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CBD for pain relief: Does it work?

July 16, 2019 | UCI Health
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Google the term “CBD” and the search engine returns 200,000,000 links in less than a second. That’s a sure indication of the intense interest in the cannabis extract cannabidiol, or CBD.

CBD is being touted as a panacea for just about anything that ails you. Claims have been made that it lowers blood sugar, slows Alzheimer’s disease, cures cancer and alleviates a wide range of psychological problems from anxiety to depression, PTSD to psychosis. But few studies have been done on cannabis and CBD to prove its effectiveness.

“You can’t make those claims — most of it is just advertising,” says UCI Health pain medicine specialist Dr. Aaron J. Przybysz, who has a PhD in pharmacology and is an assistant professor of Anesthesiology & Perioperative Care at the UCI School of Medicine.

Effects on inflammation

“What we can say is that there is research demonstrating a reduction in inflammatory markers and pain with use of topical CBD oil in a rat model of arthritis.”

Dr. Brent Yeung, who also is a UCI Health pain medicine specialist, says another study reported that CBD injections into the joints of rat models with osteoarthritis “were helpful at reducing inflammation.”

Przybysz and Yeung, who are colleagues at the UCI Health Center for Pain and Wellness in Irvine, explain what we know about CBD and ways it may help ease pain.

What is CBD?

Cannabidiol is the second most abundant of more than 100 cannabinoid compounds in the cannabis plant and it is extracted as an oil. It does not have the psychoactive properties of tetrahydrocannabinol (THC), another compound found in cannabis that produces a high.

CBD affects the body’s endocannabinoid system, which regulates such functions as:

  • Appetite
  • Digestion
  • Inflammation
  • Memory
  • Mood
  • Pain sensation

Test-tube studies indicate that CBD works on endocannabinoid system receptors to decrease the body’s inflammatory response, explains Yeung, who also is an assistant professor of Anesthesiology & Perioperative Care.

Is CBD legal?

While cannabis and CBD are legal in California and some other states, the U.S. Food and Drug Administration (FDA) has only approved CBD for use in a prescription drug called Epidiolex, which helps reduce, and in some cases stop, the number of seizures in rare forms of childhood epilepsy, such as Dravet and Lennox-Gastaut syndromes.

The FDA does not recognize its use for the diagnosis, treatment or prevention of any other disease and has issued warning letters in recent years to companies marketing unapproved new drugs containing CBD.

This spring, the FDA issued warning letters to three companies for making “unsubstantiated claims” to market CBD as a potential anti-cancer agent and a treatment for Alzheimer’s disease, fibromyalgia and substance abuse.

Seeking evidence of effectiveness

The agency has created a working group and held a public hearing to consider the scientific evidence for the use of the cannabis extract and how best to ensure public safety.

Meanwhile, sales of CBD – in the form of gummies, creams, oils, teas and drops, among others – has become a billion-dollar business.

While they can’t prescribe it, Przybysz and Yeung say there is evidence that CBD may help to relieve inflammation and pain, such as with arthritis.

Przybysz says patients may also find CBD useful to reduce reliance on prescription narcotic pain medications and in combination with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin and ibuprofen.

How do you use it?

Because CBD products are largely unregulated, it’s hard to assess their quality. It’s also tough to decide which delivery system or product is likely going to be the most effective.

But here are some pointers:

  • Make your purchase through a certified dispensary. Look for manufacturers who use third-party testing to certify the amount and quality of CBD in their products.
  • Look for a pure, organically manufactured formulation of CBD oil.
  • A topical cream applied to affected areas may be helpful for localized pain while drops under the tongue are intended for more generalized pain.
  • CBD is easily absorbed by the body in these forms.
  • Smoking or vaporizing CBD oil has the most immediate effect, but also the shortest active time. Most doctors, however, discourage people from any form of smoking.
  • In terms of dosing, the mantra is start low and go slow. Incrementally increase the dose until you see an effect on your pain.

Are there side effects?

CBD’s short-term side-effects appear to be minimal. Some people may experience nausea, diarrhea and headache. Przybysz and Yeung suspect that the oil may be the culprit here rather than the CBD.

“I haven’t seen these side effects in my patients,” Przybysz says, noting that he’s discussed CDB use with as many as 100 patients. “I have seen improvements in functionality, decreases in pain and reduction in opioid use.”

Yeung says some of his patients have reported improved sleep with CBD use. It has helped others reduce reliance on opioids as well as withdrawal symptoms.

“But we must stress that many of the physiologic effects of CBD remain unknown and unproven,” he says. “More human studies must be done to substantiate CBD claims.”

The bottom line

Some research is ongoing into CBD’s effectiveness for a range of conditions from Crohn’s disease to rheumatoid arthritis, anxiety and depression.

Other studies also will have to determine appropriate doses, long-term side effects and negative drug interactions.

“I do tell people that we’ve had more than 47,000 opioid deaths in the United States in 2017 alone, but to my knowledge there has never been a death related to the use of CBD,” Przybysz says. “So empirically it should be safer.”

However, because CBD oil is known to interact with certain medications such as calcium channel blockers, blood thinners, steroids and HIV antivirals, among others, caution is advised.

“If anybody is considering using CBD, I recommend they talk to their doctor first,” he adds.

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