relaxed. He naturally reached for his methadone (to cover his pain) less and less until we finally could start reducing the dose.
As his physician, I wanted to observe his natural response. I did not put a certain timeline on him to come down off his pain medication, but I was pleasantly surprised he came down naturally on his own, and months before I would have expected from a classic taper.
The Future of CBD
Right now, my biggest wish in the CBD space is to see further research and collaboration between medical professionals and the CBD industry – and for the government to allow more research in this field. There is so much that we need to learn about cannabinoids and the combinations of cannabinoids that fit the different types of pain (pins and needles, burning, soreness, tooth pain, bone pain, sharp stabbing pain, abdominal visceral cramping pain, ischemia pain, and headache to name a few). Thankfully some CBD companies are stepping forward to conduct studies of CBD on patients with pain.
Of the results that I see in my own practice, CBD definitely has a role to play in the management of chronic pain and the emotional aspect that comes along with this condition. It’s time to stop the suffering of millions of people across the world by allowing CBD to enter into the paradigm of chronic pain management as an option. If CBD can help people move or even sleep a little better, then perhaps they can return to walking for exercise, working, and finding more satisfaction in their daily lives.
About Lucille Vega, MD
Dr. Lucille Vega is a highly experienced board-certified physician with a strong passion for cannabinoid medicine and its potential in improving patients' lives. She received her MD from Dartmouth, completed a residency at Brown University, and has 23 years of practice in Family Medicine. Dr. Vega is the physician/owner of Vega Direct Medical Family Practice, and has dedicated the past 7 years to incorporating Cannabinoid Medicine into her medical approach.
