CBD (Cannabidiol) for Chronic Pain

Cannabidiol, commonly referred to as CBD, is a relatively new and understudied treatment for chronic pain. Studies suggest it can help reduce inflammation and combat anxiety, which are often associated with long-lasting or chronic pain.1,2

Can CBD Really Treat Chronic Pain?

Advocates of CBD believe it can be used to treat a range of conditions, including arthritis, essential tremors, multiple sclerosis3, and more.

See Common Conditions That Cause Chronic Pain

Research suggests that CBD can:

  • Reduce inflammation and other signs of pain4
  • Combat anxiety, which is often associated with chronic pain2

In addition, advocates suggest CBD can help with sleep as well as improve a person’s overall state of relaxation. Some research suggests that the use of CBD has an an effect on pain perception; however, more in-depth studies are needed.5

See Understanding Chronic Pain: The Gate Control Theory


Potential Risks and Side Effects of CBD

CBD, even in high amounts, is generally safe. A person may experience these mild side effects:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Low blood pressure

As with other natural products, there is potential for adverse reactions with other medications. Certain medication, such as those that come with a warning to avoid grapefruit products, may be of particular concern. It is important to check with a health care provider before using CBD.

See Non-opioid and Topical Medications for Chronic Pain

CBD use prior to surgery
A recent study suggests that cannabis use may have an effect on medications used to sedate patients.6 Before having surgery, all cannabis use, including CBD and medical marijuana, should be disclosed to the surgeon or anesthesiologist.

See Complementary Health Approaches and Marijuana for Chronic Pain

Where Does CBD Come From?

The cannabis sativa plant has around 100 chemical compounds, called cannabinoids, that have a range of effects.

The cannabis sativa plant has two main varieties that are grown for specific purposes:

  • THC content. THC is the compound associated with the “high” feeling of marijuana use.
  • Industrial (non-drug) uses. This form of the plant contains very trace amounts of THC (less than .03%) and can be used to make paper, clothing, and some building material. This variation of the cannabis plant is called hemp.

While CBD is present in both varieties, the CBD available to consumers is generally from the hemp plant.


How CBD Oil Is Extracted

CBD is an oil and can be extracted from the plant in several ways:

  • Carbon dioxide (CO2) extraction. This method uses special machines to extract CBD from the plant product. The machines use carbon dioxide in a variety of different temperature and pressure controlled environments to extract a concentrated CBD oil.
  • Liquid solvent extraction. This method uses a liquid solvent, such as butane or ethanol, to strip plant matter of CBD and turn it into a liquid. The liquid is then evaporated leaving a concentrated CBD oil.
  • Oil extraction. This method requires that the plant product be heated to a certain temperature in order to activate the chemicals. Once activated, they are added to oil (typically olive oil) and heated to extract the CBD. Unlike other methods, the extracted CBD is not concentrated and is not as potent.

Once extracted, CBD may be packaged and sold or used as an ingredient in food, lotions or other products.


  • 1.Burstein S. Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorg Med Chem. 2015 Apr 1;23(7):1377-85. doi: 10.1016/j.bmc.2015.01.059. Epub 2015 Feb 7. Review. PubMed PMID: 25703248.
  • 2.Crippa, J. A. S., Derenusson, G. N., Ferrari, T. B., Wichert-Ana, L., Duran, F. L., Martin-Santos, R., ... & Filho, A. S. (2011). Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. Journal of Psychopharmacology, 25(1), 121-130.
  • 3.Corey-Bloom J, Wolfson T, Gamst A, et al. Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ. 2012;184(10):1143-50.
  • 4.Russo EB. Cannabinoids in the management of difficult to treat pain. Therapeutics and Clinical Risk Management. 2008;4(1):245-259.
  • 5.Genaro K, Fabris D, Arantes ALF, Zuardi AW, Crippa JAS, Prado WA. Cannabidiol Is a Potential Therapeutic for the Affective-Motivational Dimension of Incision Pain in Rats. Front Pharmacol. 2017;8:391. Published 2017 Jun 21. doi:10.3389/fphar.2017.00391
  • 6.Twardowski MA, Link MM, Twardowski NM. Effects of Cannabis Use on Sedation Requirements for Endoscopic Procedures. J Am Osteopath Assoc. 2019 Apr 15;. doi: 10.7556/jaoa.2019.052. [Epub ahead of print] PubMed PMID: 30985870.