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Pain relief is one of the most popular and sought after uses of CBD. But pain is a very complex and individual experience and two people who experience the same level of injury will often describe their pain quite differently, including expressing very different levels of pain. Not to mention there is a myriad of different types and causes of pain. All of which raises the questions:  What gives CBD its pain-relieving abilities and is CBD as effective as it is reputed to be?

How Does CBD Alleviate Pain 

Reducing Pain By Reducing Anxiety

As a cannabinoid, CBD acts through CB1 receptors, which are present throughout your body’s pain pathways, to inhibit release of excitatory neurotransmitters that heighten your awareness of pain. Activation of these neurological alarm bells increases the amount of pain you feel and creates a memory that can provoke anxiety about the painful experience[1]. CBD has been found to extinguish ingrained memories of pain that cause anxiety and hypersensitivity when the same or a similar painful experience recurs. Its ability to alter these types of negatively reinforcing cycles is one of the ways CBD has been reported to help sufferers of PTSD[2].

To further help reduce the anxiety that contributes to the heightened pain response, at the same time as CBD prevents overexcitation, it activates release of several important calming neurotransmitters within the memory and emotion parts of your brain: GABA[1], glycine[1] and serotonin [3,4].

Functional magnetic resonance imaging (fMRI) studies have confirmed CBD’s pain-reducing activity by showing that cannabinoids reduce the connectivity within the pain pathways of the brain. This is a useful way to trick your brain because if your brain doesn’t perceive pain messages it’s as if they don’t exist.

Outside of the brain, cannabinoids reduce the stress response to pain by reducing the release of adrenaline[1].

 

How Does CBD Alleviate Pain - InfographicsQuelling Inflammation

Pain and inflammation go hand in hand, so that anything that reduces inflammation will also short circuit the signaling mechanism that leads to pain. CBD does this by activating CB2 receptors, which reduce the inflammatory component of nerve pain[1]. This helps to stop the crescendo of reactions that trigger pain and then amplify and perpetuate it.

Specifically, CBD has been shown to inhibit one of the main inflammatory signaling molecules, known as TNF-alpha[5]. This signaling molecule is released when cells are damaged and it activates your body’s acute inflammatory response[6]. Some experts feel that inhibiting TNF-alpha makes CBD potentially useful for hard-to-treat pain conditions, such as rheumatoid arthritis[5]. And it might be safer than non-steroidal anti-inflammatory drugs (NSAID’s) which can cause ulcers.

One particularly challenging area of pain research is in patients undergoing cancer chemotherapy. Drugs used for this purpose are highly toxic to nerves, which often results in peripheral neuropathy, characterized by inflammation, hyperexcitability, and pain. In some cases these nerve effects don’t resolve completely, leaving patients with permanent nerve damage. CBD has been found, in preliminary animal studies, to prevent hypersensitization of nerves from some, but not all, forms of chemotherapy and it does so through multiple different receptors[7]. CBD also works synergistically with THC, through the entourage effect to prevent chemotherapy-induced nerve pain.

 

Speaking of the Entourage Effect…

If you use a full-spectrum CBD product the entourage effect of non-CBD cannabinoids may enhance the pain-relieving effects of CBD. Cannabichromene, or CBC, the third most prevalent cannabinoid in hemp plants, has been found to alter the activity of certain protein molecules involved in pain mechanisms, thereby reducing pain levels[8]. CBD and CBC also increase levels of endocannabinoid molecules (the cannabinoids your body produces) in an area of the brain that suppresses the outgoing pain messages from your brain to your body.

Another cannabinoid known as cannabigerol, or CBG, increases activity of the calming neurotransmitter GABA by preventing it from being broken down, and CBG has been found to be more effective at this than either CBD or THC, leading researchers to speculate that it might, in the future, prove to be useful as a muscle relaxant[6].

Additionally, some terpenes contribute pain relieving benefits. Myrcene, for example, has analgesic and anti-inflammatory effects and one called β-caryophyllene has anti-inflammatory activity that is equivalent to a NSAID commonly used in veterinary medicine to treat pain and fever in animals[6].

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References:

  1. Current evidence of cannabinoid-based analgesia obtained in preclinical and human experimental settings. Eur J Pain, 2018. 22(3): p. 471-484                                https://www.ncbi.nlm.nih.gov/pubmed/29160600
  2. Cannabidiol as a Therapeutic Alternative for Post-traumatic Stress Disorder: From Bench Research to Confirmation in Human Trials. Front Neurosci, 2018. 12: p. 502                                        https://www.ncbi.nlm.nih.gov/pubmed/30087591
  3. Cannabidiol inhibits paclitaxel-induced neuropathic pain through 5-HT(1A) receptors without diminishing nervous system function or chemotherapy efficacy. Br J Pharmacol, 2014. 171(3): p. 636-45                                                                                  https://www.ncbi.nlm.nih.gov/pubmed/24117398
  4. The Cannabinoids Delta(8)THC, CBD, and HU-308 Act via Distinct Receptors to Reduce Corneal Pain and Inflammation. Cannabis Cannabinoid Res, 2018. 3(1): p. 11-20                                                https://www.ncbi.nlm.nih.gov/pubmed/29450258
  5. Cannabinoids in Pain Management and Palliative Medicine. Dtsch Arztebl Int, 2017. 114(38): p. 627-634                                                                                                                                                            https://www.ncbi.nlm.nih.gov/pubmed/29017688
  6. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag, 2008. 4(1): p. 245-59                                                                                                                                                                         https://www.ncbi.nlm.nih.gov/pubmed/18728714
  7. Single and combined effects of Delta(9) -tetrahydrocannabinol and cannabidiol in a mouse model of chemotherapy-induced neuropathic pain. Br J Pharmacol, 2017. 174(17): p. 2832-2841                https://www.ncbi.nlm.nih.gov/pubmed/28548225
  8. Non-psychoactive cannabinoids modulate the descending pathway of antinociception in anaesthetized rats through several mechanisms of action. Br J Pharmacol, 2011. 162(3): p. 584-96                                                                                                  https://www.ncbi.nlm.nih.gov/pubmed/20942863