Most importantly, CBD can interact with other important medications like blood thinners, heart medications, and immunosuppressants (medications given after organ transplantation), potentially changing the levels of these important medications in the blood and leading to catastrophic results, including death. Also, more information needs to be gathered about its safety in special populations such as the elderly, children, those who are immunocompromised, and pregnant and breastfeeding women.
If you or someone close to you is considering trying CBD, I would recommend Dr. Robert Shmerling’s advice about the dos and don’ts in choosing an appropriate product. Until there is high-quality scientific evidence in humans, it is difficult to make a recommendation for the regular use of CBD in chronic pain management.
Given the ongoing challenges of chronic pain management coupled with the consequences of the opioid epidemic, pain management practitioners and their patients are searching for effective and safer alternatives to opioids to alleviate pain. With the legalization of marijuana in many states and resulting cultural acceptance of this drug for recreational and medical use, there has been an increased interest in using cannabis for a myriad of medical problems, including pain.
Many of the CBD products on the market are unregulated
If you ask health care providers about the most challenging condition to treat, chronic pain is mentioned frequently. By its nature, chronic pain is a complex and multidimensional experience. Pain perception is affected by our unique biology, our mood, our social environment, and past experiences. If you or a loved one is suffering from chronic pain, you already know the heavy burden.
Given the rapid change in the legality of cannabis coupled with the increased appetite for something new, and driven by unprecedented profit margins, the advertising for cannabinoids in general and CBD in particular has gone wild. The FDA is very clear that it is illegal to market CBD by adding it to a food or labeling it as a dietary supplement. And it warns the public about its potential side effects, as it’s often advertised in a way that may lead people to mistakenly believe using CBD “can’t hurt.” CBD can cause liver injury, and can affect the male reproductive system (as demonstrated in laboratory animal studies).
Cannabis (most commonly obtained from the Cannabis indica and Cannabis sativa plants) has three major components: cannabinoids, terpenoids, and flavonoids. While there are over a hundred different cannabinoids, the two major components are tetrahydrocannabional (THC) and cannabidiol (CBD). Historically more attention has been paid to the psychoactive (euphoric “getting high”) component of the cannabis plant, THC; there have been fewer scientific studies on the medical use of CBD, a non-psychoactive component of the plant.
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They concluded: “To our knowledge, this is the first randomized controlled trial to demonstrate the benefit of cannabis oil – a THC-rich whole plant extract – on symptoms and on [the] quality of life of people with fibromyalgia. We conclude that phytocannabinoids can be a low-cost and well-tolerated therapy for symptom relief and quality of life improvement in these patients, and we suggest that this therapy could be included as an herbal medicine option for the treatment of this condition in the Brazilian public health system.”
A team of Brazilian researchers assessed the efficacy of THC-rich cannabis oil versus placebo in patients with FM over an eight-week period. The mean dose used in the cannabis group was 3.6 drops a day (4.4 mg of THC and 0.08 mg of CBD).
Authors reported, “[T]he impact of the intervention on quality of life in the cannabis group participants was evident, resulting in reports of well-being and more energy for activities of daily living. Pain attacks were also reduced.”
Observational, case-controlled trial data has previously reported that FM patients who inhale cannabis experience greater relief from symptoms as compared to those who do not. The administration of oral THC, as well as the synthetic cannabinoid nabilone, have also shown benefits in subjects with FM.
Cannabis dosing was associated with an “extended significant reduction” in subjects’ symptoms, as assessed by the Fibromyalgia Impact Questionnaire (FIQ). Patients receiving placebo did not experience similar reductions.
The daily administration of plant-derived, THC-rich cannabis oil is effective and well-tolerated among patients with fibromyalgia, according to clinical trial data published in the journal Pain Medicine. Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain and fatigue.
Commenting on the study’s findings, NORML Deputy Director Paul Armentano said: “The demonstration of safety and efficacy in this gold-standard model is significant. Millions of Americans suffer with FM – a condition that tends to be poorly controlled by standard medicines. These clinical findings indicate that for many of these patients, plant-derived cannabis preparations may be a safe and effective alternative.”