Do Topical CBD Products Actually Do Anything for Pain?
You don’t need me to tell you that CBD (cannabidiol) is everywhere. You can eat it, you can drink it, you can vape it, you can even bathe in it. And although there’s still plenty to learn about this fascinating little compound, fans of it claim that it has some pretty impressive benefits—particularly when it comes to managing pain.
Personally, I always keep a few jars of it at my desk to help with the shoulder and neck muscle tension inherent in a job consisting mainly of typing and holding a phone next to my face. But it turns out that the research behind these claims is pretty sparse, to say the least. Here’s what you need to know before you give topical CBD a try.
What is CBD?
Cannabidiol, commonly referred to as CBD, is a cannabinoid, a type of compound found in cannabis (marijuana). Unlike the more well-known cannabinoid THC (tetrahydrocannabinol), CBD does not produce a high.
Both THC and CBD act on a system of receptors in your body called cannabinoid receptors. You have cannabinoid receptors throughout your body and, so far, researchers have identified two major types: CB1 (found primarily in the central nervous system, including parts of the brain and spinal cord) and CB2 (found mainly in immune system tissues). Interestingly, both have been found in skin. Researchers have also found that while THC can bind to and activate both types of receptors, CBD seems to modulate and somewhat block the effects of CB1 and CB2 receptors. So, any effect that CBD has on CB receptors may actually be more related to regulating and even counteracting some of the actions of THC and other cannabinoids in the brain.
Why does the body have receptors for compounds in cannabis? Well, it doesn’t exactly. Cannabinoids like THC and CBD are similar enough to compounds that your body naturally makes, called endocannabinoids, that they can interact with this system. Normally, the endocannabinoid system is thought to play a role in a variety of functions in the body, helping to regulate things like parts of the immune system, the release of hormones, metabolism, and memory.
If you’re ingesting something that only has CBD in it and no THC, you won’t have significant effects in the brain. This is why CBD is often referred to as being “non-psychoactive,” although that’s clearly a bit of an oversimplification because it does do something to the central nervous system.
More recent research suggests that many of CBD’s effects may occur outside of CB receptors, Jordan Tishler, M.D., medical cannabis expert at InhaleMD in Boston, tells SELF. In fact, according to a recent review published in Molecules, CBD may have effects on some serotonin receptors (known to play a role in depression and anxiety), adenosine receptors (one of the neurological targets for caffeine), and even TRPV-1 receptors (more commonly associated with taste and the sensation of spiciness).
“It actually is a very promiscuous compound,” Kevin Boehnke, Ph.D., research fellow in the department of anesthesiology and the Chronic Pain and Fatigue Research Center at the University of Michigan, tells SELF. “It will bind to receptors in multiple different pathways,” which makes it difficult to know how it might cause noticeable effects.
“Cannabidiol is a super messy drug,” Ziva Cooper, Ph.D., research director of the UCLA Cannabis Research Initiative in the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the department of psychiatry and biobehavioral sciences, tells SELF. “It has lots and lots of targets and it’s not clear how much of its effects on each target contribute to the potential pain relieving effects.”
All of this points to how hard it is to study the specific effects of CBD on its own—which might be why it’s tempting to claim that it’s the cure for everything without a whole lot of research to actually back up all of those claims.
Here’s what the research says about using CBD for pain.
The most common medical reason for which people report using CBD is to manage chronic pain, followed closely by managing arthritis or joint pain. But does it actually work?
When the National Academies of Sciences, Medicine, and Engineering evaluated decades of cannabis research, they concluded that "in adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms."
But that’s not quite as exciting for CBD as it sounds: “We don’t know cannabidiol’s effects on its own,” says Cooper, who was part of the National Academies committee that put together this report. “[The conclusions about cannabis and cannabinoids] were based on what we know about THC or THC plus cannabidiol.”
In fact, the most compelling research they found for using cannabinoids for pain came from a large review and meta-analysis published in JAMA in 2015. For the study, researchers looked at results from 79 previous studies of cannabinoids and various medical conditions, including chronic pain. However, of those studies, only four involved CBD (without THC)—none of which were looking at pain. So although we might assume that CBD is doing something to help address pain—according to the studies involving the whole cannabis plant—we don’t have great evidence to prove it.
“It might be that cannabidiol by itself is helpful for pain, but at this point we don’t know that,” Cooper says.
The studies we do have about CBD for pain are all animal studies. For example, in a 2017 study published in Pain, researchers gave rats an injection into one of their knee joints to model osteoarthritis. Rats then either received doses of CBD or saline directly into an artery in the knee joint. Results showed that, after receiving CBD, rats showed less inflammation in the joint area and fewer pain-related behaviors (like shaking or withdrawing the affected paw or not being able to bear weight in that paw) compared to those that received saline.
Another study published in 2016 in the European Journal of Pain also looked at arthritis in rats but did so with a topical formulation of CBD. After the rats received an injection into one knee joint to model arthritis, they received a gel that contained either 10 percent CBD (in four different total amounts) or 1 percent CBD (the control) on four consecutive days. The gel was massaged into the rats’ shaved backs for 30 seconds each time.
Then the researchers measured the inflammation in each rat’s knee joint, the level of CBD that made it into their bloodstream, and their pain-related behaviors. They found that the rats that were given the two highest doses of CBD showed significantly lower levels of inflammation and lower pain behavior scores compared to those that got the control. The two lower doses didn’t show much of an effect.
But if you’re reading this, you are probably not a rat, which means these results aren’t directly applicable to your life. Although we know that rats do share much of our physiology—including CB1 and CB2 receptors—these studies don’t really tell us if humans would have the same results with CBD.
“There’s really no substitute for doing proper human studies, which are difficult, expensive, and ethically complicated,” Dr. Tishler says. And we simply don’t have them for CBD and pain.
The only thing that comes close is a Phase 2 clinical trial using a proprietary CBD transdermal gel (meaning it’s meant to go through the skin into the bloodstream) in 320 patients with knee osteoarthritis over 12 weeks, which has not been peer-reviewed to date. Unfortunately, in almost all of the study’s measures of pain, those who received CBD didn’t have statistically different scores from those who got placebo. But “they found some reductions in pain and improvements in physical function,” Boehnke says.
So…is CBD cream just an expensive placebo?
It’s totally possible (and actually pretty likely) that any effect you get from a commercially available topical CBD product is a placebo effect or related to some other aspect of the product. But there are a few things going on here that are more complex than they seem.
First off, we don’t know much about the correct dose of CBD needed for a pain-relieving effect. The doses in the rat studies that were effective were pretty large (for a rat, obviously). And the human participants in the Phase 2 clinical trial we mentioned received 250 mg of synthetic CBD topically per day—as much as many consumer topical CBD products contain in a single jar.
And even though the lotion was applied topically in the rat study, it wasn’t applied locally to the knee. Instead, the researchers were really using the topical application to get it into the rats’ bloodstream, or what’s called systemic administration. But you’d likely need a different dose for it to be effective locally (if you applied it just to your aching shoulder, for instance) in a human. We have no idea what that dose should look like.
Can You Use Oral CBD Oil Topically?
CBD can be eaten in an infused food, mixed into a drink, swallowed in a capsule, and rubbed onto your skin, just to name a few methods of administration. But do the lines ever cross? Can you apply a CBD product type in a way that differs from its original use?
You’re far from the first person to ask this question. In fact, it’s not uncommon for some to try out a CBD oil tincture, which is designed for ingestion, as a topical or a spot treatment. Theoretically, there’s nothing wrong with putting a tincture on your skin. However, CBD tinctures simply aren’t formulated to address the challenges that stand between you and radiant skin. However, topicals can be used to help support dry and dehydrated skin, total body relaxation and recovery, and enhance the appearance of dewy, healthy, and radiant skin when they incorporate other beneficial skin ingredients that are amplified by the skin benefits of CBD.
Here, we’ll review the purpose of CBD oil tinctures, CBD topicals, and why you’ll see the best results for your skin from a product that’s designed for topical use.
What are CBD topicals?
CBD topicals are products formulated to be applied to your skin. This product category is home to a dazzling array of options, from lotions and balms to bath products to transdermal patches. If there’s a skincare product out there, its CBD-infused counterpart can be found alongside it.
The CBD extract used in topicals, and in all CBD products, comes in three main varieties: full spectrum, broad-spectrum, and isolate. Full spectrum CBD extract contains the major and minor cannabinoids, terpenes, flavonoids, and all other substances as they are in the source hemp. This includes a trace amount of Tetrahydrocannabinol (THC), the intoxicating cannabinoid made famous by cannabis. Isolates are on the opposite end of the spectrum: all components except for the desired cannabinoid – in this case, CBD – are removed, leaving behind a roughly 99 percent pure substance that contains only CBD.
While the amount of THC in full spectrum hemp extract is so miniscule that the psychoactive effects are not typically felt – by U.S. law, hemp cannot contain more than 0.3 percent THC – you may not want to consume any THC at all. If that’s the case, broad spectrum is the right fit for you. Broad spectrum hemp extract retains all cannabinoids, terpenes, and other desirable compounds, but attempts to further remove the trace amounts of THC. At Prima, all our CBD products are made from broad spectrum phytocannabinoid-rich hemp extract.
It may be tempting to write off CBD topicals as another beauty trend, but the emerging science showcases why CBD is a perfect fit for skincare and other topical products.
Advanced recovery rub for soothing comfort
Ultra-rich body butter for dry, dehydrated skin
How are CBD topicals used?
CBD topicals are used no differently than any other lotion or body balm. Take a small amount and apply it directly to the body part of your choice. Its effect is experienced locally at the site of application.
If it’s your first time using a CBD topical, follow the directions on the label, or apply a tiny bit to an inconspicuous test spot before fully diving in. How much product you need depends on how you feel; start with a small amount and increase the amount little by little as you get used to the product. You can keep applying more until you’ve achieved the desired feeling.
What is the difference between topicals and CBD oil?
CBD oil is often what people use to describe the extract that comes from the hemp plant. Often, CBD oil the same word people use to describe a tincture, which is CBD hemp extract blended with a carrier oil, which is designed for ingestion. Tinctures can often contain flavors and other ingredients whose benefits are designed for ingestion. Topicals work differently because they are often formulated with other key ingredients that deliver skin and body benefits through skin application. Its strongest impact is seen and felt locally, in the area where you rub in or apply the topical. In addition, ingestibles are not tested for skin sensitivity and skin safety, and have different quality testing protocols. It’s always important to use products as directed both to get the desired benefit, but also to ensure that it’s safe.
Why is it so important to use CBD products on your skin that are formulated specifically for topical use? By using a CBD tincture topically, your skin would miss out on all the other nourishing ingredients added to topicals and might not be designed with the right amount of CBD to bring the desired benefit to your skin. At Prima, our CBD topicals are made with other plant-based ingredients selected to support healthy, radiant skin. Our R+R cream, for example, includes invigorating menthol and eucalyptus. Our ultra-hydrating, fast-absorbing Skin Therapy body butter is designed to support and bring balance to dry skin, and includes its own set of nourishing add-ins, including fatty-acid rich hemp seed oil and moisturizing shea and cocoa butter to lock in hydration.
Consider the convenience – or inconvenience – of a tincture applied topically. Placing tincture onto your hands or legs instead of body butter or lotion will require a significant amount of product to cover a larger surface area. Using a tincture topically on the go wouldn’t be easy; you’d have to carefully remove the dropper from the bottle and measure out the amount you’d want to apply. Plus, a tincture applied topically would likely leave a film behind that needs to be wiped off, leaves a greasy texture, or takes a significantly long time to absorb.
As you begin to explore the CBD product types available to you, keep your intended use case at heart. If you’re looking for a CBD skincare or topical product, seek out products formulated for that purpose. Take advantage of the other ingredients in the product that lend themselves to luminous, healthy skin. At Prima, we pair CBD with other botanicals, extracts, fatty acids, vitamins, and phytosterols, created to support healthy, radiant skin.
The Potential Side Effects of CBD
Wendy Rose Gould is a lifestyle reporter with over a decade of experience covering health and wellness topics.
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Karen Cilli is a fact-checker for Verywell Mind. She has an extensive background in research, with 33 years of experience as a reference librarian and educator.
Verywell / Alex Dos Diaz
Generally speaking, CBD is considered a safe substance when applied topically or taken orally. There are, however, some potential side effects to keep in mind when using this substance, the majority of which are mild.
Common Side Effects of CBD
The most comment side effects of CBD include drowsiness, gastrointestinal issues, dry mouth, reduced appetite, nausea, and interaction with other medications. Those are outlined in detail below.
Some common side effects when using CBD include drowsiness and sedation. This is also considered a benefit, but Dr. Jas Matharu-Daley, a physician and chief medical officer for a CBD brand, notes that the effects might be too strong if you’re also taking CBD with other sedating medications.
Some people may get diarrhea or liver problems [when using CBD]. This is dependent on the individual and their medical history, so monitoring is important,” says Dr. Matharu-Daley.
Also known as “cotton mouth,” CBD can potentially cause your mouth and eyes to feel very dry. Though this side effect is more likely to occur with THC, it can happen with CBD as well.
Can Interact With Other Medications
CBD might interfere with the other medications you take. Dr. Matharu-Daley says it’s important to talk to your doctor about whether CBD could affect your existing prescriptions.
In some cases, those who ingest CBD supplements might experience nausea, says Dr. Matharu-Daley. This depends on how sensitive the person is to CBD, as well as the amount they ingest.
Because CBD supplements come in so many different forms—such as oils, gummies, tinctures, and vapors—the amount that’s actually absorbed can vary drastically. This, combined with each person, will ultimately affect which (if any) CBD side effects you might experience.
What Is Cannabidiol (CBD)?
CBD—the abbreviation for cannabidiol, a substance that's generally derived from the hemp plant—has skyrocketed in popularity over the last five years. In fact, according to research, "CBD" as a Google search term remained stable from 2004 to 2014 but has since ballooned by up to 605%.
CBD is one of the many chemical compounds that is found in the cannabis plant—referred to as cannabis sativa. There are two primary parts of the plant that humans use. One is THC, or Delta-9-Tetrahydrocannabinol, and the other is CBD. Though they’re from the same plant, THC and CBD are quite different from each other.
“CBD is not an intoxicating substance, whereas THC is a psychoactive that can get you high,” explains Dr. Jas Matharu-Daley, a physician and consultant for a brand that specializes in CBD production.
She adds, “[Another difference is that] CBD is derived from hemp and has been classified as a legal substance. Hemp has <0.3% THC. Conversely, cannabis plants such as marijuana are grown to have much higher levels of THC and are still illegal according to the FDA , although individual states vary as to their use.”
Are There Any Benefits Associated With Using CBD?
There are several reasons why someone might want to use CBD. The substance can be found in a multitude of products ranging from pain-relieving creams to edible tinctures to skincare. Research is still underway, but over the last few decades scientists have become more aware of how CBD might be beneficial when applied either topically or ingested.
“Since discovering the endocannabinoid system (ECS) in the body in the 1990s, CBD has been researched more extensively. The ECS is a central regulatory system restoring normal balance and homeostasis in a range of human physiologic systems throughout the body and brain and has cannabinoid receptors and chemicals in its function,” explains Dr. Matharu-Daley.
CBD benefits include the following:
- CBD can have positive impact on the brain. In fact, Dr. Matharu-Daley says that the substance is legally prescribed in a specific medication for certain severe forms of epilepsy in children.
- It has also been shown to have anti-inflammatory properties, which is why you often see CBD in topical products such as oils, creams, and lotions.
- Some research points to CBD’s ability to relieve stress and anxiety.
- It has been used as a nausea treatment in some countries.
- CBD may potentially reduce pain symptoms.
- It has antioxidant properties, which means it can help fight off free radical damages that leads to premature aging.
- Regarding skincare, CBD may help reduce excessive oil production in those with very oily skin types.
Ultimately, the primary reasons why people use CBD is because it tends to have calming, relaxing, pain-reducing effects. It has been used to alleviate joint pain and nerve pain, reduce anxiety and stress, treat insomnia, improve migraines, and address nausea.
CBD Is Still an Unregulated Substance
It's important to point out that CBD is not regulated by the FDA and therefore dosages might not be accurate. It’s also difficult to know what an appropriate dose is the first time you try a new product.
“If the CBD is from a reputable source and one that has been inspected by a third-party independent lab, the content of CBD is more reliable,” notes Dr. Matharu-Daley. “The CBD should be organically grown, free of pesticides and heavy metals, and not sourced in food which can affect absorption. Generally, CBD is safe and side effects are few at low doses.”
A Word From Verywell
CBD is technically an unregulated substance in the United States and therefore it ought to be used with caution. This is especially important for those taking additional medications and/or those with ongoing medical issues. That said, preliminary research on CBD and its benefits are promising in relation to helping with mild to moderate health concerns and it is generally considered a safe substance. Health professionals do not consider CBD a cure-all for serious medical issues, including cancer.
As with any sort of supplement, we recommend speaking to your medical doctor about whether using CBD makes sense for you. Your doctor can also recommend certain products that align with your needs and help ensure you get the correct dosage.