Topical cbd oil for pain natures remedy

Top 7 CBD Oils for Pain Management

CBD oil for pain management has become a popular natural remedy in recent years. What is CBD? Cannabidiol, or CBD, is a compound derived from the Cannabis sativa plant. CBD is different from another well-known cannabinoid in cannabis, THC, in that it may help ease pain and relax the mind without the psychoactive effects.

Read below to learn more about the best CBD oils for pain management, how CBD may help relieve aches and inflammation, and how to use CBD oil for pain.

Does CBD Help With Pain Management?

CBD may work to reduce pain through the endocannabinoid system, or ECS, which involves CBD binding to certain receptors. In particular, the receptor CB1, found in the central nervous system, helps mediate pain regulation and activation of it can result in inflammation and oxidative stress. On the other hand, the CB2 receptor, found mostly in the tissues and cells outside of the nervous system, can help slow down chronic inflammatory processes in the body.

When CBD binds to these receptors it potentially acts as an anti-inflammatory compound, and reducing inflammation can help relieve pain.

7 Best CBD Oils for Pain Management 2021

Each product featured here has been independently selected by the writer. You can learn more about our review methodology here. If you make a purchase using the links included, we may earn commission.

  • Best Overall – Spruce
  • Strongest Full Spectrum – CBDistillery
  • Best USDA Organic – Cornbread Hemp
  • Best for Inflammation – Plant People
  • Best Full Spectrum – NuLeaf Naturals
  • Best CBD Capsule – Prima
  • Best CBD Cream – Spruce

How We Chose Our List of Oils for Pain Relief

When looking for a CBD product, it’s important to choose a high-quality product you can trust. This is because some CBD products, since they are not regulated by the FDA, may not contain the potency the label states and/or they may contain other ingredients that could cause harmful side effects.

We used the same five criteria to compare each CBD oil product and brand to find the best ones to recommend. Here is how we made our list:

Type of CBD: It’s important to consider the type of hemp extract used in the CBD product you choose. We tried to include a range of options, both full spectrum oils that contain trace amounts of THC and broad spectrum CBD that is THC-free, so that you can select the right type of CBD for you.

Strength: In general, the CBD oils for pain relief we recommend contain higher concentrations of CBD in order to help provide a stronger effect. This may allow the product to better help you manage your pain.

Source: Not only is the type of extract important when it comes to CBD, but it’s also important to consider where the hemp plant was sourced. We prefer hemp from Colorado, Kentucky, and North Carolina, states with robust industrial hemp programs. We always try to support American-grown hemp.

Flavor: The best CBD products should be effective and offer a clean, natural taste. We look for products that are vegan, non-GMO, gluten-free, and contain no artificial sweeteners or preservatives.

Transparency: It’s vital to choose a CBD product that has been independently lab-tested by a third-party to ensure that what you see on the label is what you get in your product. It can also help to choose products that have certification by ISO 9001: 2015 or by places that ensure trusted testing practices like the U.S. Hemp Authority. Tests should include a measure of heavy metals, pesticides, solvents, and bacteria and mold, and brands should make those results easily accessible.

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All of these factors went into our list of recommendations below.

Our Top CBD Picks for Pain Management

​Best Overall: Spruce Max Potency CBD Oil

Type of CBD: Full Spectrum

Concentration: 80 mg of CBD per dropper

What we like: Comes in a hemp seed oil or coconut MCT oil base; 100% natural; free of pesticides and preservatives; only 0.3% THC; made in U.S.A; vegan; gluten-free.

Why buy: We like this product because it’s free of artificial flavors or sweeteners and contains a dropper to ensure accurate dosing. The high concentration means that this formula is best for people who have been using CBD for a while or require a higher daily dosage.

​Strongest Full Spectrum: CBDistillery 2500mg Full Spectrum Tincture

Type of CBD: Full Spectrum

Concentration: 83 mg of CBD per serving (2500 mg per bottle)

What we like: Uses a fractionated MCT coconut oil base; made from U.S. Hemp Authority-certified non-GMO industrial hemp grown in the U.S.A.; supports natural farming practices.

Why buy: We like this product because it uses hemp that has been certified by the U.S. Hemp Authority and contains low levels of THC for potential pain relief without the high. At 83 mg of CBD per serving, this is the strongest oil for pain management on our list and is not recommended for those new to CBD.

Topical CBD for Pain

Given the lower risk of adverse effects and the high reported tolerability, topical cannabidiol treatments for chronic pain may represent an underutilized therapy.

Abstract

Given the high tolerability, positive safety profile, and low risk of drug interactions of topical products derived from Cannabis spp, the administration of them for chronic pain may represent an underutilized form of therapy. This article reviews the limited animal and human studies investigating cutaneous applications of cannabinoids and cannabis-derived products, with a focus on cannabidiol (CBD) and its potential mechanisms of action. Animal models show topical penetration of cannabinoids into underlying tissues, as well as dose-dependent anti-inflammatory and pain-relieving effects. While randomized, controlled trials are needed to substantiate anecdotal claims of efficacy in humans, evidence exists to warrant clinical exploration of these products by healthcare professionals.

Introduction

Interest in the therapeutic use of CBD, a phytocannabinoid found in Cannabis spp (ie, marijuana or hemp), has reached a fever pitch as CBD products, mostly derived from hemp, appear nearly everywhere, from online retailers to grocery stores and gas stations. In the United States (US), marijuana-derived CBD products are available only in licensed dispensaries in states with medical and/or adult-recreational cannabis (ie, marijuana) regulations. 1 In Canada, however, CBD products are available only through licensed producers, regardless of whether they are derived from hemp or marijuana. 2

The widespread availability of CBD products sold and marketed as dietary supplements in the United States is confounding given that the US Food and Drug Administration (FDA) has explicitly stated that as an active pharmaceutical ingredient in an FDA-approved drug (ie, Epidiolex ® , Greenwich Biosciences Inc.), CBD is precluded from being added to food and beverages or included in dietary supplements. 3 Nonetheless, consumer demand for CBD is high and growing, including demand for topical products, which are not foods, beverages, or dietary supplements and, thus, may not violate FDA regulations, assuming no drug claims are made in marketing materials. 4

In humans, relief of painful joints and sore muscles is one of the most commonly reported uses of topical cannabis products. Cross-sectional studies of CBD product users indicate that consumers are predominantly using these products to treat chronic pain conditions, including arthritis and joint pain. 1 Clinical trials investigating hemp-derived CBD products, while limited, have reported reductions in opioid use; lower pain and disability scores; and improvements in sleep quality, sleep quantity, and quality of life. 5,6

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Management of Chronic Pain

Chronic pain is consistently one of the most common reasons adults seek medical care in the United States. 7 It is associated with restrictions in mobility and daily activities; 8,9 loss of work productivity; 10 dependence on opioids; 10 comorbidities such as anxiety, depression, and sleep disorders; 8 and reduced quality of life. 8,9 Chronic pain is responsible for an estimated $560 billion in direct medical costs, lost productivity, and disability programs each year. 10

Clinical trials investigating hemp-derived CBD products, while limited, have reported reductions in opioid use; lower pain and disability scores; and improvements in sleep quality, sleep quantity, and quality of life.

Current treatments for chronic pain are inadequate. Opioid analgesics present a wide array of serious and nonserious risks, including adverse effects, opioid use disorders, and overdose mortality. Clinical evidence does not support the safety and efficacy of long-term opioid use, and such use has led to an epidemic of opioid dependence and mortality. 11 Nonopioid analgesics pose risks of their own, along with cumulative toxicity in target organs and potential drug interactions. Risks are also attributable to the route of administration, as most of these medications are taken orally, which increases the risk of adverse effects.

Topical agents for treating chronic pain represent a small percentage of the total global market for prescription and over-the-counter (OTC) analgesics ($8.9 billion in 2019 out of an estimated $71.4 billion). 12,13 This route of administration avoids potential gastrointestinal adverse effects, as well as first-pass metabolism. Given the lower risk of adverse effects, drug interactions, and toxicity as compared to oral treatments, and the high reported tolerability, 9,14 topical treatments for chronic pain may represent an underutilized therapy.

Cannabinoids and Pain

In general, phytocannabinoids mediate their effects by binding to specific G-protein coupled receptors (ie, cannabinoid receptor 1 [CB1] and cannabinoid receptor 2 [CB2]). CB1 receptors are principally found on neurons and glial cells in the central and peripheral nervous systems, while CB2 receptors are principally found on immune cells and tissues. 15,16 CBD has been described as a “promiscuous ligand” due to its interactions with a broad range of other molecular targets, including noncannabinoid receptors (eg, transient receptor potential vanilloid type 1 [TRPV1], 17 G protein-coupled receptor 55 [GPR55], 18,19 adenosine receptor subtype A1A, 20 5-hydroxytryptamine receptor subtype 1A [5-HT1A], and others). 21

The mechanisms underlying CBD-induced analgesia are not well understood. Potential pain-relieving mechanisms may include actions at CB1 and CB2 receptors. 22-24 CBD has also been shown to inhibit the endocannabinoid hydrolytic enzymes fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL), 25,26 which has been associated with increased endocannabinoid levels, analgesia, and opioid-sparing effects in preclinical models of pain. 27 Interestingly, a 2019 case report of a woman, aged 66 years, with a microdeletion of a pseudogene that codes for FAAH reported no requirement for postoperative analgesia following a normally painful orthopedic hand surgery (trapeziectomy) along with a lifelong history of painless injuries. 28

CBD has also been shown to act as a TRPV1 agonist of potency equivalent to the exogenous ligand capsaicin, 29-31 although not all studies concur. 32 TRPV1 is thought to modulate inflammation, temperature, and pain perception and is a known antinociception target. 17 Activation of TRPV1, including by phytocannabinoids, has been shown to inhibit hyperalgesia in an animal model of acute pain. 17,33

Broadly speaking, cannabinoids are powerful modulators of inflammatory mediators. 34-36 For example, inhibition of tumor necrosis factor-alpha (TNF-α) and other inflammatory mediators by CBD has been demonstrated in a rodent model of acute pain 37 and in another of rheumatoid arthritis. 38 Enhancement of adenosine signaling by CBD through inhibition of adenosine uptake has been associated with decreased inflammation in other preclinical models. 20,39

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The Entourage Effect

Cannabis spp have been called “the plant of the thousand and one molecules” because of the phytochemical diversity of the constituents (eg, cannabinoids, terpenoids, fatty acids). 40 Growing research has focused on identifying synergistic interactions of major and minor constituents in extracts, a phenomenon popularized as the entourage effect. 41

Compared to highly purified plant extracts, which may be composed of more than 95% CBD, less-refined extracts (ie, “full spectrum” or “broad spectrum”) contain a multitude of biologically active compounds, in addition to CBD. This potentially introduces the possibility of interactions among these constituents (ie, entourage effects), including dermal delivery enhancement mediated by terpenes and terpenoids. 42

Cutaneous Application of Cannabinoids

Oral methods of administering CBD products are most common. Enteric bioavailability of CBD is low, however, due to the hydrophobic nature of CBD and first-pass metabolism. 1,43 Topical or transdermal administration is also popular. 1 While evidence of topical phytocannabinoid absorption is limited, experimental models of human skin have measured skin permeation rates of delta-9-tetrahydrocannabinol (delta-9-THC or THC; CBD is a structural isomer of THC). 44 Animal studies with plasma data also show transdermal penetration of cannabinoids into the bloodstream of different animal species. 45,46 In one study, topical CB1 and CB2 agonists reduced pain behaviors when applied peripherally in a rodent model of muscular pain. 22 In another, transdermal CBD reduced inflammation and pain-related behaviors in a rat model of arthritis; the researchers also observed reductions in joint swelling, limb posture scores (as a rating of spontaneous pain), immune cell infiltration, and thickening of the synovial membrane in a dose-dependent manner. 22

Different cannabinoids have higher barriers to penetration than others. In animal models, for example, CBD crosses the skin barrier much more easily, by a factor of 10, than delta-8-tetrahydrocannabinol. 47 CBD is also more easily absorbed through the skin than cannabinol (CBN). Carriers such as ethanol may enhance topical penetration across the skin. 47 Topical effects appear to be concentration-dependent, meaning that in animal models, a more concentrated product yielded better experimental results than those with lower cannabinoid content. 24,48,49

Clinical trials using topical cannabinoid-containing products are scant but desperately needed. In one small case report, topical cannabis was associated with pain relief and reduced opioid use in 3 patients with pyoderma gangrenosum. 50 In another small human study, topical therapy with a cannabinoid receptor agonist for facial postherpetic neuralgia was effective and well-tolerated. 51

Randomized, controlled trials are needed to substantiate anecdotal claims of the efficacy of topical CBD products for pain. Future research should focus on placebo-controlled clinical studies that compare full-spectrum cannabis extracts to isolated constituents, such as CBD, and to placebo. These studies should specifically evaluate pharmacokinetics and clinically relevant safety, tolerability, and efficacy endpoints.

Conclusion

Given the widespread use of over-the-counter CBD products, the position of the FDA on topical products specifically, and the relative safety of this route of administration, investments in clinical research in this domain are important. While the experimental evidence base is not yet adequate for drawing strong conclusions about efficacy, there is enough evidence to warrant a clinical exploration of these products by healthcare professionals.

Conflicts of Interest Statement

Jake F. Felice, ND, LMP is a consultant and founder of Cannabis Matrix Consulting LLC, and former National Hemp Educator at Manitoba Harvest Fresh Hemp Foods. J.C. is the Medical Director at the Center for Medical Cannabis Education, a for-profit clinical, research and consulting entity.