The Use of Cannabis and CBD in Chronic Pain Relief

Historical Context of Cannabis Use for Pain Relief

The use of cannabis and cannabidiol (CBD) as a treatment for pain relief has its roots deep in history, dating back over 5,000 years. Throughout this vast period, various ancient cultures have utilized cannabis for its medicinal properties, particularly in addressing pain alleviation. In this section, we will explore the early medicinal applications of cannabis and examine how these historical findings have informed contemporary research into the potential of marijuana as an effective pain management tool.

Among the ancient cultures that recognized the analgesic properties of cannabis were the Indians, Chinese, and Egyptians. Each civilization produced extensive written records detailing the use of cannabis for various medical purposes, including pain alleviation. For instance, the Indian Atharvaveda, a sacred text from around 2,000 BCE, mentions the use of bhang, which is a combination of marijuana leaves and flowers, to not only alleviate pain but also treat various ailments such as fever and insomnia. Similarly, the ancient Chinese Nei Ching, believed to date back to 2,700 BCE, discusses the use of hemp seed and fibres in treating a wide variety of health issues. Even in ancient Egypt, the Ebers Papyrus, written in 1,550 BCE, mentions the use of cannabis to treat inflammation, pain, and other medical conditions.

These early medical applications in different cultures all speak to the recognition of cannabis’ potential for pain relief and suggest its efficacy in various medical contexts.

Over the ages, the understanding and use of cannabis for medicinal purposes have evolved and transformed. In the form of cannabidiol (CBD), the non-psychoactive component of cannabis, we have witnessed a growing interest in harnessing cannabis’ pain-relieving potential without producing the typical “high” associated with marijuana use. It is through their persistent recognition and documentation of cannabis’ analgesic properties throughout history that we stand on the shoulders of ancient wisdom when considering the evidence today. Cannabis and CBD continue to be researched and increasingly accepted as viable treatments for pain management, thanks to a legacy of knowledge and experience that extends thousands of years. To truly appreciate the present and future potential of cannabis as a pain management tool, it is imperative to understand and acknowledge its deep historical roots and the valuable lessons contained within them.

The Endocannabinoid System and Pain Relief

To understand the potential of cannabis for chronic pain relief, it’s crucial to delve into the endocannabinoid system (ECS), a complex cell-signaling system discovered in the early 1990s. This intricate network plays a significant role in regulating various bodily functions and maintaining overall balance, or homeostasis.

Understanding the Endocannabinoid System

The ECS consists of cannabinoid receptors, endocannabinoids (cannabinoids naturally produced within the body), and enzymes responsible for endocannabinoid synthesis and degradation. This system has been found to be involved in numerous physiological processes, such as:

  • Neurological functions: mood, memory, and cognitive processes
  • Emotional regulation: stress perception and emotional response
  • Gastrointestinal activity: motility, secretion, and visceral sensitivity
  • Immunological response: inflammation and immune modulation
  • Pain perception: the transduction and perception of pain signals

Endocannabinoids and their receptors are present throughout the body, including the central and peripheral nervous systems, the immune system, and various organs.

Cannabinoid Receptors and Endocannabinoids

The two primary cannabinoid receptors in the ECS are CB1 and CB2. While CB1 receptors are primarily located in the brain, spinal cord, and peripheral nervous system, CB2 receptors are predominantly found in immune cells. The ECS’s role in pain relief is largely mediated through these receptors.

Endocannabinoids produced by the body can bind to these receptors and regulate various physiological functions, including pain perception. When external cannabinoids from cannabis, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), are introduced into the system, they can interact with the cannabinoid receptors, potentially modulating pain and inflammation.

Interaction of Cannabis Components with the ECS

CBD interacts with the ECS through indirect mechanisms, as it does not bind directly to CB1 or CB2 receptors. Instead, it has been found to influence the release, degradation, or synthesis of endocannabinoids. This interaction may contribute to CBD’s anti-inflammatory and analgesic effects.

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THC, on the other hand, has a more direct interaction with the ECS through binding to both CB1 and CB2 receptors. THC is known for its psychoactive properties and has shown significant analgesic and anti-inflammatory effects, although it may also produce some unwanted side effects, such as euphoria and anxiety.

Role of the Endocannabinoid System in Chronic Pain Relief

The ECS plays a critical role in managing chronic pain by modulating pain signals and reducing inflammation. By interacting with cannabinoid receptors, cannabis components can potentially help alleviate chronic pain by targeting the ECS. This intricate system is at the core of the complex relationship between cannabis, cannabinoids, and the human body, making it essential to further research and understanding of cannabis’s potential in chronic pain management.

Cannabis and CBD as Alternative Treatments for Chronic Pain

The use of cannabis and CBD as alternative treatments for chronic pain is on the rise, driven by the desire for more natural and accessible options to manage pain without many of the unwanted side effects and potential for addiction associated with traditional pain management methods, such as opioids. As more people turn to cannabis and CBD for pain relief, the medical community is taking notice, with researchers working to better understand how these treatments can be integrated into the current landscape of chronic pain management.

Reasons Behind the Growing Interest in Cannabis and CBD

There are several reasons behind the increasing interest in cannabis and CBD for pain relief:

  • Natural Origin: Cannabis and CBD are plant-based substances that are seen as more “natural” alternatives to synthetic chemical pain medications, appealing to individuals who prefer a more holistic approach to health.
  • Fewer Side Effects: While all medications can have side effects, many users report fewer adverse effects with cannabis and CBD compared to opioids and other pharmaceutical options.
  • Reduced Potential for Addiction: Unlike opioids, which have a high potential for addiction and abuse, the risk of addiction and dependence is significantly lower with cannabis and CBD, making them more attractive to patients and healthcare providers concerned about the growing opioid crisis.
  • Complementary to Conventional Treatments: Some patients find that cannabis and CBD can be used in addition to or in place of some conventional treatments, potentially reducing the need for other medications, such as over-the-counter NSAIDs or prescription opioids.
  • Patient Quality of Life: Many users of cannabis and CBD report improvements in their overall quality of life, including better sleep, reduced anxiety, and a greater ability to engage in daily activities due to the pain relief provided.

Potential Advantages Over Conventional Methods

Cannabis and CBD offer some distinct advantages over traditional pain management options:

  • Diverse Mechanisms of Action: Cannabis and its compounds interact with the body’s endocannabinoid system, providing not only pain relief but also potential benefits in reducing inflammation and providing neuroprotection.
  • Customizable Experience: Cannabis and CBD can be administered in various forms that can be customized to individual patient needs, from inhalation methods to edibles, tinctures, and topicals.
  • Flexible Dosing: Patients can often titrate their doses of cannabis and CBD to find the most effective level of relief without the risk of an overdose that is associated with opioids.
  • Growing Medical Acceptance: The medical community is increasingly recognizing the potential benefits of cannabis and CBD for chronic pain, with more doctors and healthcare providers recommending these treatments to their patients.

Prevalence of Cannabis and CBD in Pain Management

The prevalence of cannabis and CBD in pain management is increasing, with many states in the U.S. and countries around the world legalizing their use for medical purposes, including chronic pain. This has led to a broader acceptance of these treatments within the medical community and has encouraged more research into their efficacy and safety.

As more research is conducted, the evidence supporting the use of cannabis and CBD for chronic pain management is growing. However, there are still challenges to overcome, such as the need for larger, more rigorous clinical trials, the inconsistency in regulatory policies, and the ongoing education of healthcare providers and the public on the proper use of these treatments.


Smoking cannabis is perhaps the most well-known method of consumption. It involves inhaling the active compounds and allows for a rapid onset of effects – usually within a few minutes. However, this method has some drawbacks, such as potential irritation to the respiratory tract and the risk of developing lung-related issues. It’s also not the most discreet method, making it less ideal for use in social settings or public places.


  • Rapid onset of effects
  • Natural and traditional method


  • Potential harm to the respiratory system
  • Involves smoking, which some users may prefer to avoid
  • Not discreet if worrying about stigma or unwanted attention


Vaping cannabis or CBD oil offers a similar rapid onset of effects as smoking, through a less harmful method. With vaping, the cannabinoids are heated to release their vapor without burning the plant material. This helps reduce the potential harm to the respiratory system. However, vaping devices can be somewhat expensive, and the technology may be intimidating for new users.

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  • Rapid onset of effects
  • Less potential harm to the respiratory system compared to smoking
  • Easier to customize serving sizes


  • Can be expensive, depending on the device used
  • Requires a learning curve for use


Cannabis tinctures are made by steeping plant material in alcohol, which extracts the active compounds. Tinctures are typically taken by placing a few drops under the tongue, where absorption into the bloodstream occurs rapidly. This results in a relatively quick onset of effects – usually within 15 to 45 minutes. Tinctures are discreet, easy to dose, and can be easier on the respiratory system compared to smoking or vaping.


  • Discreet and easy to use
  • Quick onset of effects, often within 15 to 45 minutes
  • Easy to control dosage


  • May have a less intense or long-lasting effect compared to other methods
  • Potentially less appealing taste for some users


Cannabis-infused food products, or edibles, are another popular method of consumption. Edibles allow users to avoid inhaling any substances and are less conspicuous than smoking or vaping. However, the onset of effects can take between 30 minutes to 2 hours, making it difficult to gauge the appropriate dosage for some users. Additionally, edibles can take longer to leave the system, which may be undesirable for those who want more short-term pain relief.


  • Does not involve inhalation
  • Discreet and odorless
  • Available in various forms (e.g., gummies, chocolate bars, brownies)


  • Slow onset of effects, often 30 minutes to 2 hours
  • Difficult to determine appropriate dosage due to delayed effects


Topical application involves the direct application of cannabis-infused creams, lotions, or balms to the skin. This method of consumption is suitable for localized pain relief and does not result in systemic effects or intoxication. However, it may not be effective for more widespread or systemic pain.


  • No psychoactive effects or intoxication
  • Non-invasive and easy to use
  • Ideal for localized pain relief


  • Relatively slow onset of effects, often requiring several minutes or longer
  • May not be effective for widespread or systemic pain

Each consumption method has unique advantages and disadvantages that could significantly impact the user’s experience. When selecting the best method, users should consider factors like onset time, duration of effects, potency, ease of use, associated risks, and personal preferences. Regardless of the chosen method, consulting a healthcare professional before starting any new pain management regimen is essential to ensure safe and appropriate use.

CBD vs. THC: What is Best for Chronic Pain Relief?

Both CBD (cannabidiol) and THC (tetrahydrocannabinol) can help in alleviating chronic pain, but their effects and modes of action are different. It is essential to understand their unique properties and their interactions with the endocannabinoid system, to determine which might be more suitable for specific pain conditions.

CBD (Cannabidiol)

  • Effects: CBD is non-intoxicating, which means it does not produce the characteristic “high” associated with THC.
  • Endocannabinoid system interaction: CBD primarily binds to CB2 receptors but also interacts with multiple other receptors, including serotonin and vanilloid, in addition to inhibiting an enzyme (fatty acid amide hydrolase) that breaks down endocannabinoids like anandamide.
  • Advantages: CBD is believed to have better anti-inflammatory properties compared to THC and offers potential benefits for stress, anxiety and epilepsy.

THC (Tetrahydrocannabinol)

  • Effects: THC is the primary psychoactive compound in cannabis and is responsible for the “high” that users experience.
  • Endocannabinoid system interaction: THC mainly binds to CB1 receptors in the brain, producing psychoactive effects and also interact with CB2 receptors.
  • Advantages: THC is known to have potent analgesic and muscle relaxant properties.

Using a Combination of CBD and THC

The use of both CBD and THC together may result in better outcomes for various pain conditions. Their differing effects can complement one another, creating a more balanced experience:

  • Synergy: CBD can counteract some of the potential negative effects of THC, such as anxiety and memory impairment, while THC may provide an additional analgesic effect.
  • Dosing: The appropriate ratio of CBD to THC will depend on individual needs, the type of pain, and desired levels of psychoactivity.
  • Formulations: Different cannabis products may offer different blends of these cannabinoids, allowing for personalized treatment options.

Understanding the unique properties, interaction, and potential benefits of CBD and THC can help individuals navigate the complex landscape of cannabis as a treatment for chronic pain. While more research is necessary to establish optimal dosages and formulations, many users may find relief through combining both CBD and THC for a more balanced and effective approach to managing their chronic pain.

Clinical Research and Scientific Evidence on Cannabis and CBD for Pain Relief

Current clinical research and scientific evidence on the effectiveness of cannabis and CBD for chronic pain relief are providing vital insights into the potential of these compounds as a viable treatment option. Let’s take a closer look at some key findings from various studies and clinical trials.

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Benefits of Cannabis and CBD for Pain Relief

A growing body of research supports the idea that cannabis and CBD may help alleviate chronic pain symptoms. For instance, a systematic review by the National Academies of Sciences, Engineering, and Medicine (NASEM) found “conclusive or substantial evidence” for the effectiveness of cannabis in treating chronic pain in adults. The review examined more than 10,000 scientific abstracts and included 12 individual studies.

Another meta-analysis published in the Journal of Pain found that patients who used cannabinoids such as THC or CBD together with their pain medication experienced notable improvements in pain relief compared to those who only took their medication.

CBD Specific Research

CBD, specifically, is gaining attention for its pain-relieving properties without the psychoactive effects associated with THC. A randomized controlled trial on the effectiveness of CBD for chronic pain, published in the European Journal of Pain, found patients with neuropathic pain experienced significant reductions in their pain levels after using topical CBD.

In 2018, the United States Food and Drug Administration (FDA) approved Epidiolex, a CBD-based medication for the treatment of seizures associated with specific forms of epilepsy. Although the approval was not for pain management, it still demonstrates the potential therapeutic benefits of CBD.

Challenges and Limitations in Clinical Research

While the evidence suggests a possible role for cannabis and CBD in pain management, there are still significant challenges and limitations to current research.

One issue is the quality and consistency of dosing in the clinical trials. A report by the National Academies of Sciences, Engineering, and Medicine (NASEM) highlighted this concern, noting that better-designed clinical trials are needed to establish dosage standards and potential side effects.

Regulatory barriers also contribute to the challenges in researching cannabis and CBD for pain relief. Due to its classification as a Schedule I drug under the Controlled Substances Act, cannabis has limited access for research purposes. This classification can hinder the progression of further clinical trials.

Additionally, research has mostly focused on short-term outcomes rather than long-term effects. A systematic review published in the Journal of Pain found the majority of studies were short-term, limiting our understanding of the long-term safety and efficacy of cannabis and CBD in chronic pain management.

Challenges and Future Directions of Cannabis and CBD in Chronic Pain Management

As the benefits of cannabis and CBD for managing chronic pain become increasingly acknowledged, there are still numerous obstacles to overcome before they become widely accepted as standard treatment options. This section will explore some of these challenges and discuss potential future directions for research and implementation.

Ongoing stigma associated with cannabis

Since its classification as a Schedule I substance under the Controlled Substances Act of 1970, cannabis has been subject to a significant social and cultural stigma. Many people continue to view cannabis as a harmful drug with little medicinal value, or believe that its use may lead to more dangerous substance abuse. This stigma can hinder the willingness of physicians and patients to consider cannabis as a legitimate treatment option, especially in conservative or more highly regulated regions.

It is essential to address and counteract this stigma through education and awareness campaigns, which can highlight the scientific evidence supporting cannabis’s use for pain relief, as well as distinguish between the medical use of cannabis and its recreational use.

Regulatory barriers

One of the primary obstacles to wider acceptance and use of cannabis and CBD for pain relief is the regulatory landscape, which varies significantly between countries, states, and even regions. While some countries have loosened restrictions on cannabis, it remains classified as a controlled substance in many others. This lack of consistency can limit the availability and accessibility of cannabis-based treatments for chronic pain sufferers.

As research continues to demonstrate the potential benefits of cannabis and CBD for pain management, it is crucial that regulatory bodies reevaluate the classification and legal status of these substances to ensure that patients have access to a range of effective treatment options.

Inconsistent dosing and lack of well-designed clinical trials

One of the significant challenges in implementing cannabis as a chronic pain management treatment is the lack of standardized dosing guidelines. Due to regulations and stigma, well-designed clinical trials on cannabis and CBD are relatively limited, making it difficult for researchers and healthcare professionals to determine the optimal dosage for various conditions and patients. This uncertainty can deter some physicians from prescribing cannabis-based treatments, and may make it more challenging for patients to find a consistent, effective regimen.

In order to bridge this knowledge gap, it is essential to invest in more well-designed clinical trials and create standardized dosing guidelines based on the available data. Such efforts should be prioritized to improve patient access to safe and effective treatment options.

Future directions in research and potential breakthroughs

Given the potential of cannabis and CBD in pain management, continued research in this area is needed to better understand the mechanisms of action, the most effective formulations, and the long-term safety of these substances. This involves:

  • Studying the mechanisms of action of different cannabinoids in pain management
  • Investigating potential synergistic effects between cannabinoids, terpenes, and other compounds found in cannabis
  • Exploring the use of cannabis and CBD in combination with traditional pain management methods
  • Evaluating the efficacy and safety of various delivery methods (smoking, vaping, tinctures, edibles, topicals, etc.)

Ultimately, addressing the challenges and guiding the future research will help establish cannabis and CBD as a legitimate, effective tool in the treatment of chronic pain. By focusing on education, awareness, improved clinical trials, and progressive regulation, we can help pave the way for a future where cannabis-based treatments play a significant role in pain management.

Category: Pain

  1. Ronald Amaya, PA-C is a Physician Assistant. He attended Weill Cornell Medical College and received his physician assistant degree in NYC. He has 18 years of experience in cardiothoracic surgery and over 8 years in pain management. Dr. Amaya is NCCPA board-certified in medicine and surgery.

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  2. Paulette Scott, MD is a pain management specialist. Dr. Scott is also the pain management representative at East Boston Neighborhood Health Center, Boston. She fulfilled her physical medicine and rehabilitation residency at Long Island Jewish Medical Center and completed her fellowship in pain management at Harvard Square Clinic. Dr. Scott is board-certified in physical medicine, rehabilitation, and pain management.

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  3. Andrew D. Bunn, MD is a pain management specialist. Dr. Bunn also serves as the co-director of East Boston Neighborhood Health Center, as well as the Program Director for Lahey Hospital & Medical Center and Newborn Services | MassGeneral Hospital for Children. After earning his medical degree from Drexel University College of Medicine, he completed his anesthesia residency at Perelman School of Medicine at the University of Pennsylvania where he also completed his fellowship in pain management. He is board-certified in both anesthesiology and pain management.

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  4. David D. Ford, MD is the Director of Pain Management. Dr. Ford earned a medical degree and completed his residencies in both surgery and anesthesiology. He joined the staff of Harvard Vanguard Medical Associates Watertown in 1990. He is board-certified in both anesthesiology and pain management. Dr. Ford specializes in painful disorders of the spine and sports-related injuries. He has initiated the use of advanced interventional techniques for the successful treatment of these and other conditions.

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