Reviewed by Tyler Tice, PT, DPT, OCS, ATC
This systematic review evaluated the clinical and preclinical evidence for cannabidiol (CBD), excluding THC, as a treatment for pain. The study followed PRISMA guidelines and searched PubMed and Web of Science using the terms “((cannabidiol) NOT (THC)) NOT (tetrahydrocannabinol)) AND (pain treatment)”. Inclusion criteria consisted of clinical and preclinical trials (in vitro and in vivo) in which CBD was used alone or as the major component of cannabis in any pharmaceutical form and free of THC. A total of 40 studies met inclusion criteria, including 11 human clinical trials, 2 canine clinical trials, and 27 preclinical studies. Exclusion criteria included the presence of THC or other cannabis components, systematic or narrative reviews, meta-analyses, case reports, and articles not published in English or Spanish. Literature screening was conducted independently by two researchers and supervised by a third reviewer
Cannabis (hemp) has been used for thousands of years for textile, medicinal, and culinary purposes. The primary compounds of pharmaceutical interest are cannabinoids, with CBD demonstrating a wide range of pharmacologic effects, including anti-inflammatory, antioxidant, anticonvulsant, and antipsychotic properties, mediated through interactions with multiple endogenous receptors. CBD can be administered orally, topically, intravenously, or intraperitoneally. Oral administration was the most common route in clinical trials, while intraperitoneal administration predominated in preclinical studies. One canine clinical trial reported that oral CBD bioavailability was approximately 19% lower compared to other formulations, highlighting the importance of administration route when determining appropriate dosing. The authors emphasized the need for further studies to establish optimal delivery methods based on specific pain pathologies.
Among the human clinical trials, 7 of 11 studies demonstrated pain-reducing effects of CBD. Conditions showing benefit included osteoarthritis, chronic pain, neuropathic pain, bruxism, arthritis, and atopic dermatitis. Importantly, no clinical or preclinical trials reported significant adverse effects or treatment discontinuation. The review concluded that CBD is a potentially effective and safe treatment for pain, supported by its analgesic and anti-inflammatory properties, though larger, well-designed clinical trials are needed to strengthen the evidence base.
Reference:
Cásedas G, Yarza-Sancho M, López V. Cannabidiol (CBD): A Systematic Review of Clinical and Preclinical Evidence in the Treatment of Pain. Pharmaceuticals (Basel). 2024;17(11):1438. Published 2024 Oct 28. doi:10.3390/ph17111438