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CBD, Pain and Inflammation-Myth or Magic?

 

Although first isolated in 1940, cannabidiol (CBD) had not been completely exploited until the early 1960’s. It has since been identified to have pharmaceutical applications, including anti-inflammatory, neuro-protective and anti-tumor effects, which has led to potential therapeutic interest amongst the pharmaceutical and osteopathic communities.

It has been identified through consumer trends that pain associated with chronic inflammation make up the majority for reasons why people consume CBD products today. There have been multiple animal trials that have not only proposed methods to identify responses to the administration of CBD, but anti-inflammatory markers have shown significant responses to the transdermal (topical) application of cannabidiol (CBD), and has been increasingly attracting attention of medical experts, wellness professionals and athletes.

Studies of animal models have identified that transdermal (topical) applications of CBD allow for the accumulation within the skin and skeletal muscle by indirect action on cannabinoid receptors, which are identified as receptors of both the immune system and central nervous system and play a major role in cytokine release, an important step in the inflammatory process. A study conducted by Hammell et al., 2016 explained that results of a chemical analysis of the spinal cord revealed that dose dependent reductions in pro-inflammatory markers were seen within the spinal cord after administering CBD topically over four consecutive days.

 Data would suggest that transdermal CBD applications have therapeutic potential for relief of pain associated with acute and chronic inflammation without evident side effects. Although more research is needed to prove this application in humans, animal models have shown strong evidence to believe that CBD may indeed provide a very potent transdermal (topical) pain relief with anti-inflammatory properties.

Although legislations still do not permit the sale or prescription of CBD as a means to treat any clinical ailment, foreign research has been moving through these obstacles in order to obtain concrete answers to how exactly CBD will make its way into the clinical market. Although difficult to conduct good research here in the states, specifically human trials, other countries have made huge strides in this area of research and have provided data that will ultimately make it impossible to ignore the applications of CBD. Below is a short list of scholarly articles that have looked directly at treat of pain and inflammation with the use of CBD. Studies have looked at the application from a local (topical) and systemic (oral ingestion) standpoint.

1). This study conducted by Guindon et al., 2008 looks specifically at the CB2receptor, a cannabinoid receptor which predominantly found in the peripheral aspects of the body outside of the central nervous system. The authors explain that CBD has indirect application with this receptor to reduce inflammation, pain and protection from nerve damage. This may open up a new avenue of research that will enable health care practitioners to target areas of inflammation and deem whether or not oral or transdermal application will be of greater benefit.

2). This study conducted by Hammel et al., 2016 looked directly at the transdermal (topical) applications of CBD and the effects. This study found that both 6.2 and 62.3 mg/day were effective in significantly reducing joint swelling, pain and inflammation after four consecutive days of application in osteoarthritic mice. It should be noted that these two doses were much greater than the controls of 0.6 mg/day and 3.1 mg/day, which were not effective. The two measures that proved to be effective obviously provide a large range and would bring into question what the proper dose would be for topical application (which may be difficult). If you look at 750 mg tincture, it usually consists of 30 ml total and calls for a serving size of 1 ml, which would indicate that the serving dose is 25mg/serving and 33.3 mg/day (cannabidiol) in 1000 mg tincture respectively. Almost all brands will advise a dose size and these recommendations would bring us just at or below the proposed methods of the Hammel study. However, topical applications can be much more difficult to quantify how much you are applying and it is advised to always start with less. It is important that each individual understands their own physiology and consults their physician if they have specific concerns. With that being said, often times the dose recommendations provided by CBD companies are relatively modest and can be applicable across most demographics.

3) The study conducted by Philpott et al., 2017 presented that transdermal (topical/local) administration of CBD blocked osteoarthritic pain and significantly reduced joint inflammation. Prophylactic (illness/injury prevention) CBD treatment prevented the later development of pain and nerve damage in the osteoarthritic joints. The findings suggest that CBD may be a safe and useful therapeutic treatment of osteoarthritic joint neuropathic pain. The study presented doses that ranged from 0.1-0.3 mg/day, which was the similar to the topical CBD applications seen in the Hammell study. These findings would suggest that there is a very broad range of dose responses that may provide an avenue for further research to indicate what doses are appropriate for certain demographics based on their height, weight, age and medical history.

4) A study published in neuroscience, 2013 by Nackley provide evidence of actions associated with cannabinoid CB2 receptors are sufficient enough to suppress inflammation-evoked neuronal activity and may also act as protection against neuron damage.

5.) The study conducted by Elmes et al., 2004 demonstrated that activation of peripheral CB2 receptors attenuates noxious evoked responses of wide dynamic range (WDR) neurons in models of acute, inflammatory and neuropathic pain. The study would suggest that there is a wide range of therapeutic actions of CBD, however, inflammation seems to be amongst the top of the list and peripheral endocannabinoid receptors have proven the role they play in the regulation of inflammatory responses to injury.

           In conclusion, the combination of these studies have identified that CBD does possess anti-inflammatory and anti-pain properties and has been explained through the present research articles. The CB2 receptor is predominantly found outside of the central nervous system, yet it enables cannabidiol to have an indirect systemic impact (total body) on certain physiological pathways associated with pain, inflammation and tumors. It is believed that as legislation changes, further research in the US will provide more definitive answers as to how CBD can treat certain ailments and how it might be prescribed in the clinical setting.

References:

Guindon J, Hohmann AG. Cannabinoid CB 2 receptors: A therapeutic target for the treatment of inflammatory and neuropathic pain. Br J Pharmacol2008;153(2):319–34.

Hammell DC, Zhang LP, Ma F, et al. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. Eur J Pain (United Kingdom)2016;

Philpott HT, O’Brien M, McDougall JJ. Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis. Pain2017;

Nackley AG, Makriyannis A, Hohmann AG. Selective activation of cannabinoid CB2receptors suppresses spinal Fos protein expression and pain behavior in a rat model of inflammation. Neuroscience2003;

Elmes SJR, Jhaveri MD, Smart D, Kendall DA, Chapman V. Cannabinoid CB2 receptor activation inhibits mechanically evoked responses of wide dynamic range dorsal horn neurons in na??ve rats and in rat models of inflammatory and neuropathic pain. Eur J Neurosci2004;

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