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Pain Management with Cannabidiol or CBD Oil

CBD oil and cannabidiol use is increasing among all populations and countries, and research suggests it may be helpful for seizures, anxiety, and other ailments. However, pain management, both chronic and acute, is one of the most costly conditions to treat and manage. As the elderly population of the United States grows to ever greater proportions, the number of people with chronic pain symptoms is increasing to an all-time high. According to statistics published by the U.S. Department of Commerce Economics and Statistics Administration U.S. CENSUS BUREAU, between 2012 and 2050, the United States will experience considerable growth in its older population. In 2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012. 


With the increase in the age of our population, we are now seeing millions suffering from chronic pain symptoms. These symptoms may be the aftermath of a debilitating illness such as cancer or arthritis, but all patients require special care and medications.

Low back pain is among the most common complaints, along with migraine or severe headache, as well as joint pain, aching, or stiffness.

Some other pain statistics include:

  • One-fifth of adults 65 years and older said they had experienced pain in the past month that persisted for more than 24 hours.
  • Almost three-fifths of adults 65 and older with pain said it had lasted for 1 year or more.
  • More than one-quarter of adults interviewed said they had experienced low back pain in the past 3 months.
  • Fifteen percent of adults experienced migraine or severe headache in the past 3 months. Adults ages 18-44 were almost three times as likely as adults 65 and older to report migraines or severe headaches.
  • Reports of severe joint pain increased with age, and women reported severely painful joints more often than men (10 percent versus 7 percent).
  • Between the periods 1988-1994 and 1999-2002, the percentage of adults who took a narcotic drug to alleviate pain in the past month rose from 3.2 percent to 4.2 percent.

The most common drugs used to alleviate chronic pain are opioids such as oxycodone, Percocet, fentanyl patches, or morphine, often taken in conjunction with other drugs such as antidepressants or NSAIDS such as ibuprofen. Not only are opioids addictive, but they can also leave the consumer with chronic intestinal issues such as constipation, nausea, and ulcers. While these drugs may be helpful for many, some are turning to cannabinoids as an alternative.

Regardless of method of ingestion, cannabinoids have been shown in preliminary trials to be effective in modulating the response to pain. An article published in November of 2011 showed the effectiveness of augmenting opioid treatment for chronic pain with cannabinoids in human subjects. “Pain was significantly decreased (average 27%, 95% confidence interval (CI) 9, 46) after the addition of vaporized cannabis. We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels.” Abrams, D. I., Couey, P., Shade, S. B., Kelly, M. E. and Benowitz, N. L. (2011), Cannabinoid–Opioid Interaction in Chronic Pain. Clinical Pharmacology & Therapeutics, 90: 844–851. doi: 10.1038/clpt.2011.188

How does it work? The Endocannabinoid System

The endocannabinoid system, which was named after the marijuana plant Cannabis sativa and its active ingredient delta-9-tetrahydrocannabinol (THC), is unique in that it communicates directly with receptors in the brain and body to alter the way a person perceives pain. The human body produces natural chemicals called cannabinoids, such as anandamide, which interact with receptors within the body to regulate body functions. Given that we already have cannabinoids in our body and receptors for them, this is likely why people claim to have such good results when using CBD.

While this is a very limited portrayal of the method by which CBD, THC, and other cannabinoids act upon the human body's neurotransmitters, it serves to show that we now know where the action occurs. Current studies are still identifying specific ligands and receptors on various cells upon which cannabinoids work.

How should cannabidiol, or CBD oil, be dosed?

Although there are no good studies that give clear dosing recommendations due to the lack of sustained human clinical trials, use should be based on the percent or milligrams of CBD and route of administration.

Taking under the considerations of the Davis drug guide, we have compiled common routes and dosages that have been effective for many. However, dosing should be customized to fit the situation and the individual, while remembering that all doses should be started at lower levels before being increased as needed.

CBD Tinctures and Oils

Most people start with one dropper in the morning and one in the evening, increasing as needed for their specific needs. It is generally recommended to spread them out over the entire day. If unacceptable effects occur temporarily, discontinue at current dosage and reintroduce at a lower dose or with longer intervals between doses. Titrate to optimal maintenance dose (usual range 4–8 doses/day, usually not more than 12 doses/day; higher doses have been used/tolerated). Adjust dose to changes in user's condition.


  • Administer one dropper 2 times a day, in morning and in evening, on first day. Administer under tongue or in buccal area. Administration sites in mouth can be rotated between doses to avoid irritation if necessary. Do not spray or squirt the liquid into the back of throat or into nose. After first day, increase dose by 1 dropper every 24 hours, spacing doses evenly. No more than 12 doses should be used over a 24 hour period. Space each dose by at least 15 min.
  • If using a spray tincture, prime pump before first use. Shake bottle gently and remove protective cap. Hold bottle in an upright position pointed at a tissue and press firmly and quickly on the actuator 2 or 3 times until the fluid emits steadily. Droppers do not need priming.

    CBD Edibles and Capsules

    CBD infused edibles and dosed capsules take longer to take effect due to traveling through the digestive system before entering the bloodstream. As with all CBD products, CBD edibles should be taken at lower doses at first and then increased as needed. The trick here is in the timing. Since CBD edibles can take 1-3 hours to take effect, individuals should consider overlapping with a tincture or vaporized CBD. The vaporized version will certainly be more immediate in effect, but shorter lasting and lower in strength.

    CBD Topicals

    These are commonly used for peripheral aches and pains such as in the joints or for skin afflictions such as psoriasis or shingles. Very little will enter the circulatory system, thus reducing the central effect, but patients report relatively quick relief for skin disorders, and even a little faster for muscle aches and pains. The salves and balms are typically stronger than lotions or creams, and all topicals should be rubbed in thoroughly. Research suggests that the use of heat after application will likely increase the effectiveness of the topical, as heat increases local circulation.

    Vaporizing CBD

    Vaporizing CBD is quickly becoming a popular way to use cannabidiol. Vaporization has a fast onset time that is almost immediate and therefore easy to dose. General guidelines suggest to vaporize the CBD until the desired effect is reached. While vaporizing has an almost immediate onset time, the overall strength will typically not be as strong as the oils, tinctures, or capsules, and for that reason, vaporized CBD is typically used as a CBD supplement in between other, longer-lasting CBD products.

    In summary, cannabidiol and CBD extracts are becoming a popular, natural choice for the increased population of people trying to manage their pain. Cannabidiol might be able to help you too.  

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