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Everyone knows pain. It can vary significantly in its location, severity, quality and duration. All these variables already show that pain is not just a complex, but also a subjective sensory perception. Before you can understand why CBD doesn’t work equally well for all types of pain, it is necessary to understand the differences between acute and chronic pain.

Acute pain is pain that is usually a direct response to tissue damage and subsides as the injury subsides. Anyone who opens their knee has very severe pain at the beginning, which decreases as the healing progresses. In the case of acute pain, the pain receptors (nociceptors) at the site of the event (e.g., knee) are stimulated and pass on the information about the injured tissue to the brain. This physiological warning function is essential and sensible because it forces the person concerned to withdraw from the pain-triggering factor (if possible) and thus avoid further and more severe injury. Acute pain is, therefore, based on acute illness. In addition to the example (scraped knee), other causes can also be considered, such as:

  • Acute illnesses
  • Appendicitis
  • Renal colic
  • Nerve pain
  • Sore throat and much more
  • Acute injuries
  • Cuts
  • Sprains
  • Burns
  • Acute trauma from a severe injury, e.g., B. an accident
  • Pain from medical intervention:
  • Operations
  • biopsy
  • Endoscopy
  • Vaccination and much more
  • Labor and delivery pains

Acute pain

Acute pain is defined as lasting less than three months. During this period, most acute injuries and diseases that are based on tissue damage heal with treatment. The pain gradually subsides and ultimately disappears completely.

It is important to treat acute pain well so that it does not develop a pain memory and become chronic.

Chronic Pain

Chronic pain is defined as lasting more than six months or when it recurs regularly, such as with migraines. In chronic pain, the strength or duration or quality of the pain sensation does not match the extent of an underlying injury or illness. So the pain persists or occurs without a suitable cause. This situation is extremely stressful for those affected. It often leads to a severe deterioration in the quality of life, withdrawal from social life, depressive mood up to depression, and sleep disorders. The most common types of chronic pain include back, head, nerve and tumor pain, as well as rheumatic pain and osteoporotic pain.

Chronic pain is problematic because it is difficult to treat and – depending on its duration – may no longer be curable. In the case of long-lasting pain, a reorganization of nerve tracts takes place, which causes the pain to be stored more strongly and also to be perceived more intensely. It is said that a pain memory develops.

The difference between acute and chronic pain is that in acute pain, the triggering stimulus is directly responsible for the reaction, the pain. In contrast, in chronic pain, there is no direct connection between cause and effect. Changes in the brain are responsible for this.

Effects of Cannabis on Nerve Pain, Acute Pain and Chronic pain

While medicinal CBD has already had beneficial effects on various types of chronic pain (tumor pain, patients with spinal cord injuries, neuropathic pain), cannabis or cannabis-based drugs seem to be of no benefit in acute pain. On the contrary: In the case of acute pain, it has even been observed in individual cases that the pain threshold drops, and those affected are more sensitive to painful stimuli.

To understand this, one has to look at how cannabis works, although the exact mode of action on pain is not fully understood. In acute pain, the brain tries to suppress the generation and transmission of new pain stimuli by activating pain-relieving nerve pathways that extend from the brain into the tissues in the periphery. Cannabinoids can block the activity of pain-relieving neurons. It eliminates the body’s own pain relief. For this reason, cannabinoids can even increase the sensation of pain in acute pain.

In the case of chronic pain, the body’s own response to the pain is disturbed, so that the natural pain inhibition fails. A meta-analysis from 2018, in which 18 placebo-controlled studies were evaluated, came to the result that cannabis or cannabinoids per se only have a minor influence on pain tolerance and only minimally raise the pain threshold. Cannabinoids, therefore, do not work like a typical pain reliever. Apparently, cannabinoids rather change the perception of pain: the pain can be faded out better and is, therefore, more bearable. However, this does not make the patient pain-free. Cannabinoids change the perception of pain, but cannot alleviate pain.

CBD in Pain Management

In order to prevent pain memory from developing during prolonged pain, adequate and extensive pain management is very important. The pain treatment should be based on the WHO level scheme. The pain intensity is divided into four levels, and the drugs to be used are stronger from levels 1 to 4. If the pain is mild, start with painkillers that do not contain opioids, such as NSAIDs (ibuprofen, diclofenac, acetylsalicylic acid). In level 2, weak opioids can also be used in level 3, additional potent opioids and level 4 opioids close to the spinal cord. Cannabinoids do not appear in the tiered scheme. Cannabis-based drugs are usually not used as the only drug, but rather as an accompanying drug to other substances.

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