CBD and Pain – Can it help me?
Pain, especially chronic pain, is considered a silent epidemic in the UK.
The British Pain Society has carried out research that has revealed truly worrying results. Chronic pain affects more than two fifths of the UK population, meaning that around 28 million adults are living with pain that has lasted for three months or longer. A number far higher than most people would ever imagine.
The authors further discovered that 43% of the population experience chronic pain, with up to 14.3% living with chronic pain that is either moderately or severely disabling. Just think about the loss of productivity and impact on quality of life that these numbers represent.
Pain is a critical evolutionary development. Pain usually signals damaging stimulus and its role is to force us to quickly remove ourselves from this damage, for example, touching a hot stove. Genetic conditions in which people cannot feel pain are horrific with individuals injuring themselves frequently while remaining completely unaware of the damage. Pain, when functioning properly, is critical to our survival.
Yet, when pain gets out of hand, it can ruin our lives and make us desperate for relief.
There are many types of pain ranging from temporary acute pain to long term neuropathic and idiopathic pain and there are a multitude of ways to effectively combat pain including natural compounds, exercise and pharmaceuticals.
One compound which has shown particular promise in the management of pain is cannabidiol, a naturally occurring cannabinoid extracted from the cannabis plant. Cannabidiol is a non-addictive compound and a growing body of research suggests it may be useful in alleviating acute, chronic and neuropathic pain. Furthermore, commonly prescribed pain medications such as opioids are incredibly addictive and opioid abuse and opioid-related deaths are a serious public health concern in the USA. Cannabidiol may be the safe alternative people are looking for.
‘Cannabinoids exhibit comparable effectiveness to opioids in models of acute pain and even greater effectiveness in models of chronic pain’
-Fundamentals of Clinical Pharmacology, 2013 27(1), pp.64-80
Cannabidiol is growing in popularity. As research and high-quality controlled trials continue to support its use, we expect its popularity to soar and for pharmaceutical companies to develop stronger synthetic cannabinoids based on this research.
Types of Pain
There are many different types of pain each of with can be sub-categorised to help the medical community target treatment more effectively. Although listing all types of pain and their categories are beyond the scope of this article we have summarised the main types of pain below.
Nociceptive pain is caused by the activation of sensory nerve fibres usually at a specific site of damage. Throughout our lives this is the type of pain we are most likely to experience frequently. Examples would be curing your finger on a knife or stubbing your toe. Typically, this pain is acute and short-lasting; resolving fairly quickly as the healing process takes over. This sort of pain is called nociceptive as it is dictated by nociceptors throughout the body which can sense mechanical, chemical and thermal stimulus.
As nociceptive pain is often short-lasting (acute) and caused by superficial damage, many people may fore go pain management. Otherwise, the most common form of pain treatment would include anti-inflammatories and over the counter medications like Ibuprofen and Paracetamol. For more serious acute injuries like broken bones, opioid derivatives such as morphine and codeine may be required. Additionally, cannabidiol has shown promise in relieving pain from acute injuries, especially injuries with significant inflammation like swollen or twisted ankles.
Neuropathic pain is pain caused by damage or disease affecting the nervous system. As with most pain, pain classified as neuropathic can vary widely in cause and presentation,
Neuropathic pain may be associated with abnormal sensations (dysesthesia) or pain from normally non-painful stimuli (allodynia). People may experience pain constantly or in more episodic flare-ups. These episodes typically resemble stabbing feelings or electric shocks. General Common qualities of neuropathic pain include burning or coldness, “pins and needles” sensations, numbness and itching.
Shockingly, up to 7% of the European population is affected, and in 5% of persons it may be severe. Neuropathic pain may result from disorders of the peripheral nervous system or the central nervous system (brain and spinal cord). Therefore, doctors separate neuropathic pinto peripheral neuropathic pain, central neuropathic pain, or mixed (both peripheral and central) neuropathic pain.
Central neuropathic pain is most commonly found in individuals who have suffered spinal cord injury, multiple sclerosis, and some cases, strokes. Diabetes remains the most common cause of painful peripheral neuropathy, but other causes include herpes zoster (shingles) infection, HIV-related neuropathies, nutritional deficiencies, toxins , immune mediated disorders and physical trauma to a nerve trunk (an important, thick bundle of nervous tissue).
Chronic pain is a ‘catch-all’ term for pain typically lasting longer than 9-12 months. Chronic pain may originate in the body, or in the brain or spinal cord. It is often difficult to treat. Various nonopioid medicines are recommended initially, depending on whether the pain originates from tissue damage or is neuropathic.
Severe chronic pain is associated with increased 10-year mortality (increased risk of death 10 years after onset), particularly from heart disease and respiratory disease.
People with chronic pain tend to have higher rates of depression, anxiety, and sleep disturbances, which is not surprising based on how debilitating and distracting chronic pain can be. However, these are correlations and it is often not clear which factor causes another. Chronic pain may contribute to decreased physical activity due to fear of exacerbating pain, often resulting in weight gain. Pain intensity, pain control, and resiliency to pain are influenced by different levels and types of social support that a person with chronic pain receives. Chronic pain itself can be defined either as nociceptive (stemming from tissue damage and nociceptor activation) or neuropathic, stemming from malfunctioning or damage to the nervous system.
Chronic pain is an epidemic all over the world that we don’t talk about openly enough. Tens of millions of people suffer with some form of chronic pain in the UK alone. Thankfully, as modern medicine continues to improve and research reveals new therapeutic avenues for pain treatment, pain management options are at an all-time high; summarised in the next section below.
Having pain in any of its forms is horrible. There’s no two ways about it. But there are lots of ways in which pain can be combated and in time, significantly reduced helping to restore quality of life. We have summarised the top 4 ways people have successfully reduced their pain symptoms.
Below is not a list of wishy-washy remedies; these are evidence-based methods by which various types of pain can be reduced and more effectively managed.
There are a huge number of pharmaceutical options when it comes to pain management and pharmaceutical treatment is the most common way to manage pain by far. However, natural remedies such as cannabidiol are beginning to grow in popularity due to their effectiveness coupled with a relative lack of side effects.
This table below highlights the most common types of pain medication and the types of pain they are designed to combat.
Paracetamol and NSAIDS (non-steroidal anti-inflammatory drugs) like Ibuprofen remain some of the most widely consumed pain medications in the world. Paracetamol is commonly used to target pain and fever whereas Ibuprofen is generally taken for its anti-inflammatory effects i.e. when swollen or inflamed injuries occur. They are particularly effective when taken together as they target different physiological systems.
Opioids offer much more complete pain relief in comparison to shop-bought medication but come with significant drawbacks; the main being risk of addiction and physical dependency which is currently rampant in the USA due to the widespread use of medications like Oxycontin (oxycodone).
Pharmaceutical pain medications are a confusing science so always consult closely with your doctor when deciding what is right for you. If you are wary of side effects and want to try a more natural option, cannabidiol may be an appropriate option – detailed below in the next section.
Cannabidiol (CBD) is a natural compound extracted from the cannabis plant which has been used extensively for its therapeutic properties for thousands of years. CBD has no psychoactive components so does not get you ‘high’ and is not addictive. Cannabidiol interacts with the endocannabinoid system – a signalling system in the body that plays an important role in regulating mood, pain, sleep and many other processes.
Improper functioning of the endocannabinoid system has been linked to a number of disorders and cannabidiol appears to increase the effect of your body’s own cannabinoids, thus, helping to restore the system.
A growing body of pre-clinical evidence and self-assessment trials has shown that cannabidiol can produce marked improvements in pain management and tolerance in both acute and chronic models of pain.
‘The available evidence from animal and human studies indicates that cannabinoids can have a substantial analgesic effect’
-National Academy of Medicine
A number of studies over the last 5 years have highlighted the potential therapeutic value of cannabidiol:
- CBD was found to reduce inflammation and pain behaviours in a model of arthritis.
- Cannabidiol acts as a peripheral analgesic in a myofascial pain model – this suggests cannabidiol may provide analgesic relief for chronic muscle pain disorders such as fibromyalgia without central side effects.
- Cannabidiol can reduce nerve damage in models of osteoarthritis by reducing early stage inflammation – CBD may be useful in chronic inflammatory disorders to prevent tissue damage and to treat neuropathic pain in joints.
- Cannabidiol can reduce pain associated with cisplatin induced neuropathy in pain models – cisplatin is a common chemotherapy drug suggesting cannabidiol may find use as a pain treatment in cancer patients undergoing cisplatin chemotherapy.
Most research surrounding CBD has focussed on pain management and anxiety treatment, but pre-clinical data also suggests CBD may be useful in treating the symptoms of complex diseases including some forms of Parkinson’s Disease as well Multiple Sclerosis (MS); in fact the first official UK drug based on cannabis, Sativex, is designed to treat MS. As new data emerges we will summarise and discus the findings at the Dr.Eds Knowledge Hub.
The scientific literature continues to grow and the potential benefits of cannabidiol are beginning to be revealed clearly. We are learning not just that CBD can help with pain but HOW it helps.
Cannabidiol is available widely in the UK with the number of users growing at a rapid rate who mainly use CBD for the treatment of anxiety, chronic pain and inflammatory conditions. As the compound is affordable, non-addictive and derived (depending on brand) from natural products it is becoming an increasingly popular choice.
Cognitive behavioral therapy (CBT) does appear to help with pain management. When it comes to pain, the goal of CBT is to help patients understand the relationship between physiology, emotions and behaviour. Essentially, the idea is to stimulate positive decision making and helpful thought patterns to encourage healthy activities.
So, where’s the evidence that CBT can help with pain management?
Studies have demonstrated the usefulness of cognitive behavioural therapy in the management of chronic lower back pain; data shows that CBT produced significant decreases in physical and psychosocial disability. CBT is significantly more effective than standard care in treatment of people with body-wide pain, like fibromyalgia.
There is a reason the health care profession pushes exercise on to the public and their patients. The simple reason is that exercise is generally one of the best things for your mind and body. Not only does regular exercise stave off weight gain, which is itself linked to myriad physiological and cognitive disorders, it helps build muscle, strengthen the heart the lungs and also improves general mood and cognitive performance. The benefits of exercise are a settled science and no longer up for debate. Unless there are very specific medical reasons for someone not to exercise, then they should!
Just as exercise can help maintain and improve physical health across the board, exercise can also help with pain management. The physical approach to pain management includes exercise intervention as well as physical medicine and rehabilitation.
Physical medicine and rehabilitation employ a diverse set of physical techniques such as thermal agents and electrotherapy, as well as therapeutic exercise and sometimes even aspects of behavioural therapy. These may be coupled with conventional pharmacotherapy to treat pain, usually as part of an interdisciplinary or multidisciplinary program or they be undertaken on their own. A number of doctors (in the USA particularly) recommend that physical therapy and exercise be prescribed as an alternative to opioids for decreasing one’s pain in multiple injuries, illnesses, or diseases. The sort of pain targeted by physical exercise includes chronic low back pain, osteoarthritis of the hip and knee, or fibromyalgia but this list is by no means exhaustive. Exercise alone or with other rehabilitation disciplines (such as psychologically based approaches) can have a positive effect on reducing pain.
Physical activity interventions include tai chi, yoga and Pilates. All do these exercise systems are designed promote harmony of the mind and body through total body awareness; helping you understand the mechanics of your body. These practices incorporate breathing techniques, meditation and a wide variety of movements, while training the body to perform functionally by increasing strength, flexibility, and range of motion. Physical activity and exercise may improve chronic pain (pain lasting more than 12 weeks), and overall quality of life, while reducing the need for pain medications.]
That sums up our article ‘CBD and Pain – Can it help me?’ Pain comes in many different forms and identifying the type of pain you have is important if you want to tackle it effectively. There are a range of pharmaceutical, natural and psychological remedies to pain. Cannabidiol may be a useful addition to other pain management efforts or on its own and a growing body of scientific evidence suggests CBD is both anti-inflammatory and reduces symptoms of acute and chronic pain. This article is based on pre-clinical data, surveys and our experience; always speak to your doctor for professional medical advice.