Does your pain respond best to CBD or THC?
Cannabis has a very long history of providing pain relief. Accordingly, even archeological evidence suggests we’ve been using it for painful conditions and challenging diseases. Though these ancient peoples understood little about how cannabis worked, they could certainly understand its powerful therapeutic results. Hill, K. P., Palastro, M. D., Johnson, B., & Ditre, J. W. (2017). Cannabis and Pain: A Clinical Review. Cannabis and Cannabinoid Research, 2(1), 96–104. doi: 10.1089/can.2017.0017.
Moreover, today patients frequently cite chronic pain as one of the main reasons people turn to cannabis for relief. In 2014, Webb, C. W., & Webb, S. M. (2014). Therapeutic benefits of cannabis: a patient survey. Hawai’i journal of medicine & public health : a journal of Asia Pacific Medicine & Public … Continue reading one survey highlighted by the authors of “Therapeutic Benefits of Cannabis: A Patient Survey,” reported ninety-seven percent of respondents used the plant for pain relief. Is cannabis the best pain reliever available? Many patients will emphatically tell you that it is.
Out of all the conditions treated with cannabis, the therapeutic value of cannabis for pain has been well-established. Both the current body of scientific work and general patient opinion support it as one of the best pain relievers out there, even compared with more traditional pharmaceuticals like opioids.
However, cannabis is a complicated plant with many compounds. Is one compound better than the others for pain relief?
Which Cannabinoid Is the Best Pain Reliever?
More patients than ever before are turning to cannabis for pain, and there has been an associated uptick in attention from the scientific community. On PubMed, there are now over 1,500 different papers talking about cannabis for pain, with a noticeable increase in annual publications since 2014.
With so much research exploring cannabis as a pain reliever, how much do we really know about this therapeutic application? While patients feel that cannabis is the best pain reliever, it’s hard to clarify this with a scientific approach. Even figuring out the best cannabinoid for pain is proving difficult.
In the recently published paper “Cannabis and Pain: A Clinical Review” found strong evidence behind cannabis for the reduction of pain but few details on the dose, specific cannabinoid profile, or therapeutic window. Many studies thus far have failed to control for cannabinoid profile, making it hard to determine whether THC, CBD, or another cannabinoid are best for treating pain.
What “Cannabis and Pain: A Clinical Review” did discover is a “dose-dependent curve.” Too little cannabis, and patients experience zero benefits, yet too much, and the pain increases. A medium-sized dose seems to deliver the best therapeutic value without adverse side effects.
Still, many patients are curious about how cannabinoids impact pain relief. Out of the two most common cannabinoids — CBD and THC — which is best?
How Does CBD Relieve Pain?
Many types of pain are directly linked to inflammatory conditions. As per the Encyclopedia of Neurosciences. “Inflammatory pain is the perception of and effective response to noxious stimuli that occur during an inflammatory or immune response.”
CBD rich strains seem particularly suited to treating pain that’s associated with inflammation. A 2009 study Nagarkatti, P., Pandey, R., Rieder, S. A., Hegde, V. L., & Nagarkatti, M. (2009). Cannabinoids as novel anti-inflammatory drugs. Future medicinal chemistry, 1(7), 1333–1349. … Continue reading that appeared in Future Medicinal Chemistry made this abundantly clear. In it, the authors outlined the extensive research showing how cannabinoids target inflammation in the liver, protect against rheumatoid arthritis, and reduce the inflammatory risks of diabetes. CBD evidently plays a critical role in each of these cases, thanks in part to its anti-inflammatory powers.
Another publication, this time publishedBurstein, S. (2015). Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorganic & Medicinal Chemistry, 23(7), 1377–1385. doi: 10.1016/j.bmc.2015.01.059. in Bioorganic & Medicinal Chemistry, reviewed CBD specifically for inflammation. While the research is limited, and still largely within animal models, the paper outlines the potential of CBD to target different types of pain, including:
- Arthritic Inflammatory bowel disease
- Inflammatory lung disease
- Edema and hyperalgesia
- Autoimmune disorders
So while isolated CBD may not be the best pain reliever for all types of pain, it could be uniquely suited for treating inflammatory pain.
How Does THC Relieve Pain?
Although THC is also a potent anti-inflammatory, it may be beneficial to other types of pain as well. Ethan B. Russo, the author of “Cannabinoids in the Management of Difficult to Treat Pain” 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. summarizes the research on THC for pain. Basically, Russo describes THC as helping:
- Decrease 5-HT release from platelets, which may have applications for migraines
- Reduce pain related to Fibromyalgia
- Block the development of hyperalgesia produced by capsaicin (acute pain model)
As most literature reviews on cannabis for pain to date make it clear, the most effective cannabinoid profiles for the treatment of pain tend to include at least some THC.
Alone, straight THC in an isolated format may have a significantly higher side effect profile than flower or full-spectrum products. Still, THC does play an exciting role in delivering the best pain relief.
Does the Entourage Effect Benefit Pain Relief?
Much of the scientific study of cannabinoids for pain has relied on synthetic cannabinoids or pharmaceutical preparations. One primary example is the drug Sativex derived from cannabis with equal ratios of THC to CBD. Further, it has already gone through several clinical trials for the treatment of chronic pain, and more are in the works.
In one such study, published in the Journal of Pain Symptom Management, Johnson, J. R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E. D., Potts, R., & Fallon, M. T. (2010). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the … Continue reading
compares a preparation of THC & CBD, isolated THC, and a placebo. The focus of the study was cancer-related pain. This study determined the combination of cannabinoids was the best pain reliever. The study, which was a double-blind, randomized, placebo-controlled, and parallel-group format, concluded that “THC:CBD extract is efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids.”
The Entourage Effect (the synergistic benefits of multiple cannabinoids used together) may also boost the effects of cannabis. Considering patients can experience different types of pain at the same time, with complicated biological mechanisms – it makes sense. Basically, each cannabinoid could contribute together to a create a personalized best pain reliever.
Is There a Clear Winner for Pain Relief?
Overall, the short answer is no. Thus far, the research tells us both THC and CBD have useful pain-relieving qualities, but neither has come out a clear winner. Further, CBD-rich strains like Charlotte’s Web or AC/DC may be helpful for inflammatory pain. Finally, strong THC-rich chemovars like Girl Scout Cookies and White Russian could be beneficial for neuropathic pain, migraines, or fibromyalgia.
The best pain relievers are very likely whole flower or full-spectrum preparations, which contain a mixture of both CBD and THC. Each cannabinoid has pain-relieving effects, and it seems as if they are most beneficial when used together.
|↑1||Hill, K. P., Palastro, M. D., Johnson, B., & Ditre, J. W. (2017). Cannabis and Pain: A Clinical Review. Cannabis and Cannabinoid Research, 2(1), 96–104. doi: 10.1089/can.2017.0017|
|↑2||Webb, C. W., & Webb, S. M. (2014). Therapeutic benefits of cannabis: a patient survey. Hawai’i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 73(4), 109–111. https://www.ncbi.nlm.nih.gov/pubmed/24765558.|
|↑3||Nagarkatti, P., Pandey, R., Rieder, S. A., Hegde, V. L., & Nagarkatti, M. (2009). Cannabinoids as novel anti-inflammatory drugs. Future medicinal chemistry, 1(7), 1333–1349. https://doi.org/10.4155/fmc.09.93|
|↑4||Burstein, S. (2015). Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorganic & Medicinal Chemistry, 23(7), 1377–1385. doi: 10.1016/j.bmc.2015.01.059.|
|↑5||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.|
|↑6||Johnson, J. R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E. D., Potts, R., & Fallon, M. T. (2010). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. Journal of Pain and Symptom Management, 39(2), 167–179. doi: 10.1016/j.jpainsymman.2009.06.008.|