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Approximately 50.0 million Americans suffer from chronic pain. Many pain sufferers receive powerful pain medication for their condition. The consequences can be severe side effects and dependency. However, the use of CBD as a medicine for chronic pain can complement and support pain therapy.

What is Pain

“Pain is defined as an unpleasant emotional or sensory experience which occur due to potential or current tissue damage.” That is the definition of the World Pain Organization International Association for the Study of Pain (IASP). But how does pain actually arise?

Before a pain is perceived, it is preceded by a stimulus that is triggered by a shock. There are pain receptors (sensitive sensory cells; the nociceptors) throughout the body, from the skin to the muscles and joints to the internal organs that are responsible for perceiving pain. They not only react to mechanical influences, but also to chemical stimuli, heat and cold as well as to messenger substances that are released in the event of an inflammation.

The receptors are activated by the stimuli that cause pain. But stimuli from inside the body, such as inflammation of the gastric mucosa, can also stimulate the pain receptors. This information is then relayed by the receptors to the spinal cord and brain. Processing takes place here. The corresponding reaction is then triggered.

How strong the pain sensation varies from person to person. The body releases various messenger substances under high stress. These then ensure a reduction in pain. Under certain circumstances, the pain symptoms appear when the stress has passed.

What types of pain are there?

In pain medicine, a distinction is made between the following types of pain:

Nociceptor pain

Nociceptor pain means that the pain receptors are excited directly, such as in the case of inflammatory tissue damage.

Neuropathic pain

The pain impulse triggering takes place in the pain receptor (nerve endings), whereby the nerve fibers are responsible for impulse transmission. Neuropathic pain can be dull, burning, seizure, or shooting in character. This type of pain includes sciatic pain or symptoms such as spasticity that occur in the context of multiple sclerosis.

Deafferentation pain

This type of pain occurs when an extremity is lost (phantom pain).

Reflective pain

This pain group includes pain symptoms that occur due to impaired motor skills. The pain receptors are excited by muscle tension. Again, the painful conditions increase the muscle tension, and a vicious circle begins. In the further course, there is muscle pain and muscle tension.

Psychosomatic pain

A physical sensation of pain can also arise from emotional stress. It is common in certain types of headaches.

Visceral/somatic pain

Depending on where the pain originates, it is divided into visceral and somatic pain states. Visceral pain comes from the bowels, such as a stomach ulcer. In the case of somatic pain, a distinction must be made between deep and surface pain. Muscle cramps are typical deep pain, and irritation of the skin is a surface pain.

Transferred pain

The localization of this pain is severe. Examples of this type of pain are a heart attack, as the feeling of pain usually begins in the left arm. Another cause can be gallbladder disease, where the pain is transmitted to the shoulder.

Benign chronic pain

These include headaches and pain in the musculoskeletal system, such as back pain. Psychological influences mostly determine this type of pain.

Muscle/Soft tissue pain

This pain group includes fibromyalgia as an independent disease with extensive soft tissue pain and myofascial pain syndrome, in which the symptoms are limited to a few body areas.

Mixed pain

It is a combination of neuropathic and nociceptive pain, such as tumor pain in cancer or lumbar sciatica.

Attack pain

These occur, among other things, with migraines, tension headaches, or in the back. They are an expression of a recurring or long-term overload of the body.

There are many different types of pain. We must understand the difference between acute and chronic pain.

Difference Between Acute and Chronic Pain

Acute pain should always be seen as a warning signal from the body. There is an injury or damage. As a rule, it is limited to the place of origin, such as a broken arm. The pain intensity depends on the extent of the injury or damage. A fractured arm hurts more than a slight bruise. Once the cause has been eliminated or the wound healed, the symptoms will go away on their own. Chronic pain, on the other hand, stays for at least three months and affects the person concerned.

Acute pain Chronic pain
Body’s warning signal Function as a warning signal is lost
Restriction to the injured / diseased
part of the body
Persistence of the pain symptoms despite the
cured cause
Pain intensity depends on the extent of the
injury / damage and where it
The causes are usually not recognizable
The pain subsides after healing Independent illness or illness


Chronic pain and the development of pain memory

If the pain persists and is not treated, the brain can develop a pain memory. The pain impulses are conducted through the body via the nerve tracts. If these are irritated continuously, the physical pain remains for a long time.

If this pain stimulus occurs again and again, the nerve cells react more forcefully each time even if the stimulus doesn’t get stronger. Signals are then continuously passed on to the brain. The nerve cells become spontaneously active and that pain stimuli are no longer required to fire the nerve cells. Although the inflammation has healed, the painful state remains because the nerve cells continue to send signals to the brain.

Researchers have also discovered that chronic pain can affect the genetic activity of nerve cells. As a result, new protein chains are formed. The cell membrane changes in such a way that the nerve cells react even faster and the pain intensity becomes stronger.

Pain therapy to reduce pain

Treating chronic pain is often not easy because it is a complex disease. It requires equally complex treatment. Accordingly, there is no single therapy option. As a rule, a combination of different procedures (multimodal therapy) promises the greatest success. Possible therapy methods are:

  • Physical therapy methods (physiotherapy): This includes various forms of treatment such as movement therapy, physiotherapy, sports / occupational therapy, massage, water applications, and heat or cold applications to treat many chronic pains.
  • Psychological therapy: Psychosocial factors play an essential role in development as well as in chronic pain. Many pain patients suffer from depression, which can exacerbate and maintain pain syndrome. Pain psychotherapy (cognitive-behavioral therapy) is used here.
  • Invasive therapy methods: Depending on the type of pain, invasive (interventional) techniques are used, such as injections or nerve stimulation.
  • Complementary procedures: The complementary procedures are about treating painful conditions alternatively (non-drug treatments). It can be natural healing methods or therapies from traditional Chinese medicine (TCM). Chronic painful conditions can also be treated homeopathically. Other procedures include acupuncture, acupressure, osteopathy, or reflex therapies.

Drug Treatment of Chronic Pain

Drugs play an important role in pain medicine alongside the therapy methods mentioned above. Because many patients suffer considerably, with the help of appropriate means, those affected should become active again as quickly as possible. Other treatment measures should make their lives easier by reducing pain.

Pain medication and Anti-Inflammatory Drugs

Paracetamol is one of the classic pain medications (analgesics). It has a pain-relieving and fever-lowering effect at the same time. Nonsteroidal anti-inflammatory drugs (NSAIDs) have a much stronger anti-inflammatory property. These include, for example, acetylsalicylic acid (ASA), ibuprofen, diclofenac, and naproxen. The problem here is that they have side effects. These mainly affect the gastrointestinal mucosa. These herbs also influence blood pressure and kidneys. These are not suitable for long-term treatment.


Depending on the type of pain, especially nerve pain, anticonvulsants such as gabapentin, lamotrigine, or topiramate, are prescribed. Initially, these were used in the treatment of epilepsy. However, it is now known that they can influence specific pain processes. For example, topiramate is approved for migraine prevention, and carbamazepine for neuralgic pain conditions. Commonly observed side effects are fatigue, ataxia, and dizziness. Also, according to the Food and Drug Administration (FDA), it can increase suicidal tendencies. The US regulatory agency had examined eleven active ingredients, and, according to the study, the frequency of suicidal thoughts and behavior rises from 0.24 percent to 0.43 percent.


Opioids can have severe side effects. Opioids are the descendants of morphine and are potent pain relievers. They are obtained from the juice of the opium poppy. The chemical modification of the plant’s active ingredient (alkaloid) from the opium poppy creates semi-synthetic opioid drugs (e.g., hydromorphone). In contrast, active ingredients such as tilidine, tramadol, and fentanyl are fully synthetic opioid drugs.

Opioid drugs are also divided into weaker and stronger drugs. The weaker agents include tilidine or dihydrocodeine. The stronger ones include morphine, fentanyl, oxycodone, and buprenorphine. On the other hand, doctors can prescribe fewer active agents on a regular prescription.

Not every patient benefit from these powerful pain relievers. In the case of tumor pain, the effect is usually excellent. In contrast, they only bring about an improvement in half of the chronic pain patients in the long term. There are also unwanted side effects, such as nausea, vomiting, and constipation. It is often necessary to use additional medication to make these undesirable effects tolerable.


In pain therapy, antidepressants are used very often as they can influence pain processing in low doses. The transmission of pain impulses can also be slowed down with the help of antidepressants, and pain inhibition can be controlled. The tricyclic antidepressant amitriptyline or serotonin and norepinephrine reuptake inhibitors are prescribed. These have positive effects in the diagnosis of pain. But these drugs are not free of side effects either. Typical adverse effects include dry mouth, fatigue, stomach, and intestinal complaints.

CBD as medicine in pain therapy

Tetrahydrocannabinol (THC) and cannabidiol (CBD) have analgesic and anti-inflammatory properties. When ingested, the plant compounds interact with the (body’s) endocannabinoid system. Its cannabinoid receptors are distributed throughout the body. They play an essential role in many physiological processes, such as pain management, memory, and appetite.

In addition to phytocannabinoids, the hemp plant also contains numerous terpenes, such as beta-caryophyllene, beta-myrcene, and alpha-pinene. These have analgesic and anti-inflammatory effects and increase the potential of medicinal cannabis in the treatment of chronic pain.

How does medical cannabis work against painful conditions?

The spinal cord can weaken or intensify pain impulse before pain perception. This function is known as gate control. Phytocannabinoids can alter this gate control by weakening the pain impulses. Conventional pain medication, on the other hand, works elsewhere in the central nervous system and does not target the spinal cord.

Instead, they attach to the peripheral nerves that either leads to or from the spinal cord. Phytocannabinoids also work here, but only to a minor extent. For this reason, they can also be used as a supplement to pain medication. Like phytocannabinoids, opioids work centrally in the spinal cord. Still, there are differences here because opioid drugs kill the transmission of pain, whereas phytocannabinoids slow down the transmission of pain.

The effect can be described with a simple example: When we cut our fingers, we first feel a sharp pain. It subsides by itself. The body’s cannabinoids are responsible for it. This effect is reinforced by the phytocannabinoids. Phytocannabinoids have proven to be particularly helpful in chronic pain conditions, as they can modulate the derailed body’s own regulatory system.

New studies: Cannabinoids Make the Pain More Bearable

Phytocannabinoids do not seem to reduce pain intensity but make the pain more bearable. It was shown by a meta-study that relates to experimental pain conditions i.e., pain caused in the laboratory in healthy people.

Martin De Vita from Syracuse University in the USA is the lead author of the work. The study is the first systematic overview of the effects of medical cannabis on pain conditions in the context of experimental investigations. With his research, De Vita wants to shed light on the question of how cannabis as medicine can relieve pain and what pain-relieving properties it has.

“Cannabinoid drugs are widely used as analgesics [pain relievers], but experimental pain studies have produced mixed results,” says De Vita. “Pain is a complex phenomenon with several dimensions that can be affected separately.”

The effects of THC have been studied most frequently

Phytocannabinoids are chemical compounds that give the cannabis plant its medicinal and relaxing properties. CBD is the best-known active ingredient in the hemp plant.

“THC is the primary psychoactive compound in hemp and, along with CBD, has been the focus of most medical applications and research,” said Emily Ansell, Associate Professor at Syracuse University in the United States.

When THC is ingested, it binds to receptors in the brain that control pleasure, the perception of time, and the sensation of pain. Dopamine is produced – what Ansell calls the “feel-good chemical” as it induces euphoria or relaxation.

Meta-Study Analyzed 18 Studies

De Vita and his co-authors first identified more than 1,830 experimental studies on hemp conducted in North America and Europe over 40 years. They reduced these to 18 reviews and extracted data from more than 440 adult participants.

The team found that phytocannabinoids were associated with moderate increases in pain threshold and pain tolerance. No reduction in the intensity of the ongoing experimental pain was observed.

As Professor Ansell adds, the present study focuses primarily on THC. Therefore, it is unclear whether or not other phytocannabinoids might have produced different results.

Further Studies Investigate Other Types of Pain

The scientists hope to expand their research to clinical and neuropathic pain syndromes. They are also interested in studying dynamic pain processes, as well as different types and doses of phytocannabinoids. They also want to explore the role of recreational cannabis use.

However, De Vita also draws attention to the difficulties involved in this research. The use of cannabis for medicinal purposes is legal in more than 30 states in the United States.

Reliable evidence for the effectiveness of medicinal CBD in the treatment of chronic pain conditions has yet to be created. In this sense, De Vita concludes: “At the moment, we still have a lot to learn.”

Side effects when using CBD Oil

In general, CBD-based products are well tolerated and show no long-term physical side effects. Acute side effects when using it can manifest themselves in the form of the following symptoms:

  • Drop in blood pressure
  • Acceleration of the heart rate
  • Dry mouth
  • Conjunctival irritation
  • Psychological effects like feeling high or calming effect, depending on the drug and dosage

The body builds up a tolerance to these symptoms relatively quickly, so that they can hardly be felt or not at all with regular use.

The use of medicinal cannabis is generally not suitable for the following groups of people:

  • Pregnant and nursing mothers
  • Children before puberty
  • Heart disease patients
  • Patients with psychosis

CBD Oil for Chronic Pain

Cannabidiol is a non-psychoactive cannabinoid from the hemp plant. There are already studies and many experience reports from pain patients that describe a pain-relieving and anti-inflammatory effect. CBD oil can complement and support pain therapy.

Since CBD oil is not intoxicating, it can be taken at any time of the day. Due to its nerve-protecting, antispasmodic and anti-inflammatory properties, CBD oil is very versatile. Possibly. CBD oil can also reduce the need for conventional pain relievers. However, this should be done in consultation with the doctor.

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