At some point in our lives, we have all experienced pain, whether from a sprained ankle, a tweaked lower back or all-around chronic soreness or aching. If you or someone you know suffers from physical pain, you are not alone. In fact, an estimated 100 million Americans experience chronic pain.
The burden on the health system is just as enormous as 78 percent of emergency room visits are due to pain. Pain, as a medical condition, outnumbers those suffering from cancer, heart disease and diabetes combined. Unfortunately, physicians do not have many tools to combat pain, but the three most common countermeasures include over the counter (OTC) medications such as aspirin or ibuprofen, opiates such as Vicodin or oxycontin, or drugs like gabapentin or pregabalin (marketed name Lyrica).
In the past few years, cannabidiol (CBD), a compound found in the cannabis or hemp plant, may offer an alternative to prescription or weak OTC drugs for the treatment of pain, according to Golden, Colorado-based Panacea Life Sciences.
What is wrong with current treatments?
The two biggest issues with current medications are that they do not provide enough pain relief or they have numerous side effects. Over the counter medications such as aspirin, ibuprofen, naproxen or acetaminophen are collectively called non-steroidal anti-inflammatory drugs (NSAIDs). These NSAIDs are fairly weak analgesics, and 10 percent of the population cannot take these due to side effects on the gastrointestinal system or potential liver and kidney damage. Gabapentin does relieve some chronic pain, such as fibromyalgia, but does so at dangerously high, almost sedative doses.
A more strident remedy is that of opiates, which are currently the strongest pain reliever physicians can consider for treating pain. However, these drugs are fraught with many side effects, including an addiction potential that has led to the recent “opioid epidemic.” Although there are increasingly strict rules on how many opioid doses physicians can prescribe to chronic pain sufferers, approximately 2.1 million Americans live with opioid abuse disorder.
In 2018, more than 67,000 people died from opiate overdoses (on average 183 per day), which accounts for approximately 70 percent of all drug overdose deaths. While there is more awareness of the addiction potential and regulations limiting the number of prescriptions that patients can receive, the decline in the death rate remains minimal and passive. Other side effects from opiates are lethargy, constipation and mental impairment.
While there is much more to be said about the current, ineffective treatments, the necessity for a better alternative for pain relief is of high priority.
Cannabidiol (CBD) as a possible pain reliever?
Cannabidiol is receiving a great deal of attention from pain sufferers as a natural and safe alternative to prescription medications. A 2016 report shows that in states that legalized medical marijuana, 1,826 fewer prescriptions per physician were written compared to non-medical marijuana states. With the legalization of CBD in 2018, clearly more people are using CBD products to treat their pain, but is CBD as an analgesic just a trendy hype, or does this natural compound provide hope for chronic pain sufferers?
CBD is most commonly isolated from the industrial hemp plant, Cannabis sativa L., which is not psychoactive like its cousin tetrahydrocannabinol (THC) and primarily exerts anti-inflammatory effects in the body. CBD products are well-tolerated by humans and animals with no addiction potential and very few side effects unless taking very large doses (over 10 mg/kg/day).
CBD works through the endocannabinoid system in the body to restore balance to under-performing or over-reacting functions. When examining the receptors and cells that CBD interacts with in the body, there is significant overlap with known pain targets which helps explain why CBD reduces inflammation and pain.
Research on how cannabidiol works is in its infancy as this compound was only legalized in 2018, however, increasing scientific evidence strongly suggest that CBD does provide pain relief. As of this date, there are 49 human clinical studies that have been conducted, are in progress or are ready to launch, to examine CBD’s effect on pain relief. Pain conditions being studied range from cancer pain, tooth extraction pain, to migraine or headache.
Findings from 24 published human clinical studies provide accumulating evidence that CBD does relieve pain, although the exact dosing required for efficacy and which types of pain CBD is effective at treating remain to be determined.
The best evidence on the potential of using CBD to treat pain comes from early preclinical studies. These types of studies are performed in animals and predict how the compound will act in humans. Collectively these studies indicate that CBD, whether taken orally or applied topically, will reduce swelling at the site of injury and reduce pain.
Preclinical studies at Panacea Life Sciences (not published) indicate that CBD is 40 times more potent than ibuprofen in alleviating acute pain and provides better pain relief than pregabalin when taken for a five-day period. Note that CBD is not entirely effective at providing relief from profound pain conditions such as cancer or post-operative pain. Interestingly though, in these stronger pain conditions, initial studies indicate that CBD may be used in conjunction with opiates to achieve pain release with a 70 percent lower dose of opiates.
While co-administration of CBD with opiates needs to be studied more rigorously, the implications of achieving pain relief at much lower concentrations of opiates provide the hope that chronic pain sufferers may have a solution that will alleviate addiction potential and other opiate side effects.
Which CBD products will benefit consumers experiencing pain?
As a retailer, choosing which CBD products to offer may initially seem daunting as there are large numbers of manufactures as well as several different types of products. As a first step, it is exceedingly important to select a trusted manufacturer. Since this is a very new industry, many CBD manufacturers are inexperienced at producing CBD products and do not have sufficient quality controls in place to ensure products meet potency and purity standards.
Multiple quality control surveys have demonstrated that more than 60 percent of CBD products sold on the market today fail to meet the potency that is stated on the label. Ensuring that manufacturers are compliant or certified for Good Manufacturing Processes (GMP) and can provide transparent product quality control should be a top priority when considering where to source products.
CBD products come in many forms, ranging from topicals to candies to more traditional capsules. These products also may be made from different forms of CBD, thus requiring labels such as “full-spectrum,” “broad-spectrum” or “isolate.” It is important to note that all CBD products made from industrial hemp must be below 0.3 percent THC to be legal. This level of THC is quite low and will not produce the high associated with marijuana use.
As there is limited information about what form and dose of CBD will be most effective for alleviating health conditions, chronic pain sufferers will need to experiment to determine which product and what strength works best for them. Additionally, topical salves or lotions are great products to alleviate local inflammation or pain, whereas those experiencing chronic, less-localized pain may need to take an oral product.
For retailers considering bringing CBD products to their shelves, a good starting place is to offer a topical lotion or salve, a full-spectrum oral product and a pure CBD oral product. The pure CBD oral products are for customers who want the health benefits of CBD without any THC, no matter how low the concentration. For addressing chronic pain, drops to place under the tongue, rapid melt tablets or oral soft gels may be used. Products placed under the tongue may provide benefits in as little as five minutes, while oral soft gels will provide a longer duration of effect.
One unclear area for CBD is the dosing recommendations as is still being explored through clinical studies. Currently, the UK Food Services Agency recommends that a maximum serving of 75 mg CBD may be safely consumed, although clinical studies using pure CBD indicate that doses up to 10 mg(dose) / kg(body weight) / day may be used without experiencing adverse events. Thus, higher doses are necessary for people with higher body weight and fat content and with stronger pain conditions. It is also recommended that consumers should start with low concentrations and slowly escalate dosing to determine what works best for their specific situation.