mpowered Pain Management for the Informed Patient

Chronic pain and its appropriate management is a large and growing issue in our country. With wide ranging effects on physical, mental and emotional health, chronic pain must be treated, yet guidelines for optimal treatment are allusive. Many turn to opioids as an effective option, but this course of treatment is not without significant risk. The well documented negative downstream impacts of opioid overprescription are clear for all to see, with new CDC data indicating that 75, 673 individuals died from opioid overdose in the 12-month period ending in April 2021. For those who must use opioid medications to alleviate chronic pain, living with the specter of potential opioid addiction adds a significant burden to the management of their pain. An alternative to the traditional opioid medication treatment plan for pain management is desperately needed, and cannabis is poised to offer solutions as a complementary treatment. In this article, we’ll dig deep into the science behind the cannabinoid CBD found in the cannabis plant in order to better understand how it might offer relief for those managing chronic pain.


The Body Maintains Homeostasis Through the Endocannabinoid System

In order to understand how CBD and the body work together to reduce pain, a basic understanding of the body’s endocannabinoid system (ECS) is helpful. For an in depth guide to the ECS, head to our Cannabis Academy article on this topic. The name endocannabinoid comes from the combination of the words “cannabinoid” and ”endo”. “Cannabinoid” refers to cannabis compounds, and “endo” is short for “endogenous”, meaning naturally occurring or produced by the body. With these definitions in mind, we see that “endocannabinoid” is essentially a fancy way of saying cannabis-like compounds naturally produced by the body.

The body’s endocannabinoid system consists of three parts: endocannabinoids, receptors in the nervous system that endocannabinoids and cannabinoids bond with, and enzymes that facilitate the breakdown of endocannabinoids and cannabinoids. The primary purpose of the ECS is to help the body maintain homeostasis. Homeostasis is the state the body aims to maintain for optimal function and stability. By keeping a variety of bodily functions within a certain range, your body maintains homeostasis, much the way the engine of your car shouldn’t exceed a certain temperature for optimal function. Examples of functions your body is constantly monitoring in order to maintain homeostasis include core body temperature, hormone levels, and heart rate. The body calls on the ECS to right the ship when bodily functions move outside of the optimal range for homeostasis. It does this through cannabinoid receptors that exist in tissues throughout the body. CB1 receptors are primarily present in the central nervous system contained in the brain and nerves of the spinal cord. CB2 receptors are found in the peripheral nervous system which exists throughout your digestive system, and certain cells in the immune system. When the ECS is activated, it functions extremely precisely, only targeting the functions that need regulating without impacting other functions of the body. After the endocannabinoids have regulated the functions in need of support, enzymes break down the residual endocannabinoids to ensure all functions stay in balance – homeostasis.


The Endocannabinoid System and Pain

So what does all this have to do with CBD and pain? Cannabis compounds such as CBD stimulate activity in the ECS. Research studies have provided evidence that CBD can provide pain relief through its interactions with the endocannabinoid, inflammatory and nociceptive body systems. When the body experiences events that trigger inflammation and cause pain, it produces endocannabinoids in response in order to achieve homeostasis. In the case of chronic pain though, the ECS can become deficient at regulating the perception of pain. This can result in a suboptimal experience for the individual experiencing inflammation, as the sensation of pain will be more intense than is ideal. When CBD is introduced into the body from an outside source such as a supplement, tincture, gummy, or topical cream, the CBD is supported by the ECS while working in conjunction with the central and peripheral nervous systems through CB1 and CB2 receptors. This interaction allows CBD to support the work of the ECS, creating a cascade of events in the body that reduces inflammation and relieves pain.

Research also indicates that CBD may boost the effects of the endocannabinoid AEA, which reduces pain. The sensation of pain and pain itself are also modulated by CBD through the reuptake of the neurotransmitter adenosine in the brain. This reuptake process boosts adenosine levels in the brain, subsequently inhibiting the sensation of pain. Some studies also indicate that CBD may block pain signals before they can reach the brain’s processing centers. This happens when CBD binds to a compound called TPRV1 that causes pain and inflammation.

 The evidence presented above demonstrates the clear potential for pain relief through CBD’s interaction with the ECS and other bodily systems. But CBD can also support pain relief by reducing bodily inflammation, a key contributing factor to chronic pain.




The Role of Inflammation in Chronic Pain

Inflammation and pain often go hand in hand. But let’s back up in order to get a better understanding of what inflammation is and why it causes pain. When the body experiences an injury, the immune system creates inflammation in order to defend the body and repair damage. When the inflammatory process is occurring, the body is removing harmful agents such as damaged cells, irritants, pathogens, bacteria, or a virus. Let’s take the example of an injured knee. When the body works to heal the knee injury through the inflammatory process, symptoms like joint pain, sensitivity, and redness will often occur. This is because the immune system is working in conjunction with the ECS to clear out damaged cells and repair tissues through increased blood flow.

Inflammation can be acute or chronic. Acute inflammation is characterized by a rapid onset of symptoms that often subside within a few days to a few weeks. It can be caused by a large number of things, but common causes of acute inflammation are intense exercise, muscle strains and sprains, cuts and scratches, and irritated tissue such as sore throat from a cold. Chronic inflammation differs from acute inflammation in that it can last for months or years. There are many reasons chronic inflammation may occur, but often it is the result of acute inflammation insufficiently destroying the root cause of bodily harm. An example of this would be if the aforementioned knee injury never healed correctly. This would result in the buildup of scar tissue, and the chronic sensation of pressure and pain. Acute inflammation can also be caused by the immune system attacking itself, resulting in autoimmune conditions such as fibromyalgia. Sometimes chronic inflammation occurs because an individual is chronically exposed to a low intensity irritant without awareness that this agent is causing inflammation. This can happen when someone has an undiagnosed allergic or high sensitively to common foods, or chemical agents commonly used in personal care products.


Inflammation will often result in discomfort, pain, stiffness, and irritation. Many individuals who experience chronic inflammation will also experience chronic pain as a side effect. This pain can feel like a dull throb, or a pulsating pain, and will often wax and wane in intensity. The buildup of tissue that occurs with inflammation is usually the cause of the pain (think of the knee injury again). As the tissue builds up, it presses against nerve endings, sending pain signals to the brain. If this pressure persists (chronic inflammation) the ECS will do its best to modulate the perception of pain, but as we discussed in the previous paragraph, it often falls short of total pain relief. In order to achieve total relief of pain, the body needs anti-inflammatory assistance.


CBD is a Powerful Anti-Inflammatory

Research on CBD as an anti-inflammatory suggests that CBD could be a powerful anti-inflammatory. The mechanism through which CBD reduces inflammation is multifaceted, and research is ongoing to determine the exact process through which this occurs. However, studies on animals have found that CBD reduces inflammation by modulating activity of the body’s endocannabinoid receptors. When CBD interacts with neurological receptors in the spinal cord, chronic inflammatory pain is suppressed. In a 2017 study, researchers found that CBD offered relief of both acute and chronic inflammation in animals with osteoarthritis, and a 2009 study also found that CBD may greatly reduce acute inflammation. The one, two punch of CBD is its ability to act as an anti-inflammatory powerhouse and pain reliever. By addressing the source of chronic pain through its anti-inflammatory components, CBD offers lasting relief without the harsh side effects of traditional pain medications.



Dosage and Use

Research suggests that the ideal dosage of CBD for pain relief is between 6 – 65 mg of CBD. Studies show that some individuals who consume more than 65 mg of CBD (respective to their weight and tolerance) experienced an increase in pain symptoms. Similarly, study participants who took less than 6 mg of CBD did not experience any relief of pain symptoms. The form in which you consume CBD for pain relief should be considered in order to ensure maximum bioavailability of CBD in the body. To learn more about this topic, see our article on CBD for pain – bioavailability, form, and spectrum specifics. (will link to when it’s posted)