CBD for neuropathic pain: what the science says

If you've been reading about the benefits of cannabidiol for a while, you've probably heard about the neuropathic pain-relieving properties of CBD. On the occasion of the World Day of Pain, we dedicate this topic to today's post, where you will find all the information on the subject found in the scientific literature, as well as clarify the main doubts about this type of pain and its treatment. For a general overview of how this type of discomfort is approached, read our guide on CBD for chronic pain.

The 3 key ideas:

• Neuropathic pain stems from nerve damage and responds poorly to classic painkillers.
• The most favourable evidence for CBD is topical (cream or oil massage): a study on peripheral neuropathy improved pain after several weeks.
• It works better in synergy with THC and terpenes (the entourage effect); isolated oral use has given mixed results.

What is CBD?

Cannabidiol (CBD) is one of the main phytocannabinoids in hemp. Unlike THC, it is not psychoactive: it does not alter consciousness and interacts with the body's endocannabinoid system, involved in regulating pain, inflammation and mood.

According to the World Health Organization (WHO), CBD is a compound that is well tolerated and safe in humans: it shows no effects indicative of abuse or dependence, and there is no evidence of public health problems associated with the use of pure CBD (report of the Expert Committee on Drug Dependence, ECDD).

This makes it an interesting candidate for addressing persistent conditions such as neuropathic pain. Even so, it is worth remembering that CBD is not a medicine and that Cannactiva products are for external use; this content is informational and does not replace medical advice.

What is neuropathic pain?

Neuropathic pain is a complex condition that affects millions of people worldwide. It is a type of chronic pain that arises from nerve damage or a malfunction of the nervous system.

How does neuropathic pain manifest itself?

Neuropathic pain is often described or manifested in a variety of ways and affects different parts of the body. Some examples are:

• lancinating pain: A sharp, stabbing pain that occurs intermittently, like "electric shocks" and is common in conditions such as trigeminal neuralgia.
• Tingling pain or numbness: Constant tingling sensation or numbness in a certain area. This may occur in cases of peripheral neuropathy.
• Hypersensitive pain or allodynia: The skin in the affected area becomes hypersensitive, so that even shower water or a caress causes pain. This is common in conditions such as postherpetic neuralgia or sudeck's syndrome.
• Cramping pain: Spasmodic, stabbing pain, similar to a muscle cramp.
• Phantom pain: People who have lost a limb due to amputation feel pain in the part of the body that is no longer present.
• Central pain: Pain throughout the body or in specific areas. It is common in conditions such as multiple sclerosis.
• Nerve compression pain: When a nerve is compressed due to a herniated disc, bulge or other condition, it can result in neuropathic pain that radiates along the path of the compressed nerve.

Differences between neuropathic pain and other types of pain

The main difference between neuropathic pain and other types of pain is the causal source. While nociceptive pain (from injuries, cuts, etc.) is caused by damage to body tissues, neuropathic pain is caused by damage to the nerves themselves.

Pain often persists long after the initial injury heals, making treatment complex.

Conventional treatment of neuropathic pain and its limitations

Neuropathic pain is treated with conventional analgesics, opioids, anticonvulsants and even antidepressants. However, these treatments have limitations in terms of effectiveness and toxicity, as they may not work for all patients, may cause side effects, and some medications (such as opioids) may be addictive.

Neuropathic pain is a complex condition that cannot be objectively measured and its treatment requires personalized strategies.

Listening to and trusting the people who experience pain is fundamental, as they are the ones who can best describe it and collaborate in its appropriate management.

The approach to pain should be multifactorial, combining different therapies and tools to help alleviate pain and improve the quality of life of those who suffer from it.

CBD benefits for neuropathic pain

The cannabidiol (CBD) is a compound found in hemp, and belongs to the family of phytocannabinoids that do not generate a psychoactive effect. CBD has attracted attention for its multiple therapeutic potentials, such as its effectiveness in treating inflammatory pain and possibly neuropathic pain.

The mechanism of action by which CBD may provide relief from some types of neuropathic pain is due to its interaction with the endocannabinoid system (ECS) and multiple cellular targets that regulate pain processing in our body.

Scientific studies

Several experimental studies have delved into the efficacy of CBD for neuropathic pain. In rodents, CBD has been able to control chronic pain perception, which may be significant for certain types of neuropathic pain (1, 2, 3).

Although animal studies suggest the effectiveness of CBD in treating neuropathic pain, the results are not necessarily translational. In humans, clinical studies have obtained somewhat controversial results, as some have obtained good results for the treatment of neuropathic pain and others have not.

What dose of CBD is used for pain?

The right amount of CBD depends on the type of pain and how you apply it, and there is no single rule. We have gathered the reference ranges in our guide to CBD dosage for pain.

Effectiveness of massages with cannabidiol

The topical application of massages with CBD oil has had good results in the control of peripheral neuropathy. In one study, 29 people used CBD oil on the skin and improved pain management after 4 weeks (4). Topical CBD is well tolerated and may provide a more effective alternative to other therapies.

On the other hand, there is a clinical study where CBD was administered orally for the treatment of neuropathic pain, although it did not have positive effects, the researchers state that one of the limitations was not having included other doses of CBD (5). CBD can present a bell-shaped effect, where it generates completely opposite responses depending on the dose consumed, therefore, although the study in humans has not shown an effectiveness of CBD for neuropathic pain, it is not conclusive (5).

What is the optimal CBD dosage?

There is no amount that works the same for everyone: the usual approach is to start low and build up little by little until you find what works best for you. We explain the guidelines and the most studied doses in our guide to the optimal CBD dosage.

Is CBD enough for pain, or should it be combined with THC?

Cannabis has been used for hundreds of years for the treatment of pain (6). In fact, cannabinoid therapies for the treatment of pain are most successful when CBD is used in combination with THC, producing a synergistic effect (7).

The synergistic action of phytocannabinoids that results in an enhanced pharmacological effect is called the entourage effect (8). The entourage effect may be beneficial for the treatment of neuropathic pain, as it involves not only cannabinoids, but also terpenes such as caryophyllene, myrcene and pinene, which have analgesic properties on their own (9, 10, 11).

Due to the synergistic effect, it should also be considered that CBD might have better results if full-spectrum CBD extracts are used. CBD extracts are used CBD extracts are used, as the presence of terpenes may increase its potential for pain treatment.

CBD for joint pain and other types of pain

Neuropathic pain is not the only one where cannabidiol is being researched. If you are interested in its use for the joints, we explain more in CBD for joint pain; and if you are ready to take the step, this guide to buying the best CBD oil will help you choose.

In conclusion, although there are controversial results, CBD could be a promising alternative for some types of neuropathic pain, such as peripheral neuropathy, or help in the treatment of anxiety and stress that can occur when going through a painful process.

Currently, more research continues to be done to learn about the applications of CBD in pain management. Therefore, a health professional should always be consulted before beginning any cannabinoid treatment.

How is CBD used for neuropathic pain?

The form of administration of CBD to treat neuropathic pain depends on the desired response.

For peripheral neuropathy, it can be applied topically through skin massage with CBD creams or CBD oil; or sublingually and orally with CBD oil, if CBD is required to reach the bloodstream and be distributed throughout the body and brain to reduce anxiety. Please note that, in many European countries, CBD is not regulated for oral consumption: get informed.

What is the dose of CBD?

Although orally only CBD doses of 5 mg to 45 mg per day (divided in 3 doses) have been studied without success. The effectiveness of some other doses of CBD for neuropathic pain is not known. At this point, it is worth clarifying that the use of sublingual or oral CBD is not legally authorized in some European countries. Cannactiva CBD oils are governed by EU regulations and are sold for external use.

On the other hand, CBD oil used topically with good results contained 250 mg of CBD in 90 ml. (approximately equivalent to a concentration of 2.5%).

Frequently Asked Questions on the use of CBD for neuropathic pain

Is CBD good for neuropathic pain?

The evidence is mixed: in animal models and via topical use there are promising results (peripheral neuropathy), while some oral studies showed no effect. It can be a support, not a substitute for medical treatment.

Cream or CBD oil for neuropathic pain?

For localised peripheral neuropathy, the topical route (cream or oil massage) has the best support. The sublingual or oral route is more associated with systemic effects and is not authorised in some EU countries.

What dose of CBD for neuropathic pain?

There is no standard dose. See the CBD dosage for pain guide. The reference topical study used a concentration of ≈2.5%; start low and adjust with your doctor.

Does CBD work better with THC?

Yes: cannabinoid therapies for pain are usually more effective when CBD is combined with THC and terpenes (the entourage effect), although that falls outside external-use products.

Note: This is an informational post, based on ongoing research, and cannot and is not intended to diagnose, prevent or cure any disease or symptom. Its content can complement, but never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. Consult with your physician before using CBD.

Referencias

1. Baron-Flores, V., Diaz-Ruiz, A., Manzanares, J., Rios, C., Burelo, M., Jardon-Guadarrama, G., Martínez-Cárdenas, M. L. Á., & Mata-Bermudez, A. (2022). Cannabidiol attenuates hypersensitivity and oxidative stress after traumatic spinal cord injury in rats. Neuroscience letters, 788, 136855. https://doi.org/10.1016/j.neulet.2022.136855

2. Xiong, W., Cui, T., Cheng, K., Yang, F., Chen, S. R., Willenbring, D., Guan, Y., Pan, H. L., Ren, K., Xu, Y., & Zhang, L. (2012). Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors. The Journal of experimental medicine, 209(6), 1121-1134. https://doi.org/10.1084/jem.20120242

Wang, X., Lin, C., Jin, S., Wang, Y., Peng, Y., & Wang, X. (2023). Cannabidiol alleviates neuroinflammation and attenuates neuropathic pain via targeting FKBP5. Brain, behavior, and immunity, 111, 365-375. https://doi.org/10.1016/j.bbi.2023.05.008

4. Xu, D. H., Cullen, B. D., Tang, M., & Fang, Y. (2020). The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Current pharmaceutical biotechnology, 21(5), 390-402. https://doi.org/10.2174/1389201020666191202111534

5. Hansen, J. S., Gustavsen, S., Roshanisefat, H., Kant, M., Biering-Sørensen, F., Andersen, C., Olsson, A., Chow, H. H., Asgari, N., Hansen, J. R., Nielsen, H. H., H. H., Hansen, R. M., Petersen, T., Oturai, A. B., Sellebjerg, F., Sædder, E. A., Kasch, H., Rasmussen, P. V., Finnerup, N. B., & Svendsen, K. B. (2023). Cannabis-Based Medicine for Neuropathic Pain and Spasticity-A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial. Pharmaceuticals (Basel, Switzerland), 16(8), 1079. https://doi.org/10.3390/ph16081079

6. Bonini, S. A., Premoli, M., Tambaro, S., Kumar, A., Maccarinelli, G., Memo, M., & Mastinu, A. (2018). Cannabis sativa: A comprehensive ethnopharmacological review of a medicinal plant with a long history. Journal of ethnopharmacology, 227, 300-315. https://doi.org/10.1016/j.jep.2018.09.004

7. King, K. M., Myers, A. M., Soroka-Monzo, A. J., Tuma, R. F., Tallarida, R. J., Walker, E. A., & Ward, S. J. (2017). Single and combined effects of Δ9 -tetrahydrocannabinol and cannabidiol in a mouse model of chemotherapy-induced neuropathic pain. British journal of pharmacology, 174(17), 2832-2841. https://doi.org/10.1111/bph.13887

8. Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245-259. https://doi.org/10.2147/tcrm.s1928

9. Klauke, A. L., Racz, I., Pradier, B., Markert, A., Zimmer, A. M., Gertsch, J., & Zimmer, A. (2014). The cannabinoid CB₂ receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic effects in mouse models of inflammatory and neuropathic pain. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 24(4), 608-620. https://doi.org/10.1016/j.euroneuro.2013.10.008

10. Rao, V. S., Menezes, A. M., & Viana, G. S. (1990). Effect of myrcene on nociception in mice. The Journal of pharmacy and pharmacology, 42(12), 877-878. https://doi.org/10.1111/j.2042-7158.1990.tb07046.x

11. Li, X. J., Yang, Y. J., Li, Y. S., Zhang, W. K., & Tang, H. B. (2016). α-Pinene, linalool, and 1-octanol contribute to the topical anti-inflammatory and analgesic activities of frankincense by inhibiting COX-2. Journal of ethnopharmacology, 179, 22-26. https://doi.org/10.1016/j.jep.2015.12.03912. World Health Organization. (2018). CANNABIDIOL (CBD), Critical Review Report. Available at: https://www.who.int/docs/default-source/controlled-substances/whocbdreportmay2018-2.pdf?sfvrsn=f78db177_2