Some doctors are now considering CBD to be an effective mild to moderately strong analgesic, prescribing Cannabidiol as a pain-reliever for patients with cancer-related pain, as well as other chronic pain such as central neuropathic pains.
While CBD’s pain-relief mechanisms are not yet fully understood, CBD is currently regarded as one of the potentially safest cannabinoids and it has been shown to possibly be effective against a number of cancer-related pains in numerous clinical trials.
CBD and other cannabinoids have also been shown to have effective analgesic properties for terminal cancer patients who have developed a resistance to strong opioid analgesics. This implies that Cannabidiol might be an effective alternative for pain relief even for patients whose bodies have become accustomed to high doses of powerful painkillers. Though we must remind you that our products are not intended to cure, treat, or diagnose any medical conditions, diseases, or other ailments.
“For the relief of certain kinds of pain, I believe, there is no more useful medicine than Cannabis within our reach,” wrote Sir John Russell Reynolds, neurologist, epilepsy research pioneer, and physician to Queen Victoria back in 1859. In fact, cannabis was used for pain relief in all of the major ancient civilizations from Asia through the Middle East and into Europe and the Americas. The scientific inquiry into cannabis over the past several decades has confirmed that it is an effective and safe analgesic for many kinds of pain.
Of all the reasons that people use CBD today, pain is the most common. The same can be said of cannabis in general. In the United States, over seventy million people suffer from chronic pain, which is defined as experiencing over one hundred days per year of pain. Physicians differentiate between neuropathic (usually chronic) and nociceptive pains (usually time-limited), and cannabis works on most neuropathic and many nociceptive types of pain. A number of studies have demonstrated that the endocannabinoid system is both centrally and peripherally involved in the processing of pain signals. Most discussions of using CBD for pain treatment suggest that finding the right dosage is critical.
Cannabinoids can be used along with opioid medications, and a number of studies have demonstrated that they can reduce the amount of opioids needed, lessen the buildup of tolerance, and reduce the severity of withdrawal. At least ten randomized, controlled trials on over one thousand patients have demonstrated efficacy of cannabinoids for neuropathic pain of various origins.
How to Take the Medicine: Dosage and Delivery
It is suggested that patients work with a health care practitioner experienced in recommending CBD oil or medicinal cannabis so that dosage and delivery methods can be developed and fine-tuned on an individual basis. At the same time, educated and aware patients can be their own highly informed health consultants.
Oral CBD products with a ratio of 20:1 or higher and administered as drops, capsules, or edibles can be very effective in treating pain, especially the inflammatory type. Most discussions of treating pain with CBD suggest that finding the right dosage is critical. Always start with the micro dose to test sensitivity and go up as needed within the dosing range by body weight until symptoms subside. The micro to standard dose is usually recommended to treat pain, but patients need to carefully monitor their condition and experiment to find the right formula; 10–40 mg of CBD or CBD+THC together is usually enough.
If CBD-dominant products alone are not enough to treat a particular case, products with a higher ratio of THC are sometimes recommended to better manage pain. For day use, more stimulating, sativa varieties with higher concentrations of myrcene could be added to the formula. In general, for pain, and especially for evening and nighttime, indica strains are favored for their relaxing, sedative effect. A person without experience with THC should use caution and titrate slowly up to higher doses. Research as well as patient feedback have indicated that, in general, a ratio of 4:1 CBD:THC is the most effective for both neuropathic and inflammatory pain. Each individual is different, however—for some, a 1:1 ratio of CBD:THC can be more effective, and others prefer a high-THC strain when it can be tolerated. Each patient’s tolerance and sensitivity will differ, and through titration the correct strain and ratio combination can be found.
Other cannabinoids are also shown to relieve pain, including CBC, CBG, THCV, and THCA. Chemotypes high in beta-caryophyllene, myrcene, and linalool provide additional pain relief and increase the effectiveness of other cannabinoids for analgesia.
For relief of immediate symptoms, as in a flare-up of pain, vaporizing or smoking work well. The medication effect is immediate and lasts one to three hours, whereas most ingested products take thirty to sixty minutes before taking effect (faster on an empty stomach) and last six to eight hours. Vaporizers that use a cartridge filled with the CO2 concentrate are highly effective, and these are available in various ratios of CBD to THC. Herbal vaporizers that use the whole plant are also an effective delivery method. Sublingual sprays or tinctures taken as liquid drops also take effect quickly and last longer than inhaled products.
When pain is localized, topical products can be applied. These can be made using CBD-dominant cannabis as well as THC strains. Topicals affect the cells near application and through several layers of tissue but do not cross the blood-brain barrier and are, therefore, not psychoactive. These may be available as CBD oils, ointments, salves, or other forms, and with varying ratios of CBD and THC (a ratio of 1:1 is often recommended as ideal for skin application). The skin has the highest amount and concentration of CB2 receptors in the body.
Effectiveness: Current Science—CBD Benefits for Pain
The Cannabis Health Index (CHI) is an evidence-based scoring system for cannabis (in general, not just CBD effects) and its effectiveness on various health issues based on currently available research data. Refer to cannabishealthindex.com for updated information and more about studies related to specific types of pain. Considering all of the studies together, which number over forty (for various types of pain), CBD and cannabis are shown to have a rating of likely probable efficacy. It is one of the best-substantiated medical uses of cannabinoids.
Sativex, a cannabis plant–derived oromucosal spray containing equal proportions of THC and CBD, has been approved in a number of countries for use to treat specific types of pain. Numerous randomized clinical trials have demonstrated the safety and efficacy of Sativex for treatment of central and peripheral neuropathic pain, rheumatoid arthritis, and cancer pain. 
Cannabinoids affect the transmission of pain signals from the affected region to the brain (ascending) and from the brain to the affected region (descending). A 2011 study showed that CBD and CBC stimulated descending pain-blocking pathways in the nervous system and caused analgesia by interacting with several target proteins involved in nociceptive control. Authors concluded that the cannabinoids “might represent useful therapeutic agents with multiple mechanisms of action.”  The following year, researchers reported that CBD significantly suppressed chronic inflammatory and neuropathic pain without causing apparent analgesic tolerance in animals.  And then in 2013, researchers concluded that chronic pain patients prescribed hydrocodone were less likely to take the painkiller if they used cannabis.