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The Empowered Pain Patient’s Guide to CBD

By Jennifer Lutz, Reviewed By Michael Gabay,PharmD, JD, BCPS

June 9, 2021

Tell me all I need to know about using cannabidiol for chronic pain.

When we talk about CBD, we are typically talking about CBD products, such as topical creams and ingestible oils that are created by extracting the CBD compound from the marijuana plant. Although some CBD products do contain small amounts of THC – which we will get to.

CBD has been shown to be:


  • anti-inflammatory, meaning it has potential to reduce joint pain associated with arthritis
  • anti-oxidative, so it may reduce systematic inflammation by fighting oxidative stress and decrease    symptoms of autoimmune conditions like lupus
  • anti-emetic, meaning it can decrease vomiting and nausea associated with cancer treatments
  • anti-psychotic, so it can ease symptoms of anxiety and post-traumatic stress disorder (PTSD)
  • neuroprotective, meaning it may help to slow the progression of neurological disorders such as Multiple Sclerosis (MS).

Specific conditions that may be helped by CBD include:


  • Anxiety
  • Cancer
  • Fibromyalgia
  • Irritable Bowel Syndrome
  • Migraine 
  • Multiple Sclerosis (MS)
  • Neuropathic Pain
  • Osteoarthritis
  • Post-Traumatic Stress Disorder (PTSD)
  • Rheumatoid Arthritis 
  • Seizures
  • Systematic inflammation

CBD Gets Complicated: It Differs From Medical

Marijuana and Hemp


Is CBD Actually Marijuana or Hemp, or Both?


● CBD is a cannabinoid found in marijuana plants that has many beneficial effects, without the 

psychotropic effects of its cannabinoid counterpart, THC.


● CBD can be derived from various varieties of the marijuana plant including both sativa and indica.


● Hemp is a species of the sativa marijuana varietal plant and has some unique features:

      – Won’t get you high
      – Contains 0.3% or less THC
      – Has limited chemical compounds
      – Is used to makes clothes and textiles
      – Is legally sold in many stores and online


● CBD derived from hemp is legal at the federal level. CBD derived from non-hemp marijuana is not legal at the federal level but is legal in certain states.


● CBD derived from hemp may lack certain compounds that some research suggests aids in medicinal benefits, something referred to as the entourage effect. To top it off, the entourage effect may further offer benefits that a CBD isolate doesn’t.


The Science Behind CBD: How It Works For Pain And

Pain-Related Symptoms


Your Natural Endocannabinoid System Supports CBD


Our body’s Endocannabinoid system is composed of three main components:


  1. Cannabinoid receptors, namely CB1 and CB2. CB1 receptors are predominantly found in the central nervous system (CNS, the nerves attached along the spinal cord and around the brain) and are largely responsible for the cognitive and emotional effects of marijuana, as well as our perception of pain. CB2 receptors are more common in our peripheral nervous system (PNS, the outer nerves beyond the spinal cord and brain such as those in your arms and legs, although these receptors may also be found in our CNS) and in your immune cells.
  2. Endogenous cannabinoids (the cannabinoids that your body produces)
  3. Enzymes that facilitate the breakdown and use of cannabinoids 


Our natural endocannabinoids function on demand, meaning that when our body senses inflammation, or needs to return to homeostasis (a state of stable balance) it will release endocannabinoids that bind to cannabinoid receptors.


CBD itself does not bind to receptors but is thought to work by inducing other components of the cannabinoid system.


In fact, CBD exerts a wide array of effects on the body’s central and peripheral nervous systems, as well as the immune system. It works in conjunction with our endocannabinoid system to function in an antioxidant capacity, to decrease inflammation, and to act as an analgesic or pain reliever. CBD may even slow the progression of osteoarthritis and prevent nerve damage, according to early model studies.


CBD’s Potential Benefits


Importantly, CBD is hydrophobic and lipophilic, meaning it will dissolve in fats. The dissolution helps it to be carried across the blood-brain barrier and affect your CNS, where it can have a broad range of positive effects on pain including:


● Reducing Pain Signals 
– CBD modulates pain and the sensation of pain by stimulating the reuptake of the neurotransmitter, adenosine, thereby boosting adenosine levels in the brain and inhibiting pain sensations. CBD may also block pain signals from reaching processing centers in the brain by binding to TPRV1, which is responsible for pain and inflammation.


● Increasing Immune Response 
– CBD can modulate the immune response by decreasing levels of pro-inflammatory cytokines and inhibits the proliferation of T cells that are indicated in autoimmune and systemic inflammatory disorders.


● Reducing Inflammation 
– CBD decreases oxidative stress and systemic inflammation by acting as an antioxidant. CBD may also decrease inflammation by preventing a reduction in micro elements like zinc and selenium, which are important actors for a balanced immune response, and may reduce neuropathic pain (such as fibromyalgia or neuropathic back pain) by countering hyperalgesia (an abnormally heightened pain response).


● Improving Mood and Sleep 
– Chronic pain can disrupt your daily life, relationships, work, and mental health. If you are facing anxiety, depression, insomnia, and fatigue – all common with chronic pain – CBD may help you relax or get the restful sleep you need. Note, however, that many studies that relate CBD to improved sleep focus on full spectrum CBD (described below) and it is thought that the entourage effect of THC (along with terpenes and other cannabinoids) is mainly responsible for aiding in sleep.


Having Those Hard Conversations About CBD Use


CBD is not marijuana – even though it can be derived from the marijuana plant. Still, some CBD products contain THC, and for some people these products may work better (remember the entourage effect). 

Overall, the risks of taking CBD are very low, and the rewards can be quite promising. Still, it’s important to remember that more research is needed to understand the full effects of CBD. Your treatment is a personal choice and for many, a personal journey.


CBD may help to reduce pain by acting on a variety of biological processes in the body. CBD has been shown to work as an anti-inflammatory, antioxidant, and analgesic. CBD may also reduce the anxiety that people living with chronic pain often experience.

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CBD Overview What is CBD? CBD, short for cannabidiol, is an active compound found in the cannabis plant. CBD will not get you high but may cause some drowsiness for some people. The CBD in most products is extracted from hemp, a variety of cannabis. Legally, CBD products may have up to 0.3% of THC, the active compound that gets people high. Does CBD help with arthritis? Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated in quality studies in humans. Anecdotally, some people with arthritis who have tried CBD report noticeable pain relief, sleep improvement and/or anxiety reduction. However, like any medication for arthritis, some people do not report any symptom improvements when taking CBD. Is CBD safe to use? Research evaluating the safety of CBD is underway. At this point very little is known about CBD use among people with arthritis. So far, no serious safety concerns have been associated with moderate doses. CBD is thought to have the potential to interact with some drugs commonly taken by people with arthritis. Talk to your doctor before trying CBD if you take any of the following: corticosteroids (such as prednisone), tofacitinib (Xeljanz), naproxen (Aleve), celecoxib (Celebrex), tramadol (Ultram), certain antidepressants, including amitriptyline (Elavil), citalopram (Celexa), fluoxetine (Prozac), mirtazapine (Remeron), paroxetine (Paxil), sertraline (Zoloft), and certain medications for fibromyalgia, including gabapentin (Neurontin) and pregabalin (Lyrica). In addition, CBD products can have up to .3% of THC by weight — not by dose — so taking too much of a product may still cause THC-type effects. Are CBD products legal? CBD products made from hemp are no longer considered Schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone. While you can legally purchase CBD products in nearly every state and online, their legal status may ultimately change at the state and federal level depending on how laws and regulations are developed and enforced. For example, a recent paper in JAMA Psychiatry reported that people taking a legal CBD product still had measurable quantities of THC in their urine, which could have employment repercussions. People who want to use CBD should check their state laws. Taking the First Step Should I give CBD a try? Without quality clinical studies on CBD and arthritis, doctors have not been able to say who might benefit from CBD, at what dose and in which form, who likely won’t benefit, and who should avoid it. Still, there is agreement on several points: CBD is not a substitute for disease-modifying treatment for inflammatory arthritis. Patients who are interested in trying CBD should first talk to the health care provider who treats their arthritis before trying CBD. Together, they can review what has worked or not worked in the past, whether there are other options to try first, how to do a trial run, what to watch for and when to return for a follow-up visit to evaluate the results. Keep a symptom and dose diary to track effects. Quality CBD products can be expensive, especially when used for prolonged periods. To avoid wasting money, be completely sure that the product is truly having a positive effect on symptoms. What type of product should I consider? CBD-based products can be taken orally, applied to the skin or inhaled. There are pros and cons for each. By mouth. CBD that is swallowed, whether in capsules, food or liquid, is absorbed through the digestive tract. Absorption is slow and dosing is tricky due to the delayed onset of effect (one to three hours), unknown effects of stomach acids, recent meals and other factors. Capsules can work for daily use after a safe, effective dose has been established. 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