CBD Oil is a controversial product because it is so strongly associated with the marijuana plant, Cannabis sativa. However, CBD Oil or to give it its longer name cannabidiol oil is increasingly being used as a popular natural remedy for many complaints as well as generating great interest in the medical community.
One of the most exciting areas of study is the potential treatment for pain and its management (Alexander, 2016).
Cannabidiol (CBD) is one of many chemical compounds called cannabinoids to be found in the cannabis plant. To data there are 104 different compounds but it is more than likely that variants and derivatives will continue to be extracted. CBD is the most widely studied exogenous cannabinoid and CBD-enriched cannabis extracts are widely used adjuvants in the treatment of children for example with refractory epilepsy. The Food & Drug Administration have approved a drug with CBD oil for this purpose.
Just to be aware however, CBD does not have any of the psychoactive properties of tetrahydrocannabinol (THC) which is the compound that creates the ‘high’ and is most often associated with smoking cannabis. It is also worth noting that CBD also has non-endocannabinoid targets which have not been fully explored and could also explain the pain related effects.
CBD oil is extracted from the plant. Usually a carrier oil such as hemp seed oil or coconut oil is added to stabilise the product.
Pain management using marijuana goes back to 2900 B.C. The Chinese used the herb to treat a number of conditions but joint pain and muscle spasms were perhaps one of the more widely treatable conditions (Hill et al., 2017).
The pain-relieving effects are attributed to interactions in a pain regulating system in the body known as the endocannabinoid system (ECS). This system helps in the regulation of a variety of functions such as pain, the immune system, feeding and appetite and sleep. Our body produces endocannabinoids which are potent neurotransmitters that bind to specific cannabinoid receptors linked to the nervous system. These endogenous cannabinoids are derived from arachidonic acid which is also the main derivative of leukotrienes, prostaglandins and thromboxane.
The ECS is associated not only with pain relief but with reward behaviours, emotional state, learning and memory (Luongo et al., 2017). It plays major roles in regulating what is termed synaptic plasticity in both the excitatory and inhibitory sense through potentiation and depression especially in the long-term.
Arachidonic acid is converted to the endocannabinoids such as anandamide (AEA) and 2-arachidonoylglycerol (2-AG). These molecules bind to G-protein-coupled receptors, called CB1 and CB2.
CB1R or cannabinoid receptor 1 is found in the brain in those areas associated with motor control, emotional responses, motivated behaviour and energy homeostasis (Mouslech and Valla, 2009). The same receptor is found in various other tissues throughout the body such as the adipose tissue, pancreas, liver, GI tract, skeletal muscles, heart and the reproduction system. It is worth noting that THC binds to these receptors which in part explains why it has such a reaction.
The receptor, CB2R regulates functions associated with the immune system. These are receptors that are more closely associated with pain and inflammation.
CBD oil is increasingly being used as mentioned before in pain management. One early study with rate that injections of CBD reduced the pain response with surgical incision (Genero et al., 2017).
In various human studies, a combination of CBD with THC is effective in treating the pain associated with arthritis and multiple sclerosis (MS). It is possible to use the approved oral spray Sativex with combines THC with CBD for the treatment of MS. One study in 47 people with multiple sclerosis were treated with Sativex for a month. Compared to the placebo group, the group taking the drug showed improvements in control of muscle spasms, walking and overall pain (Russo et al., 2015).
Essential tremors may also be treatable using CBD oil. At least 10 million people suffer with tremor especially as they enter old age and there is a large-scale clinical trial to start soon using imported cannabis from Canada.
The use of CBD along with other natural and synthetic cannabinoids is still being reviewed especially where its use in young people is concerned. The main issue is the long-term effect from adverse reactions. There are concerns about the impact of CBD oil in young people because their side effects and the mechanisms of actions are still being worked out. Many of the issues are probably due however to the purity of the cannabis products on offer rather than to CBD itself (Schonhofen et al., 2018).
Alexander, S.P.H. (2016) Therapeutic potential of cannabis-related drugs. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 64 pp. 157-166 https://www.sciencedirect.com/science/article/pii/S0278584615300105
Genaro, K., Fabris, D., Arantes, A. L., Zuardi, A. W., Crippa, J. A., & Prado, W. A. (2017). Cannabidiol Is a Potential Therapeutic for the Affective-Motivational Dimension of Incision Pain in Rats. Frontiers in Pharmacology, 8, pp. 391 https://doi.org/10.3389/fphar.2017.00391
Hill, K. P., Palastro, M. D., Johnson, B., & Ditre, J. W. (2017). Cannabis and pain: a clinical review. Cannabis and Cannabinoid Research, 2(1), pp. 96-104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549367/pdf/can.2017.0017.pdf
Mouslech, Z., & Valla, V. (2009). Endocannabinoid system: an overview of its potential in current medical practice. Neuroendocrinology Letters, 30(2), pp. 153-179. https://www.ncbi.nlm.nih.gov/pubmed/19675519
Russo, M., Calabrò, R. S., Naro, A., Sessa, E., Rifici, C., D’Aleo, G., … & Bramanti, P. (2015). Sativex in the management of multiple sclerosis-related spasticity: role of the corticospinal modulation. Neural plasticity, 2015. Article ID 656582 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325203/
Schonhofen, P., Bristot, I. J., Crippa, J. A., Hallak, J. E. C., Zuardi, A. W., Parsons, R. B., & Klamt, F. (2018). Cannabinoid-Based Therapies and Brain Development: Potential Harmful Effect of Early Modulation of the Endocannabinoid System. CNS drugs, 32(8), pp. 697-712. https://link.springer.com/article/10.1007/s40263-018-0550-4