Can CBD alleviate chronic pain? Original paper

This systematic review found that the efficacy of CBD for chronic pain remains inconclusive, highlighting the need for more high-quality research on the topic.

•Pain

This Study Summary was published on October 4, 2022.

Background

Cannabidiol (CBD), the most abundant nonpsychoactive (i.e., it won’t get you high) cannabinoid in cannabis, has the potential to alleviate certain types of chronic pain. However, the evidence base for its effects on chronic pain is relatively small.

The study

This systematic review assessed the safety and efficacy of CBD for adults with chronic pain. Studies were included if they met the following criteria:

  • Were conducted with human participants
  • Recruited adults >18 years old
  • Recruited participants with pain symptoms of <3 months duration
  • Assessed any preparation of CBD
  • Assessed nonacute pain
  • Were published in English
  • Were published within the last 5 years

Overall, 12 studies were included (4 narrative reviews, 4 systematic reviews, 1 case report, 2 observational studies, and 1 randomized controlled trial).

The results

Overall, the results were mixed. While a few studies suggested that CBD may be of benefit for chronic pain, the results were inconsistent, highlighting a need for more research on the topic. A summary of the included studies is provided in the table below:

Authors and publication yearPurpose of the studyNumber of participants/studiesType of studyMain findings
Boyaji et al. 2020<a href="#ref-1" id="ref-link-1" class="ref-link popover" data-tooltip="<div><p class="mb-3">Boyaji S, et al. <a href="https://pubmed.ncbi.nlm.nih.gov/31980957" target="_blank" rel="noopener noreferrer">The Role of Cannabidiol (CBD) in Chronic Pain Management: An Assessment of Current Evidence.
</a></p>Curr Pain Headache Rep (2020-Jan-24)</div>">[1]To assess nabiximols (1:1 ratio of CBD/THC) for management of chronic pain7 studiesNarrative reviewBased on this review, it is difficult to make a recommendation for the use of CBD in chronic pain management.
Fischer et al. 2022<a href="#ref-2" id="ref-link-2" class="ref-link popover" data-tooltip="<div><p class="mb-3">Fischer B, et al. <a href="https://pubmed.ncbi.nlm.nih.gov/34465496" target="_blank" rel="noopener noreferrer">Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update.
</a></p>Int J Drug Policy (2022-01)</div>">[2]To review new scientific evidence and to develop comprehensively up-to-date Lower-Risk Cannabis Use GuidelinesNot specifiedNarrative reviewIndividuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high frequency/high intensity of use, and refrain from smoking routes for administration.
Mauer et al. 2020<a href="#ref-3" id="ref-link-3" class="ref-link popover" data-tooltip="<div><p class="mb-3">Maurer GE, et al. <a href="https://pubmed.ncbi.nlm.nih.gov/32936058" target="_blank" rel="noopener noreferrer">Understanding Cannabis-Based Therapeutics in Sports Medicine.
</a></p>Sports Health (2020)</div>">[3]To determine the safety, efficacy, and adverse effects of cannabis-based products in athletes2,224 participantsNarrative reviewLack of strong-quality clinical evidence, coupled with inconsistent federal and state law as well as purity issues with cannabis-based products, make it difficult for the sports medicine clinician to widely recommend cannabinoid therapeutics at present.
VanDolah et al. 2019<a href="#ref-4" id="ref-link-4" class="ref-link popover" data-tooltip="<div><p class="mb-3">VanDolah HJ, Bauer BA, Mauck KF. <a href="https://pubmed.ncbi.nlm.nih.gov/31447137" target="_blank" rel="noopener noreferrer">Clinicians' Guide to Cannabidiol and Hemp Oils.
</a></p>Mayo Clin Proc (2019-09)</div>">[4]To provide an overview of the scientific work on cannabinoids, CBD, and hemp oil and the distinction among marijuana, hemp, and the different components of CBD and hemp oil products.102 studiesNarrative reviewAlthough CBD and hemp oils remain an unproven therapeutic option, physicians should remain open to the possible future role these products may play in the management of a variety of difficult-to-treat diseases, in particular pain and addiction treatment in the context of the opioid crisis.
Mücke et al. 2018<a href="#ref-5" id="ref-link-5" class="ref-link popover" data-tooltip="<div><p class="mb-3">Mücke M, et al. <a href="https://pubmed.ncbi.nlm.nih.gov/29513392" target="_blank" rel="noopener noreferrer">Cannabis-based medicines for chronic neuropathic pain in adults.
</a></p>Cochrane Database Syst Rev (2018-03-07)</div>">[5]To assess the efficacy, tolerability, and safety of cannabis-based medicines (herbal, plant-derived, synthetic) compared to placebo or conventional drugs for conditions with chronic neuropathic pain in adults16 studies, 1750 participantsSystematic reviewThe potential benefits of cannabis-based medicine (herbal cannabis, plant-derived or synthetic THC, THC/CBD oromucosal spray) in chronic neuropathic pain might be outweighed by their potential harms. The quality of evidence for pain relief outcomes reflects the exclusion of participants with a history of substance abuse and other significant comorbidities from the studies, as well as the small sample sizes.
Pagano et al. 2020<a href="#ref-6" id="ref-link-6" class="ref-link popover" data-tooltip="<div><p class="mb-3">Stefano Pagano, et al. <a href="https://pubmed.ncbi.nlm.nih.gov/33038581" target="_blank" rel="noopener noreferrer">Biological effects of Cannabidiol on normal human healthy cell populations: Systematic review of the literature
</a></p>Biomed Pharmacother (2020 Dec)</div>">[6]To evaluate the biological effects of CBD on normal human healthy cell populations in terms of cell viability, proliferation, migration, apoptosis, and inflammation29 studiesSystematic reviewCBD inhibited cell viability in a dose-dependent manner; CBD reduced cell proliferation and cell migration; CBD stimulated apoptosis at higher doses; CBD produced an anti-inflammatory effect
Rabgay et al. 2020<a href="#ref-7" id="ref-link-7" class="ref-link popover" data-tooltip="<div><p class="mb-3">Rabgay K, et al. <a href="https://pubmed.ncbi.nlm.nih.gov/31495691" target="_blank" rel="noopener noreferrer">The effects of cannabis, cannabinoids, and their administration routes on pain control efficacy and safety: A systematic review and network meta-analysis.
</a></p>J Am Pharm Assoc (2003) (2020)</div>">[7]To determine the effects of cannabis, cannabinoids, and their administration routes on pain and adverse euphoria events25 studies, 2,270 participantsSystematic reviewTHC/ CBD and THC via oromucosal route can reduce neuropathic and cancer pain; similarly, THC via oral route for cancer pain, standardized dried cannabis with THC via inhalation route for neuropathic pain, and standardized cannabis extract with THC via oral route for nociceptive pain.
Scuteri et al. 2022<a href="#ref-8" id="ref-link-8" class="ref-link popover" data-tooltip="<div><p class="mb-3">Scuteri D, et al. <a href="https://pubmed.ncbi.nlm.nih.gov/34891121" target="_blank" rel="noopener noreferrer">Is there a rational basis for cannabinoids research and development in ocular pain therapy? A systematic review of preclinical evidence.
</a></p>Biomed Pharmacother (2022-Feb)</div>">[8]To investigate preclinical evidence in favor of the working hypothesis of efficacy of cannabinoids in ocular pain treatment4 studiesSystematic reviewPreclinical studies are needed to establish the efficacy of CBD in ocular inflammation and neuropathic pain, although analgesia was observed using CBD oil. Topical formations show promise for ocular pain.
Diaz et al. 2021<a href="#ref-9" id="ref-link-9" class="ref-link popover" data-tooltip="<div><p class="mb-3">Diaz PL, et al. <a href="https://pubmed.ncbi.nlm.nih.gov/35030093" target="_blank" rel="noopener noreferrer">Healing of a Chronic Pressure Injury in a Patient Treated With Medical Cannabis for Pain and Sleep Improvement: A Case Report.
</a></p>Wound Manag Prev (2021-10)</div>">[9]To describe a patient with a pressure injury who received cannabis oil treatment for pain management and sleep improvement1 participantCase reportCannabis oil was effective in treating pain and sleep difficulties. During the first 2 weeks of treatment, the pressure injury started to heal and was almost completely closed at the 2-month follow-up.
Boehnke et al. 2022<a href="#ref-10" id="ref-link-10" class="ref-link popover" data-tooltip="<div><p class="mb-3">Boehnke KF, et al. <a href="https://pubmed.ncbi.nlm.nih.gov/35016733" target="_blank" rel="noopener noreferrer">A mixed methods analysis of cannabis use routines for chronic pain management.
</a></p>J Cannabis Res (2022-Jan-11)</div>">[10]To characterize naturalistic cannabis use routines and explore associations between routines and reported benefits from consuming cannabis1,087 participantsCross-sectionalWhile all participants reported similarly decreased pain, participants using noninhalation + inhalation administration routes reported larger improvements in health than the noninhalation and inhalation subgroups. Similarly, the noninhalation + inhalation group had significantly more medication substitutions than those using noninhalation and inhalation administration routes, respectively.
Capano et al. 2020<a href="#ref-11" id="ref-link-11" class="ref-link popover" data-tooltip="<div><p class="mb-3">Capano A, Weaver R, Burkman E. <a href="https://pubmed.ncbi.nlm.nih.gov/31711352" target="_blank" rel="noopener noreferrer">Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study.
</a></p>Postgrad Med (2020-Jan)</div>">[11]To investigate the impact of CBD on opioid use and quality of life indicators among chronic pain participants131 participantsCross-sectionalCBD can significantly reduce opioid use and improve chronic pain and sleep quality among participants who are currently using opioids for pain management.
Lichtman et al. 2018To assess adjunctive nabiximol treatment in advanced cancer patients with chronic pain unalleviated by opioid therapy.397 participantsRandomized controlled trialAlthough not superior to placebo on the primary efficacy endpoint (average pain Numerical Rating Scale score), nabiximols had benefits on multiple secondary endpoints (Subject Global Impression of Change, Physician Global Impression of Change, and Patient Satisfaction Questionnaire).

Note

This systematic review highlights the lack of high-quality research that has assessed CBD for chronic pain. Several of the included studies demonstrated inconclusive findings, and several coadministered CBD with THC, which makes it difficult to determine the effects of CBD alone on chronic pain.

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This Study Summary was published on October 4, 2022.

References

  1. ^Boyaji S, Merkow J, Elman RNM, Kaye AD, Yong RJ, Urman RDThe Role of Cannabidiol (CBD) in Chronic Pain Management: An Assessment of Current Evidence.Curr Pain Headache Rep.(2020-Jan-24)
  2. ^Fischer B, Robinson T, Bullen C, Curran V, Jutras-Aswad D, Medina-Mora ME, Pacula RL, Rehm J, Room R, Brink WVD, Hall WLower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update.Int J Drug Policy.(2022-01)
  3. ^Maurer GE, Mathews NM, Schleich KT, Slayman TG, Marcussen BLUnderstanding Cannabis-Based Therapeutics in Sports Medicine.Sports Health.(2020)
  4. ^VanDolah HJ, Bauer BA, Mauck KFClinicians' Guide to Cannabidiol and Hemp Oils.Mayo Clin Proc.(2019-09)
  5. ^Mücke M, Phillips T, Radbruch L, Petzke F, Häuser WCannabis-based medicines for chronic neuropathic pain in adults.Cochrane Database Syst Rev.(2018-03-07)
  6. ^Stefano Pagano, Maddalena Coniglio, Chiara Valenti, Maria Isabella Federici, Guido Lombardo, Stefano Cianetti, Lorella MarinucciBiological effects of Cannabidiol on normal human healthy cell populations: Systematic review of the literatureBiomed Pharmacother.(2020 Dec)
  7. ^Rabgay K, Waranuch N, Chaiyakunapruk N, Sawangjit R, Ingkaninan K, Dilokthornsakul PThe effects of cannabis, cannabinoids, and their administration routes on pain control efficacy and safety: A systematic review and network meta-analysis.J Am Pharm Assoc (2003).(2020)
  8. ^Scuteri D, Rombolà L, Hamamura K, Sakurada T, Watanabe C, Sakurada S, Guida F, Boccella S, Maione S, Gallo Afflitto G, Nucci C, Tonin P, Bagetta G, Corasaniti MTIs there a rational basis for cannabinoids research and development in ocular pain therapy? A systematic review of preclinical evidence.Biomed Pharmacother.(2022-Feb)
  9. ^Diaz PL, Katz TM, Langleben AC, Rabinovitch BS, Lewis ECHealing of a Chronic Pressure Injury in a Patient Treated With Medical Cannabis for Pain and Sleep Improvement: A Case Report.Wound Manag Prev.(2021-10)
  10. ^Boehnke KF, Yakas L, Scott JR, DeJonckheere M, Litinas E, Sisley S, Clauw DJ, Williams DA, McAfee JA mixed methods analysis of cannabis use routines for chronic pain management.J Cannabis Res.(2022-Jan-11)
  11. ^Capano A, Weaver R, Burkman EEvaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study.Postgrad Med.(2020-Jan)