In 2016, it was estimated that 50 million adults in the United States experienced chronic pain (pain ≥3 months). Between 2019 and 2021, the prevalence of chronic pain among U.S. adults ranged from 20.5% to 21.8% according to the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) (April 14, 2023).
Conventional treatments to pain are usually taken in a “step up” approach. Usually, we start with temporary rest and ice to the affected area and then may add anti-inflammatories.
If that doesn't remedy the situation, then we move to physical therapy. If for some reason the pain persists, then there is usually imaging and referrals to a specialist who may prescribe muscle relaxers, corticosteroids, opioids, anticonvulsants, antidepressants, topical products, sedatives, transcutaneous electric nerve stimulation (TENS), nerve blocks, epidural steroid injections, and even surgery.
Approaching pain is complex because it is not just a physical manifestation. It can be an emotional and cognitive issue as well. There has not been an individual modality of treatment that has shown consistent benefit for every type of pain; therefore, the approach should be multifaceted or multi-disciplinary if needed.
In the past 10 to 15 years, there is more and more evidence emerging that alternative or complementary therapies to pain have been beneficial for some. With the onset of the opioid epidemic and fear of addiction, many have turned to natural ways to alleviate their pain. From nutritional supplements to various forms of physical treatments, many find relief with natural alternatives rather than – or alongside – traditional pharmaceutical medicines.
CBD is one such alternative and can be a great option to add to your approach for pain management. Many find CBD can offer anti-inflammatory support, which helps reduce many types of pain, as well as helping to relax both the body and the mind, which is an added benefit.
Understanding Pain and Its Impact on Our Wellbeing
As we take a look at how pain affects our physical and mental wellbeing, we first need to understand the different types of pain people experience:
- Acute pain is caused by injury, trauma, surgery/medical procedure, or illness. It lasts for a short period of time, and generally disappears when the underlying cause has been treated or has healed.
- Chronic pain is defined as pain that persists or recurs for longer than three months.
- Neuropathic pain is defined as pain started by or caused by a primary lesion or dysfunction in the nervous system.
Any form of pain can keep people from working, limit their social lives, interrupt sleep cycles, decrease quality of life, and even cause physical intimacy to come to a halt. Pain can cause anxiety and general decline, and chronic pain can often lead to depression.
While anti-inflammatories, muscle relaxers, and opioid medications can work well in the short term to help control pain, they can often come with side effects:
- Anti-inflammatories can cause gastritis, hypertension, and can stress the kidney functions.
- Muscle relaxers can cause drowsiness and slow reaction time.
- Opioids can cause constipation, respiratory depression, slow reaction time, and lead to addiction.
We are very aware of the opioid crisis here in the U.S. In fact, the U.S. Department of Human Health Services reported in its 2019 National Survey that “ 10.1 million people misused prescription opioids in the past year” and reported 70,630 people died from drug overdose in 2019.
Exploring Natural Pain Relief Alternatives
It’s no wonder then that so many people – including the patients I see every day – search for alternatives or added options to traditional pain medicines and treatments.
One of the most common benefits of choosing natural alternatives is that they usually do not have as many side effects as the anti-inflammatories or opioids, such as respiratory depression or addiction. Another is that natural pain relief alternatives like CBD, turmeric, or arnica don’t require a prescription and are readily available.
The one thing that I tell my patients is that pain management needs to be personalized. There is no room for “cookie cutter” medicine when it comes to pain. Everyone feels – and interprets – their pain differently. As a physician, I have to assess the relationship the patient has with their pain and how long it has been going on.
For some, anti inflammatories and physical therapy is not enough. Many times there is emotional trauma that has developed from the initial cause of the pain. For example, a motor vehicle accident can cause psychological manifestations that stem from that accident and may persist for many years, even decades.
This is where I turn to CBD, psychology, reiki, biofeedback, and other energy work to help the patient release those memories from causing physical pain. I’ve seen cases where CBD helps stop that physiological response (muscle tension/tone, palpitations, anxiety, sweating, etc.) to a traumatic memory.
Examples of Natural Remedies for Pain Relief
There are many, many natural approaches to dealing with pain, so let’s look at some of them here and how they can be part of a pain management strategy.
Physical Therapy
Physical therapy is a form of treatment that uses methods such as massage, heat treatment, iontophoresis, ultrasound, stretching, and exercise to help improve movement, heal from injuries, increase mobility, and ease pain.
Herbal Supplement Therapy
Herbal supplement therapy is the use of plants or plant extracts for medicinal purposes (especially plants that are not part of the normal diet). This may also be known as botanical medicine or phytotherapy.
Acupuncture
Acupuncture is the practice of penetrating the skin with thin, solid, metallic needles that are then activated through gentle and specific movements of the practitioner's hands or with electrical stimulation. Acupuncture is part of the ancient practice of Traditional Chinese medicine and its practitioners believe the human body has more than 2,000 acupuncture points connected by pathways or meridians. These pathways create an energy flow (Qi, pronounced "chee") through the body that is responsible for overall health. They believe disruption of the energy flow can cause disease. By applying acupuncture to certain points, it is thought to improve the flow of Qi, thereby improving health.
Heat Therapy
Heat therapy is the application of heat to the body to relieve pain. It can take the form of a hot cloth, hot water, ultrasound, heating pad, hydrocollator packs, whirlpool baths, and infrared (IR) heat therapy.
Exercise Therapy
Exercise therapy is a type of rehabilitation that uses physical activity to help treat injuries or conditions.
Energy Therapy
Energy therapy (such as Reiki) is a healing technique based on the principle that the therapist can channel energy into the patient to activate the natural healing processes of the and restore physical and emotional well-being.
Chiropractic Therapy
Chiropractic therapy is manual therapy administered by a licensed doctor of chiropractic who performs adjustments, or joint and spine manipulations to realign the spine and other parts of the body to help reduce discomfort and pain.
Other things to consider as part of a holistic approach include biofeedback and dietary changes. I also cannot overstate the importance of regular exercise (walking for starters), proper water intake, and a plant-based diet to maximize recovery from pain. Processed foods can cause a lot of inflammation in the body and therefore lead to chronic pain (without any initial injury).
The Science Behind CBD for Pain Relief
As we’ve discussed in my other blogs, we all have a unique signaling system of messenger molecules and receptors in our bodies called the endocannabinoid system (ECS). This system hosts CB1 and CB2 cannabinoid receptor sites throughout the brain, central nervous system, immune system, and many organs – with the purpose to establish balance and regulation in the body. The ECS influences many bodily functions and organ systems to keep us healthy. The ECS is constantly working to keep all our systems in homeostasis (natural balance) and plays a role in protecting us from environmental stimuli.
As a very simple explanation, it is believed that cannabinoids like CBD modulate certain aspects of physical and emotional pain and may help diminish the communication of stress hormones in the brain. This, in turn, helps alleviate pain perception and decrease inflammation and anxiety/depression that may come from suffering any pain.
Benefits of CBD for Pain Management
Many people are turning to CBD for a variety of reasons. It does not require a prescription and is readily available and comes in many forms to suit individual needs.
CBD can typically be taken with many prescription medications, although I always advise discussing with your physician/provider to ensure that CBD is being well tolerated in your body and not interfering with your other medications. CBD is not addictive, and I have seen it work well as an anti-inflammatory, muscle relaxer, pain reliever, and anxiolytic.
It has been noted in research that CBD has various biological actions in our body especially as an antiinflammatory and an antioxidant. CBD has shown to modify the activity of both oxidants and antioxidants in our body. CBD can interrupt free radical chain reactions, capture free radicals, or transform them into less active forms. CBD can prevent the formation of superoxide radicals as well. CBD acts on other receptors besides their designated CB receptors.
For example, there is evidence that CBD activates vanilloid receptors (TRPV) directly and indirectly, which can lead to a desensitization action similar to that of capsaicin.
I firmly believe that CBD is a great option to add to one's natural pain management therapy. Not only can it help with inflammation, pain perception, and muscle relaxation, it also aids in helping to ease the anxiety component many patients experience as their pain medication begins to wear off.
For some patients, the CBD can help bridge the gap in between doses of a pain medication – which may allow the patient to extend the time between doses naturally. In my practice, I have seen many patients naturally lower their opioid dosages on their own since they now can go many more hours between doses. In fact, some have come off their opioid pain medication naturally with the aid of CBD products.
Choosing the Right CBD Products for Natural Pain Relief
If you’re considering CBD as part of your pain management approach, you have different delivery methods to choose from. Depending how long you need relief and how fast you need it, you may even consider using a combination of CBD products.
CBD Oil Tinctures
CBD oil tinctures are usually a blend of cannabidiol extract and an inert carrier oil like medium chain triglyceride (MCT) oil. This is usually administered under the tongue and takes the least time to feel the effects because the CBD doesn’t need to go through the digestive system. Taken this way, the effects may last up to six hours. Tinctures can also be added to drinks and food, which will increase the time it takes to feel effects.
CBD Gummies
CBD gummies are chewy edibles infused with cannabidiol. These can take about 30 to 60 minutes to feel the effect since they go through the digestive system, and effects may last up to 8 hours. Gummies are popular because they are usually flavored, portable, and can be taken easily any time of the day.
CBD Pills
CBD pills are small consumable softgels, capsules, or tablets containing CBD in an oil carrier or powder form. These also can take about 30 to 60 minutes to feel the effect and may last up to 8 hours. CBD pills are a great option to add to a daily vitamin or supplement routine and are much more convenient for travel.
CBD Topicals
CBD topicals are any product that contains CBD oil that you apply directly to the skin. It is usually used to help relieve pain and inflammation in a localized area. Many folks feel the effects within a few minutes, especially if the formula contains additional ingredients like menthol, and may last two or more hours.
Understanding CBD Potency and Dosing for Pain Management
Each person is unique in the amount of CB receptors they have in their body; therefore, I always recommend to start with a low dose (like 1 to 2 drops for tinctures and 1/5th of an edible) and increase slowly. If you first try a very low dose and you feel no relief….that is a good thing! That means that you can now start to increase slowly by adding 1 or 2 more drops if it's a tincture or a little bit more of the partial edible that you started with. Again, when it comes to pain- there is no room for cookie cutter medicine. Each person will need to find their dose that suits their pain level.
It is important to consult with your physician or provider if you are going to be starting CBD. Usually, CBD is well tolerated at low to normal doses. It would be wise to come up with a follow up plan with your doctor or provider to check for medication levels or other lab tests to ensure that the CBD is not interfering with your current medication regimen.
Choosing Quality CBD Products
I do recommend choosing a company that proves their commitment to transparency by showing their lab findings and certificates of analysis (COAs). To understand the quality and sourcing of any CBD product, make sure it is subject to third-party testing. This is important because many low quality products can have organic phosphates, pesticides, heavy metals, and other ingredients that could be harmful.
It‘s always a good idea to do your own research. Check to see if the CBD company offers any CBD education resources so you can make an informed decision about their product. A good company will put education at the forefront to help you decide if their product is right for you. You want to avoid companies that promise miracle cures or make outrageous claims. You want to choose a company that uses organic hemp and CO2 extraction methods. You may also want to read the reviews online, both the good and the bad.
Creating a Holistic & Natural Pain Management Plan
It is very important to have a comprehensive approach to pain management because the goal is not only to relieve pain in the body, but also to reduce its impact on a person’s everyday life. Every person is unique – which means their approach will be, too. Whether you choose traditional, alternative, or a complementary combination of options, it’s important to do your research and work in partnership with your health care team. Natural pain relief alternatives can be an effective, accessible, and beneficial part of your pain management plan.
About Lucille Vega, MD
Dr. Lucille Vega is a highly experienced board-certified physician with a strong passion for cannabinoid medicine and its potential in improving patients' lives. She received her MD from Dartmouth, completed a residency at Brown University, and has 23 years of practice in Family Medicine. Dr. Vega is the physician/owner of Vega Direct Medical Family Practice, and has dedicated the past 7 years to incorporating Cannabinoid Medicine into her medical approach.