Read all about the benefits of CBD for pain management, the types of CBD extracts available, and how it may help you with pain management and inflammation. CBD oil and other supplements containing cannabidiol are gaining popularity, but does CBD work for treating chronic pain? Cannabidiol in Anxiety and Sleep: A Large Case Series Cannabidiol (CBD) is one of many cannabinoid compounds found in cannabis. It does not appear to alter consciousness or trigger a “high.” A
7 Benefits of CBD for Pain Management
Move over, coconut oil: It’s time to share the spotlight with CBD. Now that CBD products are legal in states across the nation, you may have noticed how quickly acceptance of this once-controversial substance has spread. Many stores proudly display signs stating they sell CBD oil or capsules, and social media is filled with testimonials detailing how CBD helps people manage everything from anxiety to chronic pain. Tools for cbd products like a pocket size wooden hemp grinder, are also displayed from a cannabis dispensary. Some medical providers even sell CBD products to patients seeking a nonsurgical approach to pain relief.
But is CBD really worth the hype?
In many situations, yes, especially if you’re looking for a natural pain management solution. We’ve compiled seven benefits of using CBD for pain management below so you can check here and decide if cannabidiol extract is right for you.
1. CBD Comes in Many Forms
Hate swallowing pills or capsules? Many people take CBD orally, but that’s not your only option. You can also try tinctures or oils, vape CBD, gobble down edibles (like gummies from Westword.com), or massage CBD-infused lotion into your skin. Let’s do a brief rundown of each method below:
CBD Pills and Capsules
Pills and capsules are typically filled with a liquid version of CBD combined with a carrier oil, such as coconut oil. Depending on your digestive system, you can take CBD capsules with or without food. However, there may be a delay in symptom relief, as you have to wait until your body breaks down the capsule and distributes its contents.
You can get CBD pills without a prescription, but the FDA has approved a cannabidiol prescription drug called Epidiolex for epilepsy patients.
Oils and Tinctures
People who dislike pills often appreciate the convenience of tinctures that you ingest. Simply place a drop of the tincture under your tongue and wait for pain relief.
Oils are sometimes edible, but they’re generally designed for topical use. When using CBD for pain management, apply the oil where you have aches, burning, tingling, or stiffness.
Lotions and Creams
CBD lotions and creams are made for topical use. You can massage these products directly into your skin for fast-acting pain relief as well as skin-moisturizing benefits.
Gummies and Other Edibles
CBD edibles often come in candy form. You can find gummy bears, fruit chews, caramels, and chocolate with CBD on the ingredient list. Some people make their own edibles by adding food-grade CBD oil to brownies or cookie dough.
CBD for Vaping
Vaporized CBD oil goes straight from your lungs to your bloodstream, providing fast relief from painful symptoms. Be careful, though — vaping anything, even natural CBD oil, may still damage your health.
With so many options available, from pills to vaping, it’s easy to find a way to incorporate CBD into your pain management routine. If you aren’t sure which form of CBD is right for you, experiment with a few different types to figure out which offers the most benefits.
2. Different Types of CBD Extracts Are Available
Shopping for CBD products can feel overwhelming, and many people wonder: Are all these products the same, just with different labels? The answer is no, they’re not — and we’ll explain why.
Check out the label or ingredient list on the CBD product you want to try. You may notice terms such as full-spectrum, broad-spectrum, or isolate. These words describe the type of CBD inside.
Let’s quickly break down each term to help you choose CBD for pain management or other purposes:
Hemp Seed Oil
Despite common misconceptions, hemp seed oil is not the same as CBD oil, nor does it contain any phytocannabinoids. Hemp seed oil is derived from hemp seeds during a cold-press process. Hemp can be a part of a heart-healthy diet but look for another product if you actually want CBD.
As its name suggests, CBD isolate contains CBD. However, you won’t find any other phytocannabinoids in this simple compound.
Broad-spectrum CBD products are a step up from isolates. They contain all of a plant’s phytocannabinoids, but they don’t have any THC (the drug found in marijuana associated with causing a “high”).
Full-spectrum CBD products offer numerous nutritional benefits for your body. If you buy a full-spectrum product, you’re getting something derived from the entire cannabis plant, including the parts with THC, CBC, and CBG. These are phytocannabinoids that help reduce pain signals in the brain.
Nano CBD is made from shrunken molecules that are water soluble. It’s ideal for people who need an easy-to-digest CBD product that delivers nearly immediate symptom relief.
The form of CBD you choose depends on what you plan to treat. If you want to enhance your overall well-being, choose a full-spectrum or broad-spectrum product. Topical isolates may work well for patients who just want to manage pain in a specific location.
3. CBD Helps Reduce Joint Inflammation
If you’ve read some of our other blog posts, you may remember that inflammation is the culprit behind numerous symptoms and conditions we treat at Northeast Spine and Sports Medicine.
Wondering what that has to do with CBD?
Well, research indicates that CBD helps reduce inflammation in the joints, particularly when osteoarthritis is involved. The 2017 study found that not only does CBD help reduce pain, it also helps prevent nerve damage when administered via injections. Thwarting the development of nerve damage in arthritic patients may help stop the condition from worsening.
4. CBD Has Antifungal and Antibacterial Properties
If you’ve got slow-healing wounds from diabetes or other conditions, CBD may help enhance your recovery. CBD has antifungal and antibacterial properties, which can speed up your recovery time and also fend off infections.
When using CBD for wounds or blisters, you may want to apply it directly to the affected area rather than ingesting it. This helps create a protective barrier around the injured skin and ensure that nutrients are distributed where they’re needed most.
5. CBD Mimics the Effects of Prescription Pain Relief Medications
Like prescription medicines, cannabis works by activating receptors in your brain. When this happens, your receptors are basically saying, “Hey body, your pain is gone!” even if an injury or ailment still exists.
CBD isn’t just a brain-receptor manipulator, though. It has anti-inflammatory properties, so it addresses symptoms directly at their source rather than just masking your pain. Yes, you may experience relief before you’re fully healed, but CBD also helps your body repair itself.
6. CBD Treats Numerous Health Conditions and Concerns
Trouble sleeping? Stressed at work? Battling back pain?
CBD can help with all of these issues. You can also use CBD for relief from arthritis pain, foot pain, scratches and scrapes, headaches, and some digestive problems. CBD may even enhance your existing pain management treatments for sciatica and other hard-to-treat conditions.
Conflicting information is available about the benefits of CBD tinctures and capsules for cancer treatment. Speak to a medical provider before you replace your current treatments with CBD products.
7. CBD Is Easily Attainable
Now that many forms of CBD are legal options for pain management, it’s easy to find the types and formulas you need. You can order CBD online, get it from a health food store, find it at medical offices, or even get it at some pharmacies — without a prescription, of course.
CBD is often affordable when compared with other options for pain management, such as prescription pain pills and surgery, and no appointment is required before you purchase CBD.
Things to Consider Before Taking CBD for Pain Management
As we’ve described above, there are numerous benefits associated with using CBD for pain management, from its anti-inflammatory properties to its widespread availability. However, CBD is not for everyone, and there is a chance that you may experience side effects when using cannabidiol extracts.
Minor side effects include:
- Nausea or upset stomach
- Dry mouth
- Reduced appetite
Let your doctor know if you plan to combine CBD with prescription drugs, as there is a possibility for a negative interaction. CBD may interfere with your bloodstream if you take a blood thinner such as Coumadin, and it can also enhance the strength of some psychiatric medications — which isn’t necessarily a good thing.
At Northeast Spine and Sports Medicine, we understand the popularity of CBD for pain management, but we also realize cannabidiol extracts may not be an ideal choice for you. Give us a call to learn more about our other pain management services, whether you have a misaligned spine, aching knees, or activity-impacting joint pain.
Should You Take CBD for Pain?
People looking for a safer pain reliever are turning to cannabis-derived CBD. Michigan Medicine experts weigh in on what’s currently known about the trendy supplement.
Want to learn more on this topic? Listen to this podcast from the Rogel Cancer Center on Medical Marijuana for Cancer Patients.
CBD, short for cannabidiol, is undergoing a surge in popularity as the hot new supplement, with a promise to treat a variety of conditions including pain, anxiety, and insomnia, just to name a few. It’s also available in all manner of forms, from lotions and oils to CBD-infused food and drink. But does it work?
CBD is one of the compounds in the cannabis plant, better known as marijuana. Unlike the famous cannabinoid tetrahydrocannabinol (THC), CBD doesn’t cause the psychological effects typical of being “high”. Both CBD and THC act on the body’s natural endocannabinoid system, which plays a role in many processes including appetite, pain and memory.
The scientific evidence around CBD use is thin, a fact that is mainly due to politics. “Cannabis has been a Schedule 1 drug for a long time, which has limited the type of research needed to figure out how best to use it therapeutically,” says Kevin Boehnke, Ph.D., research investigator in the department of anesthesiology and the Michigan Medicine Chronic Pain and Fatigue Research Center. Under the U.S. Federal Controlled Substances Act, Schedule 1 drugs are defined as having no currently accepted medical use and a high potential for abuse.
Yet marijuana has been used as a medicinal plant for thousands of years, he notes. In fact, one of the first recorded uses of cannabis was for rheumatism, also known as arthritis. Cannabis products were widely used as medicines in the 19th and early 20th centuries, and were listed in the U.S. Pharmacopoeia before the onset of Federal restriction in 1937 under the Marijuana Tax Act.
Much of the research literature around CBD in particular supports its use as a treatment for childhood epilepsy. Indeed, in 2018 the FDA approved the CBD-based drug Epidiolex as a drug for childhood epileptic conditions. In a substantial policy shift, Epidiolex was designated as Schedule V, which is the least restrictive drug schedule and indicates little potential for abuse.
While there aren’t any published clinical trials on CBD in pain, Boehnke notes that ongoing preclinical studies in animals have demonstrated that CBD reduces pain and inflammation, and studies of CBD in humans show that it is well-tolerated and has few negative side effects. “There are also observational studies that ask why people use CBD and if it’s effective, and results tend to be quite positive. People report using CBD for anxiety, pain, sleep — all things that go hand-in-hand with chronic pain,” he says. The passage of the 2018 Farm Bill removed hemp-derived CBD (
So many people are turning to CBD as an alternative pain reliever, especially in light of the opioid crisis, that in a commentary published in Annals of Internal Medicine, Boehnke and Daniel Clauw, M.D., director of the Chronic Pain and Fatigue Research Center, provided advice for clinicians on how to counsel their patients about CBD and cannabis use.
LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily updates on iTunes , Google Play and Stitcher .
They also provided guidance for the Arthritis Foundation, who recently surveyed 2,600 people with arthritis and found that 29% currently use CBD to treat arthritis symptoms.
Boehnke and Clauw recommend that people with chronic pain talk to their doctor about adding CBD to their treatment plan, and continue to use their prescribed medication. They offer the following advice for people wanting to try CBD:
Don’t smoke or vape. Bottom line is smoking anything harms the lungs. Vaping has been associated with a recent epidemic of lung disease, according to the Centers for Disease Control & Prevention.
Purchase from reputable sources. Like vitamins and other supplements, CBD products aren’t regulated or FDA approved to treat disease, so buyer beware. Look for products that have been tested by an independent third party lab “so you don’t end up with a product that has THC in it or a product contaminated with heavy metals or pesticides,” says Boehnke.
Route of administration matters. CBD is best taken in pill or capsule form for slow extended release or as an oral tincture (infused oil that contains CBD) for faster effect onset.
Start low, go slow. Take a small amount and slowly increase your dosage until you start to get symptom relief over a matter of weeks. Track your symptoms to get a sense of whether or not CBD is a helpful part of your treatment plan.
Check your state laws. While medical marijuana is legal in many states, it’s still illegal at the Federal level, putting CBD in a legal gray zone in many areas.
Cannabidiol in Anxiety and Sleep: A Large Case Series
Cannabidiol (CBD) is one of many cannabinoid compounds found in cannabis. It does not appear to alter consciousness or trigger a “high.” A recent surge in scientific publications has found preclinical and clinical evidence documenting value for CBD in some neuropsychiatric disorders, including epilepsy, anxiety, and schizophrenia. Evidence points toward a calming effect for CBD in the central nervous system. Interest in CBD as a treatment of a wide range of disorders has exploded, yet few clinical studies of CBD exist in the psychiatric literature.
To determine whether CBD helps improve sleep and/or anxiety in a clinical population.
A large retrospective case series at a psychiatric clinic involving clinical application of CBD for anxiety and sleep complaints as an adjunct to usual treatment. The retrospective chart review included monthly documentation of anxiety and sleep quality in 103 adult patients.
Main Outcome Measures
Sleep and anxiety scores, using validated instruments, at baseline and after CBD treatment.
The final sample consisted of 72 adults presenting with primary concerns of anxiety (n = 47) or poor sleep (n = 25). Anxiety scores decreased within the first month in 57 patients (79.2%) and remained decreased during the study duration. Sleep scores improved within the first month in 48 patients (66.7%) but fluctuated over time. In this chart review, CBD was well tolerated in all but 3 patients.
Cannabidiol may hold benefit for anxiety-related disorders. Controlled clinical studies are needed.
The Cannabis plant has been cultivated and used for its medicinal and industrial benefits dating back to ancient times. Cannabis sativa and Cannabis indica are the 2 main species.1 The Cannabis plant contains more than 80 different chemicals known as cannabinoids. The most abundant cannabinoid, tetrahydrocannabinol (THC), is well known for its psychoactive properties, whereas cannabidiol (CBD) is the second-most abundant and is nonpsychoactive. Different strains of the plant are grown containing varying amounts of THC and CBD. Hemp plants are grown for their fibers and high levels of CBD that can be extracted to make oil, but marijuana plants grown for recreational use have higher concentrations of THC compared with CBD.2 Industrial hemp must contain less than 0.3% THC to be considered legal, and it is from this plant that CBD oil is extracted.3
Many different cultures have used the Cannabis plant to treat a plethora of ailments. Practitioners in ancient China targeted malaria, menstrual symptoms, gout, and constipation. During medieval times, cannabis was used for pain, epilepsy, nausea, and vomiting, and in Western medicine it was commonly used as an analgesic.4,5 In the US, physicians prescribed Cannabis sativa for a multitude of illnesses until restrictions were put in place in the 1930s and then finally stopped using it in 1970 when the federal government listed marijuana as a Schedule I substance, claiming it an illegal substance with no medical value. California was the first state to go against the federal ban and legalize medical marijuana in 1996.6 As of June 2018, 9 states and Washington, DC, have legalized recreational marijuana, and 30 states and Washington, DC, allow for use of medical marijuana.7 The purpose of the present study is to describe the effects of CBD on anxiety and sleep among patients in a clinic presenting with anxiety or sleep as a primary concern.
CBD has demonstrated preliminary efficacy for a range of physical and mental health care problems. In the decade before 2012, there were only 9 published studies on the use of cannabinoids for medicinal treatment of pain; since then, 30 articles have been published on this topic, according to a PubMed search conducted in December 2017. Most notable was a study conducted at the University of California, San Diego’s Center for Medicinal Cannabis Research that showed cannabis cigarettes reduced pain by 34% to 40% compared with placebo (17% to 20% decrease in pain).8 In particular, CBD appears to hold benefits for a wide range of neurologic disorders, including decreasing major seizures. A recent large, well-controlled study of pediatric epilepsy documented a beneficial effect of CBD in reducing seizure frequency by more than 50%.9 In addition to endorphin release, the “runner’s high” experience after exercise has been shown to be induced in part by anandamide acting on CB1 receptors, eliciting anxiolytic effects on the body.10 The activity of CBD at 5-HT1A receptors may drive its neuroprotective, antidepressive, and anxiolytic benefits, although the mechanism of action by which CBD decreases anxiety is still unclear.11 CBD was shown to be helpful for decreasing anxiety through a simulated public speaking test at doses of 300 mg to 600 mg in single-dose studies.12–14 Other studies suggest lower doses of 10 mg/kg having a more anxiolytic effect than higher doses of 100 mg/kg in rats.15 A crossover study comparing CBD with nitrazepam found that high-dose CBD at 160 mg increased the duration of sleep.16 Another crossover study showed that plasma cortisol levels decreased more significantly when given oral CBD, 300 to 600 mg, but these patients experienced a sedative effect.17 The higher doses of CBD that studies suggest are therapeutic for anxiety, insomnia, and epilepsy may also increase mental sedation.16 Administration of CBD via different routes and long-term use of 10 mg/d to 400 mg/d did not create a toxic effect on patients. Doses up to 1500 mg/d have been well tolerated in the literature.18 Most of the research done has been in animal models and has shown potential benefit, but clinical data from randomized controlled experiments remain limited.
Finally, the most notable benefit of cannabis as a form of treatment is safety. There have been no reports of lethal overdose with either of the cannabinoids and, outside of concerns over abuse, major complications are very limited.19 Current research indicates that cannabis has a low overall risk with short-term use, but more research is needed to clarify possible long-term risks and harms.
Given the promising biochemical, physiologic, and preclinical data on CBD, a remarkable lack of randomized clinical trials and other formal clinical studies exist in the psychiatric arena. The present study describes a series of patients using CBD for treatment of anxiety or sleep disturbances in a clinical practice setting. Given the paucity of data in this area, clinical observations can be quite useful to advance the knowledge base and to offer questions for further investigation. This study aimed to determine whether CBD is helpful for improving sleep and/or anxiety in a clinical population. Given the novel nature of this treatment, our study also focused on tolerability and safety concerns. As a part of the evolving legal status of cannabis, our investigation also looked at patient acceptance.
Design and Procedures
A retrospective chart review was conducted of adult psychiatric patients treated with CBD for anxiety or sleep as an adjunct to treatment as usual at a large psychiatric outpatient clinic. Any current psychiatric patient with a diagnosis by a mental health professional (psychiatrist, psychiatric nurse practitioner, or physician assistant) of a sleep or anxiety disorder was considered. Diagnosis was made by clinical evaluation followed by baseline psychologic measures. These measures were repeated monthly. Comorbid psychiatric illnesses were not a basis for exclusion. Accordingly, other psychiatric medications were administered as per routine patient care. Selection for the case series was contingent on informed consent to be treated with CBD for 1 of these 2 disorders and at least 1 month of active treatment with CBD. Patients treated with CBD were provided with psychiatric care and medications as usual. Most patients continued to receive their psychiatric medications. The patient population mirrored the clinic population at large with the exception that it was younger.
Nearly all patients were given CBD 25 mg/d in capsule form. If anxiety complaints predominated, the dosing was every morning, after breakfast. If sleep complaints predominated, the dosing was every evening, after dinner. A handful of patients were given CBD 50 mg/d or 75 mg/d. One patient with a trauma history and schizoaffective disorder received a CBD dosage that was gradually increased to 175 mg/d.
Often CBD was employed as a method to avoid or to reduce psychiatric medications. The CBD selection and dosing reflected the individual practitioner’s clinical preference. Informed consent was obtained for each patient who was treated and considered for this study. Monthly visits included clinical evaluation and documentation of patients’ anxiety and sleep status using validated measures. CBD was added to care, dropped from care, or refused as per individual patient and practitioner preference. The Western Institutional Review Board, Puyallup, WA, approved this retrospective chart review.
Setting and Sample
Wholeness Center is a large mental health clinic in Fort Collins, CO, that focuses on integrative medicine and psychiatry. Practitioners from a range of disciplines (psychiatry, naturopathy, acupuncture, neurofeedback, yoga, etc) work together in a collaborative and cross-disciplinary environment. CBD had been widely incorporated into clinical care at Wholeness Center a few years before this study, on the basis of existing research and patient experience.
The sampling frame consisted of 103 adult patients who were consecutively treated with CBD at our psychiatric outpatient clinic. Eighty-two (79.6%) of the 103 adult patients had a documented anxiety or sleep disorder diagnosis. Patients with sole or primary diagnoses of schizophrenia, posttraumatic stress disorder, and agitated depression were excluded. Ten patients were further excluded because they had only 1 documented visit, with no follow-up assessment. The final sample consisted of 72 adult patients presenting with primary concerns of anxiety (65.3%; n = 47) or poor sleep (34.7%; n = 25) and who had at least 1 follow-up visit after CBD was prescribed.
Main Outcome Measures
Sleep and anxiety were the targets of this descriptive report. Sleep concerns were tracked at monthly visits using the Pittsburg Sleep Quality Index. Anxiety levels were monitored at monthly visits using the Hamilton Anxiety Rating Scale. Both scales are nonproprietary. The Hamilton Anxiety Rating Scale is a widely used and validated anxiety measure with 14 individual questions. It was first used in 1959 and covers a wide range of anxiety-related concerns. The score ranges from 0 to 56. A score under 17 indicates mild anxiety, and a score above 25 indicates severe anxiety. The Pittsburg Sleep Quality Index is a self-report measure that assesses the quality of sleep during a 1-month period. It consists of 19 items that have been found to be reliable and valid in the assessment of a range of sleep-related problems. Each item is rated 0 to 3 and yields a total score from 0 to 21. A higher number indicates more sleep-related concerns. A score of 5 or greater indicates a “poor sleeper.”
Side effects and tolerability of CBD treatment were assessed through spontaneous patient self-reports and were documented in case records. Any other spontaneous comments or complaints of patients were also documented in case records and included in this analysis.
Deidentified patient data were evaluated using descriptive statistics and plotted graphically for visual analysis and interpretation of trends.
The average age for patients with anxiety was 34 years (range = 18–70 years) and age 36.5 years for patients with sleep disorders (range = 18–72 years). Most patients with an anxiety diagnosis were men (59.6%, 28/47), whereas more sleep-disordered patients were women (64.0%, 16/25). All 72 patients completed sleep and anxiety assessments at the onset of CBD treatment and at the first monthly follow-up. By the second monthly follow-up, 41 patients (56.9%) remained on CBD treatment and completed assessments; 27 patients (37.5%) remained on CBD treatment at the third monthly assessment.
Table 1 provides means and standard deviations for sleep and anxiety scores at baseline and during the follow-up period for adults taking CBD. Figure 1 graphically displays the trend in anxiety and sleep scores over the study period. On average, anxiety and sleep improved for most patients, and these improvements were sustained over time. At the first monthly assessment after the start of CBD treatment, 79.2% (57/72) and 66.7% (48/72) of all patients experienced an improvement in anxiety and sleep, respectively; 15.3% (11/72) and 25.0% (18/72) experienced worsening symptoms in anxiety and sleep, respectively. Two months after the start of CBD treatment, 78.1% (32/41) and 56.1% (23/41) of patients reported improvement in anxiety and sleep, respectively, compared with the prior monthly visit; again, 19.5% (8/41) and 26.8% (11/41), respectively, reported worsening problems as compared with the prior month.