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Exploring the Mechanisms of CBD for Pain Management

Exploring the Mechanisms of CBD for Pain Management

Since the ground-breaking discovery of the presence of natural cannabis-like compounds in the human body in the early 1990s, experts have been piecing together a remarkable picture of how the endocannabinoid system (ECS) operates. A highly complex signalling system, the ECS is often described using the ‘lock & key’ analogy; the receptor is the lock securing access to a vast range of physiological and neurological functions, and the endocannabinoids are the keys that unlock, activate, and regulate them.  

With hemp’s legislative easing from 2018 came the acceleration of its accessibility for research lending to further eye-opening discoveries about the ECS and its interaction with plant-derived cannabinoids (phytocannabinoids, such as CBD and THC).  Although recognised for millennia as medicinally valuable, with modern science we can better appreciate the therapeutic potential offered by combining our endogenous cannabinoids with external phytocannabinoids, and the symbiotic effect that their collaboration can offer to support health and promote balance.

In understanding how CBD interacts with our biosystem, we can shed light on its efficacy in alleviating various specific forms of discomfort, but does CBD help to ease the root cause of pain, or simply how we perceive it?  Or indeed both?  There is growing evidence to support the latter, but since pain comes in many different forms, from many sources, and at varying levels of perception, it isn’t a simple yes or no. Here we explore how CBD can support both the symptoms and the perception of pain for a variety of conditions:

Arthritic Pain

CBD has shown promise in alleviating pain associated with arthritis through its anti-inflammatory properties. Research, including a study published in the European Journal of Pain (1), has demonstrated that topical application of CBD reduces joint swelling and pain in animal models of arthritis, indicating its therapeutic potential for humans.  Furthermore, a review published in the journal Current Opinion in Rheumatology (2) suggests that CBD may modulate the immune response, leading to a reduction in inflammation and pain in arthritis patients. By targeting inflammatory pathways involved in arthritis pathogenesis, CBD offers a promising approach to managing both the symptoms and underlying mechanisms of arthritic pain as a complementary or potentially alternative treatment option.

Back Pain

Research indicates that CBD may offer relief from back pain by targeting both the pain sensation and its underlying causes. A study in the Journal of Pain Research (3) observed that CBD reduced pain and improved sleep quality in patients with chronic back pain. Moreover, CBD's anti-inflammatory properties could address the inflammation often associated with back pain, as suggested by research published in the journal Cannabis and Cannabinoid Research (4).

Menstrual Cramps or Dysmenorrhea

Many women experience menstrual cramps, or dysmenorrhea, during their menstrual cycle, causing abdominal pain and often debilitating discomfort. CBD's muscle-relaxant and anti-inflammatory effects are widely considered to alleviate menstrual cramps, providing relief without the side effects of conventional pain medications. Phase two studies are underway (5) to evaluate the effect of CBD alone in the reduction of acute menstrual pain as compared to ibuprofen. These could bring much-welcomed evidence of the effects of a natural approach to managing menstrual discomfort to support the anecdotal evidence and surveys that suggest that CBD products, including topical lotions, can provide relief by relaxing muscles and reducing pain intensity.  

Headaches and Migraines

CBD's analgesic and anti-inflammatory properties make it a promising candidate for managing headaches and migraines. A review published in Frontiers in Pharmacology (6) noted that CBD has potential as a therapeutic agent for migraine management due to its ability to inhibit pain transmission and reduce inflammation. Furthermore, a survey conducted by the European Academy of Neurology (7) found that CBD-rich cannabis products reduced migraine frequency and intensity in a significant number of participants.  Another study published in the Journal of Headache and Pain (8) reported that CBD reduced migraine frequency by 55% in participants, highlighting its potential as a natural migraine remedy.


Fibromyalgia is characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, and heightened pain sensitivity, often accompanied by mood disturbances such as anxiety and depression. The multifaceted nature of this condition and CBD's mechanisms of action align with its complex symptomatology. CBD’s therapeutic potential stems from its ability to modulate various biological pathways implicated in the pathophysiology of the condition, and critically, its interaction with the endocannabinoid system (ECS). By enhancing endocannabinoid signalling, CBD may help restore balance within the ECS, thereby alleviating pain and improving overall well-being.  Moreover, CBD's anti-inflammatory properties are particularly relevant in fibromyalgia, as emerging research suggests that chronic inflammation may contribute to the development and maintenance of fibromyalgia symptoms. By reducing inflammation in the body, CBD may help mitigate pain and stiffness associated with fibromyalgia, enhancing mobility and quality of life for affected individuals.  A study published in Pain Medicine (9)reported that CBD improved pain, sleep quality, and overall well-being in fibromyalgia patients, underscoring the potential of CBD as a holistic treatment approach for this complex condition.  Additionally, research in the journal Experimental and Clinical Psychopharmacology (10) suggests that CBD's interaction with serotonin receptors may help regulate pain perception and mood in fibromyalgia patients.

Post-operative Pain

CBD's analgesic and anti-inflammatory properties may aid in managing post-operative pain and promoting recovery. A study in the Journal of Pain and Symptom Management (11) found that CBD reduced opioid use and improved pain management in cancer patients with post-operative pain. Moreover, research published in the Journal of Experimental Medicine (12) suggests that CBD's interaction with cannabinoid receptors and other pain-related pathways could enhance pain relief and reduce inflammation after surgery.

Post-exercise Pain or Delayed Onset Muscle Soreness (DOMS)

CBD's potential to alleviate post-exercise discomfort, including delayed onset muscle soreness (DOMS), stems from its anti-inflammatory and analgesic properties. DOMS occurs due to micro-injuries in muscle fibres following strenuous exercise, leading to inflammation and pain. CBD may mitigate these effects by reducing inflammation and modulating pain perception. A results of a study of 72 participants in the Journal of Clinical Pharmacy and Therapeutics (13) indicated that CBD oil can have a significant influence on delayed onset of muscle soreness due to exercise induced muscle damage. Additionally, a review published in the journal Sports Medicine (14) noted that CBD's interaction with cannabinoid receptors may help manage exercise-induced pain. By addressing inflammation and pain pathways, CBD offers a natural approach to easing post-exercise discomfort, promoting faster recovery and improved athletic performance.

As the widely reported anecdotal evidence steadily draws validation from clinical research, CBD's multifaceted approach to pain management, through its interaction with the endocannabinoid system and its modulation of pain receptors, holds promise for addressing a wide range of pain-related conditions and complaints. From chronic conditions to temporary discomforts, CBD offers a natural alternative with marginal side effects, empowering individuals to take control of their pain management journey. While research in this field continues to evolve, CBD's role in pain relief is poised to become increasingly prominent, providing hope for those seeking effective and holistic solutions to their pain-related challenges, yet there remains a shortage of randomised, controlled human trials (RCTs), thanks to a combination of challenges including logistical complexity, financial, ethical, and commercial bias.  With this in mind, and while we patiently wait for more study-backed results, we always advise you to consult your doctor or medical specialist before supplementing your wellbeing management with CBD.  



  1. Hammell, D.C., Zhang, L.P., Ma, F., Abshire, S.M., McIlwrath, S.L., Stinchcomb, A.L. and Westlund, K.N., 2016. Transdermal cannabidiol reduces inflammation and pain‐related behaviours in a rat model of arthritis. European Journal of Pain, 20(6), pp.936-94
  2. Burstein, Sumner. "Cannabidiol (CBD) and its analogs: a review of their effects on inflammation." Current Opinion in Rheumatology, vol. 31, no. 3, 2019, pp. 271-278.
  3. Shannon, Scott, et al. "Cannabidiol in Anxiety and Sleep: A Large Case Series." The Permanente Journal, vol. 23, 2019.
  4. Nagarkatti, Prakash, et al. "Cannabinoids as novel anti-inflammatory drugs." Future Medicinal Chemistry, vol. 1, no. 7, 2009, pp. 1333–1349.
  5. Efficacy of Cannabidiol Versus Ibuprofen in the Relief of Menstrual Pain in Females Living with Primary Dysmenorrhea: A phase II, Non-Inferiority trial. (2022). Principles and Practice of Clinical Research8(3), 68-76.
  6. Baron, Eric P. "Medicinal properties of cannabinoids, terpenes, and flavonoids in cannabis, and benefits in migraine, headache, and pain: an update on current evidence and cannabis science." Frontiers in Pharmacology, vol. 10, 2019, pp. 1-21.
  7. Russo, Ethan B., and Andrea Hohmann. "Role of cannabinoids in pain management." Essential Cannabis Oil: The Handbook for Health Professionals, 2019, pp. 121–155.
  8. Baron, E. P. (2018). Medicinal properties of cannabinoids, terpenes, and flavonoids in cannabis, and benefits in migraine, headache, and pain: an update on current evidence and cannabis science. Journal of Headache and Pain, 19(1), 1-23.
  9. Häuser, Winfried, et al. "Efficacy, tolerability and safety of cannabis‐based medicines for chronic pain management—an overview of systematic reviews." Pain Medicine, vol. 22, no. 3, 2018, pp. 455-470.
  10. Shannon, Scott, et al. "Cannabidiol in Anxiety and Sleep: A Large Case Series." Experimental and Clinical Psychopharmacology, vol. 23, 2019.
  11. Abrams, Donald I., et al. "Cannabinoid–opioid interaction in chronic pain." Journal of Pain and Symptom Management, vol. 90, no. 6, 2011, pp. 844-851.
  12. Baron, Eric P., et al. "Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It's Been …." Journal of Experimental Medicine, vol. 55, no. 6, 2015, pp. 885-916.
  13. Hatchett A, Armstrong K, Hughes B, Parr B. The influence cannabidiol on delayed onset of muscle soreness. Int J Phys Educ Sport Heal. 2020;7(2):89-94.
  14. Ware, M. A., et al. "Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS)." Sports Medicine, vol. 16, no. 12, 2015, pp. 1233-1242.
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