“For the relief of certain kinds of pain, I believe, there is no more useful medicine than Cannabis within our reach,” wrote Sir John Russell Reynolds.
In 1859, Sir Reynolds was physician to Queen Victoria, neurologist, and a pioneer in epilepsy research.  As a matter of fact, cannabis was utilized for relieving pain conditions in all of the major ancient civilizations from Asia through the Middle East and into Europe and the Americas. The amount of research published in the medical literature over the past several decades and in recent news has proven cannabis is a safe and effective analgesic for a variety of types of pain.
Pain is, by far, the most common reason people seek out to find cannabidiol (CBD) today. The same is actually true for cannabis in general. In the United States, over seventy million people suffer from chronic pain; which in definition, is described as experiencing over one hundred days per year of pain. This is incredibly alarming, as most forms of medications used to treat such pain, like opioids, come with corrosive side effects, addiction, and heavy withdrawal symptoms. A high price to pay for pain management.
Physicians have defined pain into two types, neuropathic (typically chronic), and nociceptive (usually time-limited), with cannabis having the ability to bring relief to most types of both. A variety of studies have shown that the endocannabinoid system (ECS) is both centrally and peripherally involved in the processing of pain signals.  Most conversations about treating pain with CBD recommend getting the dosing right is the most critical component. Cannabinoids have been utilized alongside opioid medications with a variety of studies showing they can reduce the amount of opioids needed, and also lessen the buildup of tolerance, including reducing the severity of withdrawal (of which opioids are extremely difficult to abstain from once addicted, and they are highly addictive).  (See our article on addiction and withdrawal). There have been a minimum of ten studies completed thus far on over one thousand patients that have shown cannabinoids’ efficacy in the treatment of neuropathic pain of from a variety of origins.
Research surrounding CBD suggest in some people it can provide a sense of full body relaxation, which can feel like a bit of a non-intoxicating high. In other words, it can make you feel good, in part due to its ability to increase anandamide concentrations. Anandamide is also referred to as the "bliss" molecule. Research shows it can also assist with relieving symptoms of anxiety and depression.
In your search for knowledge, just remember that the information contained in this article is considered useful for informational purposes only and is not considered medical advice. Our policy is that prior to making changes to your lifestyle or treatment plan, or exploring the use of cannabidiol or medical cannabis products, always consult with your doctor. At the same time, educated and aware person’s, may become their own highly informed health consultants.
CBD products with a ratio of 20:1 or higher and given as capsules, drops or edibles can be very powerful as an anti-inflammatory, for assisting with pain, especially forms that involve inflammation. Many conversations surrounding treating pain with cannabidiol recommend that getting the dosage right is the most important factor. Which can involve adjusting based on body weight, past history, and pain severity. Always start with a micro dose to test for sensitivity and titrate up as needed until symptoms subside.
The micro to standard dose is typically recommended to treat pain, but people need to carefully watch their status and try different approaches and strains to get the formula right for them; 10-40 mg of CBD or CBD+THC together is generally enough.
If a quality CBD-rich product is not enough to help with a particular condition, cannabis products with a higher ratio of THC are occasionally recommended to manage the pain better. For use during the day, stimulating, sativa strains with higher concentrations of the terpene myrcene can be added to the formula (see our guide on terpenes).
Typically, for pain, and more-so for evening and nighttime, indica strains are preferred for their relaxing, sedative effect (see our article on sleep, and also anxiety). Someone who has no prior experience with THC should use caution and titrate slowly up to higher doses (along with starting on a micro dose to test for sensitivity). Generally speaking, a ratio of 4:1 CBD:THC seems to be the most effective for both neuropathic and inflammatory pain. Everyone is different, however - because for some people, a 1:1 ratio of CBD:THC is better, whereas for others, a high-THC strain is superior when it can be tolerated. Each person’s sensitivity and tolerance will differ, and through titrating up the dose, finding the right strain, and ratio combination, the formula can be found. In some people, the higher CBD ratio is more appropriate due to CBD's ability to neutralize the psychoactive side effects of THC.
In conditions involving inflammation of the joints, CBD has shown efficacy as a potent anti-inflammatory with people often reporting improved mobility, joint stiffness and less pain while being able to decrease their use of NSAIDs under the guidance of their doctor (for more see our article on arthritis).
CBD and tetrahydrocannabinol (THC) aren’t the only cannabinoids that have been found to provide pain relieving effects; CBG, CBC, THCV, and THCA are also potent analgesics. Combining cannabinoids and terpenes can create synergy and provide additional pain relief. Cannabis strains high in the terpenes myrcene, linalool, and beta-caryophyllene can increase the effectiveness of other cannabinoids for more potent analgesic effects. Keeping in mind, the side effects of CBD are few, and it is generally well tolerated in most people.
For immediate relief of symptoms, such as in a flare up of pain, smoking or vaporizing CBD-rich cannabis works well. The effect is immediate and lasts one to three hours, whereas most ingestible cannabis items take thirty to sixty minutes before taking effect (faster on an empty stomach) and last six to eight hours. Vaporizers utilizing a CO2 concentrate are highly effective and can be found in a variety of CBD to THC ratios pending the country in which you reside and the legal status of cannabis. Herbal vaporizers that use the whole plant are another effective delivery method. Sprays or sublingual tinctures taken as liquid drops also absorb quickly and can last longer in the body than inhaled products.
Topical CBD products can be used when the pain experienced is local in nature, such as in the case of a painful joint or skin irritation. These can be made from both CBD or THC dominant strains. Topicals affect the cells near application and through several layers of tissue but they don’t cross the blood-brain barrier and are, therefore, not psychoactive. These can be found as balms, oils, salves, ointments, and other forms, with a variety of ratios of CBD to THC (ratios of 1:1 are generally considered ideal for skin application). The skin contains the higher concentration and amount of cannabinoid-2 (CB2) receptors in the body.
If the pain is chronic and wide spread across different parts of the body, a tincture can be of value, whereas for more immediate relief in a localized area, a balm, lotion, or cream can be helpful for mild pain.
The Cannabis Health Index is a scoring system for cannabis (in general, not just CBD) based on the best available evidence present in the medical literature to date. Considering the many studies that have been completed, well over fifty (for various forms types of pain), cannabis is shown to have a high rating of likely-probably efficacy. It is one of the best-substantiated medical uses of cannabinoids.
Drugs that are metabolised in the liver by the family of enzymes P450 (CYP) such as Warfarin, Theophylline, Clobazam, and Valproate should not be taken with CBD. As always, consult with your doctor prior to making changes to your treatment plan.
A cannabis-derived pharmaceutical with a 1:1 ratio of CBD:THC called Sativex, has been approved in a number of countries for use to treat specific forms of pain. A variety of randomized clinical trials have shown the efficacy and safety of Sativex for treatment of peripheral and central neuropathic pain (see our article on neuropathy), cancer pain (see our articles on cancer, and chemo-related nausea), and rheumatoid arthritis (see our article on rheumatoid arthritis). 
Cannabinoids affect the transmission of pain signals from the affected region to the brain (ascending) and from the brain to the affected region (descending). A study from 2011 demonstrated that CBC and CBD activated descending pain-blocking pathways in the nervous system and caused an analgesic effect by engaging with several target proteins involved in nociceptive control. The authors of this study concluded that cannabinoids “might represent useful therapeutic agents with multiple mechanisms of action.”  The next year, scientists discovered that CBD greatly suppressed chronic inflammatory and neuropathic pain without causing any noticeable analgesic tolerance in animals.  This is extraordinary, as many commonly used analgesic drugs, such as opioids, not only create a tolerance in the users, which means they need to take more and at stronger doses to maintain the same result, but they also come with disastrous addictive and withdrawal side effects. Later, in 2013, the same science team of the 2011 study concluded that people with chronic pain prescribed hydrocodone, were less likely to take the painkilling drug if they used cannabis, which is no surprise, given just how powerful a painkiller cannabis has been proven to be. 
To learn more, find our previous article on hemp derived cannabinoids for pain relief.
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1. J. Russell Reynolds, “On Some of the Therapeutical Uses of Indian Hemp,” in Archives of Medicine, vol. 2 (London, 1859), 154.
7. M. DeGeorge, E. Dawson, P. Worcester, L. Burke, and K. Bronstein, An Analysis of the Association between Marijuana Use and Potential Nonadherence in Patients Prescribed Hydrocodon (Baltimore: Ameritox, 2013), www.ameritox.com/wp-content/uploads/Ananalysisoftheassociation-betweenmarijuanauseandpotentialnonadherence_AAPc20i013.pdf [inactive].
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