What is Pain?
We have all felt pain. It is that uncomfortable feeling we get when something is wrong. It can be dull or intense, but there is no denying it. It is sometimes throbbing, stabbing, aching, pinching, or any one of a hundred other ways that people describe it.
The interesting thing is that while we all feel it, we aren’t certain we are all feeling the same things. Some of us seem to feel it more intensely than others and in different ways. This is one reason why treating pain is so difficult. It is hard to establish in classic clinical trials that everyone is feeling the same thing, and so treatments become less systematic and harder to predict outcomes than in other kinds of treatments.
Scientifically, most pain comes from tissue damage. This can be caused by injury or disease. This pain is to let you know that you need to change what you’ve been doing, or to do something to fix the damage. Acute pain is usually immediate and directly related to an injury. Chronic pain is long term and more often associated with disease or an injury that has not healed. Nerves that detect pain send messages to the brain to cause us to do something about the pain.
Review of CBD and ECS and Effect on Pain
Cannabidiol, known as CBD, has been shown in research studies to have the potential to impact pain. In order to understand how, we need to review the endocannabinoid system (ECS) and how they interact.
The primary function of the ECS is to keep the body systems stable. This is known as homeostasis. It really means keeping things in balance. All animals with backbones have this system, and it is one of the newer systems that we have learned about in terms of how human bodies work and thrive. It turns out that our bodies naturally produce cannabinoids (human versions are called endocannabinoids, meaning they are made inside our body) and use them as messengers within our bodies as other systems within our body do.
If you have read about this topic, you are no doubt aware that there are several receptors associated with the ECS. CB1 and CB2 are the most studied, but there are at least 5 different receptors known in this system. These receptors can be found throughout the body and signal when things get “out of whack” and help get them back to normal.
It turns out that one of the primary functions of the ECS is to address pain. When the system is working right, it will enhance pain when it is appropriate (right after an injury or trauma for example) and as things start to heal, it also works to inhibit pain so that the pain reflex loop can stop.
Research has also shown that having low levels of endocannabinoids actually is a disease state called clinical endocannabinoid deficiency. If you have clinically low levels of endocannabinoids, then pain signals are amplified even when there is no cause for the pain. Some researchers now believe that this may be in some way related to various “phantom pain” syndromes (like fibromyalgia and possibly neuropathy).
We will learn much in the coming years as more and more clinical studies begin to show how these systems work and how they are controlled as well as what are appropriate and safe dosing levels.
Review of Research
The European Journal of Pain reported a study in which rats were administered CBD using a transdermal patch. These rats were genetically predetermined to have arthritis and its chronic pain. After just four days of treatment, pain measures of the rats showed a significant pain relief.
A study in the Journal of Experimental Medicine concluded that using CBD can reduce pain and inflammation. An interesting aspect of this study is that CBD users did not develop a tolerance. This is important as it implies that addiction is not a likely outcome of continued use. It also means that once the right dose is found, it is not likely that the user will need to continue to up the dose to get the same benefit.
Several other studies have shown that patients with chronic pain are able to have a significant reduction to that pain by taking CBD oil. It has been shown that CBD oil can have an effect similar or greater than COX Inhibitors (like ibuprofen, acetaminophen and others). The primary advantage over these is that CBD oil does not cause damage to the stomach and intestines that those drugs can.
Another important cause of pain is inflammation. CBD has been shown in many studies to have anti-inflammatory capacities. It works to decrease inflammation and, in this manner, reduces the associated pain.
Pain, particularly chronic pain, also has an emotional aspect to it. People with chronic pain, also develop anxiety as a result of the pain. Research into CBD oil has consistently shown that daily consumption is able to lower the anxiety score of those taking it. This also helps alleviate the anguish suffered by those with long-term chronic pain and is a factor in decreasing the overall pain itself.
Review of CBD Dosing Logic
Dr. Dustin Sulak, D.O. and Director of Integ8 Health, said that “some patients effectively use tiny amounts of cannabis while others use incredibly high doses. I’ve seen adult patients achieve therapeutic effects at 1 mg of total cannabinoids per day, while others consume over 2000 mg daily without adverse effects.”
Exact dosing for CBD is hard to predict. There are many factors that can influence exactly what the right does is for you. Let’s consider what these might be.
Weight is one obvious factor. Most drugs are prescribed on a milligram per kilogram (mg/kg) basis. This means that the dose you take depends on your weight. If we use the animal world as an example, you would not expect to give the exact same pill to a cat that you would a lion. In general, the larger you are, the bigger the dose needed. There are some on the web who suggest that a good starting dose for a 200-pound person is 15-25 mg per day, while someone at 150 pounds might do better at 15-25 mg per day.
Another factor to consider is the age of the person. It has been shown that those over 50 generally have lower levels of endocannabinoids. So, in general, the older you are, the more likely it is that you will need a higher dose overall.
How do you take your CBD?
It actually impacts this discussion as well. Studies have shown that tinctures in general deliver more into your blood stream and keep it there longer than pills/capsules or even vaping. Vaping offers the quickest hit, but it doesn’t last as long. In the stomach, some of the CBD is changed to other chemicals or simply not absorbed through the intestinal tract. For your best results, it probably means using a tincture.
However, what does your tincture contain?
There are many different CBD products available on the market, and there are wide variations amongst them. Cheaper CBD products tend to have much lower CBD concentrations than more expensive ones. Also, the FDA has often pointed out that there is a wide variety on the market in terms of labeling and actual results. You should always order from manufacturers with high quality standards and independent third-party testing.
Another question to consider is that while we are discussing only CBD, most CBD oil or industrial hemp oil products are full or broad spectrum and not isolates (isolates only contain CBD and nothing else). This means that there are other cannabinoids in them and also likely a variety of terpenes as well. Due to the entourage effect this means that simply having the same amount of CBD per ml of tincture may not guarantee that you will experience the same effect from one manufacturer to another. In other words, the cannabinoid/terpene finger print may make a difference beyond the simple concentration of CBD.
Most research has shown that it is very unlikely that pain will immediately be impacted by one single dose of CBD. For the most part, research has shown that CBD is needed from 3 days to several weeks before the full impact is felt. This means that you need to use patience if you are starting to use CBD for the first time. This is probably why most research that is showing successful results in animals and humans has the dosing occur over a several week time frame.
There are also genetic variations that can impact how dosing impacts you. Some people have genetic variations that effect the size, shape and function of the CB1 and CB2 receptors. If you are one of these people, then you may need more or less to get an effect depending upon how your specific genetics effect these receptor functions.
Finally, your lifestyle can also have a surprising impact. Recent studies have shown that routinely drinking alcohol can cause CB1 receptors to increase. Similarly, those with a high omega three levels in their blood stream also increases CB1 receptors. If you exercise often, then your body likely produces more anandamide (a naturally occurring chemical that resembles THC) which activates CB1 receptors. If any of this applies to you, then you likely do not need a high dose of CBD oil. However, other research has shown that if you have a lot of stress, this causes your cortisol levels to go up. Cortisol is known as the “stress hormone”. It also causes a decrease in the number of CB1 receptors and so decreasing the dose of CBD might be appropriate under these conditions.
The famous phrase here for dosing is “start low and go slow”. That advice takes into consideration a lot of what was described above. It also considers the classic dose response curve. CBD has an upside-down U curve. This means that there is an ideal “sweet spot” in the middle of the curve, or an area of maximum response. As you start low and move higher, your response should go up until at some point it starts to go back down again. Just to make things interesting, cannabinoids throw another curve at you. The response may also change as you move along the curve. How you feel at low dose may be different than at high dose. An example of this is that many feel energized at low doses of CBD, but then feel sleepy or sedated at very high doses.
Target Range Based on Above
With everything stated above, it turns out that the best advice is a trial and error approach. Most manufacturers recommend a starting dose of somewhere around 25 mg twice a day. You should consider the above factors and adjust that up or down. Then, try that for a week or two and consider how it impacts your pain. You then would take a little more per dose, or maybe go to three doses per day, or maybe alter the time of day you take it. The trick here is to find what works best for you – both in terms of dosing and timing – by increase or decreasing the amount of CBD oil you take and when and how often you take it.
Side Effects of CBD
While CBD is not considered addictive, it can have side effects. You should become familiar with these in case you should experience any yourself as you try to identify your optimum dose. Some of these include dry mouth, light headedness, sedation, and mild low blood pressure.
Almost everything is metabolized (broken down) in the liver. CBD is no exception. It is broken down in the part of the liver that utilizes cytochrome P450, known as CYP450. Many things go through this part of the liver, including something like 60% of drugs on the market. This includes things like antibiotics, antihistamines, anesthetics, anti-depressants, beta blockers, PPI (stomach medicines to decrease acids), and many more.
For this reason, you should consult with your healthcare professional before beginning to use CBD (or really any new drug or supplement) so that they can council you on how to do so in the safest manor. Many with chronic conditions are told of the “grapefruit juice” rule which means that they should avoid drinking excessive amounts of grapefruit juice because it interferes with CYP450. If you are taking a drug which your doctor or pharmacist has told you to be warry of grapefruit juice, then you should also ask them about CBD.
For those experiencing any kind of pain, something that relieves or reduces that pain is a wonderful thing! While nothing is perfect, CBD oil offers a good, safe option. It is considered to be on a level with prescription strength pain relievers such as ibuprofen but does not contain the severe side effects.
However, due to lack of controlled clinical trials, there is not a known dosage for all. It is recommended that you start at roughly 25 mg per day (adjusted for the factors mentioned above) and go slow and add more until you get the relief you seek. This may take several weeks to determine what is best for you. It may also take you to try several vendors to find the one that is best for you.
As always, do this after talking with your healthcare professional so that they may guide you as to what is best for your specific medical realities. With that said, many find that CBD is able to truly offer some help with pain or inflammation that is causing pain!
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