With its recent legalization in many countries, the popularity of CBD oil is booming. Most people take this oil to relieve the pain caused by conditions such as arthritis, multiple sclerosis, migraine, and IBS. But are any of these uses backed by science? And which delivery method provides the fastest and most effective pain relief? Read on to find out.
What is CBD Oil?
People commonly take both CBD and THC-containing medical cannabis for pain relief. In 2 surveys on over 3.5k people using them, over 50% reported suffering from different painful conditions. The ones most commonly managed with CBD – and other cannabis products – include [1, 2]:
- Arthritis (both rheumatoid and osteoarthritis)
- Multiple sclerosis
- Headaches (migraines, cluster, and drug overuse)
- Low back pain
- Cancer pain
- Nerve pain
- Irritable bowel syndrome
Hemp-derived CBD oil is legal in the US and many other countries, while oil derived from marijuana may contain higher THC levels and is more strictly regulated. The only FDA-approved use of CBD oil is for reducing epileptic seizures, not for pain relief .
A mouth spray supplying similar amounts of CBD and THC (nabiximols or Sativex) is approved in Canada and several European countries (but not in the US) for the involuntary and often painful muscle contractions caused by multiple sclerosis. It has also been widely investigated worldwide for other painful conditions .
CBD Oil for Pain Relief
How Does It Work?
Interaction with the Endocannabinoid System
The endocannabinoid system is made up of two receptors: CB1 and CB2. The cannabinoids you naturally produce, including the “bliss molecule” anandamide, bind to them. CB1 is mostly found in brain cells, while CB2 is most abundant in immune cells [5+, 6+, 7].
Cannabinoids in general – including anandamide and THC – reduce pain by activating these receptors. In fact, anandamide deficiency is linked to painful conditions such as migraines, fibromyalgia, and IBS [8, 9].
CBD is less likely to bind to CB receptors and blocks rather than activates them. However, CBD indirectly increases cannabinoids in the body: it stops anandamide from being broken down and removed. This probably explains why it enhances the pain-relieving effects of THC [8, 10, 11, 12, 13].
CBD and cannabis products are not the only way to increase your cannabinoids. There are 49 other natural ways to boost cannabinoids, as far as we’re aware.
CBD oil is a strong anti-inflammatory, which probably explains why it may prevent and lessen pain.
When we zoom into its effects on a cellular level, we see that it impacts over a dozen anti-inflammatory pathways and molecules.
It also blocks the major inflammatory hub NF-kB, activates anti-inflammatory PPAR-gamma, and prevents the removal of anti-inflammatory adenosine. In turn, CBD also reduces the production of many pro-inflammatory messengers (IL-1beta, IL-6, TNF-alpha, IFN-gamma, NO, and prostaglandins) [20, 21, 22, 23, 24, 25, 26, 27, 28]
Finally, CBD enhances the pain-relieving effect of opioids such as morphine .
Next, we’ll review whether CBD oil works for over 11 painful conditions. Get ready for a deep dive into the research.
When Does It Work?
1) Multiple Sclerosis
In multiple sclerosis, pain is caused by involuntary muscle contractions and damage to the nerves, muscles, and joints. THC, CBD, and their combination were similarly effective at reducing pain and involuntary muscle contractions in a small trial on 24 people with this condition .
In mice with multiple sclerosis, CBD reduced inflammation and nerve damage, which slowed the progression of the condition. Its effects may vary when CBD is combined with other hemp-derived cannabinoids: THC provided additional relief, while another compound (palmitoylethanolamide) blocked the positive effects of CBD [33, 34, 35, 36, 37, 38].
However, the mouthspray with similar amounts of THC and CBD – nabiximols – is more commonly used for this condition (see “Nabiximols for Pain Relief” below).
2) Nerve Pain (Neuropathy)
CBD reduced nerve pain – from brain injury, repeated nerve stimulation, anticancer drugs, and diabetes – in mice and rats. It activated three receptors that reduce pain sensitivity (TRPV1, 5-HT1A, and glycine receptors), lowered inflammatory cytokines, and prevented T cells from developing and invading the nerves [26, 39, 15, 16, 17, 18].
As is the case for multiple sclerosis, clinical trials successfully more frequently tested the spray combining THC and CBD – nabiximols – for difficult-to-treat nerve pain.
Arthritis is the damage of joint cartilages due to wear and tear (osteoarthritis) or autoimmunity (rheumatoid arthritis). In a survey on almost 3k people using medical cannabis, 21% did so to relieve arthritic pain and often reported good results [42+, 43+].
Although the only clinical trial carried out so far tested the spray with CBD and THC (nabiximols), a follow-up trial is underway to study the effect of CBD – both alone and followed by THC – on joint pain in people with rheumatoid arthritis and arthritis that mostly affects the spine (ankylosing spondylitis) .
Fibromyalgia can cause widespread pain, possibly because the brain becomes more sensitive to pain signals [48+].
In a clinical trial on 20 people with fibromyalgia, a vape containing a cannabis variety with similar THC and CBD content slightly reduced pain. In turn, vapes with more of either compound were ineffective .
CBD injected directly into muscles might be more effective for fibromyalgia, since it relieved pain in rats with a similar muscle disorder (myofascial pain) .
5) IBS and IBD
CBD hasn’t been tested in people with IBS. However, IBS likely causes pain by increasing the production of the TRPV1 receptor in the bowels. Although TRPV1 triggers inflammatory pain, its stimulation with CBD (or other substances such as the chili pepper compound capsaicin) reduces pain perception – explaining why CBD may provide IBS pain relief [54, 12].
Bowel inflammation increases intestinal permeability – i.e. “leaky gut” – which worsens IBD. In a clinical trial on 30 healthy men, CBD reduced gut permeability. Similarly, it prevented leakiness from inflammatory cytokines in gut lining cells .
Alternatively, CB1 activation by anandamide and other cannabinoids reduced inflammation in cells that line the gut. CBD mostly binds to other receptors but may indirectly activate CB1; thus, CBD may reduce bowel inflammation by increasing your anandamide levels [56, 12].
6) Back Pain
In a clinical trial on 11 people with back pain despite surgical interventions, a cannabis oil with CBD and THC as an add-on therapy reduced pain and improved quality of life. However, the oil contained 20x more THC than CBD .
In a study on almost 200 people with chronic pain, 19% of whom had low-back pain, medicinal cannabis (with both THC and CBD) reduced pain and opioid use .
7) Headaches and Migraines
People often take medicinal cannabis for all types of headaches. In a study on over 100 people with migraines using medicinal cannabis, 85% reported reduced pain and migraine frequency .
In a clinical trial on 13 people with headaches from overusing painkillers, two cannabis preparations (decoction and oil) reduced pain. However, the preparation with the highest THC content (oil) was more effective. In line with this, a synthetic THC analog (nabilone) relieved pain and reduced pain-killer use in another trial on 26 people [69, 70].
In a trial on over 100 people with cluster headaches, cannabis use was relatively frequent (45%) although it relieved the attacks in only 25% and worsened them in 22% .
8) Pain after Medical Procedures
The HPV vaccination may cause several adverse effects including severe pain, fatigue, and sleep disturbances. In a small trial on 12 girls who developed symptoms after the vaccination, CBD-enriched hemp oil reduced pain and improved vitality and well-being .
Chronic pain is an occasional adverse effect of kidney transplantation. People normally manage it with painkillers, which can damage the kidneys. In a small trial on 7 people with kidney transplants, CBD was safe and reduced pain in all but one person .
CBD (injected into both the bloodstream and the brain) reduced postoperative pain in rats. An oral cannabis extract also reduced postoperative pain in a small trial on 11 people, but it contained 2x more THC than CBD [74, 75].
9) Complex Movement Disorders
Complex movement disorders are an umbrella term for all conditions with abnormal movements and postures, mostly caused by brain injury. Tourette syndrome, tics, and cerebral palsy fall under this group. CBD-enriched medical cannabis preparations improved pain and reduced involuntary muscle contractions in a clinical trial on 25 children [76+].
10) Other Types of Pain
Some case studies report successful pain management with CBD (often combined with THC) in people with:
- Endometriosis 
- Two rare inflammatory skin conditions (epidermolysis bullosa and pyoderma gangrenosum) [78, 79]
- Benign tumors in the nerves (schwannomatosis) 
Limitations and Caveats
The human studies discussed above all used CBD in combination with varying amounts of THC (either as extracts or specific cannabis strains). Animal research suggests CBD oil alone may also relieve pain, but clinical trials have yet to determine if it works.
Nabiximols for Pain Relief
As hinted above, the mouth spray supplying similar amounts of CBD and THC – nabiximols – is approved in several countries for people with involuntary muscle contractions from multiple sclerosis. It has also been widely investigated for other painful conditions. Below is a short overview of the clinical research with this spray.
1) Multiple Sclerosis
Nabiximols relieved pain, reduced muscle contractions, and improved quality of life in 13 studies on over 1k people with multiple sclerosis. The spray showed sustained effectiveness in follow-up studies of up to 52 weeks [81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93].
2) Nerve Pain
In 6 clinical trials on over 700 people with hard-to-treat nerve pain – from repeated nerve cell stimulation, diabetes, nerve injury, multiple sclerosis, and anticancer drugs – nabiximols were effective and well tolerated [94, 95, 32, 96, 97, 98].
3) Cancer Pain
In 2 clinical trials on over 400 people with advanced cancer and difficult-to-treat pain, nabiximols relieved pain better than the placebo while THC alone didn’t. Low and medium doses were more effective and were better tolerated than higher doses. The spray remained effective in the long term without needing to increase the dose or take other pain-killers [99, 100, 101].
However, 2 more recent trials on over 600 people from the US and Europe found nabiximols ineffective for cancer pain management in both groups. It only improved quality of life in the US, possibly because the US center used lower opioid doses or had a different distribution of cancer types [102, 103].
CBD Oil Dosage for Pain Relief
Most clinical studies tested CBD with THC. The single clinical trial with CBD alone for pain after kidney transplants used a high dosage: they started with 100 mg/day and increased the dosage to 300 mg/day over 3 weeks .
The unofficial doses are lower and based on the recommendations from manufacturers and users. The optimal dose will depend on your:
- Body weight: heavier people will need a higher dose to experience pain relief.
- Type of pain: severe or chronic pain will normally require a higher dose than mild pain.
- Tolerance: frequent CBD users may develop tolerance over time and need to increase the dose.
With this in mind, the recommended CBD doses (taken 1x-3x/day) are:
- Light people (below 135 lbs): 10-17 mg
- Medium-weight people (135-200 lbs): 15-25 mg
- Heavy people (over 200 lbs): 22-45 mg
Consult your doctor about the best starting dose when using CBD oil for the first time. Start with a low dose and track your response. If you tolerate CBD oil well, increase the dosage gradually until you achieve the desired effect.
How to Take
CBD oil comes in different forms:
- Oil tinctures
- Capsules and tablets
- Edibles (gummies and lollipops)
- Mouth sprays
- Vaping oil
- Topical lotions, salves, and creams
Your form of choice may depend on your type of pain [105+]:
- Capsules, edibles, and teas release the CBD more slowly but their effects also last longer. They are preferred for chronic conditions.
- Vaping, mouth sprays, and oil tinctures are absorbed more quickly and are preferable in case of acute or episodic pain.
- Topical forms act locally and are mainly used for muscle and joint pain.
How Long Does It Take to Work?
The time until you notice pain-relieving effects will depend on the delivery method – which determines the rate at which CBD is released into your bloodstream. You can expect the effects to start kicking in after approximately [105+, 106]:
- Vaped or smoked: 5-15 min
- Mouth sprays and oral tinctures: 15-30 min
- Oral capsules, edibles, and teas: 30-180 min
- Topical forms: 30-120 min
Finding the Best CBD Oil for Pain Relief
In addition to choosing a CBD oil adjusted to your budget (you may want to calculate the price per mL or mg to compare different brands), you should also evaluate the product quality. Read here about how to choose the best CBD oil in detail here.
Out of various factors, CBD content is the most important one: make sure that the oil contains enough CBD, clearly stated on the label. If you want to avoid unwanted effects of THC, choose products with little or no THC. Otherwise, you may prefer the oil to contain THC as well to obtain some added pain-relief effects.
Legality is also important. Unlike marijuana-derived products, hemp-derived CBD oil is legal in all US states and in many countries around the world. Go for CBD oil from hemp to stay on the safe side and read through this post to make sure you’re not breaking any laws.
Most people used CBD oil for painful conditions such as multiple sclerosis, arthritis, nerve pain, fibromyalgia, IBS, and lower back pain. Users were normally satisfied and most of them reported pain relief.
In some cases, the users complained that the oil didn’t work for them. Adverse effects most commonly reported in negative reviews included upset digestion, dry mouth, headaches, and fatigue. Depending on the brand and form of supplementation, some users complained about its high price, poor customer service, and bad taste.
CBD Oil Side Effects
- Dry mouth
- Drowsiness and fatigue
CBD & THC Extracts
- Dizziness, vertigo, and feeling drunk
- Confusion and disorientation
- Disturbances in attention and memory
- Mood changes
- Dry mouth
- Bad taste, nausea, and vomiting
- Diarrhea or constipation
Although some of these (such as confusion, disorientation, disturbances in attention and memory, or feeling drunk) may be caused by THC, it’s important to note that CBD partly opposes its effects by blocking CB receptors. Nabiximols – and other reparations with a balanced CBD and THC composition – may have fewer unwanted effects than others with higher THC levels [105+].
Vendors sell CBD oil on Amazon, but many of them do not meet quality standards. Some don’t even specify the CBD content in their products, while others sell hemp oil with little or no CBD. Most of these vendors are not to be trusted.
We recommend the following brand, which specifies quality procedures and CBD content in their products:
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Want More Targeted and Personalized Ways to Combat Inflammation?
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SelfDecode is a sister company of SelfHacked. This post contains sponsored links, which means that we may receive a small percentage of profit from your purchase, while the price remains the same to you. The proceeds from your purchase of this product are reinvested into our research and development, in order to serve you better. Thanks for your support.
CBD oil can relieve pain by increasing anandamide, your natural cannabinoid bliss molecule. Unlike THC, it doesn’t overwhelm the cannabinoid receptors or get you high.
CBD oil may help with mild multiple sclerosis pain, nerve pain, arthritis, and IBS. Its side effects are mild and most people tolerate it well. If you need immediate pain relief, go with vapes. For a more steady CBD supply, choose capsules. If your pain is localized – such as in your lower back or knee joints – you may benefit from creams and other topical CBD formulations.
However, THC and CBD together provide greater pain relief. An extract called nabiximols (Sativex) contains similar amounts of THC and CBD. It has been approved for multiple sclerosis pain in some countries – excluding the US. It also relieved nerve, arthritis, and cancer pain in clinical trials.