The People's Perspective on Medicine

Will Cannabidiol Relieve Chronic Pain?

Readers report success using cannabidiol to relieve chronic pain, but scientists contend that more research is needed to establish efficacy and safety.

People with chronic pain often have difficulties trying to get relief. Doctors used to prescribe narcotics, but the opioid crisis has made many physicians reluctant to do so. NSAIDs, either prescription or OTC, can help alleviate acute pain. It isn’t clear, however, that they are especially helpful for chronic pain. In addition, NSAIDs can cause serious side effects if they are taken for long periods of time. As a result of these problems, many people have begun to wonder whether medical marijuana or the cannabis component cannabidiol (CBD) could relieve chronic pain.

CBD to Relieve Chronic Pain:

Q. My husband has an implanted morphine pump to treat chronic pain. He’s used it for ten years now.

Recently, his doctor suggested CBD. He has had the doctor turn his pump down 15 percent at every refill visit since then, and he has not been suffering with pain.

The pills are a bit pricey, but we’ve also had success with less expensive oil which he can take by the teaspoon. CBD does not make you high.

A. Cannabidiol is a natural compound that can be found in both marijuana and hemp plants. As you state, CBD is not psychoactive. The FDA has approved a purified form of CBD (Epidiolex) for hard-to-treat childhood epilepsy

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What Does Science Say About CBD for Pain?

So far, scientists have not done definitive studies on using CBD for pain. Nonetheless, some clinicians suggest that research would be welcome, particularly for treating cancer pain (Current Opinion in Oncology, online Feb. 14, 2019). Others doubt that it will prove very useful (Clinical Journal of Oncology Nursing, April 1, 2019). We are glad it has worked for your husband to relieve chronic pain. 

This is not the first time we have heard from a reader about using CBD to relieve chronic pain. One reader found that taking CBD oil triggered a positive drug test for marijuana.

Cannabinoids for Back Pain:

Q. The discs and vertebrae in my spine are degenerating and causing me severe pain. I started taking CBD oil for pain a few months ago.

Once it had time to build up in my system, the pain relief was miraculous. Sadly, I recently did a home drug test and it was positive for THC. I need to talk to my doctor because I have no idea how to address this. It’s legal to buy CBD oil OTC in my state, but there’s no way to prove it is the source of any THC in my test.

A. Cannabidiol (CBD) oil is legal in many states because it does not make people euphoric. It is not supposed to have any tetrahydrocannabinol (THC) in it. THC is the compound that produces a marijuana high. State by state regulation means that anyone who wishes to use this compound for pain relief will need to become familiar with the relevant laws of that state.

The FDA has approved one purified form of cannabidiol as a prescription anticonvulsant medication, Epidiolex. Research on CBD oil suggests some benefit against pain and inflammation (Molecules, online, Sept. 27, 2018).

Side Effects of Cannabidiol:

People using cannabidiol have reported fatigue, nausea, diarrhea and irritability. People on the anticoagulant warfarin (Coumadin) should avoid cannabidiol, as it may raise blood levels of warfarin. Like grapefruit, CBD can inhibit the intestinal enzyme CYP3A4, which the body uses to process a wide range of medications (Current Drug Metabolism, 2016).

But Will It Lead to a Positive Urine Test for Marijuana?

Unfortunately, certain CBD manufacturers are not able to remove all traces of THC. One study found that some people tested positive for THC after taking CBD oil (Journal of Pain Research, Feb. 12, 2016). ConsumerLab.com has written that people taking CBD oil aren’t likely to fail a marijuana drug test, but it is not impossible.

Other Readers Relate Their Experience:

J offered this explanation:

“I believe it depends on the source of the CBD as to whether you will test + for THC. My understanding is this: CBD from a marijuana source, for example Charlotte’s Web products, must have less than .03% THC per (federal?) guidelines. If ingested (drops, capsules, gummies), this will show + on a drug test. It did for me.

“CBD from hemp is not supposed to test positive. I haven’t tested this, yet.

“There are many products, with more arriving daily. Always check for quality-control certification.”

Carole reported:

“I started taking CBD oil for alleviation of back pain, neck and knee pain and hoped it would help neuropathy. To my surprise, it helped and really stopped IBS. It’s not quite enough to fix the pain, but it does help. I hate being high and have never had a problem. Eventually, I believe the recreational use will come. Michigan is already working on it. If it does, there will have to be rules as there are with alcohol use. In my opinion, we haven’t scratched the surface of the medicinal uses for this plant.”

Dave said:

“CBD oil has been an effective alternative to taking NSAIDs for my rheumatoid arthritis. In the four months I’ve been using it, I’ve had to supplement it on only four occasions with acetaminophen. That’s a heck of a lot better than tearing up my gut with other drugs.”

Not everyone can give up on other drugs completely. George reported a downside from testing positive for THC:

“I test positive for pot in a urine test at my local VA Hospital when I’m using CBD oil. The VA will not prescribe pain meds if you have a positive test.”

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • Lossignol, "Cannabinoids: A new approach for pain control?" Current Opinion in Oncology, online Feb. 14, 2019. DOI: 10.1097/CCO.0000000000000523
  • Hande, "Cannabidiol: The need for more information about its potential benefits and side effects." Clinical Journal of Oncology Nursing, April 1, 2019. DOI: 10.1188/19.CJON.131-134
  • Bruni et al, "Cannabinoid delivery systems for pain and inflammation treatment." Molecules, Oct. 2018. doi: 10.3390/molecules23102478
  • Zendulka et al, "Cannabinoids and cytochrome P450 interactions." Current Drug Metabolism, 2016. DOI : 10.2174/1389200217666151210142051
  • Wertlake & Henson, "A urinary test procedure for identification of cannabidiol in patients undergoing medical therapy with marijuana." Journal of Pain Research, online Feb. 12, 2016. doi: 10.2147/JPR.S96856
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A friend gave me some CBD capsules to try for my chronic pain, but when I investigated purchasing them, I found they are incredibly expensive. Apparently the seeds for the plants that have the highest levels of CBD are very costly, and the harvesting of just the flowers for the oil is labor intensive.

I have actually had more success with using black seed oil capsules (nigella sativa), which are also much less expensive. Had a reduction in pain levels that was very impressive.

I’m a 64 yo male in good(ish) health. I’ve been taking CBD oil for the past 2 months to alleviate pain associated with cervical spondylosis and a herniated L5/S1 disc. I can’t really tell yet if it makes a difference. I’m taking 1,000 mg per day but I haven’t been religious about it. I’ve been using it as needed (like an aspirin). But based upon other comments I’ve read in this stream it seems maybe I need to take it everyday, and let it build up in my system. If I take it right before bed, it keeps me awake and gives me unpleasant dreams when I finally do fall asleep. I also take zoloft and synthroid, and I’ve noticed no interaction with those two medications.

How long must you use CBD cream before it relieves arthritis hip pain?

I am a no-user of marijuana. I hate the smell of people smoking it. I have known so many people that have abused it and have lost all of their ambition to do anything. However, I have had chronic back pain, and when I have to use my back as in yard work, it really kills me.

Someone gave me a CBD roll-on, and it sat in the drawer for a very long time. However, my back was hurting so badly that I decided to give it a try. I was amazed. The pain almost stopped immediately. I could not believe how quickly it worked.

I started using CBD and THC tincture and topicals for chronic pain, anxiety and peripheral neuropathy. My husband and I read everything we could find on interactions with medications including a book about all types of uses for marijuana. Finding NOTHING about interactions with marijuana and cardiovascular disease and medications for CAD, I began to use a tincture and a topical. I started out slowly with small doses.

After about 2 months I began to experience cardiac symptoms, chest pain, return of arrhythmia, and shortness of breath. Disappointed, I stopped all use of tinctures, and the symptoms went away. After further research we found a few studies warning people with arrhythmia and/or cardiac problems to not use marijuana. However, with the knowledge of my Coumadin clinic pharmacist, I have continued to use topical CBD for my peripheral neuropathy, and while it doesn’t cure the horrible pain, it does relieve it. Since stopping the tinctures we have found several studies that indicate THC and CBD can exacerbate heart disease, even one report of death published by Harvard Medical School. But then there are studies that report CBD is not a problem. For me, I’m staying away from tinctures, capsules and oils. But will continue to use topical CBD. It was such a disappointment because I was using less pain medication and anti anxiety meds.

Always check with a doctor or pharmacist before using CBD oil. A lot of common medications interact with it: Drugs metabolized by CYP450 enzymes could potentially interact with cannabidiol (CBD). According to the Indiana University Department of Medicine, drugs known to use the CYP450 system include:

Steroids
HMG CoA reductase inhibitors
Calcium channel blockers
Antihistamines
Prokinetics
HIV antivirals
Immune modulators
Benzodiazepines
Antiarrythmics
Antibiotics
Anesthetics
Antipsychotics
Antidepressants
Anti-epileptics
Beta blockers
PPIs
NSAIDs
Angiotension II blockers
Oral hypoglycemic agents
Sulfonylureas

When taking CBD extracted from hemp isolate you will not test positive for THC. When taking a full spectrum product there is a slight possibility of a positive result.

I’ll hazard a guess here and say as soon as somebody figures out how to patent marijuana and can then charge “whatever they want” for it, legalization will swiftly follow. We have hundreds of drugs, many quite expensive, of very dubious efficacy flooding the market now. It is all about the money.

I am taking eliquis for atrial fibrillation. Is CBD oil contraindicated with this? I have looked on the web and can find no definitive answer.

We didn’t find anything definitive either, but it looks like a bad idea to combine them:
https://cbdeducationonline.com/cbd-and-eliquis/

Will CBD oil affect the amount of anesthesia one needs in surgery? Your earlier article indicated that marijuana lowers the effect of anesthesia used in surgery.

This is a good question that doesn’t seem to have been well studied. It appears that CBD may have a “grapefruit effect” so you should ask the anesthesiologist before you have surgery.

As someone who has used several brands and is a distributor for a reputable brand, CBD from hemp can have THC, as by U.S. law Hemp can have .3%. (THC is one of several cannabinoids in hemp and marijuana.) Many brands offer CBD isolate products, having zero THC in them. Always ask for the Certificate of Analysis (COA) of any brand you are purchasing. It will tell you exactly how much THC, if any is in the product. Also note, Hemp Oil is not the same as CBD oil. Although nutritious, it would be similar to olive oil or sesame oil. CBD Oil will say how many milligrams of CBD in each serving on the label.

I’m sorry but if something helps with chronic pain, the last thing the patient needs is “further study.” Big pharma is running scared at the thought that such a simple remedy could punch a hole in their profits.

Broke my wrist. Vaped CBD for the pain, and it worked well. Also worked for dry socket pain after wisdom tooth extraction. This is great stuff, but if you’re going to vape, make sure you buy organic hemp CBD (with no THC) that doesn’t have PG or VG in it so that your lungs stay healthy.

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