US News: Does CBD Work for Pain Relief?

KYLE WRIGHT WAS USED TO living in pain. The 31-year-old who lives in New York City regularly felt the repercussions of decades-old injuries from playing sports and bartending, and contended with the back and shoulder aches triggered by mild scoliosis.

Then, at a street fair in Denver, where he used to live, someone offered him a sample of CBD lotion, a product said to contain cannabidiol, one of the many chemicals found in the cannabis plant. (While medicinal and recreational marijuana contain CBD, the component itself doesn’t deliver the “high” that’s attributed to a different chemical, THC.) Wright gave it a shot. “I was really amazed at how effective the lotion was,” says Wright, who now runs a relationship coaching business with his wife. “About 15 minutes later, it felt like the tension had evaporated through my skin.”

Wright soon began buying CBD lotion and using it on his wrists, shoulders, back and neck – all areas that craved attention after long days tied to the computer. He continues to use a salve or lotion about twice a week and almost never uses Advil or ibuprofen, his former default remedies. “My joints felt looser, my muscles felt relaxed and the pain is significantly lessened,” Wright says.

Wright is far from the only one praising the power of CBD to treat pain and other ailments in what’s promoted as a non-addictive, side effect-free and non-psychoactive way. The Brightfield Group, a cannabis market research company, even projects the industry will reach $22 billion by 2022, thanks to people like Danielle Jenkins, a 29-year-old who works in nonprofit management in Telluride, Colorado, who says a topical CBD product was “the only thing” that helped certain leg muscles in the thigh after a hockey injury. Daisy Testa, a 31-year-old academic counselor in Chicago, also swears by CBD to relieve both stress and its associated neck pain. Mitchell Roth, a film producer in San Francisco, goes as far as to credit CBD for breaking his wife’s addiction to opioids, which she originally used to manage pain related to endometriosis. She’s now off both substances.

Some physicians are on board, too. Dr. Charlton Woodly, a podiatric surgeon in Texas who has no financial stake in CBD products, integrates CBD into patients’ recovery from surgery, breaks and sprains. “I use it in my practice because, unlike pain medications, such as Tylenol, CBD does not cause kidney or liver issues while providing the same pain relief,” he says. And Dr. Philip Blair, a family physician who serves as medical director of the CBD brand Elixinol, says he’s used CBD with over 2,000 patients after the research and his experience convinced him the substance, in fact, wasn’t too good to be true. Within minutes of giving a patient CBD, he says, “I see relaxation of their facial muscles, they become more expressive and spontaneous, their eyes get bigger and their shoulders relax. I hear a deep sigh of relief.”

But some researchers and clinicians caution against prematurely jumping on the CBD bandwagon, which is gaining members and momentum since the passing of the 2018 Farm Bill, legislation that fully legalizes hemp, a variety of the cannabis plant. But even that enthusiasm is misguided, says Dr. Jordan Tishler, a Harvard physician and CEO of InhaleMD, a Boston-area practice specializing in cannabis therapeutics. The bill, he says, will help farmers and the economy since it will spur the development of new products like textiles. But, he adds, “that has nothing to do with medicine.” Here’s what else he and other health experts say consumers need to know:

1. CBD isn’t entirely legal.

CBD companies, some health care professionals and some news reports make blanket claims that CBD is totally legal in every state. Tishler says that’s far from the truth.

Until recently, the U.S. Drug Enforcement Administration considered all cannabinoids, including CBD, a schedule 1 drug, which means it was as illegal as heroin from the federal government’s perspective. And while CBD is no longer a schedule 1 drug, it remains illegal until the U.S. Food and Drug Administration releases new regulations and companies are in compliance, Tishler explains. The only form of CBD that’s legal in the federal government’s eyes is the prescription medicine Epidiolex, which the FDA approved in 2018 to treat seizures associated with two rare forms of epilepsy – and nothing else. (CBD may be legal, though, if acquired through a state medical cannabis program.) And even though hemp, which is regulated by the U.S. Department of Agriculture, is legal so long as the THC content is negligible, people who want to make CBD by farming hemp need to have a license to do so through the federal government or, in some cases, their state, Tishler explains. Unfortunately, there’s no good way to know if your manufacturer has acquired this, he says.

Still, the federal government isn’t enforcing CBD’s illegal status, and some states like Colorado are stepping in to fill in regulatory gaps locally. In other words, consumers aren’t likely going to get in legal trouble for buying or using CBD, but that’s not the same as a green light.

2. The research on CBD for pain relief is promising, but nascent.

Scientists know that CBD is effective in treating rare forms of epilepsy, but they haven’t conducted any human studies exploring if and how it works to manage pain. However, animal studies offer hints. A rodent study in the European Journal of Pain, for one, showed that topical CBD helped lower arthritis-related pain and inflammation. In a recent study published in the journal Pain, Dr. Gabriella Gobbi and colleagues suggested that low-dose CBD was effective at reducing pain and anxiety by interfering with a neurotransmitter linked to both. Blair, who served as an Army combat physician in the first Gulf War, says there may be 150 mechanisms through which CBD works in the body.

But Tishler says the strongest support for cannabis and pain relief involves THC, which may or may not be used in conjunction with CBD. “[CBD] should be more thoroughly studied by doctors and scientists, and then go though the drug development stages and approved by regulatory agencies before being commercialized,” says Gobbi, a professor in McGill University’s neurobiological psychiatry unit.

3. Buying CBD can be risky.

Because CBD falls through regulatory cracks, it’s tough to truly know how much CBD you’re getting and if you’re getting it at all, not to mention what you might be getting instead, like pesticides and toxins. “It’s a wild wild west marketplace,” Blair says. One study found that nearly 70 percent of all CBD products sold online contain amounts of CBD that are either higher or lower than what was reported on the label. Plus, companies use different CBD sources, extraction methods and production techniques. At the very least, CBD may be a waste of time and money for some people.

If you’re willing to take the risk, look for products that are American-made, organic, full-spectrum (meaning it also contains other potentially beneficial compounds found in hemp) and don’t include thinning or flavoring agents, suggests National Pain Report, a news organization that covers chronic pain.

4. No substance is harmless for everyone.

CBD seems to be pretty safe – the most severe of reported side effects are relatively benign issues like fatigue. There’s also nothing to suggest it can be addictive, the World Health Organization reports. But health professionals worry that CBD (if, of course, that’s what you’re getting) can interact with other medications and supplements in a potentially dangerous way. And, Just because it comes from a plant doesn’t mean it’s harmless; about 50 percent of drugs including those “toxic” enough to be used for chemo come from plants, Gobbi points out. Talk with a doctor who’s an expert in pain about the best treatment option for you, she suggests, “and remember that CBD is a medicine with side effects.”

Anna Medaris Miller, Senior Health Editor at U.S. News