CBD for neuropathic pain: what the science says

If you've been reading about the benefits of cannabidiol for a while, you've probably heard about CBD's properties for relieving neuropathic pain. To mark World Pain Day, we're devoting today's post to this topic: you'll find everything the scientific literature says about it, and we'll clear up the main questions about this type of pain and its treatment. For an overview of how this kind of discomfort is approached, read our guide on CBD for chronic pain.

The 3 key ideas:

• Neuropathic pain stems from nerve damage and responds poorly to standard painkillers.
• The most favourable evidence for CBD is for topical use (cream or oil massage): in a study on peripheral neuropathy, pain improved after several weeks.
• It works better in synergy with THC and terpenes (the entourage effect); oral use on its own has given mixed results.

What is CBD?

Cannabidiol (CBD) is one of the main phytocannabinoids in hemp. Unlike THC, it is not psychoactive: it does not alter your state of consciousness, and it interacts with the body's endocannabinoid system, which is involved in regulating pain, inflammation and mood.

According to the World Health Organization (WHO)), CBD is a compound that is well tolerated and safe in humans: it shows no effects indicative of abuse or dependence, and there is no evidence of public health problems associated with the use of pure CBD (report of the Expert Committee on Drug Dependence, ECDD).

This makes it an interesting candidate for addressing persistent conditions such as neuropathic pain. Even so, it is worth remembering that CBD is not a medicine and that Cannactiva products are for external use; this content is for information only and does not replace medical advice.

What is neuropathic pain?

Neuropathic pain is a complex condition that affects millions of people worldwide. It is a type of chronic pain that arises from nerve damage or a malfunction of the nervous system.

How does neuropathic pain manifest itself?

Neuropathic pain is often described, or shows itself, in a variety of ways, and it can affect different parts of the body. Some examples are:

• Lancinating pain: A sharp, stabbing pain that comes and goes, like “electric shocks”, and is common in conditions such as trigeminal neuralgia.
• Tingling pain or numbness: A constant tingling sensation or numbness in a particular area. This may occur in cases of peripheral neuropathy.
• Hypersensitive pain or allodynia: The skin in the affected area becomes hypersensitive, so that even water from the shower or a caress causes pain. This is common in conditions such as postherpetic neuralgia or Sudeck's syndrome.
• Cramping pain: Spasmodic, stabbing pain, similar to a muscle cramp.
• Phantom pain: People who have lost a limb due to amputation feel pain in the part of the body that is no longer present.
• Central pain: Pain throughout the body or in specific areas. It is common in conditions such as multiple sclerosis.
• Nerve compression pain: When a nerve is compressed due to a herniated disc, bulge or other condition, it can result in neuropathic pain that radiates along the path of the compressed nerve.

Differences between neuropathic pain and other types of pain

The main difference between neuropathic pain and other types of pain lies in its cause. While nociceptive pain (from injuries, cuts, etc.) is caused by damage to the body's tissues, neuropathic pain is caused by damage to the nerves themselves.

Pain often persists long after the initial injury heals, making treatment complex.

Conventional treatment of neuropathic pain and its limitations

Neuropathic pain is treated with conventional analgesics, opioids, anticonvulsants and even antidepressants. However, these treatments have limitations in terms of effectiveness and toxicity, as they may not work for all patients, may cause side effects, and some medications (such as opioids) may be addictive.

Neuropathic pain is a complex condition that cannot be objectively measured, and its treatment requires personalised strategies.

Listening to and trusting the people who experience pain is fundamental, as they are the ones who can best describe it and collaborate in its appropriate management.

The approach to pain should be multifactorial, combining different therapies and tools to help alleviate pain and improve the quality of life of those who suffer from it.

Benefits of CBD for neuropathic pain

Cannabidiol (CBD) is a compound found in hemp, and it belongs to the family of phytocannabinoids that do not produce a psychoactive effect. CBD has attracted attention for its many potential therapeutic uses, such as its effectiveness in treating inflammatory pain and possibly neuropathic pain.

The mechanism of action by which CBD may relieve some types of neuropathic pain is its interaction with the endocannabinoid system (ECS) and multiple cellular targets that regulate pain processing in our body.

Scientific studies

Several experimental studies have looked into the efficacy of CBD for neuropathic pain. In rodents, CBD has managed to control the perception of chronic pain, which may be significant for certain types of neuropathic pain (1, 2, 3).

Although animal studies suggest that CBD is effective in treating neuropathic pain, the results do not necessarily carry over to humans. In humans, clinical studies have produced somewhat conflicting results: some have obtained good results for treating neuropathic pain and others have not.

What dose of CBD is used for pain?

The right amount of CBD depends on the type of pain and how you apply it, and there is no single rule. We have gathered the reference ranges in our guide to CBD dosage for pain.

Effectiveness of cannabidiol massage

Topical CBD oil massage has had good results in managing peripheral neuropathy. In a study of 29 people, those who used CBD oil on their skin had better pain control after 4 weeks (4). Topical CBD is well tolerated and may offer a more effective alternative compared with other therapies.

On the other hand, there is a clinical study in which CBD was given orally to treat neuropathic pain; although it had no positive effects, the researchers state that one of its limitations was not including other doses of CBD (5). CBD can show a bell-shaped effect, producing completely opposite responses depending on the dose taken. So, although the human study did not show CBD to be effective for neuropathic pain, it is not conclusive (5).

What is the optimal CBD dosage?

There is no amount that works the same for everyone: the usual approach is to start low and build up little by little until you find what works best for you. We explain the guidelines and the most studied doses in our guide to the optimal CBD dosage.

Is CBD enough for pain, or should it be combined with THC?

Cannabis has been used for hundreds of years to treat pain (6). In fact, cannabinoid therapies for treating pain are more successful when CBD is used in combination with THC, as this produces a synergistic effect (7).

The synergistic action of phytocannabinoids that results in an enhanced pharmacological effect is called the entourage effect (8). The entourage effect may be beneficial for treating neuropathic pain, as it involves not only cannabinoids but also terpenes such as caryophyllene, myrcene and pinene, which have analgesic properties on their own (9, 10, 11).

Because of this synergistic effect, it should also be borne in mind that CBD might give better results if full spectrum CBD extracts are used, as the presence of terpenes may increase its potential for treating pain.

CBD for joint pain and other types of pain

Neuropathic pain is not the only type of pain for which cannabidiol is being researched. If you're interested in its use for the joints, we explain it in CBD for joint pain; and if you're ready to take the step, this guide to buying CBD oil will help you choose.

In conclusion, although the results are conflicting, CBD could be a promising alternative for some types of neuropathic pain, such as peripheral neuropathy, or help treat the anxiety and stress that can come with going through a painful process.

Research into the applications of CBD in pain management is still ongoing. That is why you should always consult a health professional before starting any treatment with cannabinoids.

How is CBD used for neuropathic pain?

The way CBD is administered to treat neuropathic pain depends on the desired response.

For peripheral neuropathy, it can be applied topically by massaging the skin with CBD creams or CBD oil; or sublingually and orally with CBD oil, if the CBD needs to reach the bloodstream and be distributed throughout the body and brain to reduce anxiety. Bear in mind that, in the EU and in Spain, CBD is not authorised for oral consumption as a food or as a food supplement: check the rules.

What is the dose of CBD?

Orally, only CBD doses of 5 mg to 45 mg a day (divided into 3 doses) have been studied, without success. The effectiveness of other doses of CBD for neuropathic pain is not known. At this point, it is worth clarifying that the use of sublingual or oral CBD is not legally authorised as a food or as a food supplement in the EU or in Spain. Cannactiva's CBD oils are governed by EU regulations and are sold for external use.

On the other hand, the CBD oil used topically with good results contained 250 mg of CBD in 90 ml (equivalent to a concentration of approximately 0.28%).

Frequently asked questions about using CBD for neuropathic pain

Is CBD good for neuropathic pain?

The evidence is mixed: in animal models and with topical use there are promising results (peripheral neuropathy), while some oral studies showed no effect. It can be a support, not a substitute for medical treatment.

CBD cream or oil for neuropathic pain?

For localised peripheral neuropathy, the topical route (cream or oil massage) has the best support. The sublingual or oral route is more associated with systemic effects, and CBD is not authorised as a food or as a food supplement in the EU or in Spain.

What dose of CBD for neuropathic pain?

There is no standard dose. See the CBD dosage for pain guide. The reference topical study used a concentration of ≈0.28%; start low and adjust with your doctor.

Does CBD work better with THC?

Yes: cannabinoid therapies for pain are usually more effective when CBD is combined with THC and terpenes (the entourage effect), although that falls outside external-use products.

Note: This is an informational post, based on ongoing research, and it cannot and does not aim to diagnose, prevent or cure any disease or symptom. Its content can complement, but never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. Talk to your doctor before using CBD.