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Best Marijuana for Pain Relief: CBD or THC Strains?

Nov 28, 2018 | by Nicole Gleichmann

Best Marijuana for Pain Relief: CBD or THC Strains?

If you are struggling with chronic pain, one of the safest and most effective options could be marijuana.

Medical marijuana is becoming one of the most popular alternative treatments for chronic pain - this can range from pain caused by conditions such as migraines or arthritis to pain caused by injury. In fact, 94% of medicinal cannabis patients in Colorado indicated severe pain as to why they require cannabis.


Why use cannabis for pain relief?


With over 100 million Americans suffering from chronic pain, a safe and effective treatment is needed, and this does not exist with the presently available pharmaceutical options. 


The two main treatments currently available for relieving pain include nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid prescription medications. These pain relievers are not nearly as safe as cannabis. (1,2)


Opioid drugs are one of the most addictive drugs available today, and their use can be fatal if abused: in the US alone, sixty people die every day from opioid overdose.   


What about NSAIDs? 


While NSAIDs are generally effective at reducing pain caused by inflammation, prolonged use is accompanied by many dangerous side effects. These include increased risk of heart attacks and strokes.


Medical marijuana is becoming a popular alternative to over-the-counter and prescription painkillers, and for good reason. As a remedy for pain, pot comes with fewer side effects and no risk of tolerance or overdose. Cannabis sativa and its constituents have proven to be both safe and effective when it comes to pain management. 


With the legality of marijuana spreading across the United States and other countries, many people are now being given the opportunity to switch from dangerous, addictive medications to a natural, safer alternative.


Whether you are suffering from chronic nerve or body pain, or you are experiencing short-term pain from muscle strain, headaches, toothaches, or simply sore muscles, cannabis offers a safer and possibly more effective option than what is typically used for pain today. 

The history of cannabis: Weed and pain control


Throughout history, cannabis has been cultivated and used for its medicinal purposes. Evidence suggests that it was cultivated by humans as far back as 12,000 years ago.


Throughout this time, the cannabis plant has been exalted as miraculous and cursed as a danger to the fabric of society. Yet, throughout this varied past, one thing has remained the same: 


Cannabis has been used as a plant medicine for the treatment of an impressively wide array of diseases.


The earliest evidence of its medicinal use dates back to 2700 BC when Chinese Emperor Shen Nung documented the analgesic (pain-relieving) properties. Shen Nung is considered by many to be the father of Chinese medicine, which has helped to heal people through the use of natural remedies for thousands of years.


We have now entered a time where the benefits of this plant are beginning to come back to the forefront of the discussion. Indeed, countless individuals across the world have access to legal marijuana for chronic pain conditions. 


Yet for these patients as well as cultivators and clinicians, the question is this: 


What is the best marijuana for treating pain? 


Should patients turn to singular compounds found in the plant, or turn to the plant itself? If using the whole plant, what marijuana strains are the best for providing relief from pain?


Whole plant or THC only? The entourage effect


When you compare Western medicine to traditional medicine the world over, one of the most striking differences is the need in the West to pinpoint one specific molecule that is responsible for treating a disease or symptom. This viewpoint stands contrary to the idea of holistic medicine, where you take something in its entirety for medicinal purposes.


The ‘entourage effect’ is a new term coined to describe the idea that all compounds found in the cannabis plant work synergistically, providing more benefit together than the individual compounds would provide alone.


Cannabis sativa and the entourage effect


The Cannabis sativa plant is one of the greatest present-day examples of this tug-of-war between Western medicine and traditional medicine. 


If you live in a state where marijuana is legal, you may have noticed products being advertised as “isolates” or “whole plant extracts.” Proponents of the isolationist Western medicine theories would advocate for isolates, which are simply products containing just tetrahydrocannabinol (THC) or just cannabidiol (CBD), or far less commonly, any of the other individual phytocannabinoids.


THC is the psychotropic phytocannabinoid that is to thank for the “high” effect users get when they smoke weed. It has been found to have a variety of health-related benefits for the user.


CBD is the second most well-known cannabinoid found in cannabis, and like most of the other phytocannabinoids, it is non-psychotropic. 


These are the two most abundant and well-studied cannabinoids in marijuana, and both have been found in numerous published studies to have pain-relieving properties in humans. While they may be the most abundant, THC and CBD are certainly not the only compounds found in cannabis that are known to exert positive effects on human health. 


In every cannabis plant, there is a unique mixture of hundreds of plant compounds, comprised of phytocannabinoids, terpenes, and flavonoids. Research suggests that these compounds too have an influence on our neurochemistry, and together they may work synergistically, producing better improvements in pain relief than anyone would produce on its own. 


This research supports the idea that it is best to use the whole cannabis plant, with CBD, THC, and the natural medley of additional compounds. This harmony between the various plant chemicals found in marijuana is colloquially referred to as the entourage effect.


How CBD and THC influence the user experience together


The most well-studied compounds found in the marijuana plant that support the idea of the entourage effect are THC and CBD, which have been found to work differently together than when separate.


Using these two compounds in concert has been shown to help mitigate side effects and enhance efficacy, with CBD plus THC showing more benefit for some conditions than THC alone. 


Studies have confirmed that CBD helps to counteract some of the sedative, “high” feeling, anxiety, and rapid heartbeat that is associated with THC consumption. It has also been found to extend the half-life of THC, which may help to extend the pain-relieving benefits. This has allowed the use of higher doses of THC in clinical trials for the treatment of pain caused by multiple sclerosis, peripheral neuropathic pain, intractable cancer pain, and rheumatoid arthritis. When used in concert, a greater efficacy in treating these types of pain have been observed.  


You may be wondering, what is the ideal balance, or ratio, of CBD to THC?


Every strain of bud that you can purchase at a dispensary will be labeled with its THC and CBD content, which can be helpful when choosing which strain to choose for pain relief.


Benefits of high-CBD strains for treating pain


CBD has been found to exhibit enhancements in treating pain both when used on its own and when used in combination with THC. When used alone, CBD is largely best for inflammatory pain, such as that caused by arthritis or injuries. 


In one animal study on arthritis pain, it was found that the topical application of CBD led to a reduction in inflammation and pain. Another animal study found that CBD helps to reduce neuropathic pain through the suppression of chronic inflammation.


CBD does not directly bind to the receptors found in the endocannabinoid system but rather works to modulate the effects of the endocannabinoids (the cannabinoids found naturally in our bodies) as well as working as a CB1 receptor antagonist. 


The main mechanism by which CBD is thought to help mediate pain is by reducing inflammation, largely by blocking inflammatory mediators. It is also believed to potentiate glycine receptors, which help to regulate pain at the spinal level. This suppresses both neuropathic and inflammatory pain. 


Benefits of high-THC strains for treating pain


THC is used clinically for the treatment of pain and studies find it helps relieve central and neuropathic pain. It is also used to help reduce pain in cancer, AIDS, and fibromyalgia patients, for which resistance to other pain treatments have been found. 


The mode of action for THC is as a partial CB1 receptor agonist, which means that it will bind to these receptors but not fully which leads to the variability in effects documented when THC is present with other CB1 agonists, antagonists or both. It has been found to impact the serotonergic, dopaminergic, and glutamatergic systems – an action which may contribute to its pain-relieving benefits. Additionally, THC has been found to act as an anti-inflammatory agent


Anecdotal evidence


While human studies have found benefits from the use of THC, CBD, and whole-plant marijuana in relieving pain, much of the evidence for this use comes from user reports and surveys.


In a survey of those suffering from chronic, non-cancer pain in Canada it was found that 35% of respondents reported using cannabis for pain relief.


Another study found that, out of nearly 3,000 patients using medical cannabis, 97% reported that they were able to decrease their use of opioids when also using medical marijuana, with most reporting that the relief they experienced with cannabis was on par with other pain medications.


High THC or high CBD for pain?


When searching for the best cannabis strains for pain relief, you will first want to consider how much THC and CBD is found in the strain. Generally, you will find the most relief from a strain that has large quantities of both CBD and THC, and a high CBD: THC ratio. This is because CBD can help to mediate the side effects of THC while also providing additional anti-inflammatory and analgesic properties. 


There are certain times where you may prefer the effects of a higher THC or higher CBD strain. One example would be if you are experiencing inflammation, yet you are wanting to go about your day normally, without the psychotropic effects of THC. In this situation, a high-CBD low-THC strain can provide relief without much of an impact on mental function.


Other times you may be in enough pain that you would like something that takes your mind off the pain while also offering pain relief. In this situation, the greater “high” that you would experience with a high-THC strain could be of benefit. 


Best cannabis strains for pain


There are a few things that you will want to consider outside of simple percentage CBD and THC. One of these considerations is the ‘type’ of cannabis you are purchasing. 


There are three categories that your medical marijuana can fall into:

Indica

Sativa

●      Hybrid (a mixture of both indica and sativa)

While this is not an exact science, users tend to report more effective pain-relieving properties with indicas. In one survey, participants reported that indicas helped more than sativas when it came to headaches, joint pain, neuropathy, and spasticity. Users also reported indicas to be more helpful when it comes to sleep and sedation. 


Lastly, there are countless user reports on specific strains of weed that have been found to be powerful for relieving pain. While some of these strains are high CBD, indica strains, some strains of weed used for pain do not fall into this category.


It may be that the other cannabinoids, terpenes, and flavonoids have come together in a harmonious balance that leads to strong pain-relieving properties.  


Some of the most renowned pain-relieving strains per user reviews include:


Strain CategoryCBD ContentTHC ContentDescription
ACDCHybridHighLowProduces no noticeable high feeling due to very low THC content. Helps to relieve pain and even control stress.
Purple KushIndica dominant hybridLowHighProduces a strong body high with associated reductions in pain. A very relaxed and sleepy high. 
HarlequinMostly SativaHighHighMellow psychoactive effects that are great for pain relief experienced with menstrual cramps and arthritis. 
Table 1.  The characteristics of three of the cannabis strains most commonly used to relieve pain. 

CBD oil for pain


Whether you live in a state where medical marijuana is not available, or you would like pain relief without any “high” feeling, CBD oil may be a good option for you. 


There are limited studies examining the effect of CBD alone on pain in humans. Most of the studies out there examine the benefits of THC and CBD together, or whole Cannabis sativa plant, for pain. When it comes to CBD only studies, the majority are preclinical or animal studies. That said, the research conducted thus far, along with countless user reports, suggests that CBD itself may be able to help relieve pain.  


Activation of cannabinoid receptors has been linked to the inhibition of pain. The exact mechanisms of action are still being researched, however, CBD has been found to increase the levels of endocannabinoids in the body, specifically anandamide. It is plausible that this increase in endogenous endocannabinoids could have an impact on pain. Another study suggests that CBD in rats induced suppression of chronic inflammation and neuropathic pain through potentiating glycine receptors. 


Here we will examine the limited scientific evidence, along with theories relating to the use of CBD for pain. 


CBD oil for nerve pain


Neuropathic pain, also known as nerve pain, is a unique type of pain that is caused by injured, dysfunctional, or irritated nerves. This pain tends to be chronic and severe, and with no known cure or remedy, every individual is left to try numerous strategies to find something that works for them.


Some of the most common sources of neuropathy include diabetes, injury, cancer, infections, alcoholism, and autoimmune disorders. While there have been human clinical trials that support the benefits of THC and CBD for nerve pain, there have been fewer studies examining just CBD. In an animal study, researchers found that oral supplementation of CBD led to improvements in neuropathic pain in rats. 


CBD oil for back pain


Back pain is one of the most common forms of both acute and chronic pain. Acute back pain tends to be caused by an injury, such as by falling or lifting something heavy. Chronic back pain is that which lasts more than three months and is often caused by a ruptured or bulging disc, arthritis, osteoporosis, scoliosis, or nerve pain. 


Some back pain is partly caused by inflammation, and numerous preclinical and animal studies have found benefits of CBD for inflammation. Through possible reductions in both nerve and inflammatory pain, CBD may help relieve back pain.  


CBD lotion for pain


When it comes to localized pain, topical CBD lotion or creams may be a great option. By applying the CBD directly to problem areas, concentrated CBD is delivered to exactly where you need it the most.


While human studies on the efficacy of CBD lotion are lacking, there are plenty of animal studies and personal accounts to support this use. In one study, researchers found that rats with arthritis treated with transdermal CBD experienced reductions in pain-related behaviors and inflammation. 


Dosage amounts of cannabis and CBD for pain


Cannabis and CBD dosing for pain are highly individual. Studies have found a bell-shaped dose-response curve with cannabis extract, meaning that it slowly becomes more effective until it hits a certain point, and then the effectiveness decreases. To further complicate matters, the effective dose found in human studies varies greatly from one condition and one study to the next.


For example, in migraines, the effective dose of THC and CBD was found to be 200 mg/day, with no benefits found at 100 mg/day. However, doses of Sativex, an oral spray that delivers 2.7 mg THC and 2.5 mg CBD per spray, was found to be effective in the treatment of central neuropathic pain in Multiple Sclerosis at doses of around 20-30 mg/day CBD + 22-32 mg/day THC.


CBD dosage for pain has not been examined in any human studies. Like the Cannabis sativa extract, studies have found that exceeding the optimal dose of CBD can lead to a reduction in efficacy. In a study examining the effect of CBD on anxiety, 100 mg and 900 mg were not effective, where 300 mg was. 


So where, then, should you start when it comes to dosing Cannabis sativa or CBD oil? Follow these steps when adding in a cannabis or CBD oil product:


1. Choose the product that you would like to take

2. Start at the lowest recommended dosage

3. Split this dose between 2-3 doses throughout the day

4. Stay at the same dose for 3 or more days, evaluating your response

5. Increase your dose until you find the best dose for you

Cannabis sativa is good for pain 


Studies and anecdotal reports have shown that cannabis is good for pain. Whether you enjoy smoking weed or not, there are numerous products available for you to use if you live in a state where pot is legal.


Some products that may help if you want something other than bud itself include:

Lotions or creams 

Tinctures (dropper bottles with cannabis-infused oils)

Capsules or pills

Edibles (chocolates, candies, teas, or other foods infused with cannabis)

When looking at these products it is important to choose one that is a full-plant extract. This allows you to access the full potential of the wide array of healthful and anti-inflammatory compounds found in the Cannabis sativa plant. 

 

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