Evidence based

CBD For Pain — Does it Work? (Evidence-Based User Guide)

CBD oil is extremely popular as a natural health supplement for managing pain.

But does it really work?

Learn what the evidence suggests, what products to use, and why so many people are swapping their pain meds with CBD oil.

Article By
Justin Cooke , posted 1 week ago

Chronic pain is a problem for millions of people around the world. Even with advancements in drug development, it can be difficult to find effective pain-management options without using potentially addictive drugs. 

Over the last couple of years, CBD oil and other cannabis extracts have shown impressive results in managing pain — without the nasty side-effects.

People are using CBD products to manage pain from arthritis, multiple sclerosis, fibromyalgia, migraine headaches, ALS, nerve damage, PMS, and much more. 

Learn how it works and what the research says about it. 


    Carlos G. Aguirre, M.D., Pediatric Neurologist

    Updated on September 17, 2020

  • Table of Contents

Key Points: How CBD May Reduce Pain

  1. Blocks pain transmission in the spinal cord and brain — through the vanilloid and opioid pain receptors
  2. Reduces inflammation one of the primary causes of pain in the human body
  3. Alleviates common side-effects of pain — including insomnia, depression, and anxiety
  4. Reduces the underlying causes of arthritis pain — one of the most common causes of pain
  5. Regulates nerve cell health & regeneration — which may offer support for pain associated with ALS, multiple sclerosis, PMS, endometriosis, fibromyalgia, and more

How to Use CBD Oil For Pain

CBD is a great natural painkiller, but only if used correctly.

1. Speak With Your Doctor

It’s important to follow a few key steps when using CBD to address pain symptoms. Anybody experiencing pain should first and foremost visit their doctor. Pain is a warning sign that something is wrong, so it’s important to get checked out to learn what’s causing the pain.

2. Use the Right CBD Products

Next, the right form of CBD should be used — this could involve CBD topicals, CBD oils, or CBD capsules. Generally speaking, topicals are best for muscle, joint, and skin-related pain, and internal CBD (oils, capsules, gummies, vapes), are better for all other forms of pain.

3. Find the Right Dose

After you decide what product to use, you have to find an effective dose (more on this later). You want to find a dose that provides the benefits you’re looking for, without going overboard. Too much CBD can make you feel drowsy or groggy, and not enough won’t provide relief from your symptoms.

4. Be Patient & Persistent With Your Dose

Once you find a product that matches the type of pain you’re trying to treat and identify an effective dose, the next step is to form a routine around using CBD. It can take several days or weeks to start feeling the benefits of CBD (depending on the type of pain). Most people will take two or three doses of CBD oils or capsules throughout the day (every 6 hours or so). For topicals, you may want to apply to the affected area even more frequently (every 3-4 hours).

5. Combine CBD With Other Pain-Relief Measures

For best results, CBD shouldn’t be the only step you’re taking to alleviate pain. You should seek advice for other forms of pain management and use CBD products merely to supplement these other changes. This could involve stretching or exercising, visiting a physiotherapist, eliminating potential pain triggers, and eating a well-balanced diet.

What Type of CBD Products Work Best For Pain?

Different forms of CBD are going to offer a different set of benefits toward pain management.

The main factor to consider when choosing what CBD products to use is the source of the pain. If pain is on the surface of the skin or in the muscles, a CBD topical is usually the best option. Pain originating from inside the body, such as PMS pain, cancer pain, or deep joint pain may be better addressed through a CBD oil or capsule instead.

1. CBD Oils & Tinctures For Pain

CBD oils and tinctures are an excellent option for pain management. They have a relatively fast onset of effects, keep for long periods of time, and doses are easily tweaked to fit the individual needs of the user.

To take CBD oils and tinctures, simply measure out the intended dose using the supplied dropper, and place under the tongue for fast onset of effects, or swallow for a slower onset of effects. 

The best CBD oils for pain come with a full-spectrum extract, and offer a high potency of active CBD.

2. CBD Capsules For Pain

CBD capsules are another popular method of consuming CBD — they’re convenient, have a long duration of effects, and come in virtually any potency you may need.

3. Topical CBD Products

Topical CBD products are best for pain involving the muscles, ligaments, and skin. It delivers the cannabinoids directly to the source of the pain. The main issue with topical CBD products is that they often aren’t strong enough to produce analgesic effects.

Always look for high-potency topical CBD products for treating traumatic injuries, skin conditions, or muscle injuries.

4. CBD Vape Oils & Vape Pens For Pain

Faster acting methods, such as CBD vape oils and vape pens are useful for sudden or recent onset of pain or flare-ups of chronic pain.

However, vaporization can be counterproductive for pain management in some instances in that it can irritate the lungs and increase inflammation in the body.

5. CBD Suppositories For Pain

CBD suppositories provide yet another option for patients for whom oral consumption is not recommended, such as those with gastrointestinal conditions who may have difficulty absorbing oral CBD, or for very young or elderly patients [15]. 

What’s the Dose of CBD for Pain?

The optimal dosage for CBD products can vary from person to person.

Most of the research investigating the effects of CBD on pain management recommends high doses. Lower doses may offer some benefit but it isn’t always reliable.

Therefore, it’s best to use medium or high strength doses when treating pain conditions. For especially difficult to treat pain, significantly higher doses may be necessary. It’s also beneficial in these cases to use CBD alongside other pain-management techniques.

General Dosage Guidelines for Pain Conditions

Low Strength CBDMedium Strength CBDHigh Strength CBD
• Mild muscle pain
• Psychosomatic pain
• Early-stage arthritis
• Moderate muscle pain
• Bone fractures
• Abdominal pain
• Arthritis
• Multiple sclerosis
• Ligament injuries
• Cancer pain
• Bone pain
• Severe muscle pain
• Arthritis

Using these general guidelines, you can determine roughly what dose you can expect in order to get the level of support you’re looking for.

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Different Types Of Pain & How CBD Works For Each

While pain can be described according to its qualities, such as sharp or dull, hot or cold, tingling, numb, etc. for treatment purposes pain is often divided into two categories, according to its cause:

There many different ways of classifying pain, depending on the location, how long the pain has been present, or its source:

  • Chronic Pain — pain that persists longer than 4 weeks
  • Acute Pain — pain that has been present for 4 weeks or less
  • Bone Pain — pain in the bones
  • Soft Tissue Pain — pain in soft tissues such as muscles and ligaments
  • Nerve Pain — pain originating from nerve damage or dysfunction
  • Referred Pain — pain felt in areas away from the site of injury
  • Phantom Pain — pain in a limb or organ that has been removed
  • Psychosomatic Pain — pain originating from psychological dysfunction
  • Breakthrough pain — chronic or acute pain that appears between scheduled medication use
  • Inflammatory pain — pain caused as a side effect of inflammation
  • Cancer pain — pain caused by cancerous tumor formation
  • PMS pain — pain from cramping caused during menstruation

1. CBD For Inflammatory Pain

Inflammation is a function of the immune system and is your body’s initial response to irritation or damage to the body’s tissues — like when the area around a scratch turns red and puffy.

The inflammatory process may occur in response to infection or physical injury (bumps, bruises, fractures) as well as to metabolic, degenerative, and autoimmune conditions.

When you suffer an acute injury, such as an ankle sprain, the inflammation is quite noticeable. But when inflammation occurs internally at lower levels in chronic conditions like irritable bowel syndrome, heart disease, or diabetes the signs can go unnoticed — potentially leading to substantial tissue damage.

There are two types of inflammatory pain:

A) Acute Inflammatory Pain

Acute inflammation is the first stage of inflammation. It comes on fast and ideally should go away quickly once the tissue is repaired. Inflammation lasting less than three weeks is considered acute.

This type of inflammatory pain involves swelling, inflammation, and migration of white blood cells into the affected area.

During this phase, pro-inflammatory molecules called cytokines are released, triggering a cascade of responses that result in swelling, redness, and heat in the injured area.

These same cytokines also activate pain receptors, which send pain signals to your brain.

B) Chronic Inflammatory Pain

This form of pain sets in when inflammation doesn’t resolve after a few weeks’ time. When this happens pain sensors often become hyper-reactive, leading to a heightened sensitivity to lower levels of pain — meaning the pain signal is triggered much sooner than it would normally.

Chronic inflammatory pain can result from autoimmune conditions, cardiovascular disease, type 2 diabetes, gastrointestinal disorders, and others [32].

Stopping chronic inflammation is an important step in alleviating chronic pain and a major target in pharmaceutical drug development. CBD has been shown to directly increase levels of anti-inflammatory cytokines (messenger molecules) and decrease levels of pro-inflammatory cytokines — thereby reducing inflammation [2].

2. CBD For Neuropathic Pain (Nerve Pain)

This type of pain arises when there’s damage to peripheral nerves, i.e. nerves outside of the spinal cord and brain. Peripheral nerve damage can result in persistent impairment of nerve function even after the nerve recovers from the original injury [3].

Causes for nerve damage may include:

  • Trauma or injury
  • Exposure to neurotoxic substances
  • Metabolic disorder (such as diabetes or cardiovascular disease)
  • Autoimmune disease (such as rheumatoid arthritis).

Similar to chronic inflammatory pain, neuropathic pain can cause hypersensitization to pain signals [3].

However, while chronic inflammatory pain usually responds well to anti-inflammatory medications, neuropathic pain does not. Instead, opiate-type drugs (Oxycontin, morphine), anticonvulsants, anesthetics, and antidepressants are often used to manage neuropathic pain [17].

These drugs may have significant side effects that can be intolerable for some patients, including:

  • Dizziness
  • Drowsiness
  • Impaired coordination
  • Impaired vision
  • Loss of memory
  • Impaired speaking ability
  • Increased susceptibility to viral infections [4,18].  

How CBD May Help With Neuropathic Pain

The endocannabinoid system controls the transmission of nerve pain at many different places along the pain pathway.

A) Reducing Pain Transmission

Control occurs at the sensory nerves responsible for transmitting the first pain signals from the damaged tissue, as well as areas within the central nervous system that control the amount of pain that reaches the brain [19].

One of the ways CBD and other cannabinoids reduce pain transmission is by activating glycine receptors in the spinal cord — which has inhibitory effects on pain messages [20].

If fewer pain signals reach the brain, we experience less pain.

B) Protecting Nerve Tissue From Damage

CBD also offers protective effects on the nerves, which may prevent or reduce nerve damage. This has been shown in research looking at the protective effects of CBD on chemotherapy-induced nerve damage [21].

C) Reducing Inflammation

Additionally, the anti-inflammatory effects of CBD may prevent inflammatory conditions from causing nerve damage — again, leading to less neuropathic pain [22].

D) Supporting Microglia in the Spinal Cord

CBD inhibits the activity of cells in the brain and spinal cord called microglia.

These immune system-derived cells are tasked with the job of protecting and supporting nerve cells and are known to accumulate in neuropathic pain syndromes. By inhibiting microglia CBD may prevent the neuropathic pain response from escalating [23].

Unlike some conventional pain medications, CBD doesn’t cause drug tolerance, a process in which the same dose becomes less effective over time, prompting the user to take progressively higher doses [5].

3. CBD for Chronic Pain

Chronic pain is a fancy word for long-term pain. It can suggest an underlying dysfunction of the tissue involved and can last anywhere from 6 months to years. Chronic pain is common and can be debilitating.

The longer the pain persists, the more it may become resistant to pain management techniques.

A 2008 review article investigated the effects of CBD and THC on chronic pain that was unresponsive to other medications. Researchers in this study concluded that CBD was an excellent pain-management tool for chronic pain, without any adverse side-effects [2].

4. CBD for Arthritis Pain

There are two main types of arthritis; osteoarthritis and rheumatoid arthritis. Although both stem from different underlying causes, both result in chronic pain. It can cause anywhere from mild, sporadic pain to severe, debilitating levels of pain.

CBD may reduce the pain involved with both forms of arthritis by blocking the inflammatory processes causing the problem and through analgesic effects acting in the spinal cord and brain.

For best results, it’s recommended to use CBD both internally and topically on the affected joints.

5. CBD For Fibromyalgia Pain

A challenging condition to treat, fibromyalgia involves chronic muscle and joint pain throughout the body, along with fatigue, sleep disturbances, and cognitive impairment. In a clinical trial, participants were given one of three forms of medical cannabis, one of which contained a high CBD:THC ratio of nearly 20:1 [30].

Results showed that none of the cannabis strains resulted in pain relief that was greater than placebo. However, a closer look at the study raises some questions about the effectiveness of its design. 

In this study, participants were given vaporized cannabis in four treatment sessions spaced at least two weeks apart. Since inhaled cannabinoids are rapidly absorbed but also rapidly cleared from the bloodstream, the inhalation method produces high peak levels but lower overall bioavailability compared to other delivery forms.

So, could a different delivery form or a more frequent dosing schedule that would raise and maintain blood and tissue levels of CBD produce different results for fibromyalgia patients? Possibly, but more research is needed to explore this effect.

6. CBD for Chemotherapy-Induced Pain

An animal study found CBD may prevent painful hypersensitization of nerve receptors to temperature and pressure, a side-effect from chemotherapy medications [10]. The study found that CBD alleviated pain by binding directly to serotonin receptors in the brain.

7. CBD for NSAID-Induced Chronic Pain

NSAIDs are a common class of anti-inflammatories like aspirin and ibuprofen.

Many kidney transplant patients experience chronic pain due to toxic effects to the kidneys of  NSAID — which they need to take following surgery.

In a small clinical trial, kidney transplant patients were given doses of 50 mg to 150 mg of CBD twice per day. Results showed partial to complete pain relief in the majority of participants within the first 15 days of the 3-week study [11].

Defining Pain — Where Does Pain Come From?

What is pain? Where does it come from?

The human body is filled with sensors designed specifically to sense damage — they’re called the nociceptors.

Whenever nociceptors detect damage, they transmit signals to the brain that we perceive as pain.

The system warns us when we’re in danger and reminds us to be careful around injured areas of the body to allow for recovery.

In most cases, pain is a good thing. Without it, we could easily cause irreversible damage to the body without even knowing it.

The problem with pain is that sometimes the signals sent by the nociceptors are unnecessary (no real damage is occurring), excessive (signals are much higher than they need to be), or go on for too long.

It’s under these circumstances that want to block out pain so that we may go about our daily life more comfortably.

Here’s how pain works.

Step 1: Painful Stimulus — The Cause of Pain

This is the cause of the pain. Special receptors in the skin and internal organs are activated whenever there’s damage in the area. They initiate the transmission of the pain signal towards the brain using the peripheral nerves.

Step 2: Pain Signal Travels to Dorsal Horn in the Spinal Cord

The peripheral nervous system meets the spinal cord — the start of the central nervous system. The pain signal must pass through a region called the dorsal horn. This is the region where compounds such as endorphins and opiate medications are used to limit the intensity of the signal.

Step 3: Pain Signals are Sent to the Brain

Any pain signals that make it past the dorsal horn make their way to the thalamus in the brain where it’s processed and sent to higher brain regions. It’s these higher brain regions that perceive the pain.

Pain and Your Brain – How Pain is Amplified by the Central Nervous System

When pain persists and becomes chronic the interpretive mechanisms in your brain can go awry — leading to hypersensitization, amplification of pain messages, and worsening of chronic pain symptoms [6].

Referred to as maladaptive pathological changes [7] this process can cause physical changes in your brain, evidence of which has been demonstrated on neuroimaging studies showing reduced connectivity between areas of the brain and spinal cord where pain messages are processed [6].

This essentially means the more pain you feel, the easier it is to feel pain again, i.e., the threshold is lowered, so small triggers can lead to inappropriate pain responses.

Impaired nervous system communication reduces your body’s ability to interpret and respond to pain appropriately, resulting in increased activity of the inflammatory cascade. This shows up on laboratory tests as elevated levels of pro-inflammatory signaling molecules and decreased levels of pain-inhibiting molecules like IL-10 [6].

These changes are most evident in neuropathic pain syndromes but have also been found to occur in chronic inflammatory conditions. In these types of conditions, pain can persist even after inflammation has been brought under control [7].

Pain and Your Emotional State: How Anxiety & Depression Cause & Compound Chronic Pain

Pain, anxiety, and depression are intricately intertwined — they often occur together.

While it’s easy to see how chronic inflammatory or neuropathic pain can lead to anxiety and depression, the reverse can also occur. These negative emotional states can cause physiological changes in the brain and body that promote pain.

This makes managing pain much more complicated because now there’s also an emotional aspect to consider.

Anxiety & Pain: Fanning the Flame

Chronic pain sufferers often become anxious about their condition. Once anxiety sets in it activates the stress response resulting in elevated levels of stress chemicals — notably cortisol and pro-inflammatory cytokines.

Studies show these stress chemicals may cause pain-processing areas of the brain and spinal cord to become hypersensitive to pain messages — a condition known as anxiety-induced hyperalgesia [24].

This essentially means when we’re stressed we experience more inflammation and feel more pain.

Depression & Pain: A Self-Perpetuating Cycle

The relationship between depression and chronic pain may be mutually reinforcing.

Chronic pain can cause depression by inhibiting secretion of dopamine [25], a neurotransmitter responsible for feelings of reward and accomplishment — such as when you perform well in school or at work, or successfully complete a marathon (or a 5K).

Conversely, depression, i.e. low dopamine, has been found to suppress activity in certain areas of the brain that inhibit pain messages, resulting in heightened pain perception [26].

To boil it down, pain causes depression by lowering dopamine levels — and low dopamine causes pain by suppressing areas of the brain responsible for controlling pain.

How CBD May Help With Anxiety & Depression

There’s promising evidence that CBD offers benefits for treating complex pain syndromes involving anxiety and depression.

A large clinical study of psychiatric patients with anxiety and sleep disorders found that anxiety decreased and sleep quality improved significantly within the first month of CBD supplementation [27].

CBD has also been shown to decrease symptoms of depression in laboratory animal studies [28].

However, there’s still much to learn about the complex cause-effect relationship between pain, anxiety, and depression and CBD may prove helpful for some people, in this regard, but less so for others.

Does CBD Have Any Side-Effects?

Although CBD is proven to be highly safe many times over, it’s important to know about the potential side-effects it may produce. Everybody is different, and what works in one person doesn’t always work the same way for another.

  • Appetite Suppression
  • Diarrhea
  • Drowsiness
  • Dry mouth
  • Lightheadedness
  • Lower heart rate
  • Sedation

Conclusion: is CBD Effective for Pain?

CBD is an excellent option for people suffering from the pain of various causes. It’s especially useful for addressing pain brought on by inflammatory processes but is also useful for general pain.

It works at virtually all stages of pain transmission; directly at the site of injury, in the dorsal horn where the opioid receptors are found, and in the brain at the opioid and vanilloid receptors in the brain.

Most of the research involving CBD for pain management suggests a dose-dependent effect — meaning that the higher the dose you take, the more it inhibits pain sensations.

For best results, it’s recommended that you combine CBD use with other pain-reducing activities or supplements.

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